 |
Luigi CHIARINI
Professore Ordinario
Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto
|
Home |
Curriculum(pdf) |
Didattica |
Pubblicazioni
2023
- An Analysis of Volume, Length and Segmentation of Free Fibula Flap in Reconstruction of the Jaws: Investigation of Their Role on Flap Failure
[Articolo su rivista]
Di Bartolomeo, M; Lusetti, Il; Pinelli, M; Negrello, S; Pellacani, A; Angelini, S; Chiarini, L; Nocini, R; De Santis, G; Anesi, A
abstract
Reconstruction of defects of the jaws is mainly performed via free fibula flap. An incidence of 2-21% of overall flap failure is still described. We investigated the roles of volume, length and number of fibula flap segments on flap survival using novel three-dimensional segmentation tools. We also analyzed the role of other possible risk factors. Seventy-one consecutive patients with a follow up of at least three months and who underwent free fibula flap reconstruction in a single center between 2002 and 2022 have been evaluated. A total of 166 fibula segments were analyzed. Malignancies were the main reason of resection (45.1%). In 69% of the cases a reconstruction of the mandible was performed. The flaps were mainly divided in two segments (39%) (range 1-4), with a mean length of 2.52 cm and a mean volume was 3.37 cm(3). Total flap failure (TFF) occurred in 12 cases, (16.9%), while partial flap failure (PFF) appeared in 3 patients (4.2%). Volume, length and number of fibula flap segments did not seem to influence flap failure incidence in uni- and multivariate analysis. Reconstruction of the maxilla and use of a recipient vessel different from the facial artery seemed to significantly impact on flap failure. Smoking and previous surgeries showed a higher trend to flap failure, but they did not reach statistical significance. Prospective and multicentric analysis on a wider population should be assessed.
2023
- Folded Radial Forearm Free Flap for the Reconstruction of Total Soft Palate Defects: Operative Technique
[Articolo su rivista]
Nocini, R.; Favero, V.; Molteni, G.; Pinto, V.; Chiarini, L.; Nocini, P. F.
abstract
Background:The surgical plan to reconstruct the palate must be carefully prepared given the morphological peculiarity of the soft palate forming both the roof of the mouth and the floor of the nasal cavity. This article focuses on the use of folded radial forearm free flaps to manage isolated defects of the soft palate in the absence of tonsillar pillar involvement. Methods:Three patients affected by squamous cell carcinoma of the palate underwent resection of the soft palate and immediate reconstruction with a folded radial forearm free flap. Results:All three patients showed good short-term morphological-functional outcomes as far as swallowing, breathing, and phonation were concerned. Conclusions:The folded radial forearm free flap seems to be an efficacious way to manage localized defects of the soft palate, given the positive outcomes of the three patients treated, and in accordance with other authors. In general, the radial forearm free flap was confirmed to be a versatile solution for those intraoral defects of the soft tissue requiring a limited quantity of volume as in the case of the soft palate.
2023
- Inferior Alveolar Canal Automatic Detection with Deep Learning CNNs on CBCTs: Development of a Novel Model and Release of Open-Source Dataset and Algorithm
[Articolo su rivista]
Di Bartolomeo, Mattia; Pellacani, Arrigo; Bolelli, Federico; Cipriano, Marco; Lumetti, Luca; Negrello, Sara; Allegretti, Stefano; Minafra, Paolo; Pollastri, Federico; Nocini, Riccardo; Colletti, Giacomo; Chiarini, Luigi; Grana, Costantino; Anesi, Alexandre
abstract
Introduction: The need of accurate three-dimensional data of anatomical structures is increasing in the surgical field. The development of convolutional neural networks (CNNs) has been helping to fill this gap by trying to provide efficient tools to clinicians. Nonetheless, the lack of a fully accessible datasets and open-source algorithms is slowing the improvements in this field. In this paper, we focus on the fully automatic segmentation of the Inferior Alveolar Canal (IAC), which is of immense interest in the dental and maxillo-facial surgeries. Conventionally, only a bidimensional annotation of the IAC is used in common clinical practice. A reliable convolutional neural network (CNNs) might be timesaving in daily practice and improve the quality of assistance. Materials and methods: Cone Beam Computed Tomography (CBCT) volumes obtained from a single radiological center using the same machine were gathered and annotated. The course of the IAC was annotated on the CBCT volumes. A secondary dataset with sparse annotations and a primary dataset with both dense and sparse annotations were generated. Three separate experiments were conducted in order to evaluate the CNN. The IoU and Dice scores of every experiment were recorded as the primary endpoint, while the time needed to achieve the annotation was assessed as the secondary end-point. Results: A total of 347 CBCT volumes were collected, then divided into primary and secondary datasets. Among the three experiments, an IoU score of 0.64 and a Dice score of 0.79 were obtained thanks to the pre-training of the CNN on the secondary dataset and the creation of a novel deep label propagation model, followed by proper training on the primary dataset. To the best of our knowledge, these results are the best ever published in the segmentation of the IAC. The datasets is publicly available and algorithm is published as open-source software. On average, the CNN could produce a 3D annotation of the IAC in 6.33 s, compared to 87.3 s needed by the radiology technician to produce a bidimensional annotation. Conclusions: To resume, the following achievements have been reached. A new state of the art in terms of Dice score was achieved, overcoming the threshold commonly considered of 0.75 for the use in clinical practice. The CNN could fully automatically produce accurate three-dimensional segmentation of the IAC in a rapid setting, compared to the bidimensional annotations commonly used in the clinical practice and generated in a time-consuming manner. We introduced our innovative deep label propagation method to optimize the performance of the CNN in the segmentation of the IAC. For the first time in this field, the datasets and the source codes used were publicly released, granting reproducibility of the experiments and helping in the improvement of IAC segmentation.
2023
- Letter to the Editor: Intraosseous Cavernous Hemangioma of the Middle Turbinate: A Case Report
[Articolo su rivista]
Di Bartolomeo, M.; Negrello, S.; Rozell-Shannon, L.; Nocini, R.; Chiarini, L.; Colletti, G.
abstract
2023
- Multiple General Anesthesia in Children: A Systematic Review of Its Effect on Neurodevelopment
[Articolo su rivista]
Colletti, G.; Di Bartolomeo, M.; Negrello, S.; Geronemus, R. G.; Cohen, B.; Chiarini, L.; Anesi, A.; Femino, R.; Mariotti, I.; Levitin, G. M.; Rozell-Shannon, L.; Nocini, R.
abstract
The effect of multiple general anesthesia (mGA) procedures administered in early life is a critical theme and has led the Food and Drug Administration (FDA) to issue an alert. This systematic review seeks to explore the potential effects on neurodevelopment of mGA on patients under 4 years. The Medline, Embase and Web of Science databases were searched for publications up to 31 March 2021. The databases were searched for publications regarding “children multiple general anesthesia OR pediatric multiple general anesthesia”. Case reports, animal studies and expert opinions were excluded. Systematic reviews were not included, but they were screened to identify any possible additional information. A total of 3156 studies were identified. After removing the duplicates, screening the remaining records and analyzing the systematic reviews’ bibliography, 10 studies were considered suitable for inclusion. Comprehensively, a total cohort of 264.759 unexposed children and 11.027 exposed children were assessed for neurodevelopmental outcomes. Only one paper did not find any statistically significant difference between exposed and unexposed children in terms of neurodevelopmental alterations. Controlled studies on mGA administered before 4 years of age support that there might be a greater risk of neurodevelopmental delay in children receiving mGA, warranting the need for careful risk/benefit considerations.
2023
- Surgery for Port-Wine Stains: A Systematic Review
[Articolo su rivista]
Colletti, G.; Negrello, S.; Rozell-Shannon, L.; Levitin, G. M.; Colletti, L.; Chiarini, L.; Anesi, A.; Di Bartolomeo, M.; Pellacani, A.; Nocini, R.
abstract
Background: Port-wine stains (PWS) are congenital low-flow vascular malformations of the skin. PWS tend to become thicker and darker with time. Laser therapy is the gold standard and the first-line therapy for treating PWS. However, some resistant PWS, or PWS that have tissue hypertrophy, do not respond to this therapy. Our aim is to evaluate the role of surgery in the treatment of PWS birthmarks. Methods: A literature search was performed in PubMed, Scopus, Web of Science (WOS) and Google Scholar for all papers dealing with surgery for port-wine stains, from January 2010 to December 2020 using the search strings: (capillary vascular malformation OR port-wine stains OR Sturge Weber Syndrome OR sws OR pws) AND (surgical OR surgery). Results: Ten articles were identified and used for analysis. They were almost all case series with a short follow up period and lacked an objective–systematic score of evaluation. Conclusions: Delay in treatment of port wine stains may result in soft tissue and bone hypertrophy or nodules with disfiguring or destructive characteristics. The correction of PWS-related facial asymmetry often requires bone surgery followed by soft tissue corrections to achieve a more harmonious, predictable result.
2022
- Ameloblastoma in a Three-Year-Old Child with Hurler Syndrome (Mucopolysaccharidosis Type I)
[Articolo su rivista]
Di Bartolomeo, Mattia; Pellacani, Arrigo; Negrello, Sara; Buchignani, Martina; Nocini, Riccardo; Di Massa, Gianluca; Gianotti, Greta; Pollastri, Giuseppe; Colletti, Giacomo; Chiarini, Luigi; Anesi, Alexandre
abstract
2022
- Bilateral reconstruction of the mandibular body with symphyseal preservation using a single fibula free flap: operative technique
[Articolo su rivista]
Nocini, R.; Favero, V.; Chiarini, L.; Nocini, P. F.
abstract
Background: Mandibular osteonecrosis may occur in 5% of the patients who undergo radiotherapy for the treatment of head and neck malignancies. Resection and microvascular reconstruction is the treatment of choice in complicated osteoradionecrosis, however multifocal presentation may complicate the management of the disease given the poor quality and limited availability of adequate recipient vessels. Operative technique: A 74-year-old man affected by multifocal severe osteoradionecrosis of the mandible underwent bilateral resection of the mandibular bodies while preserving the symphysis. The defects were reconstructed with a single fibula flap composed by two bony segments connected by a central segment, corresponding to the symphyseal region, in which the bone was dissected and removed. The anastomosis was performed on a single side of the neck. Healing was uneventful and the adopted technique allowed for a quick functional and esthetic recovery. Conclusion: The presented technique provided a safe and efficacious, although technically challenging, solution in a case presenting multifocal osteonecrosis of the jaw. The morbidity of the procedure was limited because the tissue resection and reconstruction processes were minimized. Graphical Abstract: [Figure not available: see fulltext.]
2022
- Comparative Study on Bioactive Filler/Biopolymer Scaffolds for Potential Application in Supporting Bone Tissue Regeneration
[Articolo su rivista]
Degli Esposti, Micaela; Changizi, Maryam; Salvatori, Roberta; Chiarini, Luigi; Cannillo, Valeria; Morselli, Davide; Fabbri, Paola
abstract
2022
- Lymphatic malformations do not regress spontaneously
[Articolo su rivista]
Colletti, G.; Chiarini, L.
abstract
2022
- Pulsed Electro-Magnetic Field (PEMF) Effect on Bone Healing in Animal Models: A Review of Its Efficacy Related to Different Type of Damage
[Articolo su rivista]
Di Bartolomeo, M.; Cavani, F.; Pellacani, A.; Grande, A.; Salvatori, R.; Chiarini, L.; Nocini, R.; Anesi, A.
abstract
Biophysical energies are a versatile tool to stimulate tissues by generating biopotentials. In particular, pulsed electromagnetic field (PEMF) stimulation has intrigued researchers since the 1970s. To date, many investigations have been carried out in vivo, but a gold standard treatment protocol has not yet been defined. The main obstacles are represented by the complex setting of PEMF characteristics, the variety of animal models (including direct and indirect bone damage) and the lack of a complete understanding of the molecular pathways involved. In the present review the main studies about PEMF stimulation in animal models with bone impairment were reviewed. PEMF signal characteristics were investigated, as well as their effect on molecular pathways and osseous morphological features. We believe that this review might be a useful starting point for a prospective study in a clinical setting. Consistent evidence from the literature suggests a potential beneficial role of PEMF in clinical practice. Nevertheless, the wide variability of selected parameters (frequency, duration, and amplitude) and the heterogeneity of applied protocols make it difficult to draw certain conclusions about PEMF effectiveness in clinical implementation to promote bone healing. Deepening the knowledge regarding the most consistent results reported in literature to date, we believe that this review may be a useful starting point to propose standardized experimental guidelines. This might provide a solid base for further controlled trials, to investigate PEMF efficacy in bone damage conditions during routine clinical practice.
2022
- The vanishing port-wine stain birthmark—consideration for a rare type of congenital vascular anomaly
[Articolo su rivista]
Pellacani, Arrigo; Rozell-Shannon, Linda; Negrello, Sara; Di Bartolomeo, Mattia; Anesi, Alexandre; Feminò, Raimondo; Mariotti, Ilaria; Chiarini, Luigi; Colletti, Giacomo
abstract
2022
- Tongue cancer following hematopoietic cell transplantation for Fanconi anemia
[Articolo su rivista]
Di Bartolomeo, Mattia; Anesi, Alexandre; Pellacani, Arrigo; Negrello, Sara; Natale, Annalisa; Figurelli, Sabina; Vaddinelli, Doriana; Angelini, Stefano; Chiarini, Luigi; Nocini, Riccardo; Di Bartolomeo, Paolo
abstract
Objectives: The aim of this retrospective study was to determine the incidence and the clinical outcome of tongue cancer (TC) in patients affected by Fanconi anemia (FA) who received an allogeneic hematopoietic cell transplantation (HCT). Materials and methods: The patient database from the Bone Marrow Transplant Center of Pescara was reviewed to enroll FA patients. Patients', donors', HCT's, and screening's data were collected as well to look for the incidence and the treatment of TC. Results: Twelve patients affected by FA were identified. Three patients died for transplant-related causes. Five of nine surviving patients were diagnosed with TC at a median of 21.7 years since transplantation and at a median age of 32.10 years. Interestingly, no patient manifested graft-versus-host-disease (GvHD). The 28-year cumulative incidence function of TC was 46.9% (95% CI, 36.9-56.9%). Two patients were treated with chemotherapy alone, two patients were treated with surgery alone, and one with surgery followed by chemotherapy. Overall, 4 patients with TC showed a clinical course characterized by a marked aggressiveness of the tumor disease which led to death due to cancer progression between 2 and 13 months. One patient is surviving 8 months after diagnosis of TC. Conclusions: Our study confirms the high incidence of tumors and in particular tongue tumors in allotransplanted FA patients. A careful screening has to be life-long maintained. Clinical relevance: Considering the rarity of FA and the frailty of FA patients, this study may add important information for the cancer management of these patients.
2021
- A (Very) Brief History of the Nosography of Vascular Anomalies
[Articolo su rivista]
Colletti, G.; Chiarini, L.
abstract
2021
- A Case Report of a Solitary Fibrous Tumor of the Maxillary Sinus
[Articolo su rivista]
Di Bartolomeo, Mattia; Negrello, Sara; Pellacani, Arrigo; Cesinaro, Anna Maria; Vallone, Stefano; Presutti, Livio; Chiarini, Luigi; Anesi, Alexandre
abstract
A solitary fibrous tumor (SFT) is a benign neoplasm, firstly described as a mesenchymal tumor of the pleura. Its incidence range in the head and neck region is about 5–27%, but only rarely does it affect paranasal sinuses. The differential diagnosis is challenging, owing to its erosive growth pattern and immuno-histochemical features. SFTs have an aggressive behavior and an important recurrence potential. Therefore, a radical surgical excision is the gold standard therapeutic procedure. A rare SFT originating from the right maxillary sinus is reported here. The 37-year-old patient presented to the outpatient clinic with a painful expansive lesion in the whole right maxillary region. The overlying skin was inflamed and the patient had no epistaxis episodes. The 1.5 dentary element tested negative for vitality; however, a puncture of the lesion led to a hematic spill and no purulent discharge. An endoscopic-guided biopsy was suggestive either of SFT or hemangioperictoma, excluding a malignant neoplasm. A multi-equipe surgical team was activated. The lesion was embolized in order to achieve a good hemostatic control and, after 48 h, the neoplasm was radically excised with a combined open and endoscopic approach. The patient was disease-free at 12-month radiological and clinical follow-up. Given the rarity of this lesion and the delicacy required in addressing head and neck neoplasms, we believe that the present case report might be of help in further understanding how to approach cranio-facial SFTs.
2020
- Bone Healing Evaluation Following Different Osteotomic Techniques in Animal Models: A Suitable Method for Clinical Insights
[Articolo su rivista]
Anesi, Alexandre; Di Bartolomeo, Mattia; Pellacani, Arrigo; Ferretti, Marzia; Cavani, Francesco; Salvatori, Roberta; Nocini, Riccardo; Palumbo, Carla; Chiarini, Luigi
abstract
Osteotomy is a common step in oncological, reconstructive, and trauma surgery. Drilling and elevated temperature during osteotomy produce thermal osteonecrosis. Heat and associated mechanical damage during osteotomy can impair bone healing, with consequent failure of fracture fixation or dental implants. Several ex vivo studies on animal bone were recently focused on heating production during osteotomy with conventional drill and piezoelectric devices, particularly in endosseous dental implant sites. The current literature on bone drilling and osteotomic surface analysis is here reviewed and the dynamics of bone healing after osteotomy with traditional and piezoelectric devices are discussed. Moreover, the methodologies involved in the experimental osteotomy and clinical studies are compared, focusing on ex vivo and in vivo findings.
2020
- Cell Proliferation to Evaluate Preliminarily the Presence of Enduring Self-Regenerative Antioxidant Activity in Cerium Doped Bioactive Glasses
[Articolo su rivista]
Anesi, Alexandre; Malavasi, Gianluca; Chiarini, Luigi; Salvatori, Roberta; Lusvardi, Gigliola
abstract
(1) Background: a cell evaluation focused to verify the self-regenerative antioxidant activity is performed on cerium doped bioactive glasses. (2) Methods: the glasses based on 45S5 Bioglass®, are doped with 1.2 mol%, 3.6 mol% and 5.3 mol% of CeO2 and possess a polyhedral shape (~500 µm2). Glasses with this composition inhibit oxidative stress by mimicking catalase enzyme (CAT) and superoxide dismutase (SOD) activities; moreover, our previous cytocompatibility tests (neutral red (NR), 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and Bromo-2-deoxyUridine (BrdU)) reveal that the presence of cerium promotes the absorption and vitality of the cells. The same cytocompatibility tests were performed and repeated, in two different periods (named first and second use), separated from each other by four months. (3) Results: in the first and second use, NR tests indicate that the presence of cerium promotes once again cell uptake and viability, especially after 72 h. A decrease in cell proliferation it is observed after MTT and BrdU tests only in the second use. These findings are supported by statistically significant results (4) Conclusions: these glasses show enhanced proliferation, both in the short and in the long term, and for the first time such large dimensions are studied for this kind of study. A future prospective is the implantation of these bioactive glasses as bone substitute in animal models.
2020
- Emerging challenges and possible strategies in maxillo-facial and oral surgery during the COVID-19 pandemic
[Articolo su rivista]
Di Bartolomeo, Mattia; Pellacani, Arrigo; Negrello, Sara; Chiarini, Luigi; Anesi, Alexandre
abstract
The Coronavirus disease 2019 (COVID-19) pandemic suddenly took the world by storm and Italy was one of the hardest hit countries. Maxillo-facial surgery and dentistry procedures had to be significantly reorganized, since they are considered high-risk procedures. Protocols had to be changed and interdepartmental cooperation was put in place to plan surgical interventions and maintain high standards. Various improvements have been made to prevent and reduce the risks of spreading the infection. Even if the situation seems to have improved, being unprepared is not an option. In this paper the experience gained during these months has been shared and possible future challenges has been highlighted, suggesting practical adjustments based also on new guidelines and recommendations.
2020
- Primary Intraosseous Squamous Cell Carcinoma of the Anterior Mandible Arising in an Odontogenic Cyst in 34-Year-Old Male
[Articolo su rivista]
Negrello, Sara; Pellacani, Arrigo; di Bartolomeo, Mattia; Bernardelli, Giuditta; Nocini, Riccardo; Pinelli, Massimo; Chiarini, Luigi; Anesi, Alexandre
abstract
2019
- Assessment
[Capitolo/Saggio]
Anesi, Alexandre; Negrello, Sara; Chiarini, Luigi
abstract
In order to achieve an adequate oral rehabilitation after reconstruction of the jaw, a consistent prosthetic treatment is necessary. The main determinants of implant stability are the mechanical properties of the bone tissue at the implant site, and how the contact between the implant neck and the cortical bone plate is achieved. If we presume a correct surgical technique and a good implant design, the bone density determines the primary implant stability at the time of surgery. A stable implant can exhibit different degrees of displacement or resistance to load, which corresponds to varying degrees of stability. Conversely, a failed implant shows clinical mobility on the macroscale, as the implant is surrounded by a fibrous scar tissue. An increasing degree of micro-mobility is present until clinical failure of the implant. This suggests that techniques to measure and to monitor implant micro-motion/stability could give the clinician the opportunity to optimize implant treatment. Insertion torque, Periotest, and resonance frequency analysis are suitable to measure primary implant stability. Nevertheless, the resonance frequency analysis is the only method that can detect variations in different bone densities, which may be measured even during the follow-up of the implant.
2019
- Clinical Management of Acinic Cell Carcinoma of the Lacrimal Gland
[Articolo su rivista]
Anesi, A.; Negrello, S.; Lucchetti, D.; Pollastri, G.; Trevisiol, L.; Badiali, L.; Lazzerini, A.; Cavallini, G. M.; Chiarini, L.
abstract
To report a case of acinic cell carcinoma occurred in the lacrimal gland. A 59-year-old man was admitted because of sudden blurring of vision, progressive proptosis of the left eye, and mild double vision in left and down directions of the gaze (Hess-Lancaster test). His medical history detailed controlled bilateral keratoconus and open angle glaucoma. On examination, the best corrected visual acuity decreased from 8/20 till 1/50 in one week. There was a swelling of the left upper eyelid. A hard and tender mass was palpated in the superior temporal left orbit. Ultrasound scan showed an extraconal solid mass, situated in the superior lateral corner of the orbit. Computed tomography and magnetic resonance imaging (MRI) revealed a mass of two centimeters in diameter, with round well-defined outline, within the lacrimal gland. We per-formed an enucleoresection of the mass, via a coronal approach and a lateral orbitotomy by a piezosurgical device. The lesion appeared nodular, brownish, measuring about 2 × 1.5 cm. Histopathological findings were consistent with acinic cell carcinoma with a microcystic, focally papillary-cystic growth of pattern. Follow-up MRI outcomes led to removal of the residual lacrimal gland for suspicion of recurrence. No tumor recurrences where detected at 7-year follow-up.
2019
- Cytocompatibility of potential bioactive cerium-doped glasses based on 45S5
[Articolo su rivista]
Malavasi, Gianluca; Salvatori, Roberta; Zambon, Alfonso; Lusvardi, Gigliola; Rigamonti, Luca; Chiarini, Luigi; Anesi, Alexandre
abstract
The cytocompatibility of potential bioactive cerium-containing (Ce 3+ /Ce 4+ ) glasses is here investigated by preparing three different glasses with increasing amount of doping CeO 2 (1.2, 3.6 and 5.3 mol% of CeO 2 , called BG_1.2, BG_3.6 and BG_5.3, respectively) based on 45S5 Bioglass®(called BG). These materials were characterized by Environmental Scanning Electron Microscopy (ESEM) and infrared spectroscopy (FTIR) after performing bioactivity tests in Dulbecco's Modified Eagle Medium (DMEM) solution, and the ions released in solution were determined by Inductively Coupled Plasma Mass Spectrometry (ICP-MS) and Optical Emission Spectrometry (ICP-OES). The data obtained clearly show that the glass surfaces of BG, BG_1.2 and BG_3.6 were covered by hydroxyapatite (HA), while BG_5.3 favored the formation of a cerium phosphate crystal phase. The cytotoxicity tests were performed using both murine long bone osteocyte-like (MLO-Y4) and mouse embryonic fibroblast (NIH/3T3) cell lines. The cerium-containing bioactive glasses show an increment in cell viability with respect to BG, and at long times, no cell aggregation and deformation were observed. The proliferation of NIH/3T3 cells increased with the cerium content in the glasses; in particular, BG_3.6 and BG_5.3 showed a higher proliferation of cells than the negative control. These results highlight and enforce the proposal of cerium-doped bioactive glasses as a new class of biomaterials for hard-tissue applications.
