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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.

Purpose: The study evaluated in vitro the retention force and the wear resistance over simulated function of four matrix components of ball attachments for implant-retained overdentures. Materials and Methods: Four types of matrices for ball attachments were evaluated in a fatigue study simulating 5500 cycles of insertion and removal. The matrices used were (1) a Teflon matrix supported by a metal housing, (2) a titanium matrix, (3) a gold alloy matrix, (4) an O-ring matrix using the red color ring for medium retention. Dimensional changes of the ball attachments were investigated with a profilometer. Results: The Teflon matrices showed an increase of 27% in retention at 5500 cycles while the gold alloy matrices showed an increase of 50% in retention in the first 500 cycles and remained relatively stable up to 5500 cycles. On the other hand, titanium matrices and O-ring matrices exhibited progressive loss of retention ending with 68% and 75% of retention loss, respectively, at 5500 cycles. Dimensional analysis by profilometer revealed significant wear on the ball attachment only for titanium matrixes. Conclusions: Gold alloy and Teflon matrices showed the highest retention values without retention loss after 3 years of simulated function. Titanium and O-ring matrices presented a continuous loss of retention with the highest wear on the ball attachments when combined with the titanium matrix.

Prosthetic rehabilitation of head and neck cancer patients is a branch of prosthetics which, while without doubt complex, gives great technical and emotional satisfaction. To date there have been no atlases entirely devoted to the subject of prosthetics on the prosthesis publications market. Other publications have dealt with topics concerning maxillofacial prostheses, but embedded in and associated with surgery. While this choice may be fully understandable, it nevertheless limits the complete vision of the prosthetic element, because the patient needs the surgeon and oncologist (chemo- and radiotherapist) to eradicate the cancer, but, if he lives, in order to have a reasonably liveable relational life, he needs to make use of the good offices of a prosthetist.La riabilitazione protesica del paziente oncologico testa-collo e una branca della protesi, certamente complessa, ma di grande soddisfazione tecnica ed emotiva. Questo testo atlante, interamente protesico, risulta ad oggi non essere presente sul mercato editoriale della protesi. Altre pubblicazioni hanno affrontato temi inerenti la protesi maxillo facciale, ma incastonata ed associata alla chirurgia. Questa scelta pienamente condivisibile limita tuttavia la visione completa dell'elemento protesi, perche il paziente ha bisogno del chirurgo e dell'oncologo (chemio e radioterapista) per estirpare il cancro, ma, se vive, per avere una vita di relazione ragionevolmente vivibile, deve servirsi dei buoni uffici del protesista.

The distribution of stresses in bone, implants, and prosthesis were analyzed via three-dimensional finite element modeling in different implant configurations for a fixed implant-supported prosthesis in an edentulous mandible.A finite element model was created with data obtained from computed tomographic scans of a human mandible. Anisotropic characteristics for cortical and cancellous bone were incorporated into the model. Six different configurations of intraforaminal implants were tested, with the number of implants varying from three to five and the distal implants inserted either parallel to the other implants or tilted distally by 17 or 34 degrees. A prosthetic structure connecting the implants was designed, with 20-mm posterior cantilevers for the parallel implant configurations, and a load of 200 N was applied to the distal portion of the cantilevers. Stresses were measured at the level of the implant, the prosthetic structure, and the bone. Bone-level stresses were analyzed at the implant-bone interface, at the external cortical bone surface, distal to the terminal implant, and in the cancellous bone along the implant body.A three-parallel-implant configuration resulted in higher stress in the implant and bone than configurations with four or five parallel implants. Configurations with the distal implants tilted resulted in a more favorable stress distribution at all levels.In parallel-implant configurations for fixed implant-supported mandibular prostheses, four and five implants resulted in similar stress distribution in the bone, framework, and implants. A distribution of four implants with the distal implants tilted 34 degrees (ie, the "All-on-Four" configuration) resulted in a favorable reduction of stresses in the bone, framework, and implants.

Clinical and laboratory procedures to fabricate a transitional prosthesis for patients treated with laryngofissure surgery have been described. Hard resin promoted healing of the surgical area and maintained the opening because of its stiffness. The prosthesis, which can be highly polished, was easily removed by the patient for proper hygiene and was fabricated to accurately fit the inside margins of the wound. All these factors were important for a good clinical result.