Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2015
Starting from our experience with 45 consecutive cases of regional pedicled flaps, we have underl... more Starting from our experience with 45 consecutive cases of regional pedicled flaps, we have underlined the effectiveness and reliability of a variety of flaps. The marketing laws as applied to surgical innovations are reviewed to help in the understanding of why regional flaps are regaining wide popularity in head and neck reconstruction. From January 2009 to January 2014, 45 regional flaps were harvested at San Paolo Hospital to reconstruct head and neck defects. These included 35 pectoralis major muscular and myocutaneous flaps, 4 lower trapezius island or pedicled flaps, 3 supraclavicular flaps, 2 latissimus dorsi pedicled flaps, and 1 fasciocutaneous temporal flap. The basic literature of marketing regarding the diffusion of new products was also reviewed. Two myocutaneous pectoralis major flaps were complicated by necrosis of the cutaneous paddle (one complete and one partial). No complete loss of any of the 45 flaps was observed. At 6 months of follow-up, 2 patients had died of...
Oral and maxillofacial surgery clinics of North America, 2011
Dental rehabilitation with oral implants has become a routine treatment modality in the last deca... more Dental rehabilitation with oral implants has become a routine treatment modality in the last decades, with reliable long-term results. However, insufficient bone volume or unfavorable intermaxillary relationships may render implant placement impossible or incorrect from a functional and esthetic viewpoint. Among the different methods for the reconstruction of deficient alveolar ridges, the use of autogenous bone blocks represents the most frequently used treatment modality both for limited and extended bone defects. Prerequisites for a successful outcome are represented by accurate preoperative planning, proper reconstructive procedure, and adequate prosthetic rehabilitation. Even if all these principles are followed, complications involving the grafts may occur, such as dehiscence, infection, or relevant resorption of the graft. The aim of this article is to present an updated overview on the incidence, prevention and treatment of these complications.
The International journal of periodontics & restorative dentistry
The aim of this study was to evaluate the early phases of bone healing around two different impla... more The aim of this study was to evaluate the early phases of bone healing around two different implant surfaces. For this purpose, four minipigs were used. Implants with rough titanium surfaces (ITI sandblasted/acid-etched and Branemark TiUnite) were placed in the maxillae of the animals and sacrifice was scheduled in such a way that healing times of 3 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, and 7 weeks were obtained. Histologic analysis revealed that a similar pattern was observed in the phases of bone healing around both types of implants between 3 days and 7 weeks. This pattern consisted of the replacement of blood clot and bone debris with a provisional connective tissue in the first few weeks and with mineralized tissue and marrow spaces later on. Both rough surfaces allowed for "contact osteogenesis" to take place. (Int J Periodontics Restorative Dent 2009;29:549-555.).
To evaluate the outcome of dental implants placed in partially edentulous patients with a history... more To evaluate the outcome of dental implants placed in partially edentulous patients with a history of severe periodontitis (SP), moderate periodontitis (MP) and no periodontitis (NP). Sixty-two partially edentulous patients were consecutively enrolled in this study. Patients were divided into three groups according to their initial periodontal conditions, assessed with a modified Periodontal Screening and Recording (PSR) index: 26 patients were in the SP group, 7 in the MP group, and 29 in the NP group. Patients requiring periodontal treatment were treated prior to implantation. Various dental implants and procedures were used. In the SP group 129 implants were placed, 26 were placed in the MP group, and 72 in the NP group. Outcome measures were prosthetic success, implant survival, prevalence of peri-implantitis and mean peri-implant bone level changes on periapical radiographs. Six patients dropped out, two from each group, at 5 years. Two implants and their prosthesis failed with ...
The International Journal of Oral & Maxillofacial Implants, 2014
Search by Subject Search using Medical Subject Headings (< b&g... more Search by Subject Search using Medical Subject Headings (< b> MeSH</b>), a controlled vocabulary for indexing life sciences content.< br/> Note that some records do not have MeSH. These include Patents and the latest PubMed and PubMed Central records.