2019
- Evolution in Indication
[Capitolo/Saggio]
Anesi, Alexandre; Negrello, Sara; Chiarini, Luigi
abstract
Since the introduction of reconstructive technique using the fibula flap, the indications for use of this graft have evolved. The fibula graft may provide skin islands, up to 25 cm and 14 cm wide, suitable for reconstruction of associated soft tissue defects. The dual endosteal and periosteal blood supply ensures bony viability despite multiple osteotomies. Hidalgo in 1989 described the first lower jaw reconstruction with a fibular flap, using osteotomies to mimic the shape of the mandible after oncological or traumatic defects. Multiple skin islands can be harvested with the fibula graft providing an osteomyocutaneous flap, including those based on septocutaneous as well as on musculocutaneous peroneal perforators. This graft provides convenient tissue for simultaneous reconstruction of bony and soft tissue defects inside as well as outside the oral cavity, bringing viable tissue to a mostly irradiated and contaminated field, with the lowest complication rate among osteocutaneous flaps. Soleus muscle connected to motor branches at the recipient site is described to restore the motor function or by using the sural cutaneous nerve together with a skin island for restoring sensation. Flap combinations were performed by anastomosing a second free flap to the distal peroneal artery and vein, which do not significantly reduce in caliber and thus can also serve at the recipient site. The use of free vascularized fibula has become the gold standard for mandibular and maxillary extensive defects.
2019
- Lateral, Hemimandibular, Anterior.
[Capitolo/Saggio]
Chiarini, Luigi; Anesi, Alexandre; Negrello, Sara
abstract
Maintaining projection and support of the lower face and planning for endosseous dental implant positioning require bony reconstruction of the mandible when a major defect occurred. To completely restore the anterior mandible, it is necessary to overcome the limited height of the fibula compared to the native symphyseal and parasymphyseal region; adequate bone height is a precondition for dental implant planning. Intraoral tissue reconstruction and a myofascial lining can also be performed with myofascial fibula flap or with simple/folded skin island of fibula flap. For the largest defects, a double flap (fibula osteocutaneous flap externally, radial forearm fasciocutaneous or vertical rectus abdominis myocutaneous intraorally) may be required. We briefly describe the mandibular reconstructive principles through fibula flap related to specific defects, referring to the classification proposed by Cordeiro et al.
2019
- Linfadenectomia sovraomoioidea.
[Capitolo/Saggio]
Chiarini, Luigi; Anesi, Alexandre; Negrello, Sara
abstract
Lo svuotamento linfonodale sovra-omoioideo è la dissezione laterocervicale selettiva più frequentemente eseguita in caso di carcinoma del cavo orale. Con il termine “svuotamento linfonodale selettivo” si intende l’asportazione dei pacchetti linfonodali a maggior rischio di metastasi, con la preservazione di uno o più livelli linfonodali di solito rimossi durante uno svuotamento radicale. In particolar modo lo svuotamento sovraomoioideo prevede la dissezione del I-II-III livello linfonodale (ovvero al di sopra, cranialmente, rispetto al muscolo omoioideo). La possibilità di eseguire dissezioni selettive del collo si basa sul fatto che il drenaggio linfatico delle mucose del cavo orale, in pazienti con carcinoma a cellule squamose precedentemente non trattati, segue percorsi relativamente costanti e di conseguenza le metastasi linfonodali presentano un pattern di diffusione relativamente prevedibile in base alla localizzazione del tumore primitivo. Gli studi anatomici di Rouvière, Fish e Sigel (e successivamente Shah) hanno concluso che i tumori della cavità orale metastatizzano più frequentemente ai linfonodi del collo del I, II, e III livello, mentre i tumori dell’orofaringe, ipofaringe, laringe metastatizzano più frequentemente al II, III, e IV livello. Il trattamento chirurgico delle metastasi linfonodali è stato proposto ed eseguito in origine da Von Albrecht nel 1875, ai primordi della chirurgia laringea, con la sola asportazione dei linfonodi metastatici; Gluck e Sorensen asportavano anche il muscolo sternocleidomastoideo, la giugulare interna e, talvolta, la carotide. Crile nel 1898 introdusse lo svuotamento linfonodale sistematico in monoblocco con la laringectomia, dimostrando che nella sua casistica i malati così trattati sopravvivevano mediamente quattro volte di più di quelli trattati con semplice laringectomia. In seguito, circa 70 anni dopo, Suarez e Bocca iniziarono a conservare il nervo spinale accessorio, la vena giugulare interna e il muscolo sternocleidomastoideo in caso di tumori della laringe e ipofaringee con collo clinicamente negativo per localizzazioni metastatiche linfonodali. L’origine dello svuotamento selettivo, invece, non è del tutto chiara. Molti chirurghi hanno usato questo tipo di procedura per decadi senza descriverla formalmente. Per esempio, Kocher eseguiva un’asportazione parziale dei linfonodi nei pazienti con carcinoma del cavo orale e collo N0 già alla fine del diciannovesimo secolo. Con il tempo si diffuse una procedura detta “svuotamento sovraioideo” (cioè del I livello) nei casi di linfoadenopatie occulte associate ai carcinomi soprattutto del labbro. In seguito, nel 1972, Lindberg ha dimostrato che i livelli più frequentemente coinvolti in pazienti con carcinoma del cavo orale sono in genere il II e il III; nei carcinomi del pavimento della bocca e della lingua mobile il livello più frequentemente coinvolto è, invece, il I. Più tardi Byers propose i termini “anteriore” e “sovraomoioideo” per indicare le dissezioni parziali, ma solo nel 1991 si iniziò ad usare il termine selettivo per descrivere le resezioni linfonodali limitate (Academy’s Committee for Head and Neck Surgery and Oncology). In generale lo svuotamento linfonodale laterocervicale del collo può essere eseguito secondo due diversi tempi rispetto al momento dell’asportazione del tumore primario: 1) in contemporanea all’asportazione del tumore primario ed in assenza di evidenza clinica e radiologica di metastasi linfonodali laterocervicali, ovvero in stadio cN0, al fine di eradicare eventuali metastasi occulte: viene definito svuotamento elettivo o elective neck dissection. 2) successivamente all‘intervento sul tumore primario, al manifestarsi clinico o radiologico delle metastasi linfonodali laterocervicali: viene definito svuotamento terapeutico o therapeutic neck dissection. Lo svuotamento linfonodale elettivo (cN0) è abitu
2019
- SBF assays, direct and indirect cell culture tests to evaluate the biological performance of bioglasses and bioglass-based composites: Three paradigmatic cases
[Articolo su rivista]
Bellucci, Devis; Salvatori, Roberta; Anesi, Alexandre; Chiarini, Luigi; Cannillo, Valeria
abstract
A novel bioglass composition (BGMS10), containing strontium and magnesium and characterized by an ultra-high crystallization temperature, is here employed for the first time to produce different composites with the addition of specific amounts of hydroxyapatite. After an investigation of the samples’ bioactivity in vitro in a simulated body fluid solution (SBF) – according to a widely used protocol – the biocompatibility of the new materials was tested with respect to murine fibroblasts both by direct and indirect tests, in order to evaluate possible cytotoxic effects of the materials’ eluates. Although none of the samples were cytotoxic and their bioactivity in SBF increased with the increasing amount of the glass in the composite, thus showing the best performance in the case of pure BGMS10 glass, the findings of the biological investigation did not confirm those arising from the SBF assay. Surprisingly, while the composites with the lowest glass amount showed an enhanced biocompatibility in direct tests, on the contrary their biological responsiveness is typically lower in the indirect ones, based on filtered materials’ extracts. This fact could be ascribed to the high release of particulate from the composites, which are more porous than the glassy samples: in fact, such pronounced dissolution may affect both the cell viability and the absorbance readings used in the colorimetric assays. The pure BGMS10 glass showed the best biological response only in the cell proliferation test (which is an indirect contact test), being able to stimulate cell proliferation in particular after 24 h. For these reasons, when considering bioactive glasses and bioglass-based composites, the results of direct cell culture assays should be integrated with those obtained by indirect ones, while the findings regarding the in vitro bioactivity in SBF should be interpreted with great care.
2019
- Second Vascularized Fibula Flap and Osteotomy to Correct Malocclusion
[Capitolo/Saggio]
Nocini, Pier Francesco; Anesi, Alexandre; Chiarini, Luigi
abstract
For alveolar bone augmentation, a further reconstructive procedure is possible with a new revascularized fibula flap fixed onto the surface of the first fibula, placed as reconstruction of the basal bone of the mandible. Two consecutive vascularized free flaps are reported in a small series of patients affected by recurrent squamous cell carcinoma. A second fibula vascularized flap is reliable for simultaneous augmentation in symphysis, parasymphysis, and the premolar area over a previous fibula flap: implant-borne dental rehabilitation becomes practicable to improve quality of speech and diet. Malocclusion and asymmetric facial contour may follow reconstruction of the jaws with vascularized fibula flap for an inaccurate insetting procedure. The misaligned reconstructed jaw may influence the implant placement, resulting in occlusal overload that may impair the long-term survival of implant-supported prostheses. Correction of malocclusion after fibula graft may be obtained by secondary osteotomies. We described the use of a Le Fort osteotomy to correct malocclusion after fibula flap reconstruction of the maxilla. The ideal dental relationships of the osteotomized and moved jaw can be established by using a surgical acrylic splint, which is secured to the opposing dentition. The peroneal vessels can be ligated on this occasion, enabling the osteotomized jaw to move with more ease and thus proceed according to the planning.
2019
- Technique
[Capitolo/Saggio]
Chiarini, Luigi; Anesi, Alexandre; Negrello, Sara
abstract
The aim of maxillary or mandibular reconstruction must be to restore not only aesthetics but also complete oral function. Cortical bone thickness, height, and bicortical structure of the fibula shaft is ideal for long-term implant-borne prosthetic rehabilitation. Fibular cortical thickness is superior with respect to the iliac crest or the scapula crest. The efficacy of dental implants placed into free fibula flaps for orofacial reconstruction has been thoroughly proved. Some authors have reported the possibility of inserting implants into the free fibula flap during the primary reconstruction. The major disadvantage of immediate implant insertion concerns the high possibility of misalignment of the fixtures. The use of oral implants in irradiated tissue is not considered to be contraindicated. The timing of the implantation procedure, with regard to the effects of irradiation on the jawbone, remains inconclusive for lack of scientific evidence. Typically, dental implants are placed 6–12 months after radiation therapy. The fibula flap is commonly harvested as osteocutaneous flap, so that a skin paddle is harvested with the fibula bone graft. The skin paddle is bulky, much thicker than the gingiva, not fixed to the bone by the periosteum, and not keratinized. Several techniques are used in soft-tissue management after a fibula vascularized graft, such as skin graft, mucosa graft, or biological membranes.
2018
- Bioglass and bioceramic composites processed by Spark Plasma Sintering (SPS): biological evaluation Versus SBF test
[Articolo su rivista]
Bellucci, D.; Salvatori, R.; Cannio, M.; Luginina, M.; Orrù, R.; Montinaro, S.; Anesi, A.; Chiarini, L.; Cao, G.; Cannillo, V.
abstract
The biocompatibility of hydroxyapatite (HA), a lab-made bioglass (BGCaMIX) with high crystallization temperature and different HA/BGCaMIX composites, pro- duced by Spark Plasma Sintering (SPS), was tested with respect to murine osteocytes both by direct and indirect tests, in order to also investigate possible cytotoxic effects of the samples’ extracts. Previous investigations demon- strated that the samples’ bioactivity, evaluated in a simu- lated body fluid solution (SBF), increased with the increas- ing amount of BGCaMIX in the sample itself. Although none of the samples were cytotoxic, the findings of the bi- ological evaluation did not confirm those arising from the SBF assay. In particular, the results of direct tests did not show an enhanced “biological performance” of materials with higher glass content. This finding may be due to the high release of ions and particulate from the glass phase. On the contrary, the performance of the BGCaMIX alone is better for the indirect tests, based on filtered samples’ extracts. This work further demonstrates that, when con- sidering bioglasses and HA/bioglass composites, the re- sults of the SBF assays should be interpreted with great care, making sure that the results arising from direct con- tact tests are integrated with those arising from the indirect ones.
2018
- Bone regeneration by novel bioactive glasses containing strontium and/or magnesium: A preliminary in-vivo study
[Articolo su rivista]
Bellucci, Devis; Cannillo, Valeria; Anesi, Alexandre; Salvatori, Roberta; Chiarini, Luigi; Manfredini, Tiziano; Zaffe, Davide
abstract
In this work, a set of novel bioactive glasses have been tested in vivo in an animal model. The new compositions, characterized by an exceptional thermal stability and high in vitro bioactivity, contain strontium and/or magnesium, whose biological benefits are well documented in the literature. To simulate a long-term implant and to study the effect of the complete dissolution of glasses, samples were implanted in the mid-shaft of rabbits' femur and analyzed 60 days after the surgery; such samples were in undersized powder form. The statistical significance with respect to the type of bioactive glass was analyzed by Kruskal-Wallis test. The results show high levels of bone remodeling, several new bone formations containing granules of calcium phosphate (sometimes with amounts of strontium and/or magnesium), and the absence of adverse effects on bone processes due to the almost complete glass dissolution. In vivo results confirming the cell culture outcomes of a previous study highlighted that these novel bioglasses had osteostimulative effect without adverse skeletal reaction, thus indicating possible beneficial effects on bone formation processes. The presence of strontium in the glasses seems to be particularly interesting.
2018
- Structural and ultrastructural analyses of bone regeneration in rabbit cranial osteotomy: Piezosurgery versus traditional osteotomes.
[Articolo su rivista]
Anesi, Alexandre; Ferretti, Marzia; Cavani, Francesco; Salvatori, Roberta; Bianchi, Michele; Alessandro, Russo; Chiarini, Luigi; Palumbo, Carla; Bianchi, Michele
abstract
Clinical advantages of piezosurgery have been already proved. However, few investigations have focused on the dynamics of bone healing. The aim of this study was to evaluate, in adult rabbits, bone regeneration after cranial linear osteotomies with two piezoelectrical devices (Piezosurgery® Medical - PM and Piezosurgery® Plus - PP), comparing them with conventional rotary osteotomes (RO). PP was characterized by an output power three times higher than PM. Fifteen days after surgery, histomorphometric analyses showed that the osteotomy gap produced with PM and PP was about half the size of that produced by RO, and in a more advanced stage of recovery. Values of regenerated bone area with respect to the total osteotomy area were about double in PM and PP samples compared with RO ones, while the number of TRAP-positive (tartrate-resistant acid phosphatase positive) osteoclasts per linear surface showed a significant increase, suggesting greater bone remodelling. Under scanning electron microscopy, regenerated bone displayed higher cell density and less mineralized matrix compared with pre-existent bone for all devices used. Nanoindentation tests showed no changes in elastic modulus. In conclusion, PM/PP osteotomies can be considered equivalent to each other, and result in more rapid healing compared with those using RO.
2017
- A comparative in vivo evaluation of bioactive glasses and bioactive glass-based composites for bone tissue repair
[Articolo su rivista]
Bellucci, Devis; Anesi, Alexandre; Salvatori, Roberta; Chiarini, Luigi; Cannillo, Valeria
abstract
In this work a set of novel materials for bone tissue regeneration have been tested in vivo in an animal model. In fact, despite many studies have been devoted to amorphous 45S5 Bioglass®, there is lack in the literature of works aimed to study the in vivo performance of heat-treated – and thus partially crystallized – 45S5. As widely reported, crystallization limits the bioactivity of 45S5 and is the main reason that prevents a broader use of this material. Thus, in the present work, a recently developed bioactive glass (BG_Ca/Mix) is tested, since previous investigations demonstrated that BG_Ca/Mix is particularly promising by virtue of both its high bioactivity and lower tendency to crystallize with respect to 45S5. BG_Ca/Mix sintered powders and two composites, which contain BG_Ca/Mix and an increasing percentage (20 wt% or 70 wt%) of hydroxyapatite (HA), were considered. As a term of comparison, 45S5 sintered powders were also studied. The samples were implanted in rabbits' femurs and harvested after 8 weeks. The histological analysis demonstrated that BG_Ca/Mix has an osteoconductive ability slightly higher than that of 45S5 glass-ceramics, followed by that of the composites, which may represent the starting point for obtaining systems with degradation rate tailored for a given clinical application. Moreover, the 45S5 samples were locally cracked, probably because of a non-uniform dissolution in the physiological environment. On the contrary such cracks, which could lead to implant instability and unsuitable mechanical performance, were not observed in BG_Ca/Mix.
2017
- Il trattamento del collo cN0 nel carcinoma della lingua
[Capitolo/Saggio]
Chiarini, Luigi; Anesi, Alexandre
abstract
Risulta universalmente riconosciuta l’importanza oncologica dello svuotamento laterocervicale terapeutico (therapeutic neck dissection - TND) in caso di evidenza clinica o radiologica di metastasi linfonodali. Lo svuotamento elettivo (elective neck dissection - END), nel caso la stadiazione clinica di malattia risulti essere T1-T2/cN0, rimane invece uno degli argomenti più dibattuti degli ultimi cinquant’anni per ragioni legate alla morbilità chirurgica della procedura di dissezione chirurgica latero-cervicale (Kokemueller et al., 2002; Carlson et al., 2006). Attualmente si possono fondamentalmente individuare due scuole di pensiero: una che sostiene la necessità di eseguire lo svuotamento laterocervicale elettivo in unico tempo con la resezione del tumore primario e l’altra che propone la strategia del watchful waiting (attento monitoraggio). Da una parte il 60-80 % dei cN0 trattati risulta privo di metastasi occulte, e pertanto appare essere iper-trattato, ovvero gravato da una maggiore morbilità data da un secondo sito chirurgico al collo (cicatrici cutanee, asimmetria laterocervicale, possibile paresi del labbro inferiore e, in particolare, dolore e perdita di funzionalità della spalla con anche pesanti ripercussioni sulla qualità di vita dei pazienti) . D’altra parte gli esami diagnostici attualmente disponibili non consentono di identificare con sufficiente certezza le metastasi linfonodali; circa il 20-40 % dei colli cN0 operati risultano in seguito avere delle metastasi occulte ed andrebbero inevitabilmente incontro a recidiva latero-cervicale di malattia, se venisse applicata la teoria del watchful waiting. Sempre a supporto dell’intervento elettivo di svuotamento laterocervicale, diversi lavori dimostrano una migliore sopravvivenza e una minor frequenza di recidive in caso di svuotamento elettivo rispetto a quello terapeutico. Finalmente, un ampio studio prospettico randomizzato condotto su 500 pazienti con carcinoma squamo-cellulare T1-T2 del cavo orale dal Professor Anil D'Cruz supporta l’importanza dello svuotamento elettivo. Questo lavoro è stato presentato al congresso annuale dell’ASCO (American Society of Clinical Oncology) e pubblicato nel New England Journal of Medicine nel 2015 (D’Cruz et al., 2015). Secondo lo studio, nei 3 anni osservati, lo svuotamento laterocervicale elettivo (END) aumenta l’overall survival del 12,5% ed il disease free-survival de 23.6% rispetto allo svuotamento terapeutico (TND). Lo stesso lavora dimostra che l’unico fattore realmente legato ad una maggior probabilità di riscontro di metastasi linfonodali sembra essere una profondità del T maggiore di 3 mm, parametro verificabile solo con l’esame istologico del pezzo operatorio e quindi argomento non applicabile per far cadere l’indicazione ad uno svuotamento elettivo. In conclusione dobbiamo considerare che circa un terzo dei pazienti con carcinoma squamocellulare orale presenta tuttora (nonostante le nuove metodiche di imaging) metastasi linfonodali occulte alla diagnosi, e che, se non trattati chirurgicamente al collo durante l’asportazione del T, hanno possibilità di dover essere rioperati a livello latero-cervicale in un secondo tempo, con una minor prospettiva di controllo locoregionale della malattia ed una peggiore prognosi, considerati il maggior volume linfonodale e la possibile invasione extranodale. Quindi, nonostante il rischio di complicanze legate allo svuotamento laterocervicale (nello studio menzionato riguardano comunque solo il 5 % dei pazienti), al momento rimane indicato intervenire in maniera elettiva nei colli cN0. Riteniamo giustificato osservare questa pratica terapeutica perlomeno fino allo sviluppo di metodiche di imaging in grado di garantire una precoce diagnosi di metastasi occulte laterocervicali. Più precisamente lo svuotamento selettivo del collo è indicato nei pazienti con carcinoma squamoso del cavo orale senza evidenza clinica o radiologica di coinvo
2017
- La Tecnologia CAD / CAM applicata alla Chirurgia Ricostruttiva della Mandibola
[Relazione in Atti di Convegno]
Anesi, Alexandre; Ragoni, Matteo; Chiarini, Luigi; DE SANTIS, Giorgio
abstract
L’intento è quello di condividere le prime impressioni relative alla messa in pratica della cosiddetta «Computer Aided Surgery», (CAS) ossia della chirurgia assistita da computer, nelle ricostruzioni mandibolari con lembo libero di perone.
Molti chirurghi considerano la modellazione del perone, il suo adattamento e la sintesi ai monconi mandibolari, come la fase chirurgica più impegnativa della ricostruzione, dalla cui accuratezza dipendono gli esiti chirurgici ed a cui si associa un dispendio di tempo non indifferente, capace di incidere sulla durata totale dell’intervento e, di conseguenza, sui costi associati a questo tipo di chirurgia.
La svolta nella pianificazione di trattamento si è avuta con lo sviluppo della tecnologia CAD/CAM e conseguenti applicazioni in campo medico & chirurgico.
CAD stà a significare «disegno assistito da computer», CAM «produzione assistita da computer». I software CAD, nati negli anni 60’, permettono di progettare, sul monitor bidimensionale di un computer, modelli tridimensionali di oggetti reali o meno. I software CAM invece sono in grado di tradurre le informazioni provenienti da un progetto CAD in istruzioni per macchinari capaci di materializzare il progetto virtuale stesso, le così dette stampanti 3D. Dime chirurgiche di taglio del perone e per l'osteotomia oncologica sono pianificate digitalmente
2017
- Role of magnesium oxide and strontium oxide as modifiers in silicate-based bioactive glasses: Effects on thermal behaviour, mechanical properties and in-vitro bioactivity
[Articolo su rivista]
Bellucci, Devis; Sola, Antonella; Salvatori, Roberta; Anesi, Alexandre; Chiarini, Luigi; Cannillo, Valeria
abstract
The composition of a CaO-rich silicate bioglass (BG_Ca-Mix, in mol%: 2.3 Na2O; 2.3 K2O; 45.6 CaO; 2.6 P2O5; 47.2 SiO2) was modified by replacing a fixed 10 mol% of CaO with MgO or SrO or fifty-fifty MgO-SrO. The thermal behaviour of the modified glasses was accurately evaluated via differential thermal analysis (DTA), heating microscopy and direct sintering tests. The presence of MgO and/or SrO didn't interfere with the thermal stability of the parent glass, since all the new glasses remained completely amorphous after sintering (treatment performed at 753 °C for the glass with MgO; at 750 °C with SrO; at 759 °C with MgO and SrO). The sintered samples achieved good mechanical properties, with a Young's modulus ranging between 57.9 ± 6.7 for the MgO-SrO modified composition and 112.6 ± 8.0 GPa for the MgO-modified one. If immersed in a simulated body fluid (SBF), the modified glasses after sintering retained the strong apatite forming ability of the parent glass, in spite of the presence of MgO and/or SrO. Moreover, the sintered glasses, tested with MLO-Y4 osteocytes by means of a multi-parametrical approach, showed a good bioactivity in vitro, since neither the glasses nor their extracts caused any negative effect on cell viability or any inhibition on cell growth. The best results were achieved by the MgO-modified glasses, both BGMIX_Mg and BGMIX_MgSr, which were able to exert a strong stimulating effect on the cell growth, thus confirming the beneficial effect of MgO on the glass bioactivity.
