Perineural invasion (PNI) hinders the ability to establish local control of oral squamous cell ca... more Perineural invasion (PNI) hinders the ability to establish local control of oral squamous cell carcinoma (OSCC). To date, PNI can be evaluated only in surgical specimens and not in preoperative biopsy material, rendering timely therapeutic planning impossible. Insulin-like growth factor-II mRNA binding protein-3 (IMP3) expression appears to be of diagnostic and prognostic utility for many solid tumours, and laminin-5 expression in surgical specimens has been identified as a valid predictor of neural spread of head-and-neck neoplasms. The ability to use preoperative biopsy material to identify patients exhibiting PNI is fundamental for good management of OSCC. We examined a series of 64 consecutive patients treated (primarily via surgery) for OSCC between 2009 and 2014 at the Maxillofacial Surgery Unit, University of Bologna. We evaluated IMP3 and laminin-5 expression in preoperative biopsy material using immunohistochemistry and quantitative reverse transcription polymerase chain reaction. We sought to correlate expression of IMP3 and laminin-5 with PNI evident in surgical specimens. Expression of IMP3 and laminin-5 in preoperative biopsy material appeared to be predictive of PNI in patients with OSCC (P < 0.001). Additionally, the results of multivariate analyses showed that IMP3 status was an independent predictor of death of patients with OSCC (P = 0.001). The present study demonstrates that IMP3 and laminin-5 expression in preoperative biopsy material correlate well with PNI status and may allow accurate preoperative risk stratification of patients with OSCC.
Journal of prosthodontics : official journal of the American College of Prosthodontists, Jan 19, 2015
This study was undertaken to design an updated connection system for an eyeglass-supported nasal ... more This study was undertaken to design an updated connection system for an eyeglass-supported nasal prosthesis using rapid prototyping techniques. The substructure was developed with two main endpoints in mind: the connection to the silicone and the connection to the eyeglasses. The mold design was also updated; the mold was composed of various parts, each carefully designed to allow for easy release after silicone processing and to facilitate extraction of the prosthesis without any strain. The approach used in this study enabled perfect transfer of the reciprocal position of the prosthesis with respect to the eyeglasses, from the virtual to the clinical environment. Moreover, the reduction in thickness improved the flexibility of the prosthesis and promoted adaptation to the contours of the skin, even during functional movements. The method described here is a simplified and viable alternative to standard construction techniques for nasal prostheses and offers improved esthetic and f...
A viable protocol for the reconstruction of the maxilla after cancer ablation was tested, taking ... more A viable protocol for the reconstruction of the maxilla after cancer ablation was tested, taking into account final rehabilitation with an implant-supported fixed prosthesis, and using CAD-CAM technology. The protocol involved seven steps: surgical planning of the bony resections, CAD and rapid prototyping of cutting guides, titanium mesh, and bone plate, maxillofacial surgery, oral implant surgery, and prosthetic rehabilitation. CAD-CAM technology was used for each step, to design and prototype the surgical guides and the bone plate for the maxillofacial surgery; to make the impression of implants; and to prototype the framework of the final prosthetic rehabilitation. With respect to the maxillofacial surgery, to evaluate the margins of the bone cuts, the planes of the postoperative cuts were compared with those planned in the virtual environment. The accuracy of the rapid prototyping and intraoperative surgical positioning protocol was evaluated. With regard to implants and prosthetic rehabilitation, the framework confirmed a passive fit on implants using the Sheffield test, and occlusal and interproximal points of contact resulted clinically as projected virtually. Prosthetically Guided Maxillofacial and Implant Surgery is a viable method to reproduce the correct anatomy of the maxillary arches in relation to the prosthetic needs of rehabilitation. Moreover, the protocol presented in this paper offers some adjunctive benefits, such as time and cost saving and ideal aesthetic facial contouring.
