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Aim of the Study: Solitary central osteomas of the jaw seem to be especially rare lesions; since 1955, only 12 cases have been reported and 4 of these were located in the maxilla. Osteomas are benign osteogenic lesions considered as real tumours but without infiltrative or metastatic potential. Their growth potential is usually limited, but certain rare and large cases of peripheral osteoma are described in literature. Although surgery is recommended, there are no reports of malignant transformation. In this study, we describe successful implant rehabilitation in a patient with a central osteoma of the maxilla with immediate loading in a fresh extraction socket., Materials and Methods: The report concerns a 33-year-old woman with a compromised deciduous first molar in the left premolar region of the maxilla; an asymptomatic bony expansion of the palatal and vestibular sides of the left canine/premolar/molar area of the maxilla and by radiograph revealed a well-defined radiopaque mass. An immediate non-occlusal loading was performed, and complete loading of the implant was completed five months later., Discussion and Conclusion: The pathogenesis of these osteomas is unclear. Several authors reported a clear history of traumatic events, but others had no history of previous trauma or contributory medical factors. Since in our case no cancer growth happened over a period of more than four years, we decided to perform an immediate loading procedure during the implant rehabilitation. The outcome was successful.

Aim of the Study: The change in anatomy and physiology resulting from radical mandible surgery is often exacerbated by radiation therapies that make the mucosa atrophic and susceptible to irritation and ulceration rendering the task of areating functional complete dentures for edentulous subjects very challenging to prosthodontists. The aim of this study is to describe an implant supported denture rehabilitation in an edentulous hemimandibulectomized patient with a singular prosthetic design in order to compensate for the lack of a condylar process., Materials and Methods: The subject of the clinical case, had a history of squamous cell carcinoma of the right tonsillar region for which it was subjected to a hemimandibulectomy and was primarily rehabilitated with an over denture mounted onto a bar furnished by a resin condylar eminence in articulation with the glenoid fossa of the upper denture. The need to provide greater stabilization for the upper prosthesis led to a maxillary implant insertion and to the realization of a new joint connection that was constituted inferiorly by a titanium condyle and superiorly by a teflon acetabulum., Discussion: The prosthetic balance guaranteed by the second rehabilitation greatly affected the biomechanics of mastication leading to a reduction of eccentric interferences, a stabilization of centric occlusion, and a lowering of intensity contraction by masticatory muscles. This difference is well represented by two and three-dimensional plans obtained from the application of a T-Scan III device., Conclusions: The rehabilitative solution proposed was effective in resolving the lateral deviation, in relieving masticatory and speech discomfort, as well as restoring an aesthetically acceptable appearance in a hemimandibulectomized and not reconstructed patient.

Objective: the present case report aims at illustrating how implant-prosthetic rehabilitation in patients with oral cancer resection aids to improve their quality of life., Material and Methods: a patient with verrucous squamous cell carcinoma of the mandible was treated with surgery and rehabilitation with three interforaminal dental implants and Toronto bridge. Three years after treatment, because of cancer recurrence, a segment of jaw and one of the three mandibular implants were removed. The histological examination showed healthy bone contact to implant surface, despite proximity to the neoplastic area., Results: the case shows the maintainance of the osseointegration implants despite the cancer recurrence in the same area., Conclusions: endosseous implants represent a useful and valid tool for the prosthetic rehabilitation of cancer patients. Long-term effects of implant-prosthetic rehabilitation in patients with cancer still need to be verified. It would be interesting to confirm the data obtained by numerical studies of representative samples.

Purpose: currently, head and neck irradiation is not considered an absolute contraindication for implant placement (1), especially due to the transition from conventional to conformal radiotherapy. However, there is a difference in the success rate of implant placement between irradiated and non-irradiated bones (5). Successful osseointegration is mainly affected by the total dose of radiation (6). The main purpose of this study was to minimize problems related to radiation dose by evaluating in advance the most suitable site for implant insertion on the basis of the mean absorbed dose. Additional aims were: to estimate the appropriate timing for implant insertion in irradiated bones, to analyze the difference in stability between maxilla and mandible, and to evaluate the success of implants with wrinkled microgeometry and increased layer of TiO(2)., Materials and Methods: five patients who had been irradiated for head and neck cancer using intensity-modulated radiotherapy (IMRT) were recruited for our study. Surgical procedures were performed following a pre-surgical evaluation of the correct insertion position of implant fixtures. The latter was based on a scrutiny of dose-volume histograms (DVH) developed by a team of experts in medical physics and radiotherapists after dentists had contoured the volumes of interest. Student's t test and Pearson's correlation test were used for comparison and correlation between the variables considered., Results: the percentage of osseointegration was 100%, which supports the usefulness of the adopted technique. A statistically significant difference in stability and crestal bone resorption emerged in the comparison between maxilla and mandible, but not between times of insertion. Moreover, there was a significant correlation between radiation dose and ISQ values: an increase in radiation dose corresponded to a decrease in primary stability. However, the correlation between ISQ values and implant length was not significant as well as that between primary stability and implant diameter., Conclusions: implantology guided by assessment of absorbed irradiation dose in the site to be rehabilitated can lead both to an increase in implant survival into irradiated tissue bone, and to a reduction in the incidence of ORN. However, both a larger sample size and the development of long-term prospective studies are necessary to validate the described method.