2016
- Basic and advanced endoscopic sinus surgery course: open and endoscopic cadaver dissection techniques and live surgery.
[Esposizione]
Presutti, Livio; Chiarini, Luigi; Anesi, Alexandre
abstract
This course originates from the close collaboration
experienced and established over many years between the
three professionals most involved in the surgical treatment
of lesions of the anterior skull base. We believe, and the
results have proved us right, that the achievement of the best
treatment in such complex anatomical regions can be born
only from an accurate preoperative study, the realization of
several surgical procedures and the care of every detail during
the post-operative period carried out in a close collaboration
among Otolaryngologists, Maxilo-Facial surgeons and
Neurosurgeons. The relatively recent introduction of
endoscopic surgery and the huge expansion of the latter has
further expanded the possibilities of collaboration.
On the other hand those who want to approach to this type of
pathologies necessarily have to know not only the techniques
and possibilities of endoscopy but also the open techniques
which are essential to face certain situations or clinical
manifestations.
The experience of many years of shared work between two
surgical university schools with great traditions such as
Modena and Verona besides a personal friendship established
over time has enabled us both to joint the three specialties
and to create a group that is inspired by the same principles.
2016
- COMPARATIVE MORPHOLOGICAL STUDY OF BONE REGENERATION IN DIFFERENT RABBIT CRANIAL OSTEOMOMIES: TRADITIONAL VERSUS NEW GENERATION OSTEOTOMES
[Abstract in Rivista]
Ferretti, Marzia; Cavani, Francesco; Checchi, Marta; Smargiassi, Alberto; Anesi, Alexandre; Salvatori, Roberta; Chiarini, Luigi; Palumbo, Carla
abstract
COMPARATIVE MORPHOLOGICAL STUDY OF BONE REGENERATION IN DIFFERENT RABBIT CRANIAL OSTEOMOMIES: TRADITIONAL VERSUS NEW GENERATION OSTEOTOMES
2016
- Composite orbital reconstruction using the vascularized segmentalized osteo-fascio-cutaneous fibula flap
[Articolo su rivista]
Lundgren, T. Kalle; Pignatti, Marco; Martin, Halle; Boscaini, Giulia; Ann Charlotte, Docherty Skogh; Chiarini, Luigi; DE SANTIS, Giorgio
abstract
Reconstruction of composite orbital defects must address the orbit and an exposed skull base and/or maxillary region. The orbit should not only be covered but also reshaped to accommodate the orbital contents or an epithesis when warranted. This study presents a rationale for a near-anatomical reconstruction of the orbit, together with adjacent dead space obliteration, using the segmentalized osteo-fascia-cutaneous fibula flap. Before the flap transfer, a cutting template for the fibula is made according to the measures and requirements of the facial defect. The segmentalized bone is then osteosynthesized to the facial skeleton and revascularized. Thus, an orbital depth is created by the bony fibula, whereas the fascio-cutaneous part of the flap may be used for lining the orbit and obliteration of the skull base or the maxillary region, or resurface the palate and/or the nasal cavity.
2016
- Orbital approaches for primary and secondary tumours
[Poster]
Negrello, S; Anesi, Alexandre; Casadei, M; Chiarini, Luigi
abstract
Background: Orbital tumours are uncommon and represent approximately only 3.5 - 4 % of ophthalmic disease. Most published articles report case report, comparative studies with small numbers of patients or non-comparative studies with limited statistical power to provide clear treatment and reconstructive recommendations.
Purpose: This paper reports our experience in treating orbital tumours. In particular, we analyzed both epidemiology, histology, methods of treatment and follow up. Particular emphasis is laid on the complications and aesthetic results of the different surgical approaches.
Method: A retrospective study was carried out of 152 patients with orbital masses treated at Head and Neck Surgery Department of the University Hospital of Modena between January 2001 and the end of March 2016. The follow-up period begins in 2001 and finish by the 31th of March 2015. The survival has been calculated according to Kaplan-Meyer method (using IBM SPSS Statistics 20).
Discussion: The median survival was ninety-six months. The cumulative survival at 12 months was 88 %; it came to 78 % in 24 months. The cumulative survival at 5 aa (60 months ) was 77 %.
The lowest survival was showed in patients treated with an extensive osteotomy or exenteration. This result, however, could not be linked to the surgical approach but it could be due to the poor prognosis of the more advanced tumours and to the intracranial lesions involvement. Patients undergoing extensive osteotomies presented the greatest number of complications : 25 % complained of diplopia , 10% a decrease of visual acuity and 15 % had lagophthalmos , in two cases with epiphora .
Conclusion: Preserving the contents of the orbital cavity and function is often possible after radical excision. However, conservative purposes have not to impair the oncologic efficacy.
2016
- Progressive limitation in mouth opening: Jacob disease
[Articolo su rivista]
Robiony, Massimo; Casadei, Matteo; Scott, Cathrin Anne; Chiarini, Luigi
abstract
We would like to discuss with you a rare condition
known as Jacob disease. The first description of coronoid process
enlargement was by Langenbeck1 in 1853, but the first report of an
osteochondroma of the coronoid process, forming a pseudojoint
between the coronoid process and zygomatic arch, was attributed to
the French anatomist Jacob2 in 1899. Currently, only 42 patients of
Jacob disease have been reported and confirmed by histologic
evidence.3,4 Additionally, to our knowledge, our patient is the sixth
typical patient of mushroom-shaped Jacob disease—only 5 similar
patients having been reported.5–9
2016
- RECONSTRUCTION MORPHOSTRUCTURAL ANALYSIS OF FIBULA BONE OSTEOTOMIES WITH PIEZOSURGICAL DEVICE IN JAWS RECONSTRUCTION: A MIRROR OF A NEW FASTER PIEZOELECTRICAL OSTEOTOME
[Relazione in Atti di Convegno]
Anesi, Alexandre; Casadei, M; Negrello, S; Chiarini, Luigi
abstract
BACKGROUND: Segmentation of vascularized bone flaps with piezoelectrical device is a valuable alternative to conventional cutting methods because it improves the intraoperative safety of the procedure. The time needed for completion of a single osteotomy with the piezoelectric device is longer than with the oscillating saw. However, the time normally needed to dissect and protect both the periosteum and the pedicle at each osteotomic site is greatly reduced. In 2015 a new piezoelectrical device suitable for highly mineralised bone and significantly efficient through all the cutting depth was engendered. Hardness and thickness of human fibula bone cortex may be fitting for this new piezoelectrical osteotome. AIM: We present and discuss the use a new generation of the piezoelectric bone-cutting device in microvascular free bone flap for the reconstruction of jawbone defects. The aim of this study was to evaluate on human fibula the time required for completion of each osteotomy comparing new piezoelectrical device and previous commercial device. A comprehensive study that evaluates and compares histomorphometry and histology of bone surfaces created with two piezosurgical devices is carried out.
MATERIALS AND METHOD: In 2016 seven consecutive patients underwent microsurgical reconstruction of the jaws. One specimen from each fibular bone diaphysis was harvested with the piezoelectric device and histologically evaluated.
CONCLUSIONS: The new generation piezoelettrical device halves the time needed for linear and wedge osteotomies on human fibula flap compared to tradizional piezoelectrical device. No significant histological and histomorphometrical differences are detected between bone surfaces osteotomized with both devices.
2015
- Bioactive glass/hydroxyapatite composites: Mechanical properties and biological evaluation
[Articolo su rivista]
Bellucci, Devis; Sola, Antonella; Anesi, Alexandre; Salvatori, Roberta; Chiarini, Luigi; Cannillo, Valeria
abstract
Bioactive glass/hydroxyapatite composites for bone tissue repair and regeneration have been produced and discussed. The use of a recently developed glass, namely BG_Ca/Mix, with its low tendency to crystallize, allowed one to sinter the samples at a relatively low temperature thus avoiding several adverse effects usually reported in the literature, such as extensive crystallization of the glassy phase, hydroxyapatite (HA) decomposition and reaction between HA and glass. The mechanical properties of the composites with 80wt.% BG_Ca/Mix and 20wt.% HA are sensibly higher than those of Bioglass® 45S5 reference samples due to the presence of HA (mechanically stronger than the 45S5 glass) and to the thermal behaviour of the BG_Ca/Mix, which is able to favour the sintering process of the composites. Biocompatibility tests, performed with murine fibroblasts BALB/3T3 and osteocites MLO-Y4 throughout a multi-parametrical approach, allow one to look with optimism to the produced composites, since both the samples themselves and their extracts do not induce negative effects in cell viability and do not cause inhibition in cell growth.
2014
- Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)
[Capitolo/Saggio]
Pozzi, Samantha; Anesi, Alexandre; Generali, Luigi; Bari, Alessia; Consolo, Ugo; Chiarini, Luigi
abstract
Osteonecrosis of the jaw (ONJ) is a rare condition that has been mainly related to the treatment with i.v. bisphosphonates in patients affected by cancer bone disease. The ethiopathology is still unknown and the frequency is between 0.8 and 12 %. It can appear in edentulous patients, but invasive procedures have been demonstrated to increase the risk of developing this complication. Few cases have been described in the endodontic literature. In the next chapter, we will describe ONJ, will analyze the data from literature, and will report expert opinions and guidelines about the best clinical practice in the endodontic fi eld. Finally, since data in this field are limited, we would like to underline that the best treatment plan for cancer patients receiving bisphosphonates and requiring dental procedures is a multidisciplinary, case-by-case approach.
2014
- COMPOSITE CUSTOM-MADE BONE GRAFTS (SMARTBONE® ON DEMAND™) FOR A LARGE SPHENO-ORBITAL RECONSTRUCTION
[Abstract in Atti di Convegno]
Chiarini, Luigi; Anesi, Alexandre; Pertici, G; Perale, G.
abstract
The treatment of anterior and lateral skull base tumors has always constituted a complex surgical challenge: extensive bony demolitions produce aesthetic deformities that need accurate reconstructions. Indeed, highly destructive procedures increased the need to introduce new reconstructive techniques. Wide defects, e.g. those involving more than a single orbital wall, have to be reconstructed with solid tissues such as autologus grafts or alloplastic materials. Surgical visual limits may reduce the possibility to properly repair the three-dimensional bony architecture of the craniofacial skeleton: because of the nonlinear nature of the bone in the craniofacial skeleton, even small degrees of error can lead to poor outcomes.
Here we investigated the innovative application of custom-made bone grafts in a case of skull base reconstructive surgery, a technique that is not previously reported. Innovations applied to this case were multiple: basing on high resolution patient’s CT scans, virtual surgery and computer-aided design were used to plan resection; contralateral disease-free skull base was used as a reference and mirroring technique was used to create the ideal grafts, which were then manufactured accordingly using the new composite custom-made bone grafts (SmartBone® on Demand™). SmartBone® is shaping resistant and offers high tenacity to screws and surgical fixation manoeuvres, because it is produced by combining bovine mineral bone structures with biopolymers and cell nutrients (polysaccharides).
The patient underwent resection of a meningioma in the spheno-orbital-temporal region. The neurosurgeon resected the meningeal involved district, which was then reconstructed with a collagenous membrane. SmartBone® on Demand™ were then very precisely grafted into destination site. During follow-up, nor cerebrospinal fluid leakage nor intracranial infection were registered. Postoperative CT scans showed excellent stability and integration of all bone grafts; postoperative morphological results are satisfactory.
Outcomes confirm the high reliability and accuracy of virtual surgical planning and grafts design, which, together with SmartBone® high performances, allow producing very precise and stable custom-made grafts and, finally, addressing the previously unmet needs in skull base reconstructive surgery.
2014
- CONDYLAR REPOSITIONING BY MEANS OF A NEW DEVICE IN TMJ DYSFUNCTIONAL PATIENTS
[Abstract in Atti di Convegno]
Chiarini, Luigi; Albanese, M; Anesi, Alexandre; Nocini, Pf
abstract
Introduction: Many devices have been proposed for preserving the preoperative position of the mandibular condyle during bilateral sagittal split osteotomy. Accurate mandibular condyle repositioning is considered important to obtain a stable skeletal and occlusal result, and to prevent an impairment of previous temporomandibular disorders (TMD).
Objective: This study is a preliminary report concerning the use of a new condylar positioning device (Medicon, Tuttlingen, Germany) in a group of 5 dysfunctional TMJ patients with the aim of maintaining the preoperative position of the condyle during orthognathic surgery.
Methods: Five TMJ dysfunctional patient underwent a bimaxillary surgery for dento-scheletal malocclusion. Fabrication of preoperative positioning wax bite was done according to an optimized proximal segment position as assessed in clinical examination, through stabilization splints and TMJ cone beam tomography study. The positioning wax bite was set in occlusion, fixed by intermaxillary wires, and positioning plates were adapted on the anterior mandibular ramus thorough an intraoral approach in female patients, while a transcutaneous via(trocar device) is chosen in male patients. The plates are connected with removable extraoral articulated arms to a modified cranio-facial bow, fixed on temporal/parietal bones by means of transcutaneous pins. The articulated joints of the arms are locked, allowing the registration of optimized proximal segment position in accordance of the preoperative wax bite. Bimaxillary surgery was then performed according to the planning. Before mandibular fixation with 2 rigid titanium plate on each side, the articulated locked arms are repositioned and connected to positioning plates. Mandibular fixation is then completed. The articulated arms and the positioning plates are removed. The dental and skeletal stability, signs and symptoms of TMD, the comparison of preoperative and post-operative TMJ cone beam tomography are evaluated during the follow-up period.
Questions:
1 - Anterior distraction of the condyle from the fossa during orthognatic surgery produces:
a) Immediate skeletal relapse
b) Spontaneous and uneventful occlusal stabilization
c) Condylar resorption
d) All of the above
2-Late skeletal relapse is likely attributable to:
a) Muscle memory
b) Proximal segment rotation and posterior repositioning of the condyle
c) Any mandibular advancement
d) None of the above
3-Condylar positioning devices in mandibular orthognathic are:
a) Often used in orthognathic surgery
b) Barely used while manual repositioning is preferred
c) All of the above
d) None of the above
4-TMJ dysfunctional patients that underwent orthognathic surgery with rigid fixation:
a) Always report a worsening on TMJ sign and symptoms after surgery
b) Can achieve an improving in pain and functional status after surgery
c) All of the above
d) None of the above
2014
- Eagle Syndrome Surgical Treatment With Piezosurgery
[Articolo su rivista]
Dario, Bertossi; Massimo, Albanese; Chiarini, Luigi; Claudia, Corega; Carmen, Mortellaro; Pierfrancesco, Nocini
abstract
Introduction: Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic
calcification. It is an uncommon condition (4% of the population) that
is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloidcarotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently
after head turning and neck compression. Although conservative treat-
ment (analgesics, anticonvulsants, antidepressants, local infiltration
with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases.
Materials and Methods: We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1- 10 insert, pump level 4, vibration level 7.
Results: No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES.
Conclusions: The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics — such
as precision, selective cut action, and bloodless cut.
2014
- Expression of CD133 Correlates with Tumor Stage, Lymph Node Metastasis and Recurrence in Oral Squamous Cell Carcinoma
[Articolo su rivista]
Reggiani Bonetti, L; Migaldi, Mario; Boninsegna, A; Fanali, C; Farina, M; Chiarini, Luigi; Anesi, Alexandre; Cittadini, A; Leocata, P; Maccio, L; Sgambato, A.
abstract
Objective: CD133 is a pentaspan membrane protein expressed by the so-called cancer stem cells (CSC) in
the majority of human cancers. The aim of this study was to analyze CD133 expression levels in specimens of oral
cancer and to evaluate its relation with disease evolution.
Methods: Expression of the CD133 protein was evaluated by immunostaining in a series of oral squamous cell
carcinoma (OSCC) and its relation with traditional prognostic indicators and the clinical outcome of patients was
analyzed.
Results: CD133 expression was highly variable amongst different samples with a median percentage of positive
cells of 5 (range 0 - 80; mean = 11) and CD133 staining was not detectable in tumor cells in 29 (43%) cases. No
correlation was observed with age at diagnosis, gender and grading while a significant correlation was observed
with tumor stage. Kaplan-Meier curves of disease-free survival displayed a significant separation between the
negative and positive groups of patients (p = 0.001 by log-rank test) but CD133 staining did not confirm to be an
independent predictor of clinical outcome in a multivariate analyses.
Conclusion: Expression of CD133 was detectable in the majority of OSCC samples and correlated significantly
with tumor stage and the clinical outcome of patients in terms of disease-free survival. Further studies are warranted
on a larger series of cases to elucidate the role of CD133 in the development and progression of OSCC and its
suitability as a prognostic biomarker.
2014
- PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL
[Abstract in Atti di Convegno]
Anesi, Alexandre; Palumbo, Carla; Ferretti, Marzia; Salvatori, Roberta; Cavani, Francesco; Chiarini, Luigi
abstract
The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies
have revealed differences between conventional osteotomes, such as rotating or sawing devices, and
ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness
values of osteotomized bone surfaces.
Objective: the present study compares the micro-morphologies and roughness values of
osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery
Medical® and Piezosurgery Medical New Generation Powerful Handpiece.
Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following
osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New
Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded.
Micromorphologies and roughness values to characterize the bone surfaces following the different
osteotomy methods were described. The prepared surfaces were examined via light microscopy,
environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal
laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized
tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone
necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were
investigated, as well as the proportion of apoptosis or cell degeneration.
Results and Conclusions: The potential positive effects on bone healing and reossification
associated with different devices were evaluated and the comparative analysis among the different
devices used was performed, in order to determine the best osteotomes to be employed during
cranio-facial surgery.
2014
- Simultaneous Le Fort I Osteotomy and Zygomatic Implants Placement With Delayed Prosthetic Rehabilitation
[Articolo su rivista]
Pier Francesco, Nocini; Antonio, D’Agostino; Chiarini, Luigi; Lorenzo, Trevisiol; Pasquale, Procacci
abstract
Abstract: Patients affected by severe maxillary atrophy and skeletal malocclusion have been widely treated by simultaneous orthognathic
surgical procedures, interpositional bone insertion and immediate or delayed implant placement.
Although several authors have described that the “ quad ” technique using 4 zygomatic fixtures as an effective way to fully rehabilitate the severe atrophic maxilla, there are still no experiences relative to the use of zygomatic fixtures associated to maxillary osteotomies in case of large skeletal discrepancy.
The aim of this study is to report a 1-step surgical rehabilitation
of severe atrophic maxilla by means of Le Fort I osteotomy for maxillary forward repositioning and simultaneous insertion of 4 zygomatic implants with immediate prosthetic loading.
2014
- Sol-gel derived bioactive glasses with low tendency to crystallize: synthesis, post-sintering bioactivity and possible application for the production of porous scaffolds.
[Articolo su rivista]
Bellucci, Devis; Sola, Antonella; Salvatori, Roberta; Anesi, Alexandre; Chiarini, Luigi; Cannillo, Valeria
abstract
A new sol-gel (SG) method is proposed to produce special bioactive glasses (BG_Ca family) characterized by a low tendency to devitrify. These formulations, derived from 45S5 Bioglass®, are characterized by a high content of CaO (45.6 mol%) and by a partial or complete substitution of sodium oxide with potassium oxide (total amount of alkaline oxides: 4.6 mol%), which increases the crystallization temperature up to 900°C. In this way, it is possible to produce them by SG preserving their amorphous nature, in spite of the calcination at 850°C. The sintering behavior of the obtained SG powders is thoroughly investigated and the properties of the sintered bodies are compared to those of the melt-derived (M) counterparts. Furthermore, the SG glass powders are successfully used to produce scaffolds by means of a modified replication technique based on the combined use of polyurethane sponges and polyethylene particles. Finally, in the view of a potential application for bone tissue engineering, the cytotoxicity of the produced materials is evaluated in vitro.
2014
- Surgical Treatment of Unilateral Condylar Hyperplasia With Piezosurgery
[Articolo su rivista]
Chiarini, Luigi; Massimo, Albanese; Anesi, Alexandre; Pier Francesco, Galzignato; Carmen, Mortellaro; Pierfrancesco, Nocini; Dario, Bertossi
abstract
INTRODUCTION:
Unilateral condylar hyperplasia (UCH) is a disorder of unknown etiology mainly seen in growing patients, which results in facial asymmetry. High condylectomy alone or in association with orthognathic surgery can improve the occlusion and the facial aesthetics.
MATERIALS AND METHODS:
Between 2005 and 2012, a total of 5 patients underwent high condylectomy for UCH using a piezoelectric cutting device. All patients were treated postoperatively with functional rehabilitation.
RESULTS:
The long-term follow-up showed that all patients had a satisfactory temporomandibular joint articular function associated with stable occlusion without any recurrence of further condylar growth.
CONCLUSIONS:
High condylectomy in the surgical treatment of unilateral UCH seems to be the procedure of choice in growing patients. The use of a piezoelectric cutting device allows a safe and less invasive high condylectomy.
2013
- Aneurysmal bone cyst of the nasal bone: case report
[Articolo su rivista]
Galzignato, P; Trevisiol, L; D'Itri, L; Bissolotti, G; Mocella, S; De Santis, D; Chiarini, L; Nocini, P. F; Bertossi, D.
abstract
The aneurysmal bone cyst (ABC) is a solitary, expansile, non-neoplastic bone lesion, described as a distinct clinicopathological entity by Jaffe and Lichtenstein. We report a case of an ABC arising from the nasal bone in a adult male patient treated with complete surgical excision.
2013
- BONE GRAFT SUBSTITUTES IN MAXILLO-FACIAL SURGERY
[Abstract in Atti di Convegno]
Anesi, Alexandre; Salvatori, Roberta; Chiarini, Luigi
abstract
Biomaterials for reconstruction of bony defects of the skull comprise of osteosynthetic materials applied after osteotomies or traumatic fractures and materials to fill bony defects which result from malformation, trauma or tumour resections. Other applications concern functional augmentations for dental implants or aesthetic augmentations in the facial region. The wide range of biomaterials available on the market, together with lack of established criteria to guide the use of a specific biomaterial in a particular application, has resulted in different surgeons using different materials, with no uniformity in clinical application. The optimal biomaterial that meets every requirement (e.g. biocompatibility, stability, intraoperative fitting, product safety, low costs etc.) does not exist. The different material types are (autogenic) bone and many alloplastics such as metals, ceramics, plastics and composites. We discuss our clinical experience in the use of biomaterials for craniofacial application and we present our experience with some experimental laboratory studies . Based on literature review, we present guidelines for use of different biomaterials in maxillo-facial surgery.
2013
- Evaluation of quality of life in patients with total or partial edentulism treated with computer-assisted implantology.
[Articolo su rivista]
Bertossi, D; Rossetto, A; Piubelli, C; Rossini, N; Zanotti, G; Rodella, Lf; Bissolotti, G; Colletti, G; Chiarini, Luigi; Nocini, P. f.
abstract
Aim: The study deals with a preliminary analysis that compares quality of life of a randomized sample of patients with total or partial edentulism rehabilitated through conventional implantology or computer-assisted implantology. Methods: The first group was treated with conventional implantology, while the second group was treated with NobelGuide™ computer-assisted implantology. every patient has filled up a questionnaire about quality of life in presurgical period (sf-361), in postsurgical period (sf-361; tiq2) and about the gratification after prosthetic treatment. the questionnaire has evaluated physical, general and psycho-emotive health parameter. Results: sf-36 has demonstrated an improvement in quality of life after computer-assisted surgery. tiq has revealed that patients symptoms in post-surgical week were inferior in quality and in quantity in NobelGuide™ technique. gratification questionnaire has demonstrated that quality of life improvement matches patient full satisfaction after the treatment. Conclusion: NobelGuide™ protocol improves physical health after implantology with positive reflections on psycho-emotive health. furthermore prefabricated temporary prostheses reduces treatment time and patient discomfort.