Acta of bioengineering and biomechanics / Wroclaw University of Technology
A test of the accuracy in transferring the virtual data into the surgical environment was carried... more A test of the accuracy in transferring the virtual data into the surgical environment was carried out. Differences between the virtually planned and the actual position during surgery of the rapid prototyped guides and the bone plates were investigated. The accuracy of the method was evaluated in terms of the precision of cuts in the mandible, the final positions of the rami and condyles, and the sectioning precision of the fibula. The guide position presented a mean value dislocation of 0.6 mm in the right side and of 4.1 mm in the left side; the cut line of the mandible presented an angular deviation of 2.9° (right) and of 17.5° (left). The right condyle was positioned 2.5 ± 0.05 mm more medial than native position, and the left condyle 5.2 ± 0.05 mm medial. The total length was 0.3 ± 0.05 mm short of the virtually projected length at the inferior margin of the mandible and 1.9 ± 0.05 mm longer than projected at the superior margin. The Prosthetically Guided Maxillofacial Surgery ...
International Journal of Oral and Maxillofacial Surgery, 2006
The study aimed to assess the proliferative activity and karyotype in Oral Lichen Planus (OLP) le... more The study aimed to assess the proliferative activity and karyotype in Oral Lichen Planus (OLP) lesions. G-banding chromosomal analysis of short-term primary cultures, and immunohistochemical expression of Ki67 and p53 were applied in 30 consecutive OLP patients divided into two groups according to clinical presentation of the lesions, and in nine subjects as negative controls. Mean values of Ki67 and p53 expression differed significantly (P<.01) between controls and patients groups with reticular or atrophic-erosive forms of OLP, whereas there was no significant difference between the two groups of patients with reticular or atrophic-erosive lesions. Six OLP patients showed clonal chromosome alterations, four of them associated with p53 overexpression. In conclusion, OLP is characterized by a high cellular turnover in most patients irrespective of clinical disease presentation. The genetic instability found in some patients should be interpreted as a consequence of the enhanced epithelial turnover, although we cannot rule out the possibility that some of the cytogenetic non-random anomalies observed represent early steps in cancer development.
The recognition of the role of craniofacial abnormalities in the development of obstructive sleep... more The recognition of the role of craniofacial abnormalities in the development of obstructive sleep apnea (OSAS) has led to several treatment strategies to correct or improve craniofacial structures. We report a case of severe OSAS [Apnea Hypopnea Index (AHI) = 80] in which an increase in the transverse dimensions by surgically assisted rapid maxillary expansion and mandibular symphyseal distraction osteogenesis dramatically decreased the OSAS index. Polysomnographic examen 6 months after surgery noticed normalization of the somnographic parameters (AHI = 9). This case report indicates that maxillomandibular transverse expansion can be a useful surgical procedure for treating severe OSAS with transverse deficiency. The results reported in the present case report are encouraging and emphasize the need for further critical evaluations of this potential new approach for the treatment of OSAS.
Because of the recent development of three-dimensional technology, computer software is increasin... more Because of the recent development of three-dimensional technology, computer software is increasingly being used for diagnosis, analysis, data documentation, and surgical planning for orthognathic surgery. Currently, the typical method to reposition jaws in the correct and planned location is based on the use of surgical splints, which have a quite high level of imprecision. The most important differences between planned and achieved maxillary movements are in the vertical and rotational positioning. Several methods have been described for intraoperative maxillary control, but none of these procedures is satisfactory. We present a new method to transfer individualized three-dimensional virtual planning of the patient using a navigation system in the operating room to improve reproducibility of the simulation. We enrolled 10 patients with dentofacial deformities from November 2008 to May 2009. All patients were studied and treated according to the following steps: cone-beam computed tomography data acquisition, virtual simulation of the surgical procedure, surgery with intraoperative navigation, and validation through reproducibility evaluation. We found 86.5% mean preoperative surgical plan reproducibility with the assistance of simulation-guided navigation compared with 80% mean reproducibility obtained in our previous group, in which no intraoperative navigation was performed. According to these results, we can assume that simulation-guided navigation would be a helpful procedure during orthognathic surgery to improve reproducibility of the preoperative virtual surgical planning.