To characterize intraosseous vascular malformations and describe the most appropriate approach fo... more To characterize intraosseous vascular malformations and describe the most appropriate approach for treatment according to clinical experience and a review of the published data. We performed a retrospective review of 11 vascular malformations (7 venous and 4 arteriovenous) of the facial bones treated during a 10-year period using en bloc resection or intraoral aggressive curettage alone or preceded by endovascular embolization. Corrective surgery was planned to address any residual bone deformities. The cases were reviewed at a mean follow-up point of 6 years. Facial symmetry was restored in the cases requiring reconstruction. Tooth sparing was possible in the case of jaw and/or maxillary localization. Recanalization occurred in 14% of the venous and 33% of the arteriovenous malformations. Facial intraosseous venous malformations can be successfully treated using surgery alone. Facial intraosseous arteriovenous malformations will be better addressed using combined approaches. Aggressive curettage will obviate the need for extensive surgical resection in selected cases.
The aim of this study was to analyse the clinical outcome of two different surgical methods for t... more The aim of this study was to analyse the clinical outcome of two different surgical methods for the reconstruction of narrow edentulous ridges before implant installation: guided bone regeneration with e-PTFE membranes and autologous bone chips or grafting of autologous bone blocks without e-PTFE membranes. Thirty partially edentulous patients, presenting insufficient bone width (less than 4 mm) in the edentulous sites for installation of screw-type titanium implants, were selected and assigned to two different treatment modalities. Fifteen patients (group 1) were treated by means of guided bone regeneration with e-PTFE membranes supported by stainless steel screws and autologous bone chips taken from intraoral sites. Fifteen patients (group 2) were treated by means of autologous bone blocks taken from intraoral or extraoral sites (anterior iliac crest and calvaria) and stabilized with titanium microscrews. Six to 8 months later, during re-entry for implant insertion, the gain of ridge width obtained was measured. In group 1 the average amount of bone gain was 2.7 mm, whereas in group 2 the value was 4.0 mm. Five to 6 months after implant placement prosthetic rehabilitation was started. The mean follow-up after prosthetic load has been 22.4 months. Success rates of implants according to Albrektsson criteria has been 93.3% in group 1, and 90.9% in group 2. Although a statistical comparison between the two treatment modalities may not be feasible, due to the bias resulting from the choice of treatment by the clinician and from the differences in donor sites and defect extension, some considerations can be made: 1) both methods are a reliable means for the correction of narrow edentulous ridges; 2) both techniques necessitate overcorrection of the defect because of interposition of connective tissue beneath the membrane in the first group and bone resorption in the second one; 3) the use of semipermeable barriers increases the costs of the surgical procedure, as compared to bone grafting without membranes; 4) guided bone regeneration presents a higher risk of infection because of wound dehiscence and membrane exposure. Therefore, in case of wide edentulous areas, reconstruction of narrow ridges should be performed with bone blocks without membranes.
Clinical Implant Dentistry and Related Research, 2014
To evaluate: (1) the survival rate of Straumann® Tissue Level and Bone Level implants placed in a... more To evaluate: (1) the survival rate of Straumann® Tissue Level and Bone Level implants placed in atrophic edentulous jaws previously reconstructed by means of autogenous onlay bone grafts; (2) to compare peri-implant bone resorption values over time. From 2005 to 2010, 50 patients presenting with vertical or tridimensional defects of the edentulous ridges were treated with autogenous bone grafts. Three to 7 months afterward, 192 implants were placed (Group A: 97 Tissue Level implants; Group B: 95 Bone Level implants) in the reconstructed areas. After a further waiting period of 2 to 3 months, patients were rehabilitated with implant-supported fixed prostheses. The follow-up ranged from 12 to 68 months after the start of prosthetic loading (mean: 33 months). No implants were removed (survival rate: 100%), but in Group B 13 implants (8 placed in iliac grafts, 2 placed in ramus grafts, and 3 placed in calvarial grafts) presented peri-implant bone resorption values higher than those proposed by Albrektsson and colleagues. for successful implants: the overall implant success rate was then 100% for Group A and 86.8% for Group B. No prosthetic failures were recorded, thus leading to a 100% prostheses success rate. No significant differences were found between the two types of implants as far as implant survival rate is concerned, but results from this study seem to demonstrate that Tissue Level implants may present better long-term results in terms of peri-implant bone maintenance, as compared with Bone Level implants, when placed in reconstructed areas.