2013
- Experimental analysis about the evaluation of tungsten carbide-bur, piezoelectric and laser osteotomies.
[Articolo su rivista]
De Santis, D; Gerosa, R; Zanotti, G; Cigikov, N; Cenzi, A; Chiarini, L; Rossetto, A; Nocini, Pf; Bertossi, D.
abstract
Aim: Osteotomies are performed in oral surgery with five kinds of cutting instruments: 1) burs (Tungsten carbide cylindric burs), 2-3) ultrasound Piezosurgery (type I and II), 4-5) and lasers (Er:YAG; Er,Cr:YSGG). This study compares the quality of cutting of every single instruments, evaluating accuracy (length, thickness, depth and morphology), velocity (number of passages and time) and entity of damage. Methods: In vitro experiments with ten osteotomies were performed on one-hundred of cow ribs with each instrument. In vivo surgery was performed on New Zealand white rabbit: two osteotomies are made with all instruments on the mandible and on the shinbone, totalizing four osteotomies for each instrument. Samples are processed to be evaluated through histological exam at stereomicroscopy Discussion: Results show a statistically significant variability on "thickness" (p value=0.001), "time" (p value=0.001), "depth" and penetration speed (p-value=0.001; p-value=0.001) and the "number of passages" (p-value=0.001). No differences have been observed in "length" (p-value=0.078). Histological analysis reveals that osteotomy performed with laser and Piezosurgery II generates major damage to osteocytes near cutting surfaces. Conclusion: Currently, purchase and management elevated costs, minor versatility of use, and long training times for equipments such as Piezosurgery and laser limit their general use, but remain advantageous in case of risky interventions near noble structures. Choice of device depends on experience maturated by operator in time, characteristics of operation and patient's clinical conditions.
2013
- How to improve retromandibular transmasseteric anteroparotid approach for mandibular condylar fractures: our clinical experience
[Articolo su rivista]
Salgarelli, Attilio Carlo; Anesi, Alexandre; Bellini, Pierantonio; G., Pollastri; D., Tanza; S., Barberini; Chiarini, Luigi
abstract
Fractures of the mandibular condyle are common and account for 25–35% of all mandibular fractures reported in the literature. Even with the development of a consensus on the preference for open reduction and internal fixation of these fractures, the clinician is still faced with a dilemma concerning the optimal approach to the ramus–condyle unit. Limited access and injury to the facial nerve are the most common problems. The most commonly used extraoral approaches are the submandibular, retromandibular and preauricular methods. In this study, we propose a modified cosmetic preauricular incision with a short end in the neck, to improve the transmasseteric anteroparotid (TMAP) approach previously described by Wilson et al. in 2005. We retrospectively analysed 13 patients treated in our department for mandibular condylar fractures. Post-operative complications, occlusal status, interincisal opening and joint tenderness were evaluated at 3 months after surgery. The wider skin incision described here provides a convenient approach for open reduction and rigid internal fixation, and good results were obtained. The follow-up ranged from 6 to 40 months.
2013
- Lingual frenectomy: a comparison between the conventional surgical and laser procedure.
[Articolo su rivista]
De Santis, D; Gerosa, R; Graziani, Pf; Zanotti, G; Rossini, N; Castellani, R; Bissolotti, G; Chiarini, Luigi; Nocini, Pf; Bertossi, D.
abstract
Aim: Ankyloglossia, commonly known as tongue-tie, is a congenital oral anomaly characterized by a short lingual frenulum that may contribute to feeding, speech and mechanical problems. The purpose of this study is to compare the advantages of laser vis-à-vis conventional frenectomy in both intra- and post-surgical phases. Methods: This study took into consideration two patients, who were respectively 9 and 10-year-old. The first one underwent a common surgical procedure. A Nd:Yap laser device with a micropulsed wavelength of 1340 nm and power of 8 watts was used for the second. The postsurgical discomfort and healing characteristics were evaluated. Results: The results indicated that the Nd:Yap laser has the following advantages when compared to the conventional frenectomy: 1) soft tissue cutting was efficient, with no bleeding, giving a clear operative field; 2) there was no need to use sutures; 3) the surgery was less time-consuming; 4) there was no postsurgical infection and no need for analgesics or antibiotics; 5) wound contraction and scarring were decreased or eliminated; 6) despite the initial slowness of the healing process, the complete and final recovery was faster. Conclusion: Considering the above elements, it is possible to assert that the laser frenectomy has a series of unquestionable advantages if compared to the conventional surgical technique.
2013
- NobelGuide™ influence in the perception of postoperative pain.
[Articolo su rivista]
Bertossi, D; Gerosa, R; Schembri, E; Zanotti, G; Rossini, N; Colletti, G; Rossetto, A; Chiarini, Luigi; Nocini, P. f.
abstract
Aim: The aim of this study was to evaluate the perception of pain after Computer-aided-implantology Implant Surgery (NobelGuideTM, Nobel Biocare, Göteborg, Sweden) compared to the conventional implant surgery. Methods: Eighteen patients from dental and maxillo-facial clinic of Policlinico G. B. Rossi (Verona, Italy) have been recruited: 9 were treated with the NobelGuide™ Technique, and 9 with the conventional one (approved by Local Ethical Committee) After the operation, painkillers (Ibuprofene tablets of 400 mg) were prescribed to the patients. Patients were asked to answer a questionnaire during the postoperative days and to report on the Visual Analogue Scale form (VAS), the intensity of pain and the number of painkillers used. Results: The VAS mean one day after the operation (peak of maximum pain) was 47.22 for the conventional technique, and 12.77 for the NobelGuide™ technique, and also the number of painkillers assumed is smaller for the NobelGuide™ technique. The 5th day after the operation all the patients treated with the NobelGuide™ Technique stopped painkillers and nobody felt pain, while the patients treated with the conventional technique felt more pain and for a longer period. They also took painkillers until the 7th day. Conclusion: Pain is minor and disappears more quickly with the Nobelguide™ Implant Surgery compared with the conventional surgical technique. Nobelguide™ Implant Surgery can reduce hospitalization improving the compliance of odontophobic patients towards implant therapy.
2013
- Reduction of precocious peri-implant resorption cone
[Articolo su rivista]
De Santis, D; Zanotti, G; Morandini, S; Bordanzi, A; Gerosa, R; Rodella, Lf; Rossetto, A; Chiarini, Luigi; Nocini, Pf; Bertossi, D.
abstract
Aim: After implant-insertion, bone tissue, newly-formed on peri-implant crest, undergoes to a mild marginal osseous readjustment due to build-up of inflammatory cell tissue (ICT). The present study verifies the possibility to limit bone resorption by placing implant fixtures 0.5 mm outside cortical bone edge. Methods: A clinically-controlled randomized study on 100 implants has been performed to compare early resorption process of implant fixtures placed 0.5 mm outside cortical bone edge with implant-fixtures inserted according to juxtacortical bone conventional protocols. Results: After 6 months, bone implant level was higher with emersion approach (-1.01±0.54 mm, mean±SD) than with submerged treatment (-1.56±0.5 mm) (P<0.001). Conclusion: Factors to achieve an excellent result at mean-long term seem to be very good, even though the latter have to be confirmed by follow-up.
2013
- Retrospective analysis of orbital floor fracture: our clinical experience
[Articolo su rivista]
Anesi, Alexandre; Chiarini, Luigi
abstract
Aim. This retrospective study aimed at investigating
indications, surgical approaches, and the materials
used for orbital floor reconstructions, as well as the
clinical followup, particularly with regard to postoperative complications.
Methods. This study comprised 120 patients who underwent surgery for orbital floor fractures between
2001 and 2011. Diagnosis and treatment were based
on both physical examination and orbital CT scan.
Patients were retrospectively analyzed for data, such
as mechanism of injury, classification of fracture, and
complications.
Results. The most common cause of injury was physical assault followed by traffic accidents. Surgery
was performed with a mean delay of 5 days after
the incident. Subciliary lower eyelid incision was the
most common surgical approach to the orbital floor,
followed by mid lower eyelid incision and transconjunctival lower-eyelid approach. For orbital floor reconstruction, collagenous membrane derived from
bovine pericardium (65%) is mainly used, followed
by titanium mesh (35%); 18.0% of patients showed
postoperative complications: 10.0% presented transient hypesthesia, 4.2% transient diplopia, 2.0% enophthalmos, 1% visible scar and 0.8% from scleral
show.
Conclusion. The main goal of this report is to discuss
indications and timing for surgical repair of orbital
floor fracture fractures and other facial fracture. Complications due to surgery are described.
2013
- TONGUE FLAP TO TREAT A SEVERE CASE OF MIESCHER'S CHEILITIS GRANULOMATOSA
[Articolo su rivista]
Nocini, Pf; Procacci, P; Albanese, M; Trevisiol, L; D'Agostino, A; Girolomoni, G; Palma, P; Chiarini, Luigi; Bertossi, D.
abstract
Miescher's cheilitis granulomatosa is the monosymptomatic form of Melkersson-Rosenthal Syndrome. Severe macrocheilitis often causes a functional and esthetical impairment of the lip. Conservative treatment represents the first option to face this rare disease. Unfortunately, medical treatment is often ineffective without any significant result as far as swelling and disfigurement are concerned. Reductive cheiloplasty is indicated in all those patients who have failed to respond to medical treatment. Excision of excess tissue may be obtained by means of several surgical techniques. We report a case of a 55-year-old man affected by severe granulomatous cheilitis refractory to any medical treatment and then treated with the use of tongue flap for the reconstruction of the excised lower lip.
2012
- Absence of adjuvant radiotherapy may be an additional criteria in diagnosing a branchiogenic squamous cell carcinoma: a case report
[Articolo su rivista]
Anesi, Alexandre; Pollastri, G; Bondì, V; Barberini, S; Chiarini, Luigi
abstract
Branchiogenic carcinoma is extremely rare. The ma-jority of branchiogenic carcinomas are cystic metas-tases originating in the tonsils, and not true carcino-mas arising in a branchial cleft cyst. Isolated cystic neck lesions necessitate a thorough search for a primary tumor, as with other occult primaries pre-senting with cervical metastases. As the existence of primary branchiogenic carcinoma is controversial, Martin and colleagues and then Khafif and coworkers established a series of widely accepted criteria to recognize this type of carcinoma.We report a case of a large cervical mass, consistent with a branchiogenic carcinoma of the second bran-chial arch. The patient underwent excision of the neck mass through a radical neck dissection. The cyst wall was found to have squamous cell carcinoma arising from the benign epithelium. Follow-up at 7 years revealed no evidence of recurrence. All diagnostic criteria for a true branchiogenic carcinoma were met in this case. The absence of adjuvant irradiation is a further confirmation that the mass is not a cystic node metastasis but a carcinoma arised from within a branchial cleft cyst.)
2012
- Otolaryngology fantastica: the ear, nose, and throat manifestations of Munchausen's syndrome
[Articolo su rivista]
ALICANDRI CIUFELLI, Matteo; Moretti, Valentina; Ruberto, Marco; Monzani, Daniele; Chiarini, Luigi; Presutti, Livio
abstract
OBJECTIVES/HYPOTHESIS: Munchausen's syndrome (MS) is a form of severe, chronic, factitious disorder with physical symptoms. Some essential features define MS, such as recurrent, feigned, or simulated illness; peregrination (traveling or wandering); pseudologia fantastica; and drug abuse. Munchausen's syndrome by proxy (MSBP) classically involves a parent or other caregiver who inflicts injury or induces illness in a child. The aim of the present study was to summarize and study the main ear, nose, and throat (ENT) manifestations of MS and MSBP.STUDY DESIGN: A systematic literature review carried out in a tertiary university referral center.METHODS: An appropriate string was run on PubMed to retrieve articles dealing with ENT manifestations of MS and MSBP. A double cross-check was performed on citations and full-text articles found using selected inclusion and exclusion criteria.RESULTS: In total, 24 articles were finally included in the study, describing 30 cases of MS or MSBP involving the ENT region; 15/30 (50%) cases involved the face, most often presenting as facial pain or facial swelling; and 7/30 (23.3%) cases presented with symptoms involving the ear. Six cases out of 30 (20%) were MSBP.CONCLUSIONS: MS and MSBP may present with symptoms involving the head and neck area, particularly the face and external ear canal. The ENT specialist should suspect MS in patients with strange and long-lasting symptoms, so as to avoid misdiagnosis and unnecessary treatments that waste time and money in the healthcare sector.
2012
- SINONASAL TUMOURS WITH ORBITAL INVOLVEMENT: THE COMBINED APPROACH
[Abstract in Atti di Convegno]
Anesi, Alexandre; Pollastri, G; Barberini, S; Chiarini, Luigi
abstract
Advanced sinonasal tumours often present with orbital
involvement. Surgical treatment and radical excision are
also possible, preserving the eye. Oncological safety and
functional outcome of the preserved eye are the counterpart
in orbital preservation surgery. Irrespective of the
orbital invasion, tumour histology influences the prognosis. Surgical approaches to the orbit in sinonasal tumour
are divided in anterior and posterolateral procedures. The
combined transfacial and trancranial surgical approaches
have been well described in the literature for craniofacial
resection, when the anterior or medium skull base are
involved. Multidisciplinary collaboration with microscopic
and/or endoscopic control have improved surgical
technique to extirpate tumours extended to dura, spehenopalatine
area and pterygomaxilmary fissure, infratemporal
fossa, roof of nasopharynx and apex of orbit.
We describe the multiphase combined surgical approach
with maxillofacial, otolaryngology and neurosurgical
collaboration in sinonasal tumour treatment.
2012
- THE USE OF PMMA FOR RESTORATION OF THE TEMPORALIS FLAP DONOR SITE: OUR CLINICAL EXPERIENCE
[Abstract in Atti di Convegno]
Anesi, Alexandre; Barberini, S; Pollastri, G; Ferrari, C; Chiarini, Luigi
abstract
The use of temporalis myofascial flap (TMF) as a pedicled
flap in craniofacial reconstructive surgery is well established.
This technique may provide a cosmetic deformity
of the temporal fossa with an asymmetric contour of the
head. Reconstruction of this donor site deformity is desirable.
We report the use of polymethyl-methacrylate
(PMMA) (Palacos ®). From January 2009 to December
2011, 11 patients (6 men and 5 women) aged 81 to 56
years (mean 67) were treated. Ten patients had squamous
cell carcinoma and 1 mucoepidermoid carcinoma of minor
salivary glands in the upper jaw. The oncological defects
were reconstructed with TMF and the temporal fossa was
simultaneously filled with PMMA. A retrospective review
of the postoperative complications (hematoma, seroma)
and the aesthetical results was conducted. All patients were contacted 6 months later by phone and provided with
information pertaining to the aims of this study. The patients
were then instructed on how to fill out the relevant
questionnaires. Aesthetic results were judged satisfactory
from all patients. The hemicoronal skin flap healed uneventfully
in all patients and did not cause a visible scar
even to bald male patients. In our group of patients no
surgical seroma or hematoma in temporal fossa were
observed. PMMA reconstruction was characterized by
excellent biocompatibility with no inflammatory activation.
The symmetry of temporal fossa was judged satisfactory.
Intraoperative cast-molded camouflage of the temporalis
flap donor site with PMMA is a feasible, accurate,
fast, and cost-efficient technique that results in excellent
cosmetic.
2011
- Cosmetic procedures in orthognathic surgery
[Articolo su rivista]
Nocini, Pf; Chiarini, Luigi; Bertossi, D.
abstract
Purpose: Orthognathic surgery produces cosmetic and functional effects, and patients should be evaluatedfor additional cosmetic improvements beyond those possible with orthognathic surgery. Soft tissue procedurescan be performed on an outpatient basis in an office environment and can be combined withorthognathics and delayed in a second stage.Methods: Systematic accurate facial evaluation is necessary to focus on cosmetic soft tissue problems.Features that make the patient look unattractive, old, tired, out of shape, weak, or sad must be identified byaccurate clinical analysis and 3-dimensional planning. Then it will be possible to select the treatment planaccording to the patient’s input, prioritizing the additional cosmetic improvements that can be added toprimary surgery.Results: It is particularly important to review the results and the patient’s satisfaction by clinical examination,a questionnaire, and with 3-dimenisonal pictures, and to understand if the treatment options have beenaccurately chosen and their lasting effect on follow-up. The treatment sequence is analyzed, and if there areresidual defects, a secondary cosmetic procedure can be planned to complete the result.Conclusions: The surgeon’s goal must be the simultaneous treatment of malocclusions and facial estheticdisharmonies, and orthognathic surgical procedures and facial cosmetics must be performed simultaneously,if possible. Residual defects must be treated after at least 6 to 12 months.
2011
- Parapharyngeal space tumors without mandibulotomy: our experience
[Articolo su rivista]
Presutti, Livio; Molteni, Gabriele; Chiarini, Luigi; ALICANDRI CIUFELLI, Matteo; Malve', Laura; Marchioni, Daniele; Ghidini, Angelo; Tassi, Sauro
abstract
Parapharyngeal space (PPS) tumors are rare and benign in 80% of cases. Since surgeons first resected this anatomical region, the surgical approach to PPS bulks has been a hot topic due to their shape and the important structures involved. We present a series of patients treated with a transcervical or transcervical-transparotid approach to benign PPS tumors without mandibulotomy. Between May 2003 and March 2009, 18 patients (11 male and 7 female) with benign PPS tumors underwent a surgical resection, avoiding mandibulotomy. Average age of the patients was 49 years (range 3-76), average tumor size was 5.5 × 4 × 3 cm and histological examination of the resected tumors showed: seven pleomorphic adenomas of the deep parotid lobe, four schwannomas, two mycobacteriosis, two paragangliomas of the vagus nerve, one lipoma, one neurofibroma and one cavernous hemangioma. Seven patients underwent a transcervical approach, while 11 patients underwent a transcervical-transparotid approach. Excision of benign PPS tumors is possible without mandibulotomy even in the case of a large tumor mass, but exposure with the mandible in situ is certainly poor. Avoiding mandibulotomy reduces patient morbidity and hospital stay. In our experience, mandibulotomy can be avoided in most cases of benign PPS tumors leaving this procedure for malignant tumors or in patients with very poor exposure.
2011
- Sinonasal tumors with orbital involvement: the combined approach
[Relazione in Atti di Convegno]
Anesi, Alexandre; Chiarini, Luigi
abstract
Advanced sinonasal tumors often present with orbital involvement. Surgical treatment and radical excision are also possible preserving the eye. Oncological safety and functional outcome of preserved eye are the counterpart in orbital preservation surgery. Irrespectively of the orbital invasion, tumor histology influences the prognosis. Surgical approaches to the orbit in sinonasal tumor are divided in anterior and posterolateral procedures. The combined transfacial and trancranial surgical approach have been well described in the literature for craniofacial resection, when the anterior or medium skull base are involved. Multidisciplinary collaboration with microscopic and/or endoscopic control have improved surgical technique to extirpate tumors extended to dura, spehenopalatine area and pterygomaxilmary fissure, infratemporal fossa, roof of nasopharynx and apex of orbit. We describe the multiphase combined surgical approach whit maxillofacial, otolaryngology and neurosurgical collaboration in sinonasal tumor treatment.
2009
- An unusual case of giant cell tumour involving the middle cranial fossa, originating from soft tissues of the temporomandibular joint.
[Articolo su rivista]
Chiarini, Luigi; Figurelli, S; Ghidini, A; Nocini, Pf; Procacci, P; Rubini, C; Lo Muzio, L; Lo Russo, L.
abstract
A rapid onset swelling in the left temporomandibular joint(TMJ) region occurred in a 70-year-old man. The remoteclinical history was unremarkable; crepitus at the involvedTMJ, omolateral tinnitus, hearing decrease and persistentheadache in the sovraorbital area was reported. A firm masswas palpable intra- and extra-orally. Laboratory investigationswere within normal limits.Computed tomography (CT) and magnetic resonanceimaging (MRI) demonstrated a 2.5-cm ovoidal mass in theinfratemporal fossa (IF), which eroded the middle cranialfossa and emerged in an extradural location (Fig. 1a-c).A craniotomy was performed; the cut off of the zygomaticbone and the removal of the upper arm of the jaw allowed theexposure of the IF fully occupied by the neoplasm, whicheroded the floor of the middle cranial fossa; the intactoverlying dura was preserved. Tumour dissection was extendedto the anterior cranial fossa and the ovale foramen, invadedby the tumour; the rotundum foramen was uninvolved.Histological examination showed (Fig. 1d-e) abundantgiant cells with an osteoclast-like appearance, strong CD68positivity, a large number of centrally located nuclei andabundant eosinophilic cytoplasm. Numerous ovoid tospindle-shaped stromal cells with a thin rime of eosinophiliccytoplasm were also present, as well as several foci ofhaemosiderin pigment deposition and no areas of necrosis.Mitotic figures were scarce and without atypia. Thelabelling index (Ki67) was <30% and predominant in theosteoclast-like cells. The diagnosis was: giant cell tumour(GCT). Chest radiograph excluded pulmonary metastases.At 3-years follow-up there was no evidence of recurrence.
2009
- Le Fort I Osteotomy to Correct Malocclusion AfterReconstruction of the Maxilla With the Free Fibula Flap
[Articolo su rivista]
Nocini, Pf; Chiarini, Luigi; Fior, A; Bedogni, A.
abstract
Malocclusion and facial asymmetry may follow microsurgical jawbone reconstruction. We describe the use of a Le Fort I osteotomy to correct malocclusion after fibula flap reconstruction of the maxilla. A 49-year-old patient with an extremely atrophied maxilla underwent alveolar crest augmentation by free fibula transfer. Bone healing was uneventful, but gross asymmetry of the reconstructed maxilla was apparent 3 months after surgery, with canting of the alveolar bone on the right side and residual skeletal discrepancy in the sagittal plane. A Le Fort I osteotomy was planned to correct malocclusion 6 months after fibula transfer. The maxilla was moved downward and forward and impacted in the right molar region. There were no postoperative complications. Solid bone union was achieved between the mobilized maxilla and the buttresses 3 months after surgery. At that time, osteointegrated implants were inserted, and an implant-supported prosthesis was completed. Neither bone resorption nor implant failure was encountered after 12 months of masticatory loading. Surgical correction of malocclusion after maxillary bone augmentation with the fibula flap is possible. Le Fort I osteotomy represents a reasonable option after microvascular alveolar bone reconstruction of the maxilla, when additional movements are required to restore facial symmetry and occlusion.
2009
- Vascularized fibula flap reconstruction of the mandible in bisphosphonate-related osteonecrosis
[Articolo su rivista]
P. F., Nocini; G., Saia; G., Bettini; M., Ragazzo; S., Blandamura; Chiarini, Luigi; A., Bedogni
abstract
AIMS: To point out the feasibility of microsurgical reconstruction of the mandible in patients with bisphosphonate-related osteonecrosis (BRONJ). METHODS: Seven patients with extensive mandibular osteonecrosis underwent subtotal mandibulectomy and immediate reconstruction with a free fibula flap. They were six women and one man aged 49-72years. The mean size of the bone and oral mucosa defects were 18.5 and 22.5cm(2) respectively. RESULTS: The mean time of surgical intervention was 12h. All flaps survived and the postoperative course was uneventful. Oral feeding was resumed 14days after surgery in all cases. The donor legs healed without complications. The pathology report confirmed the diagnosis of BRONJ in all patients. Normal bone was detected at the resection margins in six out of seven patients. Patients were followed-up at intervals of 3months. After a median follow-up time of 23months, no clinical and radiographic evidence of recurrent BRONJ were detected in six patients. One patient with osteomyelitis at the resection margins had signs of recurrent BRONJ 6months after surgery. The overall curative rate of the population was 86\%. CONCLUSIONS: Despite the limited number of patients studied so far, our data show that mandible reconstruction with the fibula flap is feasible and does not influence the natural course of the primary disease in BRONJ-resected patients.