Melanocytes are normally present in the oral mucosa, but unlike the skin, melanocytic colonizatio... more Melanocytes are normally present in the oral mucosa, but unlike the skin, melanocytic colonization and pigmentation of nonmelanocytic tumors rarely occur. A case of pigmented mucoepidermoid carcinoma (MEC) in a 36-year-old woman is reported. On H&E-stained sections, brownish granules were seen in intermediate and epidermoid neoplastic elements and in elongated or dendritic cells showing histologic and immunohistochemical features of melanocytes. Ultrastructurally numerous epithelial cells contained large aggregates of melanin granules, a feature suggestive of phagocytosis. In addition small individual melanin granules were observed at the external border of the epithelial cell membrane. These features suggest that melanocytes colonized the MEC and that neoplastic cells may phagocytose the granules, similarly to what occurs with epidermal melanocytes. The phenomenon of melanocyte colonization of nonmelanocytic tumors should be taken into consideration in dealing with pigmented lesion...
Dynamic navigation (DN) is a computer-guided technique employed in different surgical fields and ... more Dynamic navigation (DN) is a computer-guided technique employed in different surgical fields and recently adopted in dental implantology to improve the accuracy of dental implant insertion. Medication-related osteonecrosis of the jaws (MRONJ) often requires the surgical removal of the impaired, hard tissue, trying at the same time to spare the healthy tissue and the noble anatomical structures. A case of extensive bilateral medication-related osteonecrosis, with the symptomatic involvement of the right mandibular canal, was successfully resolved with the use of ultrasonic surgery associated with a dynamic navigation, in order to limit the invasiveness of the surgical approach improving its reliability and accuracy. The usefulness of this technology in the management of MRONJ can be considered in future clinical trials to confirm the advantages and standardize the technique.
The aim of this study was to evaluate the survival and clinical success rate, complications, and ... more The aim of this study was to evaluate the survival and clinical success rate, complications, and patients’ quality of life after computer-aided rehabilitation supported by zygomatic implants in cases of severe maxillary atrophy (ten patients) and in bone defects in oncologic patients (ten patients). All patients underwent computer-aided planning and surgery. Seventy-three zygomatic implants were placed. The mean follow-up period was 39.9 months. Implant survival and clinical success rate, the effectiveness of planning the implant length, biological and prosthetic complications, and the quality of life were evaluated. The five-year implant survival rate for patients with maxillary atrophy and oncologic patients was 97.4% and 96.7%, respectively. The prosthetic survival rate was 100%. Two implant failures occurred in the first year. One implant failure was observed in each group. Minor biological and prosthetic complications occurred in both groups without significant differences. All...
Dynamic Navigation is a computer-aided technology that allows the surgeon to track the grip instr... more Dynamic Navigation is a computer-aided technology that allows the surgeon to track the grip instruments while preparing the implant site in real time based on radiological anatomy and accurate pre-operative planning. The support of this technology to the zygoma implant placement aims to reduce the risks and the errors associated with this complex surgical and prosthetic treatment. Various navigation systems are available to clinicians currently, distinguished by handling, reliability, and the associated economic and biological benefits and disadvantages. The present paper reports on the different protocols of dynamic navigations following a standard workflow in correlation with zygomatic implant supported rehabilitations and describes a case of maxillary atrophy successfully resolved with this technology. An innovative and minimally invasive dynamic navigation system, with the use of an intraoral anchored trust marker plate and a patient reference tool, has been adopted to support t...
Background: In the context of guided surgery, augmented reality (AR) represents a groundbreaking ... more Background: In the context of guided surgery, augmented reality (AR) represents a groundbreaking improvement. The Video and Optical See-Through Augmented Reality Surgical System (VOSTARS) is a new AR wearable head-mounted display (HMD), recently developed as an advanced navigation tool for maxillofacial and plastic surgery and other non-endoscopic surgeries. In this study, we report results of phantom tests with VOSTARS aimed to evaluate its feasibility and accuracy in performing maxillofacial surgical tasks. Methods: An early prototype of VOSTARS was used. Le Fort 1 osteotomy was selected as the experimental task to be performed under VOSTARS guidance. A dedicated set-up was prepared, including the design of a maxillofacial phantom, an ad hoc tracker anchored to the occlusal splint, and cutting templates for accuracy assessment. Both qualitative and quantitative assessments were carried out. Results: VOSTARS, used in combination with the designed maxilla tracker, showed excellent t...