Objectives: this report describes the masticatory implant- supported rehabilitation of a patient undergoing resection for mandibular ameloblastoma., Case Report: in the reported case the patient underwent resection and reconstruction with a fibula flap for masticatory rehabilitation of 7 implants at the level of the mandible., Discussion: ameloblastoma is a benign locally invasive tumor of maxillary bones that often causes facial disfigurement. The dental management of the patient requires a collaboration of various specialists such as anesthetists, maxillofacial surgeons, and dentists., Conclusions: in patients with oral cancers such as ameloblastoma, the correct planning of surgery for the tumor resection as well as prosthetic rehabilitation are crucial. Osseointegrated implants open a new perspective of treatment to improve the quality of life of patients resected for cancer.

Aim of the Study: the treatment of oral cancer requires different surgical approaches such as marginal or segmental mandibular resection in order to allow a safe removal of the neoplastic lesion. The aim of this work is to evaluate the efficacy of an implant-supported denture rehabilitation for restoring oral function and facial appearance on a hemimandibulectomized patient., Materials and Methods: the patient was a 64 years old man, hard smoker and moderate drinker. Due to a jaw neoplastic lesion, he underwent a hemimandibulectomy, followed by the insertion of 4 implant fixtures at the chin cap symphysis site. The denture rehabilitation consisted in an over-denture mounted onto a bar furnished by a condylar eminence in articulation with the glenoid fossa of the upper denture., Results: this type of implant-supported denture rehabilitation allows the recovery of the masticatory function and the mandibular reposition with a satisfactory restoration of the proper facial symmetry and appearance., Conclusion: in the edentulous patient implant-supported denture with artificial condyle allows the recovery of the masticatory function without the need of additional operations to re-establish the temporomandibular joint anatomy. It is currently considered as a low invasive technique with very low risk of side effects.

Aims: this work aims at demonstrating that multiple systemic conditions, in association with the development of bisphosphonate associated osteonecrosis of the jaw (ONJ), increase the risk of complications and may lead to hospitalization. For this reason the dental approach to patients with multisystem disease should be carefully managed by a team of specialists., Case Report: a case of mandibular necrosis associated with intake of oral bisphosphonates in a complex systemic context is described., Results and Discussion: many different diseases and systemic conditions may draw the line at oral surgery. Multiple treatments (e.g. antithrombotic, calcium channel blockers, diuretics, antibiotics and bisphosphonates) can alter the normal physiological response to tissue healing., Conclusions: patients taking bisphosphonates for more than three years (i.e. the term over which the risk of ONJ increases according to the literature, in presence of complex systemic situations, need to be carefully managed during the pre-operative, peri-operative and postoperative phases through a synergistic collaboration among different kind of specialists.

Aims: the assessment of the limit dose for the organs at risk in external radiotherapy is a fundamental step to guarantee an optimal risk-benefit ratio. The aim of this study was to assess, through contouring the single dental cavities, the absorbed radiation dose on irradiated alveolar bones during the treatment of cervico-facial tumours, so as to test the correlation between the absorbed dose of radiation at alveolar level and the level of individual surgical risk for osteonecrosis., Materials and Methods: we selected 45 out of 89 patients on the basis of different exclusion criteria. Nine of these patients showed evidence of osteoradionecrosis. The patients were treated either with 3D conformational radiation therapy (3D-CRT) or with intensity-modulated radiation therapy (IMRT), there after alveolar bones were contoured using computed axial tomography (CAT scans) carried out following oncological and dental treatment. The dose-volume histograms (DVH) were obtained on the basis of such data, which included those relating to the dental cavities in addition to those inherent to the tumours and the organs at risk., Results: all patients, irrespective of type of treatment, received an average of 60 to 70 grays in 30/35 sittings. The patients treated with IMRT showed higher variation in absorbed radiation dose than those treated with 3D-CRT. The alveolar encirclement allowed the assessment of the absorbed radiation dose, and consequently it also allowed to assess the individual surgical risk for osteonecrosis in patients with head and neck tumours who underwent radiography treatment., Conclusions: the study of DVH allows the assessment of limit dose and the detection of the areas at greater risk for osteoradionecrosis before dental surgery.