2008
- Ameloblastic fibroma in a 6-year old child:case report.
[Abstract in Rivista]
Anesi, Alexandre; Bissolotti, G.; Toller, N.; Corrocher, G.; Chiarini, Luigi; Nocini, P. F.
abstract
Ameloblastic fibroma (AF) is defined in WHO classification as a ''neoplasm composed of proliferating odontogenic epithelium embedded in a cellular ectomesenchymal tissue that resembles dental papilla, and with varying degrees of inductive change and dental hard tissue formation''. AF is a rather uncommon tumor, accounting for only 2.5% of all odontogenic tumors. AF is a true mixed tumor, in which the epithelial and ectomesenchymal elements are neoplastic. AF raises at any age, ranging from 6 months to 42 years (mean 14.6 to 15.5 years); it does not show sex predilection. The lesion occurs in nearly 70% of cases in posterior areas of the mandible. Patients exhibit swelling of the jaw; pain is not usually described. Authors present a clinical and surgical management of an early onset of a large mandibular ameloblastic fibroma in a 6-year-old girsl.
2008
- BMP-7 effects on osteogenic differentiation of stem cells
[Relazione in Atti di Convegno]
G., Bissolotti; D., De Santis D; G., Bettini; Chiarini, Luigi; P. F., Nocini
abstract
Objectives: To evaluate in preclinical models (in vitro and inanimal model) all requests of Good Manufacturing Practice’srules before the clinical application of mesenchymal stem cells(MSC), in order to elaborate the protocols for using humanautologous MSC in oral regenerative and maxillofacial medicine.Methods: MSC lies in bone marrow an other tissues; they areautologous cells that have not immunological reaction and areexpandable in vitro. MSC are taken from bone marrow samplefrom healthy donor. After medium procedures, an omogeneousSMC colony is reached and its osteoblast differenziating capacitywas tested with or without bone morphogenetic protein-7 (BMP-7). Four medium were used (standard medium, growth medium,osteogenic medium, osteogenic medium with BMP-7).Results: The expression of osteogenic genes are analized bypolimerase chain reaction (PCR): alkaline phosphatase (ALP),osteopontin (SPP1), osteocalcin (BGLAP). In the osteogenicmedium with BMP-7, it was observed an increase of ALP,involved in the early phase of the osteogenetic differenziation,as well as an increase of SPP1 and BGLAP, involved in the latephase of osteogenetic differenziation and mineralization.Conclusions: Results suggest that BMP-7 amplifies the osteogenicdifferenziation process. These results are present in thequality, efficency and safety protocol: “maxillo-facial surgerybone defects by using autologous stem cells expansed in vitro.
2008
- Bisphosphonate-associated jawbone osteonecrosis: a correlation between imaging techniques and histopathology.
[Articolo su rivista]
Alberto, Bedogni; Stella, Blandamura; Zerina, Lokmic; Palumbo, Carla; Mirko, Ragazzo; Francesca, Ferrari; Alberto, Tregnaghi; Francesco, Pietrogrande; Olindo, Procopio; Giorgia, Saia; Ferretti, Marzia; Giorgio, Bedogni; Chiarini, Luigi; Giuseppe, Ferronato; Vito, Ninfo; Lucio Lo, Russo; Lorenzo Lo, Muzio; Pier Francesco, Nocini
abstract
Objectives. Recently, jawbone osteonecrosis has been reported as a potential adverse effect of bisphosphonates administration. This paper considers and highlights histopathologic and radiologic features of this condition. Study design. Eleven patients, owing to unresponsiveness to conservative treatment and uncontrollable pain, underwent surgical resection of diseased jawbone after extensive hyperbaric oxygen therapy. A thorough clinical, laboratory, and imaging study was performed. Surgical specimens underwent histopathologic and immunohistochemical evaluation. Results. Computerized tomography (CT) scans showed increased bone density, periosteal reaction, and bone sequestration in advanced stages. With magnetic resonance imaging (MRI), exposed areas showed a low signal in T1-and T2-weighted and inversion recovery images, which suggests low water content and is histopathologically correlated with paucity in cells and vessels (osteonecrotic pattern). Unexposed diseased bone was characterized by T1 hypointensity and T2 and IR hyperintensity, which suggests high water content and inflammation, associated with hypercellularity, osteogenesis, and hypervascularity (osteomyelitic pattern). Conclusions. Diseased bone extends beyond the limits of the bone exposed in the oral cavity. Histopathologic examination correlated well with CT and MRI, which are the choice for the evaluation of bisphosphonate-associated jawbone osteonecrosis.
2008
- Fresh frozen graft in Le Fort I for pre-prostheticsurgery
[Abstract in Rivista]
G., Bissolotti; M., Albanese; D., Bertossi; Chiarini, Luigi; P. F., Nocini
abstract
To evaluate preliminary clinical, radiological andhistological result using fresh frozen cortico-cancellous blockallograft in combination with Le Fort I osteotomy for preprosteticsurgery.Methods: Since 2007, 5 patients suffering of extremely atrophicjaws bone were selected for repositioning of the maxilla andsinus lift augmentation, prior implant-supported prosthetic rehabilitation.Patients underwent Le Fort I procedure and freshfrozen cortico-cancellous blocks were used as interpositionalallograft. Resorbable double-layer membrane were placed whenon-lay grafts were performed. Harvesting of bone blocks wasperformed from iliac crest of multi-organ donor. Pre-operativex-ray evaluation included a standard x-panoran and CT Dentascan.Immediately before surgery, bone chips were washed withsaline solution at 40ºC in order to de-fat it, and mixed withautologous venous graft. Standard chemio-profilaxis and postoperativetherapy were administer to each patient. Six monthsafter bone grafting a CT Denta-scan was obtained prior implantsurgery. A bony biopsy was performed at the time of implantinsertion to evaluate bone graft osteorigeneration.Results: All surgical procedure were performed without complications.Only moderate swelling and moderate blood loss fromnose during immediate time after surgery were observed. CTDental-scan, performed 5 months after surgery, confirmed noneradiological signs of re-absorbed bone tissue neither periostealreactions. Histological results showed good bone integration withnone tissue necrosis or immunological reactions.Conclusion: Fresh frozen homologous grafts can be consider asvalid substituted bone tissue in maxillo-facial surgery.
2008
- Genioplasty with piezosurgery
[Abstract in Rivista]
Turra, M.; Bertossi, D.; Bissolotti, ; Anesi, Alexandre; Chiarini, Luigi; Nocini, P. F.
abstract
Aims: The chin is the most prominent and median sector of the lower third of the face giving harmony to nose and lips.
We present the application of piezoelectric bone cutting device for the correction of different chin deformities. The distinctive characteristics of this device allows us to avoid or reduce the immediate genioplasty complications.
Methods: 25 cases of defective chin have been treated from January 2006 to April 2007. Intraoral chinplasty was performed
during the correction of dentofacial dysmorphisms or associated to nasal surgery. We used a piezoelectric cutting device to
perform different osteotomies and if necessary, different kind of interpositional grafts were used to stabilize bony segments.
Results: We observed a more precise and thin osteotomies (100% of cases), a reduced intraoperative bleeding (92%) with light degree of postoperative hematoma, no nervous injuries (100%, slight paresthesia 36%) and patients’ satisfaction (96%).
Discussion: Chinplasty represent one of the most common ancillary procedures and may be associated with corrective surgery of skeletal bases in dentofacial dysmorphisms. Mental nerve injuries, asymmetries, intraoperative bleeding are the main immediate complications of genioplasty. Distinctive characteristics of ultrasonic piezoelectric osteotomy are selective cutting of only mineralized structure with less risk of vascular and nervous damage (microvibrations), intraoperative precision (thin cutting scalpel and no macrovibrations), blood free site (cavitation effect).
In our experience, piezoelectric cutting device, compared to saw and drill, enables us to reduce or avoid immediate complications of chin surgery, helping the surgeon to reach patients’ satisfaction.
2008
- Long term analysis after rhinoplasty in a series of 214
[Abstract in Rivista]
G., Bissolotti; D., Bertossi; L., Trevisiol; Chiarini, Luigi; P. F., Nocini
abstract
Objective: To assess secondary nose defects incidence.Methods: We performed a clinical analysis focusing on residualdefects of 643 patients who previously underwent to rhinoplasticprocedures. Among these, 568 cases had secondary rhinoplasty,65 tertiary rhinoplasty and 4 had four procedures. 123 got surgeryafter nasal trauma, 96 had previous orthognatic surgery.Results: We reported 3.27% of nasal pyramid asymmetry andright deviation in 13 cases 6.07% versus left deviation in 5.6%.The dorsal hump was in 10.2%, and right dorsal nose concavityin 5.6% versus left in 6.07%. Nose base was fine in 12.6%,thicker in 5.6%. Nasal tip was boxy in 0.93%, bulbous in 16.35%,sovratip was in 12.6%, polly beak in 5.14%, asymmetry such aspinched tip 1.40%. A double dome was seen in 1.86%. In 8.87%the columella was self-evident such as hidden, with deviationon right in 2.8% and on left in 1.40%. The nostrils were rightasymmetric in 5.14% and left in 6.54%, a sagittal direction in3.73%. The nasal ala appeared proximal bilaterally in 0.93% andunilateral on left in 1.86%, while appeared distal bilaterally in0.93%. The nasal valve showed collapse on right side in 13.55%and on left in 12.15%, among these 10.74% had bilateral collapse.The nasal-labial angle was open in 13.55%, closed in 7%. Scarswere noticeable in 3.73% and nasal cartilage was observable in0.46%.Conclusion: Whatever the technique used, according to literature,we have observed an 5−10% incidence of defects afterrhinoplastic procedures.
2008
- Mandible reconstruction in bisphosphonate relatednecrosis
[Abstract in Rivista]
M., Ragazzo; G., Bettini; G., Saia; Chiarini, Luigi; G., Ferronato; A., Bedogni; P. F., Nocini
abstract
Aims: to point out the feasibility of microsurgical reconstructionof the mandible in patients with bisphosphonate-relatedosteonecrosis (BRONJ).Methods: seven patients with extensive mandibular osteonecrosisunderwent subtotal mandibulectomy and immediate reconstructionwith a free fibula flap. They were six women and one managed 49 to 72 years. The mean size of the bone and oral mucosadefects were 18.5 cm and 22.5 cm2 respectively.Results: the mean time of surgical intervention was 12 hours.All flaps survived and the post-operative course was uneventful.Oral feeding was resumed 14 days after surgery in all cases. Thedonor legs healed without complications. The pathology reportconfirmed the diagnosis of BRONJ in all patients. Normal bonewas detected at the resection margins in six out of seven patients.Patients were followed-up at intervals of three months. After amedian follow-up time of 23 months, no clinical and radiographicevidence of recurrent BRONJ were detected in six patients. Onepatient with osteomyelitis at the resection margins had signs ofrecurrent BRONJ six months after surgery. The overall curativerate of the population was 86%.Conclusions: Despite the limited number of patients studied sofar, our data show that mandible reconstruction with the fibulaflap is feasible and does not influence the natural course of theprimary disease in BRONJ-resected patients.
2008
- Nodular fasciitis of the face: Aesthetic considerations
[Articolo su rivista]
Chiarini, Luigi; L., Lo Russo; S., Figurelli; P., Procacci; C., Rubini; L., Lo Muzio
abstract
Nodular fasciitis is an uncommon tumor-like fibroblastic proliferation that occurs rarely in the head and neck region. A new case of nodular fasciitis occurring in the cheek of a 56-year-old woman is reported. The case was characterized by dental trauma preceding the appearance of the lesion (extraction of tooth 35). Histologically, the lesion consisted of proliferating fibroblasts and myofibroblasts presenting clinically as a rapidly growing subcutaneous nodule. A conservative surgical excision with curettage is the treatment of choice, and the lesion usually does not exhibit a tendency to recur. The clinical relevance of this condition relies on the fact that both the disorder and its surgical treatment may cause tissue distortion resulting in aesthetic compromise. Furthermore, it needs to be differentiated from malignancy due to its very rapid growth, its rich cellularity, and its high mitotic activity. Both of these aspects, i.e. aesthetic implications and differential diagnosis, have been discussed.
2008
- Open rhinoplasty and nasal dorsal leiomyoma:case report
[Abstract in Rivista]
G., Bettini; N., Toller; M., Albanese; G., Bissolotti; Chiarini, Luigi; P. F., Nocini
abstract
Objective: To describe the surgical management of a leiomyomaof the nasal dorsum.Clinical case: A 50 years-old man was referred with a slow progressiveasymptomatic swelling of the nasal dorsum. History wasnegative for frontonasal trauma, infection or previous surgery.Clinical examination revealed an asymmetric subcutaneousslightly mobile mass of the nasal dorsum; there was not evidenceof cutaneous sinus. Intranasal examination detected a mass protrudinginto the right vestibulum, covered by pink mucosa.RM demonstrated a well-circumscribed mass consistent withfibroma or leiomyoma extending into the upper portion of thenasal septum.Open septorhinoplasty was performed. A stair-step columellarincision was made, the lower and upper lateral cartilage weredelimited. The mass was dissected from both the upper lateralcartilage and the underside of the nasal bones with completeexcision of the mass. The defect was curetted. Two paraseptalspreaders grafts, taken from septum, were sutured transeptal. Alarremodelling and interdomal suture were performed.Histopathologic analysis was consistent with a leiomyoma(size 2.3 cm×2 cm×2.5 cm). Postoperative clinical examinationshowed a good esthetic result; no complications or recurrenceoccurred at 22 months of follow-up.Conclusion: The use of an open septorhinoplasty may appearan invasive approach for the benign nature of the lesion, but itrevealed to be a suitable technique to immediately overcome thenegative consequence of the surgical dissection over the sub-nasalstructures preserving both function and aesthetic of the nose
2007
- Neoplasie delle cavità nasali e paranasali.
[Capitolo/Saggio]
Chiarini, Luigi
abstract
Il presente capitolo esplora le patologie neoplastiche relative alle cavità nasali e paranasali
2006
- A severe case of Madelung syndrome
[Articolo su rivista]
Baccarani, Alessio; Chiarini, Luigi; Antonio, Spaggiari; Follmar, Keith E.; DE SANTIS, Giorgio
abstract
We were very interested in reading the brief communicationby Dr. B. Civelek et al. entitled “AnUnusual Entity for a Plastic Surgeon: Madelung Syndrome”(Plast. Reconstr. Surg. 117: 693, 2006).1During the past 3 years, we have treated four cases ofMadelung syndrome. Two patients had upper extremitylocalizations that were treated by liposuction only;one patient had upper trunk and neck involvement thatwas treated by combined liposuction and lipectomy.One patient had major involvement of the neck thatwas managed with an open approach, and which wepresent herein. In all three cases treated by liposuction,we encountered disease recurrence to various degrees.Our experience strongly supports Civelek et al.’s conclusionthat open excision is the best approach to avoidrecurrence in these cases.
2006
- Bisphosphonate-associated jawboneosteomyelitis: Clinical, radiological andhistological features
[Abstract in Rivista]
A., Bedogni; G., Saia; Chiarini, Luigi; P. F., Nocini
abstract
Introduction and Objectives: Patients taking amino-bisphosphonatesmay develop jawbone disease. We evaluated theclinical, radiological and histological features of bisphosphonateassociatedjawbone disease with the aim of defining the natureof bone lesions and the possible pathogenesis.Methods: Thirty-five consecutive patients with bisphosphonateassociatedjawbone disease were studied. Clinical and radiologicalassessment were performed; the number and featuresof each lesion and history of previous traumatic events wererecorded. Eleven patients underwent extensive jawbone resection.Resected jaws were subjected to histological analysis. Basedon CT and MRI findings, bone specimens were obtained fromexposed necrotic areas, unexposed areas and resection margins.Results: Sixteen patients had metastatic bone disease and 19 hadmultiple myeloma without jawbone involvement. Forty-one bonelesions were identified (mandible 29, maxilla 12), correspondingto 1.2 lesions on average per patient. The mean duration ofbisphosphonate treatment before diagnosis was 32.8 months.Histologically, the specimens obtained from the areas of exposedbone were typified by non-vital bone, with rough boundariesand empty lacunae, vessels were scanty, without signs of boneremodelling. In contrast, specimens from the areas of unexposedbone were characterized, by a highly vascularized fibrous tissueand inflammatory infiltrate within large intertrabecular spaces; apeculiar feature was the detachment of osteoclasts from bonesurfaces. The margins of resected bone showed normal bonestructure and vascular supply.Conclusions: Our study suggests that bisphosphonate-associatedjawbone disease may be a form of osteomyelitis with peculiarfeatures, possibly caused by interference of bisphosphonates withbone remodeling, rather than avascular osteonecrosis.
2006
- Two techniques for the preparation of cell-scaffold constructs suitable for sinus augmentation: steps into clinical application.
[Articolo su rivista]
Ingo N., Springer; Pier F., Nocini; Karl A., Schlegel; Daniele De, Santis; Jung, Park; Patrick H., Warnke; Hendrik, Terheyden; Robert, Zimmermann; Chiarini, Luigi; Klaus, Gardner; Francesca, Ferrari; Jörg, Wiltfang
abstract
The objective of this clinical trial was the analysis of 2 methods for engineering of autologous bone grafts for maxillary sinus augmentation with secondary implant placement. Group 1 (8 patients, 12 sinuses): cells of mandibular periosteum were cultured in a good manufacturing practice laboratory (2 weeks) with autologous serum and then transferred onto a collagen matrix. After another week, these composites were transplanted into the sinuses. In group 2A (2 patients, 3 sinuses), cells of maxillary bone were cultivated with autologous serum for 2 weeks, seeded onto natural bone mineral (NBM, diameter [Ø] = 8 mm) blocks, and cultivated for another 1.5 months. These composites were transplanted into the sinuses. Group 2B (control, 3 patients, 5 sinuses) received NBM blocks alone. In the course of implant placement 6 (group 1) and 8 (group 2) months later, core biopsy were taken. Clinical follow-up period was 1 to 2.5 years in group 1 and approximately 7 years in groups 2A and 2B. New vital bone was found in all cases at median densities of 38\% (n = 12) in group 1, 32\% in group 2A (n = 3), and 25\% in group 2B (n = 5). Differences between group 1 and 2B as well as 2A and 2B were statistically significant ( p = 0.025). No adverse effects were seen. All methods described were capable of creating new bone tissue with sufficient stability for successful implant placement.
2006
- Use of a combined protocol to treatbisphosphonate-associated jawboneosteomyelitis: a 12-month follow-up
[Abstract in Rivista]
A., Bedogni; M., Ragazzo; Chiarini, Luigi; P. F., Nocini
abstract
Introduction and Objectives: Treatment of bisphosphonateassociatedjawbone osteomyelitis represents an emerging challengein our practice. Although use of antibiotic treatment,chlorhexidine mouth rinses and bone debridement have beensuggested, results are disappointing and frequently fail withdisease progression.Based on the clinical, radiological and histological features of thedisease, we developed a combined treatment protocol. The resultsof the use of this protocol, at 3, 6 and 12 months follow-up arepresented.Methods: Fifty consecutive patients with bisphosphonateassociatedjawbone osteomyelitis were studied. The combinedprotocol consisted of: temporary bisphosphonate discontinuation,25 sessions of HOT, complete resection of the diseased bone andjaw reconstruction if needed, per-op 10-day cycle of antibiotictherapy, and 25 post-op sessions of HOT. Inclusion criteria ofthe study population considered were: (1) absence of jawbonelocalisation of metastatic disease or multiple myeloma; (2) sufficientstability of the primary disease; (3) unmanageable painwith antibiotic therapy and debridements; (4) rapid progressionof disease. Patients who completed the protocol were assessed at3, 6 and 12 months.Results: 14/50 patients completed the protocol and reached1-year follow-up. Histologically, 11/14 patients had normal bonearchitecture at the resection margins. 13/ 14 pts had completepain relief at one year. No recurrent bone disease was seen at CTand MRI at 1 year in 12/14 cases. No progression of the primarydisease was seen after bisphosphonate discontinuation.Conclusions: Despite the limited number of the study population,the proposed protocol seem to treat effectively bisphosphonateassociatedjawbone osteomyelitis in selected patients.
2005
- 10 years follow-up of 60 cleft lip patients treated for secondary nasal defects
[Abstract in Rivista]
P. F., Nocini; Chiarini, Luigi; D., Bertossi
abstract
The purpose is to evaluate the long term results of 60 of 180 patientstreated with an "Anatomical Balance" method of secondary nasal correction,which means detouch and dismount progressively the septum,the alar cartilages, the bone vault and finally the soft tissues for thenre-build and re-orient and, if necessary, graft the nose structure withautologous material (1-2). 60 patients treated from 1993 to 2002, 39mono and 21 bi-lateral, medium age 24.5 years. Our procedures weredirected to the nasal tip, preserving and re-orienting the nasal structureswith an open approach and applying a personal technique called BCRCC(3) (14% of the patients), re-modelling and re-positioning of the domes(90% of the cases). Cartilage and bone have been used as grafts in80% of our patients The follow-ups made on our 60 patients after 1 to10 years seem to support the results that guarantee a better shaping ofthe tip without the need of a second surgical time. No major immediateand long term complication was observed except columellar scars (4%Symmetry and nasal function improved in all our cases (98.9%). Overthe years the first surgical step in cleft li patients has been the correctionof the lip, and then the remaining structures (Salyer 1992, Chase 1983,Mulliken 1992). Finally we can conclude that the primary treatment isof the lip-nasal deformity (Gubisch 1995, Salyer 2004). The treatmentof secondary nasal defects with the "anatomical Balance" method givean improvement of the tip projection by means of various techniques,one of them to be known as the Bilateral Controlateral Rotation of theupper Cephalic segment of the lateral Crura (BCRCC) (Nocini et al 2001)avoiding further surgical treatments.References[1] J.B. Mulliken, M.D.: "Principles and Techniques of Bilateral Complete CleftLip Repair". Plast. Reconstr. Surg. Vol. 75, N O 4: 477-486, April 1985.[2] C. Cutting, et AI..: "Presurgical Columellar Elongation and Primary Retrogradenasal Reconstruction in One-Stage Bilateral Cleft lip and NoseRepair". Plast. Reconstr. Surg. Vol. 101, N O 3: 630-639, March 1998.[3] EF. Nocini, G.N. Trenite, D. Bertossi: 'q-he correction of the tip in cleftlip secondary rhinoplasty: bilateral controlateral rotation of the cephalicsegment of the lateral crura (BCRCC)". Face vol. 7 no1 pp 13-20 2001.4) Salyer KE, Genecov ER, Genecov DG. Unilateral cleft lip-nose repair -long-term outcome. Clin Plast Surg. 2004 Apr;31(2):191-208. Review.
2005
- Carcinogen metabolism, DNA damage repair and oral head and neck squamocellular carcinoma (HNSCC). A review.
[Articolo su rivista]
F., Biolchini; G., Pollastri; S., Figurelli; Chiarini, Luigi
abstract
Head and neck squamocellular carcinoma (HNSCC) has now become the 6th most common cancer among men in the developed world and affects the oral cavity, salivary glands, larynx and pharynx. Tobacco chewing, alcohol consumption and last but not least, smoking seem to be the most important risk factors. In particular in non-drinkers, smoke increases the relative risk (RR) of developing HNSCC of the oral cavity and pharynx from 2 to 20 fold; especially in the oral cavity, the association between alcohol and smoke could have a multiplier effect. Cancer arises from damage to DNA of genes located at various points of the short (p) and long (q) arms of a number of chromosomes, caused by exposure to various carcinogens. Thus, the carcinogenic process requires continuous exposure to environmental carcinogens (i.e., longstanding history of smoking and drinking), an increased susceptibility to carcinogens (induced by xenobiotic metabolizing enzyme polymorphism) and an impaired DNA repair capacity (both inherited and acquired). Our purpose in this paper is to review advances in the understanding of the role of the European or Caucasian genetic aberrations that affect carcinogen metabolism and DNA repair genes in oral HNSCC development: we consider that those abnormalities will be useful in assessing individuals at risk.