Perineural invasion (PNI) hinders the ability to establish local control of oral squamous cell ca... more Perineural invasion (PNI) hinders the ability to establish local control of oral squamous cell carcinoma (OSCC). To date, PNI can be evaluated only in surgical specimens and not in preoperative biopsy material, rendering timely therapeutic planning impossible. Insulin-like growth factor-II mRNA binding protein-3 (IMP3) expression appears to be of diagnostic and prognostic utility for many solid tumours, and laminin-5 expression in surgical specimens has been identified as a valid predictor of neural spread of head-and-neck neoplasms. The ability to use preoperative biopsy material to identify patients exhibiting PNI is fundamental for good management of OSCC. We examined a series of 64 consecutive patients treated (primarily via surgery) for OSCC between 2009 and 2014 at the Maxillofacial Surgery Unit, University of Bologna. We evaluated IMP3 and laminin-5 expression in preoperative biopsy material using immunohistochemistry and quantitative reverse transcription polymerase chain reaction. We sought to correlate expression of IMP3 and laminin-5 with PNI evident in surgical specimens. Expression of IMP3 and laminin-5 in preoperative biopsy material appeared to be predictive of PNI in patients with OSCC (P < 0.001). Additionally, the results of multivariate analyses showed that IMP3 status was an independent predictor of death of patients with OSCC (P = 0.001). The present study demonstrates that IMP3 and laminin-5 expression in preoperative biopsy material correlate well with PNI status and may allow accurate preoperative risk stratification of patients with OSCC.
Journal of prosthodontics : official journal of the American College of Prosthodontists, Jan 19, 2015
This study was undertaken to design an updated connection system for an eyeglass-supported nasal ... more This study was undertaken to design an updated connection system for an eyeglass-supported nasal prosthesis using rapid prototyping techniques. The substructure was developed with two main endpoints in mind: the connection to the silicone and the connection to the eyeglasses. The mold design was also updated; the mold was composed of various parts, each carefully designed to allow for easy release after silicone processing and to facilitate extraction of the prosthesis without any strain. The approach used in this study enabled perfect transfer of the reciprocal position of the prosthesis with respect to the eyeglasses, from the virtual to the clinical environment. Moreover, the reduction in thickness improved the flexibility of the prosthesis and promoted adaptation to the contours of the skin, even during functional movements. The method described here is a simplified and viable alternative to standard construction techniques for nasal prostheses and offers improved esthetic and f...
A viable protocol for the reconstruction of the maxilla after cancer ablation was tested, taking ... more A viable protocol for the reconstruction of the maxilla after cancer ablation was tested, taking into account final rehabilitation with an implant-supported fixed prosthesis, and using CAD-CAM technology. The protocol involved seven steps: surgical planning of the bony resections, CAD and rapid prototyping of cutting guides, titanium mesh, and bone plate, maxillofacial surgery, oral implant surgery, and prosthetic rehabilitation. CAD-CAM technology was used for each step, to design and prototype the surgical guides and the bone plate for the maxillofacial surgery; to make the impression of implants; and to prototype the framework of the final prosthetic rehabilitation. With respect to the maxillofacial surgery, to evaluate the margins of the bone cuts, the planes of the postoperative cuts were compared with those planned in the virtual environment. The accuracy of the rapid prototyping and intraoperative surgical positioning protocol was evaluated. With regard to implants and prosthetic rehabilitation, the framework confirmed a passive fit on implants using the Sheffield test, and occlusal and interproximal points of contact resulted clinically as projected virtually. Prosthetically Guided Maxillofacial and Implant Surgery is a viable method to reproduce the correct anatomy of the maxillary arches in relation to the prosthetic needs of rehabilitation. Moreover, the protocol presented in this paper offers some adjunctive benefits, such as time and cost saving and ideal aesthetic facial contouring.
