Search

Aim The purpose of this review is to address the surgical procedures that need to be followed to obtain a maxillary defect that can be suitable to receive a prosthesis. Methods An extensive search of the literature was performed, on the databases of PubMed/Medline and Scopus, in addition to congress proceedings and books, written in English or Italian. Literature search was performed using combinations of the following keywords: (“obturator prognosis” OR “palatal obturator” OR “obturator prosthesis” OR “prosthetic prognosis”) AND (“maxillectomy” OR “maxillary defect”). Results 35 articles, 2 books and 3 congress proceedings were included. After the study of the records included in this review, it was found that surgeon must preserve the anterior maxilla as much as possible, because it is the most suitable site for the placement of implants. Furthermore, if the implant site is involved in post-operative radiotherapy, it is advisable to know the x-ray dose of such an exposition. The surgical cut should preserve mucosa and bone support around the tooth adjacent to the defect, and keratinized mucosa should cover the palatal margin of the defect Equally important is to prepare an adequate access to the defect, because the turbinates and the bands of oral mucosa may prevent the prosthesis from engaging key areas of the defect, impairing function. Conclusion A complete knowledge about the construction techniques and biological/mechanical principles of maxillofacial prosthesis is essential to perform surgical interventions that enhance the prosthetic prognosis.

L’Organizzazione Mondiale della Sanità considera la salute orale come parte integrante, non solo dello stato di salute generale, ma anche della qualità della vita di ciascun individuo. In tale ottica, in accordo e con il sostegno del mondo professionale e della comunità scientifica di questo settore, le raccomandazioni cliniche in odontostomatologia contenute nel presente volume forniscono indicazioni e definiscono standard di intervento per la prevenzione e la cura delle più comuni patologie del cavo orale nonché per l’identificazione di percorsi terapeutici appropriati a supporto degli operatori pubblici e privati. Esse costituiscono, inoltre, uno strumento utile per mantenere alto il livello di qualità delle cure in questo periodo storico, nel quale, se da un lato crescono le opportunità tecniche di cura e la potenziale domanda delle stesse, dall’altro la riduzione delle risorse economiche a disposizione dei cittadini tende a limitare l’accesso all’offerta professionale privata e, al contempo, i processi di razionalizzazione dell’allocazione dei fondi nel SSN rendono più difficile l’accesso alle strutture pubbliche. L’individuazione di raccomandazioni cliniche chiaramente definite e rese pubbliche può facilitare la condivisione degli obiettivi e dei percorsi terapeutici tra odontoiatra e paziente, migliorare la comunicazione e, in ultima analisi, accrescere la fiducia sia nei riguardi del proprio specifico professionista che del “sistema delle cure” più in generale. La revisione delle “Raccomandazioni cliniche in odontostomatologia” si è resa necessaria in considerazione del cambiamento dell’evidenza scientifica, dell’immissione in commercio di nuovi materiali e dell’utilizzo di nuove tecnologie, specie in ambito protesico. Come per la precedente, alla realizzazione di questa edizione ha contribuito un ampio gruppo di docenti ed esperti delle singole branche odontoiatriche insieme alle più importanti e rappresentative Associazioni professionali e ai componenti della Commissione Albo Odontoiatri (CAO) nazionale.

Non-carious cervical lesions (NCCL) are characterized by a loss of hard dental tissue near the cement-enamel-junction. Commonly, their shape is like a wedge with the apex pointing inwards. Other times, they appear as regular depressions, like a dome or a cup. Their main characteristic is the presence of hard-mineralized tissue. According to the literature, the prevalence of cervical lesions is 85%, while their incidence is about 18% among permanent teeth. NCCL are currently classified as erosion, abrasion, or abfraction. Their etiology seems to be related to different factors: hexogen and endogen acids, mechanical abrasive action, tooth flexion under axial and non-axial loads. Moreover, it seems that a fundamental role is ascribable to tooth bending phenomena due to the strength components parallel or oblique to the occlusal level, which occur during the normal function as well as during parafunctions. The frequent therapeutic failures are probably due to the same factors causing the onset of the original lesion. Several materials have been proposed to restore NCCL: amalgam (abandoned), glass-ionomer cements, compomers, and composite resins. Early failures of these restorations have often been reported in the literature, probably due to the same factors which originally caused the lesions. Further investigations are required to determine more reliable restorative therapies.

Obstructive sleep apnea syndrome (OSAS) is a sleep disorder characterized by repetitive episodes of upper airway obstruction. Recently, it has been suggested that edentulism worsens sleep apnea; sleeping without dentures is associated with a significant increase in the apnea-hypopnea index. OSAS is also related to depression. The aim of this study was to assess, in a group of elderly occupants in residential homes in the Turin district of Italy, (1) the prevalence of key symptoms and indicators of OSAS and the prevalence of depressive feelings; (2) how the reduction of vertical dimension of occlusion (VDO) influenced the onset of OSAS; and (3) whether a relationship between OSAS and depression was present.The sample population consisted of 403 people (77% men, 23% women; age range, 65 to 90 years). The subjects underwent the Italian version of the Mini Mental State Examination (MMSE) to assess their mental condition. The remaining collaborating subjects completed 2 questionnaires to assess the risk of OSAS (Berlin Questionnaire) and depressive feelings (Beck Depression Inventory).Of the 403 elderly residents initially evaluated with the MMSE, 97 were excluded from the study, reducing the sample size to 306 subjects (75% women, 25% men; mean age +/- standard deviation, 83.12 +/- 11.10 years). The analysis of these data revealed a statistically significant association between the risk for sleep apnea and the VDO (P.0001), and between sleep apnea and depressive feelings (P.05).This study revealed that inadequate VDO is closely associated with the risk of OSAS, and that depressive feelings are more present if there is a high risk for OSAS.

To evaluate the dimensional contour variations of acrylic resin denture bases before and after storage in water.The fit of 40 bases was evaluated by measuring the thickness of a layer made with silicone placed between the bases and the casts. The measurements were repeated on a new set of silicone layers after having stored the bases in water for 42 days.Significant differences were found both for the maxillary and the mandibular bases.Water sorption had an important effect on the contour of the prosthetic bases.

Obstructive sleep apnea syndrome (OSAS) is a disorder characterised by repeated obstructions of the upper airway, with consequent episodes of apnea and hypopnea during sleep, snoring, and daytime sleepiness. Recently, a role of edentulism in the occurrence or in the worsening of this disorder was suspected. The aim of the study was to assess, through a cephalometric analysis, if the removal of denture induces, and where, modifications that can favour the pharynx collapse.A total of 27 subjects with complete or partial loss of teeth and with heavy loss of the vertical dimension, were examined. The patients were submitted to radiographs of the cranium in supine position, to simulate as much as possible the night condition, with the denture in intercuspal position (ICP), and in relaxed position both with denture (D-RP) and without it (edentule-relaxed position, E-RP). The radiographs were analysed through specific measures for OSA evaluating the parameters that could be modified by the denture.The pharyngeal airway space (PAS) decreases, at the level of uvula, from ICP (6.7 mm) to RP (5.3 mm) (P0.05). The distance between the base and the tip of the tongue significatively decreased both from ICP vs E-RP (7.35 mm vs 6.87 mm; P0.05), both from D-RP to E-RP (7.22 mm vs 6.87 mm; P0.005).From the data obtained from the cephalometric analysis it seems that wearing denture induces modifications in the position of the tongue, of the jaw and of the pharyngeal airway space that can favour the reduction of apnea episodes.