2005
- Microvascular jawbone defectsreconstruction: the fibular flap versatility
[Abstract in Rivista]
P. F., Nocini; Chiarini, Luigi; S., Valsecchi; A., Bedogni
abstract
vedi allegato
2005
- Prelaminated fascio-mucosal radial flap inoral cavity reconstruction
[Abstract in Rivista]
Chiarini, Luigi; P. F., Nocini; A., Bedogni; S., Valsecchi
abstract
vedi allegato.
2005
- Pull up spreader graft to a tip support effect
[Abstract in Rivista]
D., Bertossi; Chiarini, Luigi; P. F., Nocini
abstract
Nasal airway obstruction can be associated to a deviated septum or nasal valve collapse with or without anatomical obstructions (polyps). Furthermore, the architectural defect can involve the aesthetics of the nasal dorsum and tip. The purpose of the Author is a new technique of simultaneous spreader grafting of the nasal vault and the rotation of the tip in the desired position. 10 patients affected by light (4) to severe (6) nasal obstruction were treated from 2001 to 2003 with a new technique of nasal spreading. This technique is performed with an open approach. The upper part of the lateral crus is splitted androtated medially and therefore inserted in a precise pocket between thenasal septum and the upper lateral. The cartilages are fixed pulling upthe nasal domes and tip with PDS 5-0. The dorsal part of the lateralcrus can be adjusted with a scalpel creating a supratip break and tipsupport. Also the spreading gives an anatomically related quantity ofcartilage and dorsal enlargement. There is no scarring and no need ofcartilage harvesting, all 10 patients had an improvement in nasal airway (scale 1 to 10), 6 patients with a clinical score of 7 and 4 patients with a clinical score of 10. Nobody complained for the open approach scarring and all had a good aesthetic result, with a stable upward rotation of the tip after 2 years. Nor displacement of the sutured cartilagen neither infections or hematoma was observed in 100% of patients, we propose a new technique of nasal spreading that cannot substitute the conventional use of dorsal spreaders, but can be an aid in cases of thin
2005
- Trattato di chirurgia preprotesica e ingegneria tissutale
[Monografia/Trattato scientifico]
Nocini, Pier Francesco; Chiarini, Luigi; DE SANTIS, Giorgio
abstract
.
2004
- Cranioplasty using acrylic material: a new technical procedure.
[Articolo su rivista]
Chiarini, Luigi; Sabina, Figurelli; Giuseppe, Pollastri; Elio, Torcia; Francesca, Ferrari; Massimo, Albanese; Pier Francesco, Nocini
abstract
AIM: Today, cranioplasty is performed using different procedures. Numerous materials may be used to reconstruct the cranial vault including autologous bone and different types of synthetic resins. When plastic materials are used, the main requirement for an effective cranioplasty is the preoperative shaping of the implant to fit the bony defect precisely. In this paper, experience with a new method for cranioplasty using an acrylic cranial implant is presented. MATERIAL AND METHODS: In this new technical procedure an acrylic implant, precisely shaped to the defect, is fabricated preoperatively using CT data. The study consists of 15 cases in whom cranioplasty was performed using this method. In all these, reconstruction was at least 3 months after the initial operation that lead to the cranial bony defect. RESULTS: No major complications occurred and the final functional and aesthetic results were good in all cases. The acrylic implant manufacture does not require the use of complex computer interface software or high-tech equipment, but involves simple, cheap, repeatable processes.
2004
- Functional rehabilitation of the atrophic mandible and maxilla with fibula flaps and implant-supported prosthesis.
[Articolo su rivista]
DE SANTIS, Giorgio; P. F., Nocini; Chiarini, Luigi; A., Bedogni
abstract
Historically, nonvascularized bone grafts have been the standard treatment for severe mandibular and maxillary atrophy, followed by immediate or delayed implant placement. Extreme atrophy is an unfavorable biological and mechanical location for nonvascularized autologous bone transplants. The authors present the results of a multidisciplinary treatment protocol for rehabilitation of extreme mandibular and maxillary atrophy by use of the vascularized fibular flap. This protocol includes bone augmentation, implant surgery, soft-tissue management, and prosthetic restoration. Since 1993, 18 patients with a mean age of 47.5 years presented with extreme mandibular and/or maxillary atrophy and underwent alveolar crest augmentation with vascularized fibular flaps. Bone healing was achieved in 17 of the 18 patients. Seventy-three osteointegrated implants were inserted in 12 of 17 fibular flaps. Altogether, 62 implants were loaded and 11 dental prostheses were made. Average follow-up of the loaded implants was 41 months. The success rate of loaded implants was 100 percent. The authors strongly recommend the use of the fibular bone flap when dealing with extreme atrophy of the mandible and maxilla and suggest the protocol outlined in this review.
2003
- Combined effect of vestibular and craniomandibular disorders on postural behaviour.
[Articolo su rivista]
Monzani, Daniele; G., Guidetti; Chiarini, Luigi; G., Setti
abstract
Sebbene l’esistenza di una correlazione tra i disordini dell’articolazione
temporo-mandibolare e le alterazioni dell’apparato
muscolo-scheletrico sia stata più volte riportata in Letteratura in
campo odontostomatologico, la questione se esista una correlazione
tra questi disordini e le modificazioni della postura è ancora
da definire. In questo studio il Cranio Mandibular Index è stato
utilizzato per valutare il grado di disfunzione temporo-mandibolare
ed i problemi ed essa corrrelati in 40 pazienti con funzionalità
vestibolare nella norma, ed in 42 pazienti affetti da disordini
vestibolari periferici. La valutazione dell’equilibrio è stata
eseguita utilizzando la posturografia statica e la “body sway
area” misurata in due condizioni: ad occhi aperti e ad occhi
chiusi. Questi dati sono stati successivamente confrontati con
quelli ottenuti nei 40 soggetti sani. Il controllo posturale ha evidenziato
un comportamento significativamente differente tra i
due gruppi con un aumento del “body sway” medio nei pazienti
con disordini cranio-mandibolari rispetto ai controlli (p<0,005).
Sebbene il coinvolgimento dell’apparato stomatognatico non risulti
quantitativamente differente nei due campioni patologici, i
pazienti affetti anche da sofferenza vestibolare periferica hanno
presentato un “body sway” medio maggiore rispetto ai pazienti
affetti solo da disordini craniomandibolari (p<0,005). Questi ultimi
hanno presentato un “body sway” medio maggiore dei controlli
solo nelle prove ad occhi chiusi (p<0,05). I risultati di questo
studio hanno dimostrato che le alterazioni craniomandibolari
possono essere alla base di una moderata instabilità posturale
nei pazienti con funzionalità vestibolare nella norma. Al contrario
tali alterazioni, se associate a disordini vestibolari periferici,
possono determinare problemi nel mantenimento della stazione
eretta, probabilmente a causa dell’effetto negativo di origine somatosensoriale
sui riflessi vestibolo-spinali.
2003
- Maxilla reconstruction with free fibula flap: Twelve-year experience
[Articolo su rivista]
DE SANTIS, Giorgio; Pinelli, M.; Baccarani, A.; Spaggiari, A.; Chiarini, Luigi; Pedone, A.
abstract
Since 1997 maxilla reconstruction with free fibula flaps has become the gold standard after wide resection of malignancy. A few years later also Cawood's class VI atrophy became an indication for fibula microvascular transplantation. We present our 12-year experience in maxilla reconstruction in the management of post-oncological surgery defects and in the correction of severe alveolar ridge atrophy. Since 1989 27 patients have been treated in our division. Of them 17 were post-oncological and ten had severe bone atrophies. Age ranged from 45 to 60. In all cases except one the flap successfully healed. We had one flap necrosis after vascular pedicle trombosis. Ninety-eight osseo-integrated implants were inserted, with a success rate of 93.8%. Follow-up ranged from 14 to 86 months of functional load. Results turned out to be satisfactory from a functional and aesthetic standpoint.
2003
- Tumori non odontogeni.
[Capitolo/Saggio]
Torricelli, Pietro; Pecchi, A.; Chiarini, Luigi; Figurelli, S.; Romagnoli, R.
abstract
Nell'ambito della diagnostica per immagini nella patologia odontostomatologica e maxillo-facciale, questo capitolo di libro si occupa dei tumori non odontogeni.
2002
- Autologous bone reconstruction possibilities in maxillofacial surgery.
[Abstract in Rivista]
Nocini, P. F.; Bedogni, A.; Valsecchi, S.; Chiarini, Luigi
abstract
To demonstrate the versatility of autologous bone use in reconstruction of bony defects in the cranio maxillofacial region.To date reconstruction is a complex surgical subject thus making it difficult to develop a standardize form of treatment .The use of autologous bone has been our "golden standard" for 30 years. None of the donor sites described can be considered ideal or always applicable
2002
- Folded radial forearm free flap for soft palate reconstruction
[Abstract in Rivista]
Nocini, P. F.; Chiarini, Luigi
abstract
The radial forearm flap can be considered one of the possibilities in soft palate reconstruction because it is sufficiently ductile to restore an adequate diaphragm between the oro and rhinopharinx.We prpose a feasible mode for the restoration of the soft palate
2002
- Il trattamento degli esiti nasali nelle labiopalatoschisi:revisione di 149 casi e metodiche di trattamento della punta.
[Relazione in Atti di Convegno]
Bertossi, D.; Chiarini, Luigi; Trevisiol, L.; Nocini, P. F.
abstract
Per molti anni l'obiettivo primario per la correzione delle labiopalatoschisi è stato il labbro lasciando ad interventi successivi le restanti strutture.
2002
- L'utilizzo di osso autologo nella ricostruzione del terzo medio.
[Abstract in Atti di Convegno]
Nocini, P. F.; Bedogni, A.; Valsecchi, S.; Trevisiol, L.; Chiarini, Luigi
abstract
La ricostruzione dei dieftti ossei del distretto cranio-maxillo-facciale rappresenta ancora oggi un ambito chirurgico complesso e di difficile standardizzazione .L'utilizzo dell'osso autologo costituisce da oltre 30 anni il golden standard della Scuola di Verona.Tra le possibili sedi di prelievi descritte, nessuna può essere considerata di per sè ottimale e quindi sempre applicabile.
2002
- Lining the mouth floor with prelaminated fascio-mucosal free flaps: clinical experience.
[Articolo su rivista]
Chiarini, Luigi; DE SANTIS, Giorgio; Bedogni, A; Nocini, P. F.
abstract
Soft-tissue defects of the mouth floor need thin, foldable, and pliable tissues able to preserve local anatomy as well as chewing, phonation, and deglutition. The oral mucosa is made of a stratified, nonkeratinized, epithelium-secreting mucus, which lubricates the oral cavity and facilitates tongue movements. No flap exists that can reproduce the physiology of the oral mucosa better than the oral mucosa itself. Prefabrication of mucosal flaps may represent the best solution. Therefore, 10 consecutive cases of mouth floor cancer were treated with prelamination of the fascia antibrachialis with mucosal grafts obtained from the healthy cheek, and with subsequent transplantation 3 weeks later. A significant increase in mucosal graft surface was seen in all cases, with a mean size twice the original. All flaps healed uneventfully. Follow-up time ranged between 2-60 months (average, 26.6 months). Morphological and functional results were excellent. Tongue motility, speech intelligibility, and swallowing were reestablished in all treated cases. Mucosal prelamination of the forearm fascia is feasible and allows physiological reconstruction of oral cavity defects up to 6 x 4 cm.
2002
- Lipofilling della regione facciale:valutazione istologica ed ultrastrutturale del tessuto adiposo prelevato ed innestato.
[Relazione in Atti di Convegno]
Trevisiol, L.; Bertossi, D.; Chiarini, Luigi; Zancanaro, C.; Nocini, P. F.
abstract
Lo studio condotto dimostra come tramite un'adeguata tecnica di prelievo sia possibile incremenatre la qauntità di tessuto adiposo innestato, detremiando a livello del sito ricevente un incremento volumetrico composto da dipociti, tessuti fibroso e cisti adipose.
2002
- Simultaneus bimaxillary alveolar ridge augmentation by a single free fibular transfer : a case report
[Articolo su rivista]
Nocini, P. F.; DE SANCTIS, G.; Bedogni, A.; Chiarini, Luigi
abstract
Class VI atrophy according to Cawood still represents a major challenge in pre-prosthetic surgery.Reconstruction of mandibular and maxillary bony defects using microvascular techniques is safe and reliable. Thefibula, due to its morphological properties, is ideal for alveolar ridge augmentation and its donor site morbidity isthe lowest among vascularized bone flaps. In this paper, we report the first case, to our knowledge, of extremeatrophy of both jaws, successfully treated by simultaneous bony augmentation of the maxillary and mandibularalveolar ridges with just one free fibula flap. Pre-operative planning, surgical technique and prosthetic restorationare discussed in detail.
2001
- Adenomatoid odontogenic tumor. A case report
[Articolo su rivista]
Figurelli, Sabina; Pollastri, G; Giannetti, Luca; Chiarini, Luigi
abstract
The adenomatoid odontogenic tumor is a benign bony lesion of the maxilla and mandible, it represents 3% of all odontogenic tumors, and is more frequent in females in their second decade of life. It affects mainly the maxilla associated with embedded teeth, often canines, but it also occurs in the mandible, especially in the anterior region. It originates from epithelial cells of the dental lamina complex system, but the histologic feature with gland-like structures explains its name and classification. Clinically silent, it is often discovered during radiological examinations as a well defined unilocular radiolucent image. The definitive diagnosis is obtained by histological examinations, which allow the differential diagnosis from other bony lesions. Treatment must include close examinations, such as axial and coronal CT scanning and eventually 3D reconstruction. Histological examination with a preoperative biopsy suggests a conservative surgical treatment consisting of a simple enucleation for the low incidence of recurrence. A clinical case is presented with peculiar features different from that reported in letterature.
2000
- Applicazione preoperatoria dello studio TC spirale per la valutazione morfologico-dimensionale della fibula a scopo implanto-protesico in microchirurgia ricostruttiva cervico-facciale.
[Abstract in Atti di Convegno]
Bedogni, A.; Testoni, M.; Nocini, P. F.; Morana, G.; Chiarini, Luigi; DE SANTIS, Giorgio
abstract
Atti del 49° Congresso Nazionale SICPRE
2000
- Correzione delle atrofie estreme delle creste alveolari mediante perone vascolarizzato.
[Abstract in Atti di Convegno]
DE SANTIS, Giorgio; Pinelli, M.; Chiarini, Luigi; Richeldi, G.; Nocini, P. F.
abstract
No abstract
2000
- Finalizzazione implanto-protesica del lembo osseo rivascolarizzato di fibula per la ricostruzione del distretto cranio-maxillo-facciale :10 anni di esperienza.
[Abstract in Atti di Convegno]
Nocini, P. F.; Bedogni, A.; DE SANTIS, Giorgio; Chiarini, Luigi; Avesani, F.; Fior, A.
abstract
No abstract
2000
- Free prelaminated fasciomucosal flaps in oral cavity floor reconstruction [Lembi liberi prelaminati fascio-mucosi per la ricostruzione del pavimento del cavo orale]
[Articolo su rivista]
DE SANTIS, Giorgio; Chiarini, Luigi; Bedogni, A.; D'Agostino, A.; Consolo, Ugo; Nocini, P. F.
abstract
The Chinese fasciocutaneous flap is the most versatile method for repairing soft tissue defects of the oral cavity. Its slenderness and pliability make it preferable to other free flaps in the reconstruction of mobile structures. Its chief limitations are, however, its unfavourable skin characteristics, which are void of mucosecretory activity, and the presence of cutaneous appendages. The consequent reduction in oral cavity lubrication is responsible for the dry feeling which hinders rehabilitation, irrespective of reconstructive outcome. The softness of the donor region is cosmetically and functionally consistent. Clinical application of tissue prefabrication techniques in reconstructive microsurgery enables the problem to be solved by raising tailored flaps with the same characteristics as the region under repair, affording excellent long-term results. Between February 1997 and February 1999 we produced 6 prefabricated fasciomucosal radial flaps in 6 patients affected by squamous cell carcinoma of the oral cavity floor. Surgery was performed in two separate stages. The first phase consisted of prelamination of the fascia antebrachii by a mucosal graft raised from the cheek. The prelaminated flap was then transferred in the second stage. Complete integration of the mucosal graft took three weeks. On reopening after three weeks, initial dimensions were found in all cases to have increased approximately two-fold. The post-operative period was free of complications in all treated cases. Healing by first intention was achieved in the forearm from which the graft was raised. Patients were followed up for between 12 and 34 months. In 5 cases, morphological outcome was excellent, with preservation of tongue motility and restoration of lateral excavations. In all cases, speech, mastication and deglutition were preserved. To date, all patients are free from illness.
2000
- Functional rehabilitation of jaw bone defects with vascularized free fibula flap and implant-supported prsthesis: 10- year experience.
[Abstract in Rivista]
Pf, Nocini; DE SANTIS, Giorgio; Chiarini, Luigi; Consolo, Ugo; A., Bedogni; D., Bertossi
abstract
No abstract available
2000
- Intracranial spread of a giant frontal mucocele: case report.
[Articolo su rivista]
Chiarini, Luigi; Nocini, P. F.; Bedogni, A.; Consolo, Ugo; Giannetti, Luca; Merli, G. A.
abstract
A giant mucocele eroded both the anterior and posterior wall of the frontal sinus and infiltratedthe dura mater. Its extracranial growth caused a frontal bony prominence. The tumour and part of the durawere resected. A 126 cm defect in the dura was repaired with a freeze-dried patch. A split-thickness bonegraft from the right parietal region was used to repair the anterior frontal bony defect. The result one yearlater was satisfactory. Spiral computed tomography with three-dimensional reconstructions excluded anyrecurrence of the tumour and showed good integration of bone grafts. © 2000 The British Association of Oraland Maxillofacial Surgeons
2000
- La versatilità del lembo osseo rivascolarizzato di perone nella ricostruzione dei mascellari resecati per neoplasie. Fibula flap versatility in the reconstruction in resected jawbone
[Articolo su rivista]
DE SANTIS, Giorgio; Bedogni, Alberto; Chiarini, Luigi; Pinelli, Massimo; Nocini,
abstract
No abstract available
2000
- Mucocele gigante dei seni frontali ad estensione intracranica.
[Articolo su rivista]
Chiarini, Luigi; Angari, P.; Consolo, Ugo; Torcia, E.; Roberti, F.; Merli, G.
abstract
Vedasi allegato
2000
- a comparison between radial forearm flap and preliminated fasciomucosal free flap in oral recostruction
[Abstract in Rivista]
Chiarini, Luigi; Nocini, P. F.; Bedogni, A.; Giannetti, Luca; DE SANTIS, Giorgio; Consolo, Ugo
abstract
1999
- Mezzi di osteosintesi per FIR: metallosi dei tessuti perimplantari.
[Abstract in Atti di Convegno]
Bertoldi, Carlo; Zaffe, Davide; Chiarini, Luigi; Tanza, D.; Consolo, Ugo
abstract
Placche per osteosintesi e tessuti circostanti sono stati studiati al fine di individuare la reale entità dei depositi metallici e le loro influenze sulle caratteristiche tissutali dal punto di vista patologico. Le placche, dopo 1÷9 anni di permanenza in sede, sono state espiantate da 8 pazienti (M/F, età 16÷38) il cui grado di flogosità locale era piuttosto elevato in 2 ed apprezzabile negli altri. Il tessuto osseo veniva incluso in Metacrilato, ottenute sezioni sottili per l’analisi istologica, mentre sia una sezione spessa (dopo dissolvimento superficiale del metacrilato) che le placche (in titanio o acciaio) con i tessuti aderenti (criosostituiti con CPD) venivano utilizzati per lo studio al SEM e microsonda a raggi X (EDS system). Nei pazienti a basso grado di flogosi, particelle di Ti erano evidenziabili solamente nei tessuti molli perimplantari. Nei due pazienti ad alto grado di flogosi, invece, in un caso si riscontravano cospicui depositi di Ti in cavità vascolari dell’osso, ma non nel tessuto calcificato; nell’altro, l’unico portatore di placca in acciaio, presenze di Fe e Cr ma non di Ni si riscontravano nel tessuto molle in contatto con l’acciaio, mentre in vicinanza di esso molti aggregati metallici, contenenti numerosi elementi, erano presenti in posizione perivascolare in una grossa cavità ossea. In conclusione, i risultati dimostrano una diretta relazione tra reattività patologica e le caratteristiche del mezzo di osteosintesi che, se inadeguate, sono la causa di una cospicua metallosi. Di particolare interesse clinico, poi, appare la distribuzione tissutale dell'Al (metallo sulla cui tossicità restano molti meno dubbi), che risulta contenuto sempre e comunque nelle viti per placche in lega di Ti esaminate e che presenterebbe una certa facilità alla diffusione ed alla fissazione nella lamine dense (acellulari-ipocalcifiche) degli osteoni.
Codice: IT\ICCU\BVE\0164941
1999
- jaw reconstruction by free fibular transfer: emphasis on osteointegrated implants, TMJ and maxillary reconstruction
[Articolo su rivista]
DE SANTIS, Giorgio; Chiarini, Luigi; A., Bedogni; P. F., Nocini
abstract
From December 1989 to September 1997 21 patients were treated for mandible reconstruction and 10 for maxilla reconstruction using the fibular flap. The age of patients ranged from 25 to 64, the length of the bone grafts from 7 to 25 cm. In 16 cases osseointegrated implants were used for denture rehabilitation; in 3 cases the reconstruction involved the TM joint. In the maxilla the fibula flap was used to reconstruct extreme atrophy of the alveolar process in 4 cases; to reconstruct a previous hemimaxillectomy in 3 cases and post-traumatic bone loss in 3 cases. Bone fixation was obtained by K-wires in 4 cases and miniplates in the remaining 27. The TM joint was reconstructed with an osteochondral graft from the second metatarsal head or an ear cartilage graft sutured on top of the fibula. In one case the homologous condyle conserved after tumor resection was used. The flaps were bone only (12 cases), bone plus muscle (15 cases) and osteocutaneous (4 cases). Average follow-up was 3–4 years. Twenty-eight flaps had no complications, with good functional and morphological results. One flap was lost because of infection, 1 flap was lost after 3 years due to a recurrence of malignancy; 1 flap had a segmental bone necrosis because partial devascularization occurred after hemostasis to stem major bleeding. Seventy-nine fixtures were placed, 47 into the new mandibles and 32 into the reconstructed maxillae. All implants have been well osseointegrated, except 1 removed at the time of surgery because of poor primary stability. Sixteen patients have had an implant-supported prosthesis. In our experience fibula is one of the most versatile flaps for jaw reconstruction, especially when osseointegration is planned or the TMJ and the maxilla need to be reconstructed.
1998
- Functional rehabilitation of the atrophic jaws with revascularized free fibula flap and implant supported prosthesis
[Abstract in Rivista]
Nocini, P. F.; Gotte, P.; Bedogni, A.; Chiarini, Luigi; DE SANCTIS, G.
abstract
Experience in jaw rehabilitation with fibula.
1998
- Gli effetti della permanenza in ambito biologico e i risultati di test standardizzati sulla ricettività corrosiva di alcuni dei più diffusi mezzi di osteosintesi e su due tipi di impianti dentali: uno studio preliminare.
[Relazione in Atti di Convegno]
Bertoldi, Carlo; Giannetti, Luca; Galetti, Riccardo; Chiarini, Luigi; Consolo, Ugo
abstract
Vedasi l'allegato
1997
- Il trattamento del paziente portatore di recessioni gengivali tramite un modello bilaminare di innesto libero: valutazione di uno studio preliminare.
[Relazione in Atti di Convegno]
Bertoldi, Carlo; Chiarini, Luigi; Gatti, Antonietta
abstract
Con il termine di recessione gengivale si intende una parziale messa a nudo della superficie radicolare secondaria alla retrazione dell'intero sistema parodontale in direzione corono-apicale.