Acta of bioengineering and biomechanics / Wroclaw University of Technology
A test of the accuracy in transferring the virtual data into the surgical environment was carried... more A test of the accuracy in transferring the virtual data into the surgical environment was carried out. Differences between the virtually planned and the actual position during surgery of the rapid prototyped guides and the bone plates were investigated. The accuracy of the method was evaluated in terms of the precision of cuts in the mandible, the final positions of the rami and condyles, and the sectioning precision of the fibula. The guide position presented a mean value dislocation of 0.6 mm in the right side and of 4.1 mm in the left side; the cut line of the mandible presented an angular deviation of 2.9° (right) and of 17.5° (left). The right condyle was positioned 2.5 ± 0.05 mm more medial than native position, and the left condyle 5.2 ± 0.05 mm medial. The total length was 0.3 ± 0.05 mm short of the virtually projected length at the inferior margin of the mandible and 1.9 ± 0.05 mm longer than projected at the superior margin. The Prosthetically Guided Maxillofacial Surgery ...
International Journal of Oral and Maxillofacial Surgery, 2006
The study aimed to assess the proliferative activity and karyotype in Oral Lichen Planus (OLP) le... more The study aimed to assess the proliferative activity and karyotype in Oral Lichen Planus (OLP) lesions. G-banding chromosomal analysis of short-term primary cultures, and immunohistochemical expression of Ki67 and p53 were applied in 30 consecutive OLP patients divided into two groups according to clinical presentation of the lesions, and in nine subjects as negative controls. Mean values of Ki67 and p53 expression differed significantly (P<.01) between controls and patients groups with reticular or atrophic-erosive forms of OLP, whereas there was no significant difference between the two groups of patients with reticular or atrophic-erosive lesions. Six OLP patients showed clonal chromosome alterations, four of them associated with p53 overexpression. In conclusion, OLP is characterized by a high cellular turnover in most patients irrespective of clinical disease presentation. The genetic instability found in some patients should be interpreted as a consequence of the enhanced epithelial turnover, although we cannot rule out the possibility that some of the cytogenetic non-random anomalies observed represent early steps in cancer development.
The recognition of the role of craniofacial abnormalities in the development of obstructive sleep... more The recognition of the role of craniofacial abnormalities in the development of obstructive sleep apnea (OSAS) has led to several treatment strategies to correct or improve craniofacial structures. We report a case of severe OSAS [Apnea Hypopnea Index (AHI) = 80] in which an increase in the transverse dimensions by surgically assisted rapid maxillary expansion and mandibular symphyseal distraction osteogenesis dramatically decreased the OSAS index. Polysomnographic examen 6 months after surgery noticed normalization of the somnographic parameters (AHI = 9). This case report indicates that maxillomandibular transverse expansion can be a useful surgical procedure for treating severe OSAS with transverse deficiency. The results reported in the present case report are encouraging and emphasize the need for further critical evaluations of this potential new approach for the treatment of OSAS.
Because of the recent development of three-dimensional technology, computer software is increasin... more Because of the recent development of three-dimensional technology, computer software is increasingly being used for diagnosis, analysis, data documentation, and surgical planning for orthognathic surgery. Currently, the typical method to reposition jaws in the correct and planned location is based on the use of surgical splints, which have a quite high level of imprecision. The most important differences between planned and achieved maxillary movements are in the vertical and rotational positioning. Several methods have been described for intraoperative maxillary control, but none of these procedures is satisfactory. We present a new method to transfer individualized three-dimensional virtual planning of the patient using a navigation system in the operating room to improve reproducibility of the simulation. We enrolled 10 patients with dentofacial deformities from November 2008 to May 2009. All patients were studied and treated according to the following steps: cone-beam computed tomography data acquisition, virtual simulation of the surgical procedure, surgery with intraoperative navigation, and validation through reproducibility evaluation. We found 86.5% mean preoperative surgical plan reproducibility with the assistance of simulation-guided navigation compared with 80% mean reproducibility obtained in our previous group, in which no intraoperative navigation was performed. According to these results, we can assume that simulation-guided navigation would be a helpful procedure during orthognathic surgery to improve reproducibility of the preoperative virtual surgical planning.