Clinical Implant Dentistry and Related Research, 2014
The purpose of this study was to compare (1) the clinical outcome of the reconstruction of extrem... more The purpose of this study was to compare (1) the clinical outcome of the reconstruction of extremely atrophic edentulous maxillae with fresh frozen allogeneic bone (FFB) (group A) and autogenous bone (AB) (group B) iliac blocks; and (2) the peri-implant bone resorption and the survival rate of implants in the two groups. In a 1-year period, eight patients were treated with FFB and seven with AB iliac grafts. Five to seven months afterward, 108 implants were inserted (59 in group A and 49 in group B). Four to five months afterward, patients were rehabilitated with implant-supported prostheses. The mean follow-up was 24 months. Prior to implant placement, graft exposure occurred in two patients in group A and in one patient in group B. The mean graft resorption prior to implant placement was 0.78 mm and 0.54 mm in group A and B, respectively. After implant placement, bone graft exposures with partial loss of the graft occurred in six out of eight patients in group A and in none of the group B patients. The survival rate of implants was 90.1% and 100% in group A and B, respectively. The mean values of peri-implant bone resorption at the end of the follow-up period were 1.64 mm and 0.92 mm in group A and B, respectively. Results of this study seem to demonstrate that FFB does not represent a reliable alternative to AB blocks because of the higher rate of bone exposure and partial loss of the grafts, the lower implant survival, and the higher peri-implant bone resorption in FFB patients.
Odontogenic sinusitis, a condition once believed to be on the verge of extinction, is becoming mo... more Odontogenic sinusitis, a condition once believed to be on the verge of extinction, is becoming more and more prevalent. The relevant number of implantological and preimplantological complications performed on a daily basis by oral surgeons surely play a determinant role in this prevalence increase. The authors published in 2013 a comprehensive classification and treatment protocol shifting the perspective from odontogenic sinusitis to sinonasal complications of dental treatment. This change of perspective is not merely a lexical choice: virtually omnipresent prior dental treatments, whether classic, preimplantological or implantological should be considered the prime mover in this kind of conditions. The classification is composed by three groups (classic dental treatment complications, preimplantological treatment complications and implantological treatment complications) further subdivided in different and univocal classes and provides a treatment protocol for each class. The auth...
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 2015
Starting from our experience with 45 consecutive cases of regional pedicled flaps, we have underl... more Starting from our experience with 45 consecutive cases of regional pedicled flaps, we have underlined the effectiveness and reliability of a variety of flaps. The marketing laws as applied to surgical innovations are reviewed to help in the understanding of why regional flaps are regaining wide popularity in head and neck reconstruction. From January 2009 to January 2014, 45 regional flaps were harvested at San Paolo Hospital to reconstruct head and neck defects. These included 35 pectoralis major muscular and myocutaneous flaps, 4 lower trapezius island or pedicled flaps, 3 supraclavicular flaps, 2 latissimus dorsi pedicled flaps, and 1 fasciocutaneous temporal flap. The basic literature of marketing regarding the diffusion of new products was also reviewed. Two myocutaneous pectoralis major flaps were complicated by necrosis of the cutaneous paddle (one complete and one partial). No complete loss of any of the 45 flaps was observed. At 6 months of follow-up, 2 patients had died of...
Oral and maxillofacial surgery clinics of North America, 2011
Dental rehabilitation with oral implants has become a routine treatment modality in the last deca... more Dental rehabilitation with oral implants has become a routine treatment modality in the last decades, with reliable long-term results. However, insufficient bone volume or unfavorable intermaxillary relationships may render implant placement impossible or incorrect from a functional and esthetic viewpoint. Among the different methods for the reconstruction of deficient alveolar ridges, the use of autogenous bone blocks represents the most frequently used treatment modality both for limited and extended bone defects. Prerequisites for a successful outcome are represented by accurate preoperative planning, proper reconstructive procedure, and adequate prosthetic rehabilitation. Even if all these principles are followed, complications involving the grafts may occur, such as dehiscence, infection, or relevant resorption of the graft. The aim of this article is to present an updated overview on the incidence, prevention and treatment of these complications.