Scopo del presente lavoro è la valutazione del trattamento delle recessioni mediante l'impiego di una variante della tecnica bilaminare di Langer e Langer (1985) (con innesto bilaminare connettivo-epiteliale) comprendente l'esecuzione di incisioni di scarico divergenti ed un letto di ricopertura dell'innesto (da parte del lembo peduncolato) tale da garantire la protezione dell'innesto senza, tuttavia, incorrere nella totale ricopertura della parte epiteliale dello stesso.
La ricerca è stata condotta su una casistica di 60 interventi ridotti, poi, a 8 casi clinici (affetti da recessioni di Classe I e II di Miller) realisticamente standardizzabili per paramentri clinici e fisiologici. L'area (paramentro che risulta della massima sensibilità per quanto riguarda lo sviluppo di una recessione) di una possibile recidiva della recessione era valutata longitudinalmente, a tempi differenti, cominciando da prima dell'intervento e poi subito dopo l'intervento, a 15 giorni, 6 mesi e ad 1 anno dallo stesso da 2 equipe indipendenti di ricercatori.
Poichè la dispersione dei valori delle aree valutate seguiva una distribuzione "normale" e poichè ci interessava valutare gli stessi pazienti a differenti tempi dall'intervento, si è deciso di impiegare il test di valutazione statistica di Analisi della Varianza per Misure Ripetute eventualmente seguito (per dirimere tra quali osservazioni vi fosser eventuali differenze) dal t-test di Bonferroni.
L'Analisi della Varianza presentava un F=130,8 corrispondente a p tendente a 0 per cui doveva esistere tra i gruppi di osservazione almeno una differenza statisticamente significativa che il successivo t-test di Bonferroni indicava essere tra le osservazioni compiute tra prima e subito dopo l'intervento.
L'affidabilità della metodica nel tempo, quindi, risulta provata e si osservano, parimenti, ridotti tempi di guarigione. La metodica tuttavia (già quella di base di Langer e Langer) è indubbiamente abbastanza complessa ed, inoltre, non si dispone a tuttoggi di confronti obiettivi tra tali tipi di interventi ed altri modelli bilaminari od altre tipologie di intervento disponibili alla risoluzione di tali classi di difetti.
Codice: Codice: IT\ICCU\BVE\0121041
1997
- [Management of facial pain resulting from cancer in oral and maxillofacial surgery]. Il trattamento del dolore facciale di natura oncologica in chirurgia oro-maxillo-facciale.
[Articolo su rivista]
Chiarini, Luigi; Stacca, R; Bertoldi, Carlo; Malagnino, F; Pollastri, G; Narni, Franco
abstract
Pain, which is among the most prevalent symptoms experienced by cancer patients, must absolutely be treated. The most important biologic effects of this sort of pain plays on patients' psychosociality. This is in reference to the quality of pain, the amount of pain and to the character of the patients. Actually, pain only in appearance is presented as a symptom; it is usually a disease. Patient assessment, the use of anticancer therapies and systematically administered non-opioid and opioid analgesics are pivotal. Practical aspects of cancer pain treatment include both drug selection, method of analgesic administration: selection of the appropriate route, dose titration and an understanding of the management of side effects. Pain therapy includes another series of possibilities like the use of adjuvant analgesics, psychological therapies, physiatric techniques and invasive interventions such as the use of intraspinal drugs, neural blockade and neuroablative techniques. This kind of therapy must be employed at all times, whether the case may be resolved surgically or not. So we think that pain can be effectively treated. This study was carried out to obtain the correct therapeutic approach for facial cancer pain syndrome. The research was performed on seven women and thirteen men with a mean age of 58 years. All the patients' clinical appearances were standardized with care. Study participants included odontostomatologists and anesthesiologists with experience of controlling cancer pain. The sensation of pain was quantified by means of the Visual Analogue Scale (VAS) while their psychosocial ability was assessed with the Karnofsky Performance Scale (KPS). In this way the authors hoped to obtain a good quality of standardization. The study was performed for a period of two months. The conclusions are that Trans Epidermis Nervous Stimulation (TENS) offers positive results for variable periods and only in 60% of patients with a low level of pain. The use of antiphlogistic non-steroid drugs and of opioid drugs, with a particular management requested from the personal clinical status of each patient, result as being the most effective therapeutic resource. Such therapies must be employed, whether the case may be resolved surgically or not. Nevertheless it is necessary to realize that drugs or other therapies for cancer pain are independent and propaedeutic to each surgical approach. Finally, the use of opioids is addressed in the management of patients with pain that is refractory to other interventions. This approach can provide adequate relief to the vast majority of patients. We find the morphinomania risk in cancer pain patients is not scientifically wellfounded.
PMID: 9173214
1997
- [Management of patients with coagulation defect in oral and maxillofacial surgery. I. Management of patients with drug-induced hypocoagulation]. Il trattamento del paziente con difetto di coagulazione in chirurgia orale e maxillo-facciale. Il management dei pazienti in stato ipocoagulativo farmacoindotto.
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Narni, Franco
abstract
Odontoiatric problems, clinical and surgical, connected with defective coagulation, are very frequent. Such cases can be divided into two groups: in the first we find patients with iatrogenic coagulopathy while in the second we find patients with hypocoagulative diseases. In this article the authors present the result of several years of research carried out to obtain a correct clinical and therapeutic approach for clinical and surgical Odontostomatology. After an introduction on clinical pharmacology and the use of anticoagulants, the principal clinical cases are discussed. Various laboratory tests evaluating patients with pharmacological coagulopathy are examined. The most specific and significant tests are illustrated following up the authors experiences. In the last part the authors illustrate cases corresponding to the two serious and frequent complications that can be found in patients with iatrogenic coagulopathy: hematorrhea and thromboembolism. These matters were dealt with from an Odontostomatologic point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.
PMID: 9173217
1997
- [Management of patients with coagulation disorder in oral and maxillofacial surgery. II. Management of patients with hypocoagulation caused by primary thrombocytopathy]. Il trattamento del paziente con difetto di coagulazione in chirurgia orale e maxillo-facciale. Nota II. Il management dei pazienti in stato ipocoagulativo a causa di una patologia primaria trombocitopatica.
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Narni, Franco
abstract
Any oral and maxillo-facial surgical treatment, however urgent it may be, must not include pathological states in which the patient's life may be particularly at risk as, for example, with Disseminated Intravascular Coagulation (DIC) or thrombotic thrombocytopenic purpura. In this article the authors present the result of studies carried out on the nosology of thrombocytopathy from an odontostomatological point of view. Thrombocytopathy can be divided into two groups: the first including the pathologies with a predominant defective number of thrombocytes (i.e.: thrombocytopenia, thrombocythemia, thrombocyto-sis), the second including forms with predominant qualitative defects (commonly known as thrombocytopathies). The authors, after having presented in short the physiopathologic functions of thrombocytes, illustrate the clinical and therapeutic aspects of the most important thrombocytopathies. Morbus Maculosus Werhofii, Glanzmann's disease, Bernard-Soulier syndrome, thrombocytopathies from defective reaction of release, Thrombocytopathies from defective procoagulant activity of blood plaques, thrombocytopathies in linkage to other genetic anomalies, von Willebrand's pseudodisease and a lot of acquired thrombocytopathies are identified. In the last part the authors illustrate the most opportune clinical steps corresponding to the most important thrombocytopathies. The results obtained suggest the necessity of keeping to the management that was described, Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.
PMID: 9173218
1997
- [The treatment of the cardiac patient in dentistry and oromaxillofacial surgery. I. The practical management of patients with arrhythmias]. Il trattamento del paziente cardiopatico in odontoiatria ed in chirurgia oro-maxillo-facciale. Nota 1: Management pratico nei pazienti portatori di turbe del ritmo.
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Cappello, C; Narni, Franco
abstract
Cardiac patients consist of a high incidence rate in odontostomatology, both clinical and surgical. Moreover this serious complication disease conditions odontostomatological and, particularly, surgical works. In this article the authors present the results of several years of research carried out to obtain a correct clinical and therapeutic approach for clinical and surgical dentistry. After an introduction on the clinical features of heart diseases the most important clinical cases of heart dysrhythmia are discussed: like, i.e. hypokinetic arrhythmia, hyperkinetic arrhythmia and the management of patients with pacemakers. The principal diacritic features of dysrhythmic diseases are illustrated. Anxiety is a sort of disease not directly related with dysrhythmia. Moreover a lot of clinical studies find in heart arrhythmia the principal problem caused by anxiety on heart physiology. Consequently the authors describe anxiety in the same part of pathologies commonly known as heart dysrhythmia. In the last phase the authors illustrate the most opportune therapeutic steps corresponding to the principal pathologies described above. These matters were dealt with from an odontostomatological point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.
PMID: 9221318
1997
- [The treatment of the cardiac patient in dentistry and oromaxillofacial surgery. II. The practical management of patients with hemodynamic pathologies]. Il trattamento del paziente cardiopatico in odontoiatria ed in chirurgia oro-maxillo-facciale. Nota 2: Management pratico nei portatori di patologie emodinamiche.
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Cappello, C; Narni, Franco
abstract
When odontostomatological or surgical treatment is performed we suggest, in a first phase, to distinguish cardiac patients from the others. In a second phase a careful nosological diagnosis will be performed. Consequently, patients' medical history plays a fundamental role in both diagnostic phases. In this article the authors present the results of several years of research carried out to obtain a correct clinical and therapeutic approach for clinical and surgical Odontostomatology. After an introduction on the clinical features of heart hemodynamic pathologies the most important clinical cases are discussed: like, for example, acardiohemia, valvulopathies and heart decompensation. The principal diacritic features of hemodynamic diseases are illustrated. Essential hypertension (borderline and resident) is a sort of disease not directly related to hemodynamics pathology. Moreover a lot of clinical studies find in heart hemodynamic pathologies the principal problem caused by hypertension on heart physiology. Consequently the authors describe essential hypertension in the same part of pathologies commonly known as heart hemodynamic pathologies. In the last phase the authors illustrate the most opportune therapeutic steps corresponding to the principal pathologies above-described. These matters were dealt with from an odontostomatological point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.
PMID: 9221319
1997
- [Treatment of the patient with a coagulation defect in oral and maxillofacial surgery. III. The management of patients in a hypocoagulative state because of a hemophilic-type primary pathology]. Il trattamento del paziente con difetto di coagulazione in chirurgia orale e maxillo-facciale. Nota III: Il management dei pazienti in stato ipocoagulativo a causa di una patologia primaria di tipo emofilico.
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Narni, Franco
abstract
Hemophilia plays a particularly important role among the diseases caused by abnormal coagulation. Defective blood-clotting factor diseases have a particular importance between coagulopathies: hemophilia, among these hematic disorders, plays a principal role. In this paper the authors present the results of scientific research on hemophilic disease carried out to obtain a correct clinical and therapeutic approach for clinical and surgical Odontostomatology. The authors, after having presented in short the physiopathologic function of coagulation factors, illustrate the clinical and therapeutic aspects of Hemophilia A and Hemophilia B. The correct Odontostomatological and Maxillo-Facial Surgical approach is presented as the result of the authors' research. Also von Willebrand's disease is illustrated even if it is not exactly a hemophilic disease. This is because all hemophilias must produce a gynephoric inheritance pattern. Nevertheless clinical, therapeutic and molecular biology appearance suggests the illustration of von Willebrand's disease together with hemophilias. Von Willebrand's disease can be divided into three nosologic groups and to each one corresponds a particular clinical and therapeutic management. Such cases are illustrated and examined from an Odontostomatologic point of view. The results obtained suggest the necessity of keeping to the management that was described. Actually a low percentage of accidents occurred only when the above-mentioned clinical processes were completely performed.
PMID: 9173221
1996
- Active materials inducing calcium-phosphate precipitation for the treatment of bone defects.
[Capitolo/Saggio]
Gatti, Antonietta; Monari, Emanuela; Chiarini, Luigi; D., Tanza
abstract
Active glasses are materials that, when implanted in bone, degrade releasing ions that can positively interact with the bony cells stimulating the osteogenesis. This phenomenon regards two different aspects: the biological and the chemical-physical one. Glassy granules of different compositions were implanted in rabbit’s muscles and sheep’s mandibular bone at different times. After the animals’ sacrifice particles with the surrounding tissues were explanted, fixed and embedded in PMMA.
Sections were prepared for the scanning electron microscopy. The
observations showed that the glass with the less amount of silicon
degrades in a shorter time than that with the higher content. In sheep`s mandibular bone, the glassy particles with 52 and 55% molar weight content in silicon, degrade and on the surface of glass little needles of precipitates appear. The EDS analyses show that they are composed of Calcium and Phosphorus with a P content greater than that of HA of bone. New bone trabeculae surrounds the granules.
1996
- In-vivo leaching of A-WG particles for dental use.
[Relazione in Atti di Convegno]
Gatti, Antonietta; T., Kokubo; Monari, Emanuela; Chiarini, Luigi; D., Tanza
abstract
Bioactive glass granules are used as filler for bone defects in Dentistry.
Present work studies the in-vivo behaviour of a glass-ceramic material (A-WG) used as granules of three different sizes. After implantation in soft and hard tissues, the morphology of granules is studied with Scanning Electron Microscopy, and the chemical
degradation is detected with an Energy Dispersive System. The results show the biocompatibility of the glass and the best size in order to optimize the interaction with bone.
1996
- La retrazione dei tessuti gengivali per la rilevazione, in fase di improntazione, dei margini sottogengivali delle preparazioni protesiche per corone complete. Nota II: Una sperimentazione clinica che pone a confronto una originale tecnica di manipolazione delle impronte con un'altra basata sull'impiego di capsule provvisorie in resina opportunamente foggiate.
[Articolo su rivista]
Bertoldi, Carlo; Chiarini, Luigi
abstract
Gli autori, con questo lavoro, vogliono valutare la capacità che alcuni accorgimenti tecnico-operativi possono avere nel favorire una buona rilevazione d'impronta.
Tra essi saranno presi in considerazione un particolare sistema di manipolazione delle impronte, che risulta essere atto a garantire la retrazione opportuna dei tessuti gengivali, ed un altro sistema che impiega allo stesso fine delle cappette in resina autopolimerizzante opportunamente foggiate.
In questo ambito appare estremamente utile ed indicativo condurre il nostro studio su una popolazione accuratamente selezionata che, in particolare, non presenti al momento della protesizzazione alcun indizio di malattia parodontale manifesta nè alcuna diatesi sistemica o locale che possa giocare un ruolo importante nel condizionare alterazioni nel comportamento del tessuto parodontale superficiale e/o profondo.
Abbiamo così ottenuto una popolazione di studio composta da 18 soggetti di età compresa tra i 18 ed i 50 anni.
Su 10 soggetti si cercava di ottenere la corretta retrazione mediante il particolare tipo di "scarico" eseguito sulla pasta base dell'impronta presa in "2 tempi" mentre su 8 pazienti si è applicato il sistema di improntazione imperniato sulle cappette di resina.
Le valutazioni sono state eseguite sui gessi corrispondenti alle impronte.
La comparazione statistica tra i risultati conseguiti attraverso l'impiego dei suddescritti artifici non consente di rilevare differenze qualitative tra i due gruppi suddetti.
L'impiego delle cappette consentirebbe, ad un'analisi non matematica dei dati, una precisione superiore la cui apparenza non trova, tuttavia, un oggettivo riscontro quando gli stessi dati vengono elaborati secondo il modello statistico.
Appare comprovato, comunque, che entrambe le metodiche forniscano risultati di eccellente qualità.
1996
- Microstomia secondaria a sclerodermatomiosite: presentazione di un caso con correzione chirurgica.
[Relazione in Atti di Convegno]
Chiarini, Luigi; Bertoldi, Carlo; Giannetti, Luca
abstract
La sindrome Sclero-Dermatomiositica è una malattia cronica caratterizzata da irrigidimento ed inspessimento della cute, da anomalie dei piccoli vasi sanguigni e da fenomeni fibrotici che interessano, tra l'altro, l'apparato muscolare e numerosi organi interni quale il tratto gastrointestinale, il polmone, il cuore ed i reni.
Mentre la sindrome Sclero-Dermatomiositica sistemica è una forma patologica molto facilmente (anche se non obbligatoriamente) progressiva, esiste una forma Sclero-Dermatomiositica limitata (limited Systemic Sclerosis) che solitamente non presenta l'andamento progressivo della precedente e difficilmente condurrà a complicazioni viscerali o sistemiche.
Un quadro preciso, particolare ed assai dettagliato di accertamenti Clinico-Strumentali vengono giudicati in grado di consentire la diagnosi differenziale tra le suddette forme e definire la direzione eventualmente evolutiva di esse.
In campo Oro-Maxillo-Facciale esistono complicanze specifiche delle sindromi Sclero-Dermatomiositiche tra cui troviamo l'assottigliamento atrofico delle labbra e la microstomia secondaria.
Gli autori illustrano la procedura diagnostica corretta e dimostrano che, in caso si possa verificare una forma Sclero-Dermatomiositica limitata, l'intervento di correzione della microstomia tramite tecnica di Gillies presenta risultati soddisfacenti e stabili nel tempo.
Codice: IT\ICCU\AQ1\0020032
1996
- Morphological and Functional Rehabilitation of Severe Mandibular and Maxillary Atrophy by Free Vascularized Flaps.
[Abstract in Rivista]
Chiarini, Luigi; Consolo, Ugo
abstract
Vedasi l'allegato
1996
- Prelievo d'osso dall'olecrano: proposta d'utilizzo in campo oro-maxillo-facciale."
[Relazione in Atti di Convegno]
Chiarini, Luigi; DE SANTIS, Giorgio; Bertoldi, Carlo
abstract
Nonostante la sempre più massiccia presenza commerciale di materiali alloplastici ed eterologhi per la chirurgia oro-maxillo-facciale, l'impiego di osso autologo è, comunque, universalmente ritenuto il più affidabile, sicuro e quello che offre i migliori risultati.
L'unico inconveniente legato all'uso di quest'ultimo materiale è il costo biologico (necessità, quasi costante, di prelievo in sedi secondarie rispetto a quella d'intervento) e sociale (legato all'allungarsi dei tempi di intervento).
Da queste considerazioni sono scaturite le proposte più diverse di zone donatrici.
Gli autori hanno studiato la tecnica di prelievo osseo dall'olecrano applicata in campo Oro-Maxillo-Facciale per fini eminentemente pre-protesici.
Il prelievo dall'olecrano, infatti, è comunemente utilizzato in campo ortopedico ed otorinolaringologico, ma non è stato mai proposto nel nostro settore di ricerca.
Gli autori studiano le caratteristiche dell'accesso alla zona olecranica con tassello osseo corticale che può arrivare a dimensioni di 25x10 mm e con un volume di osso spongioso prelevabile che varia tra i 2 e i 4 CC.
Lo studio è stato condotto in 9 casi di rialzo del pavimento del seno mascellare ed in 3 casi per riempimenti di difetti ossei di varia natura.
Secondo le valutazioni degli autori il prelievo osseo olecranico può rappresentare, in una tale tipologia di interventi e nei casi in cui la carenza ossea sia compatibile, un metodo di elezione.
Codice: IT\ICCU\AQ1\0020032
1996
- Su di un caso di osteoma mandibolare gigante: presentazione clinica della scelta chirurgica.
[Relazione in Atti di Convegno]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.
abstract
L'Osteoma è una rara patologia osteo-formativa che può svilupparsi sia all'interno che alla periferia dei segmenti ossei.
Esso fa parte di un insieme di lesioni tra cui troviamo anche l'Osteoma Osteoide, l'Osteoblastoma, la Miosite Ossificante, il Lipoma Ossificato, l'Osteocondroma, le diverse forme di Osteosarcoma oltre ad altre patologie ancora.
Gli autori, in questo lavoro, verificano che la diagnosi di Osteoma si deve fondare su precisi reperti Clinici, Radiologici ed Anatomo-Patologici.
L'insieme di questi dati deve essere tenuta presente in sede di diagnosi differenziale che, in questo ambito specifico, diventa di grandissima importanza.
Nella diagnosi di Osteoma si deve essere certi, infatti, di poter escludere una delle forme suelencate ed, in particolar modo, le diverse forme di Osteosarcoma ed Osteocondroma.
In tali casi, con una diagnosi di Osteoma certa, gli autori dimostrano che anche la terapia chirurgica, quando attuata, potrà essere solo conservativa, limitata, cioè, ad una sola parte della massa neoplastica.
Questo, in particolare, quando un'escissione radicale comporti esiti estesamente invalidanti e solo se il controllo routinario post-chirurgico si renderà possibile.
Codice: IT\ICCU\AQ1\0020032
1996
- The Prefabricated Antebrachial Fascio-Cutaneous Flap in Reconstructive Maxillo-Facial Surgery.
[Abstract in Rivista]
Chiarini, Luigi; Consolo, Ugo
abstract
Vedasi allegato
1995
- I rapporti intercorrenti tra le più comuni preparazioni dei margini cervicali per corone complete e l'integrità parodontale: una sperimentazione clinica.
[Articolo su rivista]
Bertoldi, Carlo; Chiarini, Luigi
abstract
Gli autori, con questo lavoro, vogliono valutare i rapporti intercorrenti tra la collocazione e la preparazione dei margini di corone complete e la patologia parodontale.
Dati i rapporti ormai universalmente accettati tra parodontopatia e placca batterica risulterà particolarmente opportuno valutare quest'ultima in relazione alle unità protesiche suddescritte.
In questo ambito appare estremamente utile ed indicativo condurre il nostro studio su di una popolazione accuratamente selezionata che, in particolare, non presenti, al momento della protesizzazione, alcun indizio di malattia parodontale manifesta nè alcuna diatesi sistemica o locale che possa giocare un ruolo importante nel condizionarla.
Abbiamo così ottenuto una popolazione di studio composta da 38 soggetti di età compresa tra i 18 ed i 30 anni . Su 11 individui costituenti tale popolazione è stata condotta una preparazione sopragengivale ed a spalla del margine, su 8 di essi è stata compiuta una preparazione sottogengivale senza spalla (a lama di coltello), su 9 una preparazione sottogengivale a chamfer ed, infine, su 10 una preparazione a spalla sottogengivale.
La valutazione di Gengivite, tramite l'Indice di Gengivite GI, esprimeva differenze statisticamente significative solo tra il primo ed il secondo dei suddetti gruppi, mentre l'Indice di Placca Batterica PI differenziava il secondo gruppo dagli altri 3.
La ricerca condotta conferma, seppure con importanti precisazioni, quanto è possibile reperire in letteratura circa il maggior rispetto del parodonto che conseguirebbe ad una preparazione sopragengivale ma, soprattutto, dovranno far riflettere i rapporti tra i risultati conseguiti dalle valutazioni degli indici GI e PI considerando il tipo di popolazione da cui abbiamo tratto i nostri campioni.
I'Indice PI, infatti, potrebbe essere inteso come un "campanello di allarme" in grado di farci riflettere su ciò che potrebbe accadere al parodonto una volta che le potenzialità lesive della placca non fossero più frenate da un fisico giovane e/o sano.
1995
- In vivo study of the degradation of 4 different composition active glass
[Relazione in Atti di Convegno]
Gatti, A. M.; Hench, L.; Monari, Emanuela; Chiarini, Luigi; Bulgarelli, S.; Tanza, D.
abstract
The present study investigated the behavior of 4 different glasses. used as granules for bone repair, to understand the influence of the composition in bone stimulation and their degradation in a biological environment.
1995
- Influence of granule size on the reactions of a bioactive glass for repair of bone defects.
[Relazione in Atti di Convegno]
Gatti, Antonietta; O. H., Andersson; G., Valdrè; Chiarini, Luigi; D., Tanza; S., Bulgarelli; Monari, Emanuela
abstract
the present work analyses the in-vivo behaviour of a bioactive glass that can be used for osteostimulation in bone defects. The glass called SP53P4 was implanted as granules of 3 different sizes in pockets created in rabbit' dorsal muscles to investigate the reactions in the biological fluids. Before the implantation the granules were coated with a layer of gold on one side in order to obtain two sides with different permeability in the same granule and thus two different velocities of diffusion.