Melanocytes are normally present in the oral mucosa, but unlike the skin, melanocytic colonizatio... more Melanocytes are normally present in the oral mucosa, but unlike the skin, melanocytic colonization and pigmentation of nonmelanocytic tumors rarely occur. A case of pigmented mucoepidermoid carcinoma (MEC) in a 36-year-old woman is reported. On H&E-stained sections, brownish granules were seen in intermediate and epidermoid neoplastic elements and in elongated or dendritic cells showing histologic and immunohistochemical features of melanocytes. Ultrastructurally numerous epithelial cells contained large aggregates of melanin granules, a feature suggestive of phagocytosis. In addition small individual melanin granules were observed at the external border of the epithelial cell membrane. These features suggest that melanocytes colonized the MEC and that neoplastic cells may phagocytose the granules, similarly to what occurs with epidermal melanocytes. The phenomenon of melanocyte colonization of nonmelanocytic tumors should be taken into consideration in dealing with pigmented lesion...
Dynamic navigation (DN) is a computer-guided technique employed in different surgical fields and ... more Dynamic navigation (DN) is a computer-guided technique employed in different surgical fields and recently adopted in dental implantology to improve the accuracy of dental implant insertion. Medication-related osteonecrosis of the jaws (MRONJ) often requires the surgical removal of the impaired, hard tissue, trying at the same time to spare the healthy tissue and the noble anatomical structures. A case of extensive bilateral medication-related osteonecrosis, with the symptomatic involvement of the right mandibular canal, was successfully resolved with the use of ultrasonic surgery associated with a dynamic navigation, in order to limit the invasiveness of the surgical approach improving its reliability and accuracy. The usefulness of this technology in the management of MRONJ can be considered in future clinical trials to confirm the advantages and standardize the technique.
The aim of this study was to evaluate the survival and clinical success rate, complications, and ... more The aim of this study was to evaluate the survival and clinical success rate, complications, and patients’ quality of life after computer-aided rehabilitation supported by zygomatic implants in cases of severe maxillary atrophy (ten patients) and in bone defects in oncologic patients (ten patients). All patients underwent computer-aided planning and surgery. Seventy-three zygomatic implants were placed. The mean follow-up period was 39.9 months. Implant survival and clinical success rate, the effectiveness of planning the implant length, biological and prosthetic complications, and the quality of life were evaluated. The five-year implant survival rate for patients with maxillary atrophy and oncologic patients was 97.4% and 96.7%, respectively. The prosthetic survival rate was 100%. Two implant failures occurred in the first year. One implant failure was observed in each group. Minor biological and prosthetic complications occurred in both groups without significant differences. All...
Dynamic Navigation is a computer-aided technology that allows the surgeon to track the grip instr... more Dynamic Navigation is a computer-aided technology that allows the surgeon to track the grip instruments while preparing the implant site in real time based on radiological anatomy and accurate pre-operative planning. The support of this technology to the zygoma implant placement aims to reduce the risks and the errors associated with this complex surgical and prosthetic treatment. Various navigation systems are available to clinicians currently, distinguished by handling, reliability, and the associated economic and biological benefits and disadvantages. The present paper reports on the different protocols of dynamic navigations following a standard workflow in correlation with zygomatic implant supported rehabilitations and describes a case of maxillary atrophy successfully resolved with this technology. An innovative and minimally invasive dynamic navigation system, with the use of an intraoral anchored trust marker plate and a patient reference tool, has been adopted to support t...
Background: In the context of guided surgery, augmented reality (AR) represents a groundbreaking ... more Background: In the context of guided surgery, augmented reality (AR) represents a groundbreaking improvement. The Video and Optical See-Through Augmented Reality Surgical System (VOSTARS) is a new AR wearable head-mounted display (HMD), recently developed as an advanced navigation tool for maxillofacial and plastic surgery and other non-endoscopic surgeries. In this study, we report results of phantom tests with VOSTARS aimed to evaluate its feasibility and accuracy in performing maxillofacial surgical tasks. Methods: An early prototype of VOSTARS was used. Le Fort 1 osteotomy was selected as the experimental task to be performed under VOSTARS guidance. A dedicated set-up was prepared, including the design of a maxillofacial phantom, an ad hoc tracker anchored to the occlusal splint, and cutting templates for accuracy assessment. Both qualitative and quantitative assessments were carried out. Results: VOSTARS, used in combination with the designed maxilla tracker, showed excellent t...
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Papers by CLAUDIO MARCHETTI