The International journal of periodontics & restorative dentistry
The aim of this study was to evaluate the early phases of bone healing around two different impla... more The aim of this study was to evaluate the early phases of bone healing around two different implant surfaces. For this purpose, four minipigs were used. Implants with rough titanium surfaces (ITI sandblasted/acid-etched and Branemark TiUnite) were placed in the maxillae of the animals and sacrifice was scheduled in such a way that healing times of 3 days, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, and 7 weeks were obtained. Histologic analysis revealed that a similar pattern was observed in the phases of bone healing around both types of implants between 3 days and 7 weeks. This pattern consisted of the replacement of blood clot and bone debris with a provisional connective tissue in the first few weeks and with mineralized tissue and marrow spaces later on. Both rough surfaces allowed for "contact osteogenesis" to take place. (Int J Periodontics Restorative Dent 2009;29:549-555.).
To evaluate the outcome of dental implants placed in partially edentulous patients with a history... more To evaluate the outcome of dental implants placed in partially edentulous patients with a history of severe periodontitis (SP), moderate periodontitis (MP) and no periodontitis (NP). Sixty-two partially edentulous patients were consecutively enrolled in this study. Patients were divided into three groups according to their initial periodontal conditions, assessed with a modified Periodontal Screening and Recording (PSR) index: 26 patients were in the SP group, 7 in the MP group, and 29 in the NP group. Patients requiring periodontal treatment were treated prior to implantation. Various dental implants and procedures were used. In the SP group 129 implants were placed, 26 were placed in the MP group, and 72 in the NP group. Outcome measures were prosthetic success, implant survival, prevalence of peri-implantitis and mean peri-implant bone level changes on periapical radiographs. Six patients dropped out, two from each group, at 5 years. Two implants and their prosthesis failed with ...
The International Journal of Oral & Maxillofacial Implants, 2014
Search by Subject Search using Medical Subject Headings (< b&g... more Search by Subject Search using Medical Subject Headings (< b> MeSH</b>), a controlled vocabulary for indexing life sciences content.< br/> Note that some records do not have MeSH. These include Patents and the latest PubMed and PubMed Central records.
To characterize intraosseous vascular malformations and describe the most appropriate approach fo... more To characterize intraosseous vascular malformations and describe the most appropriate approach for treatment according to clinical experience and a review of the published data. We performed a retrospective review of 11 vascular malformations (7 venous and 4 arteriovenous) of the facial bones treated during a 10-year period using en bloc resection or intraoral aggressive curettage alone or preceded by endovascular embolization. Corrective surgery was planned to address any residual bone deformities. The cases were reviewed at a mean follow-up point of 6 years. Facial symmetry was restored in the cases requiring reconstruction. Tooth sparing was possible in the case of jaw and/or maxillary localization. Recanalization occurred in 14% of the venous and 33% of the arteriovenous malformations. Facial intraosseous venous malformations can be successfully treated using surgery alone. Facial intraosseous arteriovenous malformations will be better addressed using combined approaches. Aggressive curettage will obviate the need for extensive surgical resection in selected cases.
The aim of this study was to analyse the clinical outcome of two different surgical methods for t... more The aim of this study was to analyse the clinical outcome of two different surgical methods for the reconstruction of narrow edentulous ridges before implant installation: guided bone regeneration with e-PTFE membranes and autologous bone chips or grafting of autologous bone blocks without e-PTFE membranes. Thirty partially edentulous patients, presenting insufficient bone width (less than 4 mm) in the edentulous sites for installation of screw-type titanium implants, were selected and assigned to two different treatment modalities. Fifteen patients (group 1) were treated by means of guided bone regeneration with e-PTFE membranes supported by stainless steel screws and autologous bone chips taken from intraoral sites. Fifteen patients (group 2) were treated by means of autologous bone blocks taken from intraoral or extraoral sites (anterior iliac crest and calvaria) and stabilized with titanium microscrews. Six to 8 months later, during re-entry for implant insertion, the gain of ridge width obtained was measured. In group 1 the average amount of bone gain was 2.7 mm, whereas in group 2 the value was 4.0 mm. Five to 6 months after implant placement prosthetic rehabilitation was started. The mean follow-up after prosthetic load has been 22.4 months. Success rates of implants according to Albrektsson criteria has been 93.3% in group 1, and 90.9% in group 2. Although a statistical comparison between the two treatment modalities may not be feasible, due to the bias resulting from the choice of treatment by the clinician and from the differences in donor sites and defect extension, some considerations can be made: 1) both methods are a reliable means for the correction of narrow edentulous ridges; 2) both techniques necessitate overcorrection of the defect because of interposition of connective tissue beneath the membrane in the first group and bone resorption in the second one; 3) the use of semipermeable barriers increases the costs of the surgical procedure, as compared to bone grafting without membranes; 4) guided bone regeneration presents a higher risk of infection because of wound dehiscence and membrane exposure. Therefore, in case of wide edentulous areas, reconstruction of narrow ridges should be performed with bone blocks without membranes.
