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The aim is to discuss four cases of gingival reactive hyperplastic lesions in patients with a history of excision of oral neoplastic lesions and rehabilitation by a free revascularized flap of the iliac crest. One female and 3 male patients were referred due to the presence of exophytic lesions at the rehabilitated sites. The clinical examination revealed that the poor oral hygiene was the common trigger factor in all the cases, in addition to trauma from the upper left second molar in the first case, pericoronitis related to a partially erupted lower right third molar in the third case, and poor stability of an upper removable partial denture in the fourth case. All the cases were subjected to elimination of these suspected triggering factors, exclusion of dysplasia, excisional biopsy by CO2 laser, and five follow-up visits. The histological examination of all the cases confirmed the diagnosis of pyogenic granuloma. These presented cases suggest that the limitations in oral functions and maintaining the oral hygiene measures following the free revascularized flap reconstruction surgery probably played a role in the development of gingival reactive hyperplastic lesions with presence of trigger factors such as local trauma, chronic infection, or inadequate prosthesis.

Background: Surgical procedures for tumors of the paranasal sinus, palatal epithelium, minor salivary glands or osteosarcoma of the upper jaw require a partial or total maxillectomy of the upper jaw. When the surgical procedure and/or radiation therapy result in a communication, the solution is necessarily prosthetical, through a palatal obturator that recreates a partition between the oral and nasal cavities. Methods: Authors selected 32 post-oncological patients with the upper maxilla completely edentulous prosthetically rehabilitated with a palatal obturator. Results: No serious complications or adverse reactions were reported during the fabrication of surgical or definitive obturators. All patients stated to benefit the palatal obturator in terms of quality of life. Conclusion: Prosthetic rehabilitation of edentulous maxillectomy with oral communication is a demanding challenge for the prosthodontist. The goals of prosthetic rehabilitation include separation of oral and nasal cavities to allow adequate deglutition and articulation of teeth, restore midfacial soft tissue contour and a satisfactory esthetic outcome. When, for any reason, the patient is not a suitable candidate for an implant-retained overdenture, a total removable prosthesis should ensure the most comfort in terms of swallowing, phonation and aesthetics.

Numerous studies have been published about the prosthetic rehabilitation of the postoncological maxillo-facial patient, but the guidelines that emerge lack a correlation between the anatomical classification of the treated site, which generally is preparatory upon surgery, and the type of prosthetic rehabilitation appropriate to the new anatomical and functional condition. With this correlation, it would be possible to obtain a multidisciplinary and predictable therapeutic process, able to identify from the beginning the best type of prosthetic rehabilitation.The authors analyzed a sample of 78 patients treated in the Maxillofacial Surgery Unit of "Sapienza" University of Rome for a tumor of the head and neck area, and at a later stage prosthetically rehabilitated in the years from 2010 to 2013 in the Prosthetic Rehabilitation Unit of the same University because of the consequences of the ablative surgery. After having analyzed data concerning the treatment of the maxillofacial tumor, Authors classified the kind of prosthetic rehabilitation. Removable prosthesis was chosen in 18 cases, while implant (or teeth)-supported rehabilitation was performed in 60 cases.Authors correlated the kind of surgical reconstruction to the prosthetic rehabilitation performed. In the maxilla removable prosthesis was chosen in 8 cases, while implant supported rehabilitation was performed in 18 cases. In the mandible 10 cases were rehabilitated through a removable prosthesis and 42 through a teeth or implant supported prosthesis.It is evident the need to perform a careful evaluation of the patient, in order to identify the best possible prosthetic rehabilitation.

Facial arteriovenous malformations (AVMs) are quite rare morbid conditions that clinically present themselves mainly as a massive bleeding or a significant aesthetic defect. Vascular malformations do not regress spontaneously; this is the reason why their resection is necessary. The successful treatment of these vascular anomalies is often compromised, since a high incidence of recurrence could be expected if the lesion is not managed properly. A multidisciplinary approach is needed for the assessment and treatment of these lesions. The therapeutic management involves a preoperative superselective embolisation, a surgical resection of the lesion within the following 24 hours and finally an aesthetic reconstruction.The study was carried out on a total of 62 patients with facial AVMs; all the patients underwent surgical procedures from 2000 to 2010.The case series consisted of 8 patients with haemangiomas and 54 patients with AVMs; in 31 cases of the latter group the vascular malformations showed a low blood flow, whereas the remaining 23 cases had a high blood flow. The lips were the most common localization. All 54 patients with AVMs underwent a surgical resection. Among the 23 patients with facial high-blood flow AVM, 21.7% were classified as stage I Schobinger, 47.9% as stage II, and 30.4% as stage III. The treatment consisting of associated embolisation and resection was performed in 14 arteriovenous malformations (stage II, III) with high blood flow; 5 of them required a flap reconstruction.Recent advances in microsurgery and interventional angioradiology have improved the prognosis of treatment for these malformations. Combining embolisation and resection with aesthetic flap reconstruction represents the therapy of choice for facial arteriovenous malformations, as it prevents their recurrence.

Prosthetic rehabilitation in post-oncologic patients after bone reconstruction are not substantially different than those of patients affected by severe atrophia of upper or lower jaw after bone reconstruction.Aim of this paper is to evaluate the possibilities of prosthetic rehabilitation on these patients and to present our method. Prosthesis-based oral rehabilitation of such tumor cases rapresents a challenge.The report analyses two cases of patients who underwent ablative oral surgery. Both have received a fibula free vascularised flap. The first was rehabilitated with a removable prosthesis fixed on the residual teeth, while the second with an implant supported prosthesis.In case of carcinoma resection of the oral mucosa, the removable prosthesis guarantees a simplification in dental care operations. On the other hand, irradiated mucosa is frequentely unable to tolerate the friction created by the acrylic base. However, the fixed prosthesis can limit the view during follow-up controls.In our school, according to all exposed reasons, we consider the implant supported overdenture prosthesis to be the best choice for those patients.

The most frequent type of treatment for patients diagnosed with a malignant neoplasia of the oral cavity is surgical removal of the tumor. As a result of the resection performed, it is difficult to obtain satisfactory results in the oral rehabilitation of these patients. When possible, fixed prostheses are the best option, because they guarantee stability, but they should be made so that the operator can remove them periodically to check the health of the oral tissues underneath and to intercept any relapse of the tumor. This study analyses two cases of patients surgically treated for a tumor of the upper maxilla at the Oral and Maxillo-Facial Surgery of Sapienza University, in Rome. In the first case the surgical site was covered with local flaps, and the patient was rehabilitated with an implant-supported removable prosthesis. In the second case the maxilla was reconstructed with a fibula vascularized free flap, and the patient was rehabilitated with an implant-supported prosthesis screwed to a titanium bar solidarizing the implants. Therefore, this prosthesis was fixed, but could be removed by the dentist. The different approach to these two cases was influenced by the different anatomic situations after the reconstruction. It is important for the dentist to approach these patients knowing the kind of surgery they received because this aspect will influence rehabilitative choices. Rehabilitation should be planned, when possible, before surgical treatment, in order to cooperate with the maxillo-facial surgeon in choosing the most appropriate restorative treatment.