Clinical Implant Dentistry and Related Research, 2014
To evaluate: (1) the survival rate of Straumann® Tissue Level and Bone Level implants placed in a... more To evaluate: (1) the survival rate of Straumann® Tissue Level and Bone Level implants placed in atrophic edentulous jaws previously reconstructed by means of autogenous onlay bone grafts; (2) to compare peri-implant bone resorption values over time. From 2005 to 2010, 50 patients presenting with vertical or tridimensional defects of the edentulous ridges were treated with autogenous bone grafts. Three to 7 months afterward, 192 implants were placed (Group A: 97 Tissue Level implants; Group B: 95 Bone Level implants) in the reconstructed areas. After a further waiting period of 2 to 3 months, patients were rehabilitated with implant-supported fixed prostheses. The follow-up ranged from 12 to 68 months after the start of prosthetic loading (mean: 33 months). No implants were removed (survival rate: 100%), but in Group B 13 implants (8 placed in iliac grafts, 2 placed in ramus grafts, and 3 placed in calvarial grafts) presented peri-implant bone resorption values higher than those proposed by Albrektsson and colleagues. for successful implants: the overall implant success rate was then 100% for Group A and 86.8% for Group B. No prosthetic failures were recorded, thus leading to a 100% prostheses success rate. No significant differences were found between the two types of implants as far as implant survival rate is concerned, but results from this study seem to demonstrate that Tissue Level implants may present better long-term results in terms of peri-implant bone maintenance, as compared with Bone Level implants, when placed in reconstructed areas.
Clinical Implant Dentistry and Related Research, 2014
The purpose of this study was to compare (1) the clinical outcome of the reconstruction of extrem... more The purpose of this study was to compare (1) the clinical outcome of the reconstruction of extremely atrophic edentulous maxillae with fresh frozen allogeneic bone (FFB) (group A) and autogenous bone (AB) (group B) iliac blocks; and (2) the peri-implant bone resorption and the survival rate of implants in the two groups. In a 1-year period, eight patients were treated with FFB and seven with AB iliac grafts. Five to seven months afterward, 108 implants were inserted (59 in group A and 49 in group B). Four to five months afterward, patients were rehabilitated with implant-supported prostheses. The mean follow-up was 24 months. Prior to implant placement, graft exposure occurred in two patients in group A and in one patient in group B. The mean graft resorption prior to implant placement was 0.78 mm and 0.54 mm in group A and B, respectively. After implant placement, bone graft exposures with partial loss of the graft occurred in six out of eight patients in group A and in none of the group B patients. The survival rate of implants was 90.1% and 100% in group A and B, respectively. The mean values of peri-implant bone resorption at the end of the follow-up period were 1.64 mm and 0.92 mm in group A and B, respectively. Results of this study seem to demonstrate that FFB does not represent a reliable alternative to AB blocks because of the higher rate of bone exposure and partial loss of the grafts, the lower implant survival, and the higher peri-implant bone resorption in FFB patients.
Odontogenic sinusitis, a condition once believed to be on the verge of extinction, is becoming mo... more Odontogenic sinusitis, a condition once believed to be on the verge of extinction, is becoming more and more prevalent. The relevant number of implantological and preimplantological complications performed on a daily basis by oral surgeons surely play a determinant role in this prevalence increase. The authors published in 2013 a comprehensive classification and treatment protocol shifting the perspective from odontogenic sinusitis to sinonasal complications of dental treatment. This change of perspective is not merely a lexical choice: virtually omnipresent prior dental treatments, whether classic, preimplantological or implantological should be considered the prime mover in this kind of conditions. The classification is composed by three groups (classic dental treatment complications, preimplantological treatment complications and implantological treatment complications) further subdivided in different and univocal classes and provides a treatment protocol for each class. The auth...
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Papers by Matteo Chiapasco