After 2 months bone and granules were explanted and processed for observation under Scanning Electron Microscope with an X_ray microprobein ordet to study the changed morphology of the granules and the distribution of the elements.
The granules were partly leached but there were no sign of total glass breakdown and resorption.
1995
- La retrazione dei tessuti gengivali per la rilevazione, in fase di improntazione, dei margini sottogengivali delle preparazioni protesiche per corone complete. Nota I: Una sperimentazione clinica basata sull'impiego dei fili retrattori e di una originale tecnica di manipolazione delle impronte.
[Articolo su rivista]
Bertoldi, Carlo; Chiarini, Luigi
abstract
Gli autori, con questo lavoro, vogliono valutare la capacità che alcuni accorgimenti tecnico-operativi possono avere nel favorire una buona rilevazione d'impronta.
Tra essi saranno presi in considerazione alcuni tipi di fili retrattori (inerti e disinertati, con l'eccezione di quelli impregnati con principi farmacologici vasocostrittivi, date le forti controindicazioni sistemiche) come anche un particolare sistema di manipolazione delle impronte che sembrava potesse essere atto a garantire la retrazione opportuna dei tessuti gengivali.
In questo ambito appare estremamente utile ed indicativo condurre il nostro studio su una popolazione accuratamente selezionata che, in particolare, non presenti al momento della protesizzazione alcun indizio di malattia parodontale manifesta nè alcuna diatesi sistemica o locale che possa giocare un ruolo importante nel condizionare alterazioni nel comportamento del tessuto parodontale superficiale e/o profondo.
Abbiamo così ottenuto una popolazione di studio composta da 48 soggetti di età compresa tra i 18 ed i 50 anni.
Su 9 individui, costituenti tale popolazione, è stata condotta l'improntazione mediante l'ausilio di un filo Inerte, su 10 era stato impiegato un filo impregnato di Cloruro di Alluminio, su 10 individui veniva utilizzato un filo retrattore disinertato con Solfato di Alluminio, su altri 10 soggetti si cercava di ottenere la necessaria retrazione unicamente mediante un particolare "scarico" eseguito sulla pasta base dell'impronta presa in "2 tempi" ed, infine, su 9 pazienti non è stata impiegata alcuna peculiare procedura di retrazione.
Le valutazioni sono state eseguite sui gessi corrispondenti alle impronte.
Su tale basi si delineano statisticamente 4 popolazioni distinte:
alla base di questa piramide, con i peggiori risultati, stanno quei casi in cui le impronte sono state rilevate senza l'impiego di alcun artificio particolare.
L'utilizzazione di un filo retrattore inerte ha consentito risultati superiori.
L'inserimento di fili retrattori disinertati con Cloruro o Solfato di Alluminio ha permesso il conseguimento di un risultato ancora migliore (e statisticamente indistinguibile tra i risultati ottenuti mediante i due ultimi diversi fili disinertati).
I migliori risultati, tuttavia, venivano conseguiti tramite la tecnica basata sullo "scarico" particolare delle impronte da noi messo in atto.
1995
- Microstomia da Sclero-Dermatomiosite: caso clinico
[Abstract in Atti di Convegno]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Giannetti, Luca
abstract
Gli autori si propongono uno studio preliminare sulle possibilità di inquadramento clinico e trattamento chirurgico dei pazienti portatori di Sindrome Sclero-Dermatomiositica con interessamento orale.
Basandosi sui dati della letteratura applicano un protocallo atto ad individuare le forme Sclero-Dermatomiositiche non evolutive (o a lenta evoluzione).
Presentano quindi un intervento per correzione di microstomia secondaria a Sclero-Dermatomiosite riservandosi la valutazione dei risultati dello stesso nel tempo.
1995
- Osteoma mandibolare gigante: caso clinico.
[Abstract in Atti di Convegno]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Giannetti, Luca
abstract
Gli autori svolgono uno studio preliminare sulle diverse possibilità di diagnosi clinica e terapia su pazienti portatori di lesione Osteomatosa.
Diversi sono i sistemi descritti in bibliografia per giungere ad una diagnosi definitiva di "neoformazione osteomatosa".
Si va dalle metodiche, quasi esclusivamente radiologiche, impiegate dagli studiosi delle forme multifocali ereditarie ai sistemi imperniati esclusivamente sull'istologia (considerata l'unico esame dirimente) del pezzo asportato sostenuti dagli anatomo-patologi.
Gli autori propongono una metodica valutativa più completa ed adattabile alla clinica del soggetto e su questa base eseguono un trattamento chirurgico conservativo su un paziente latore di una notevole massa osteomatosa riservandosi la valutazione longitudinale dell'intervento.
1995
- Possibili effetti tossici provocati da materiali di comune impiego in ambito odontoiatrico su cheratinociti umani in coltura: uno studio preliminare.
[Relazione in Atti di Convegno]
Bertoldi, Carlo; Benassi, Luisa; Chiarini, Luigi
abstract
Gli autori propongono uno studio tossicologico basato sull'impiego di colture di cellule epidermiche isolate.
Svariati effetti clinicamente patologici a carico del cavo orale pare possano essere indotti dai polimeri acrilici per basi protesiche mentre, per quanto riguarda i cementi vetroionomerici, secondo molti autori, questi parrebbero così privi di effetti collaterali tanto da consigliarli addirittura nelle otturazioni retrograde o quali materiali sostitutivi di altri più tradizionali (es. resine ed amalgami) per ovviare a quei casi che potrebbero essere inquadrabili come patologie iatrogene del cavo orale.
I polimeri acrilici, nel tempo, sono stati accusati di essere tra i principali fattori determinanti i più svariati effetti nocivi del cavo orale (dal lichen alle moniliasi).
Testando questi due materiali, quindi, massima dovrebbe essere l'esaltazione dell'effetto tossico, trovandosi essi apparentemente così distanti nella scala della biocompatibilità tissutale.
La componente tissutale più esposta, di inerenza al cavo orale, è indubbiamente, nel caso di impiego di queste due tipologie di materiali, il tessuto epiteliale gengivo/mucoso.
Venne scelto un sistema di testazione tossicologica basato su culture cellulari isolate poichè ci garantiva, più di ogni altro, la semplificazione (eliminazione di interferenze biotissutali ambientali), la standardizzazione e la riproducibilità necessarie.
Le alternative, ovvero le colture d'organo e d'espianto, pur presentando una situazione biologica più simile a quella del vivente, non erano in grado di esprimere in maniera sufficiente le tre essenziali caratteristiche suelencate.
Gli scopi dello studio erano quelli di creare le basi per la futura messa a punto di coltivazioni di cheratinociti gengivali e di cominciare a capire se esisteva ed, eventualmente, su quali sistemi biologici insisteva, un'eventuale citotossicità acuta diretta da parte dei materiali testati in grado di indurre le patologie di cui eventualmente li si "incriminava".
I materiali testati furono la resina SR 3/60® (Ivoclar) ed il cemento vetroionomerico VitremerTM® (3M) consigliato dalla ditta produttrice anche per restauri conservativi su denti decidui e definitivi.
Le colture primarie e secondarie furono allestite su feeder layer di fibroblasti murini 3T3 con terreno di coltura prevalentemente basato sul Dulbecco's Modified Eagle's Medium mentre nelle colture terziarie (su cui si doveva condurre la testazione) era impiegato il terreno serum free Keratinocyte Growth Medium® al fine di evitare di impiegare feeder layer cellulari e quindi di avere interferenze nei successivi test.
Preparate le colture controllo e quelle campioni furono versati su quest'ultime i materiali di testazione in forma di eluato.
I test applicati furono: la conta cellulare ed il test al Trypan Blue come indici di vitalità cellulare, l'incorporazione di Timidina Tritiata per valutare la sintesi attiva del DNA ed il test di assunzione del Rosso Neutro che, invece, era atto a dimostrare la funzionalità del sistema delle membrane cellulari.
Le valutazioni furono condotte nel rispetto dei metodi basati su modelli statistici opportuni impiegando i conteggi di Valore di Decremento Percentuale e, ove possibile, l'Analisi della Varianza accoppiata al test per confronti multipli di Student-Neuman-Keuls.
Già da questo studio preliminare i risultati emersi furono sorprendenti dimostrando un'indiscussa maggior tossicità del cemento vetroionomerico rispetto alla resina che si discostava solo un poco (ma comunque in modo statisticamente rilevante) dalle colture campione.
Questo era da porre sicuramente in relazione anche alla maggiore solubilità dimostrata dal cemento vetroionomerico ed alla sua capacità di alterare in senso acido (pH 5,5) il pH del mezzo.
Tali risultati, tuttavia, sembrano ribaltare quello che sembra essere il "luogo comune" (con qualche riserva rimarchevole solo da p
1995
- Sperimentazione ed analisi clinica dei rapporti intercorrenti tra il danno dentale e la malattia celiaca.
[Articolo su rivista]
Bertoldi, Carlo; Balli, Fiorella; Tanza, D.; Bertolani, P.; Chiarini, Luigi
abstract
Gli autori hanno voluto valutare l'"impatto" dentale della Malattia Celiaca aumentando le "dimensioni" del numero di pazienti controllati e dei controlli di circa un 22% (33 pazienti) rispetto ad antecedenti studi preliminari.
Lo stato dentale dei soggetti affetti da Celiachia veniva confrontato in "doppio cieco" con un gruppo controllo costituito da soggetti sani.
Si rileva che solo un 38% dei pazienti celiaci presenta le tipiche lesioni della malattia mentre la percentuale cresce sino a circa il 50% se si prendono in considerazione solo quelli che si trovano in dentatura mista o permanente escludendo coloro che sono in fase dentale decidua.
Neppure le presentazioni sintomatologiche "forte", "tipica" o "forte e tipica" assieme della Celiachia possono sortire un effetto, variando le suddette percentuali mentre, per le presentazioni atipiche, il modello matematico-statistico non si dimostra ancora attendibile.
I valori dell'indice dfs (scelto poichè ritenuto maggiormente sensibile rispetto al dft), impiegato per valutare lo stato di eventuale degrado carioso dell'organo dentale, non sembra indicare differenze significative tra la popolazione celiaca e quella di controllo. Tuttavia, l'elaborazione statistica dei dati per ogni singolo soggetto, costituendo, così, una popolazione di dfs celiaci in confronto con una di soggetti sani, pur confermando il dato precedentemente riportato, indica una flessione rispetto a studi pilota precedentemente condotti rendendo, così, plausibile l'esistenza di un vero "rischio dentale" carioso nei celiaci (anche terapizzati).
Riteniamo, poi, confermando precedenti studi, che la dentatura decidua non offra, al presente, lesioni indicative per la diagnosi di Malattia Celiaca e che, quindi, lo screening dentale debba essere compiuto dopo i 7 anni e che oltre a tale età debba essere rimandato ogni eventuale test di "scatenamento" diagnostico, al fine di evitare danni allo smalto dentale ancora in formazione.
Per quanto riguarda le differenze di incidenza tra sintomi clinici e danno dentale tra la nostra casistica ed altre osservazioni, riteniamo che, al presente, molti fattori, non ultimo un'accresciuta efficienza dei sistemi italiani di informazione e di igiene sanitaria, possano stare alla base di ciò.
In sostanza riteniamo che lo screening Odontoiatrico si sia rivelato assolutamento indicato anche perchè di agevole impiego, di nessuna invasività ed a basso costo. Se infatti calcoliamo che nel circondario USL sanitario di Modena si conoscono solo 101 soggetti celiaci su 266.500 assistiti, considerando un'incidenza di solo 1 paziente su 500 per la Celiachia (incidenza calcolata per la nostra Regione su basi diagnostiche sintomatologiche classiche e non tenendo conto delle moderne, più sofisticate, tecniche anticorpali) dovrebbero esserci, in realtà, 533 celiaci ed il solo test Odontoiatrico potrebbe rivelarne il 38%, ovvero 202.
Questo significa regalare una spettanza di vita normale e scevra dalle gravi complicazioni, che la Celiachia porta con sè, ad altre 101 persone che costituiscono un numero pari ai pazienti ora conosciuti.
PMID: 7623758
1995
- Studio in vivo di un nuovo impianto protesico
[Abstract in Rivista]
Gatti, Antonietta; Monari, Emanuela; Chiarini, Luigi; S., Bulgarelli; D., Tanza
abstract
n/a
1995
- Valutazioni cliniche e sperimentali di una nuova linea implantoprotesica: ricerca sperimentale.
[Articolo su rivista]
Gatti, Antonietta; Monari, Emanuela; S., Bulgarelli; Chiarini, Luigi; D., Tanza
abstract
La ricerca in oggetto è consistita in un test d'impianto su animale di perni in titanio e della successiva analisi sia del materiale che dell'interfaccia creata coi tessuti biologici.
1994
- Healing of periodontal ligament after implantation of bioactive glass in surgically created periodontal defects: a pilot study.
[Relazione in Atti di Convegno]
Gatti, Antonietta; O. H., Andersson; A., Piattelli; P., Trisi; Monari, Emanuela; Chiarini, Luigi
abstract
Granules of a bioactive glass were implanted in a surgically created hole in a sheep's mandibular bone. After one year the bone with the glass was explanted, processed and examined under optical and scanning electron microscope. All particle were surrounded by a layer of minerilized tissue with histological features very similar to root cement; serial sections revealed that a small cementum bridge connected this mineralized tissue directly to root cementum. Under polarized light it was possible to observe oriented collagen fibers similar to the periodontal ligament inserting on the mineralized tissue.
1994
- Il danno dentale nei soggetti affetti da malattia celiaca: analisi di una sperimentazione clinica.
[Relazione in Atti di Convegno]
Bertoldi, Carlo; Balli, Fiorella; Chiarini, Luigi; Bertolani, P.; Tanza, D.; Marchi, S.; Melli, P.
abstract
La Malattia Celiaca è una grave patologia invalidante caratterizzata da atrofia dei villi intestinali e, spesso, da malassorbimento.
Le lesioni intestinali sono indotte, attraverso sistemi patologici non ancora chiariti, dalle proteine del glutine che sono contenute nel frumento, orzo, segale ed avena.
Da un punto di vista etiologico grande rilevanza ha l'"habitus" genetico del soggetto mentre la teoria patogenetica maggiormente accreditata chiamerebbe in causa un meccanismo disimmunoergico.
La componente immunologica anticorpo-mediata è, tuttavia, sicuramente importante per quanto riguarda i test di diagnosi e monitoraggio di questi pazienti.
Tra gli anticorpi che presentano un maggior interesse clinico-diagnostico stanno gli Anticorpi Anti-Glutine (AGA) e quelli Anti-Endomisio (EMA).
La diagnosi di Celiachia è sempre stata condotta seguendo i criteri fissati dal Gruppo Europeo di Gastroenterologia e Nutrizione Pediatrica (ESPGAN).
Da tempo si sa che esiste un interessante risvolto sintomatologico orale nell'ambito della Malattia Celiaca.
Essa, infatti, può presentarsi accompagnata a segni quali afte ricorrenti, malattie francamente autoimmuni e lesioni dentali specifiche individuabili, in particolare riguardo, sulla serie permanente ed in rapporto allo smalto dentario.
Tali ultime lesioni sono sicuramente in assoluto maggior rapporto con i periodi embriologici dentali della istodifferenziazione e della mineralizzazione e sono rappresentate da forme particolari di ipoplasie e di opacità.
Le lesioni tipiche dentali riscontrabili nella Celiachia ricordano concettualmente l'Ipoplasia Cronologica dello Smalto in quanto la noxa colpsce sistematicamente e simmetricamente le aree di smalto che sono in corso di maturazione durante lo svolgersi della stessa.
Al fine di standardizzare le osservazioni dentali abbiamo deciso di adottare la tabella "per Gradi" elaborata da Aine poichè si dimostra semplice, adottabile e ripetibile ovunque ed anche particolarmente adatta a rilevare una simile tipologia di lesioni.
Lo scopo di questo studio preliminare è stato quello di compiere una prima ricognizione sulle condizioni specifiche dello smalto dentale nei pazienti affetti da Malattia Celiaca.
A tal fine la campionazione dei pazienti e dei controlli è stata estremamente accurata, escludendo tutti coloro in cui patologie intercorrenti od altro potevano interferire nel quadro valutativo, e fissando rigidi paramentri per la valutazione dentale.
Lo studio è stato condotto in "doppio cieco".
Dai 27 pazienti che componevano la nostra casistica è risultato che il 38% di questi presentavano lesioni specifiche accertate mentre, considerando solo quelli in dentatura mista o permanente, la percentuale di positivi cresceva al 50%.
Nessun caso è stato individuato in dentatura decidua nè si sono riscontrate differenze di incidenza, statisticamente accettabili, in rapporto a presentazioni della Celiachia Tipiche od Atipiche o con Sintomatologia forte o debole (in tutte e 4 le possibili combinazioni).
E' emerso anche che la dentatura decidua non offre caratteristiche sintomatologiche note, specifiche per la Celiachia per cui per una procedura di screening dentale occorrerà procedere dopo i 7 anni, cioè almeno in fase di dentatura mista.
Nel caso in cui si rendesse necessaria un'indagine di Challenge (risomministrando glutine al paziente sospetto celiaco) i protocolli ESPGAN consigliano di eseguirla il più presto possibile noi, invece, riteniamo sia assolutamente indicato agire dopo i 7 anni, quando saranno conclusi i processi amelogenetici dei gruppi principali di denti (tranne gli ottavi), al fine di ridurre al minimo ogni potenziale rischio di danno specifico (anche alla luce delle moderne possibilità di diagnosi anticorpale che potrebbero rendere obsoleta la prova di Challenge).
Codice: IT\ICCU\UFI\0356726
1994
- Il lichen planus orale: una patologia caratterizzata da molteplici aspetti e che trae origine da una complessa disfunzione del sistema immunitario.
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Cappelletto, M.
abstract
Il Lichen Planus si configura come un'affezione papulosa relativamente comune a carico di cute e mucose (orale e genitale soprattutto) in cui il cavo orale si trova interessato nel 75-92% dei casi con un 20-33% (o più) in cui la lesione è a carico esclusivo orale e/o spesso precede l'interessamento cutaneo.
Dal punto di vista diagnostico l'istologia è essenziale.
La triade sintomatologica costituita da Ipercheratosi, Distruzione dello Strato Basale dell'Epitelio ed Infiltrato Sub-Epiteliale "a Banda" appare patognomonica quando contemporaneamente verificata.
Diversamente, nei casi di diagnosi solo "compatibile", alcuni reperti quali i "Fluorescent Bodies" e la presenza di materiale fibrino-simile nei pressi della membrana basale oltre che certi quadri di slatentizzazione di molecole CD e/o antigeni HLA di II ordine a carico dei Cheratinociti e delle cellule del Langerhans, contribuiscono a rendere sicura la diagnosi.
Da un punto di vista patogenetico riteniamo essenziale il ruolo svolto dal sistema immunitario e, a nostro giudizio, meriterebbe un maggior approfondimento l'ancora oscuro meccanismo dei circuiti soppressivi.
Da un punto di vista etiologico interessante è il nesso riscontrabile con i virus epatitici.
Pur non esistendo un apparente diretto legame di causalità, un preciso rapporto statistico è stato individuato tra Lichen Orale ed Epatopatie (anche su un versante qualitativo in quanto peggiore è la prognosi epatopatica, quanto più grave è stata la forma di Lichen Orale che l'ha preceduta).
Su un altro fronte appare, tuttavia, provata la sensibilità di alcuni individui affetti a vari materiali di comune impiego odontostomatologico.
Anche da quanto risulta dalle nostre osservazioni, il decorso del Lichen può essere acuto anche se, solitamente, presenta un più o meno accentuato grado di cronicizzazione con possibilità frequente di recidive a "pussee". Riteniamo che la tendenza alla trasformazione maligna va ridimensionata non superando il 10% dei casi ed è ancora dibattuto, ove ciò occorra, il possibile ruolo giocato dai vari fattori estrinseci. La terapia da noi verificata si basa sui cortisonici, su derivati ed analoghi della vitamina A oltre che, in casi selezionati, su altri presidi quali la rimozione dei materiali dentari incriminati o l'impiego di ansiolitici.
La terapia basata sulla ciclosporina-A per via topica orale nei casi resistenti ad altro si sta dimostrando estremamente promettente.
1994
- Importance of the physical parameters in the bone stimulation induced by active- surface glasses.
[Capitolo/Saggio]
Gatti, Antonietta; O. H., Andersson; G., Valdrè; Chiarini, Luigi; D., Tanza; S., Bulgarelli; Monari, Emanuela
abstract
The present work analyses the in vivo behaviour of a bioactive glass that can be used for osteostimulation in bone defects. the glass called S53P4 was implanted as granules of 3 different sizes in pokets created in rabbit's dorsal muscles to investigate the reactions in the biological fluids. Before the implantation the granules were coated on one side with a layer of gold in order to obtain two sides with different permeability in the same granule and thus two differen velocities of diffusion. After 2 months granules were explanted and processed for observation under Scanning Electron Microscope with an X-ray microprobe in order to study the changed morphology of the granules and the distribution of the elements. The granules were partly leached but there were no signs of total glass breackdown and resorption.
1994
- In-vivo study of the interface developed by three different grain size of a bioactive glass-ceramics AW-G
[Abstract in Atti di Convegno]
Gatti, Antonietta; T., Kokubo; Monari, Emanuela; Chiarini, Luigi; S., Bulgarelli; D., Tanza
abstract
n/a
1994
- Influence on the granule size on the bioactivity of a bioactive glass for the repair of bone defects
[Abstract in Atti di Convegno]
Gatti, Antonietta; O. H., Andersson; G., Valdrè; Chiarini, Luigi; Monari, Emanuela; D., Tanza
abstract
n/a
1994
- Stati cancerizzabili del cavo orale: Nota I. Considerazioni generali. Rassegna critica della letteratura
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Cappelletto, M.
abstract
The authors deal with the current topic of precancerous states of the oral cavity, considering various aspects such as etiopathology, diagnosis, the clinical picture and therefore, nosological classifications. The region of the Air Passages and Superior Digestive Tract (APSDT) should be considered as a single system and it is affected by a set of genetic and environmental conditions common to the various anatomical regions of which it consists. The significance of several irritating agents, which are also habitually used (e.g. tobacco), has been demonstrated for some time, whereas, the actual harmful effects of other factors such as immunodepression in particular, are only now being evaluated and detected. The discussion concerning precancerous lesions of the oral cavity, should actually refer to lesions that do not present the histologic, biological and clinical characteristics of malignant neoplasms, but that have the objective possibility of developing them. Some lesions that traditionally belong to this pathological grouping often present dysplastic aspects, if not the actual characteristics of "carcinoma in situ". Therefore, the availability of a set of indexes is of primary importance and it should be capable of providing an orientation for diagnosis and clinical practices in a precise, standardized manner. The authors hold these indexes to be divisible into three groups as follows. The first group is composed of the "parameters of cellular kinetics" and includes the percentage of cells in phase S (LI), phase S time (Ts), cell cycle duration (Tc), and the growth fraction (GF). The second group consists in the "parameters of cellular morphology", including the nuclear content in DNA, the value of the nuclear surface and the ploidy. The third group is more specific for the existence of a pathologic mass. However, given the uncertainties of the borderlines traditionally attributed to precancerous pathology, this group is definitely useful. It is composed of the potential doubling time (Tpot) and the tumor volume doubling time (Td). Moreover, biopsy is held to be an indispensable tool and the procedure should be conducted in the various manners possible according to well-defined conditions. A correct evaluation of these parameters allows for a correct approach to precancerous pathology and the prevention of the clinical risks of "rapid proliferation" even in the diagnostic biopsy phase.
Gli autori affrontano, in questa loro ricerca, l'attuale tematica degli stati cancerizzabili del cavo orale da un punto di vista etiopatologico, diagnostico, clinico e quindi nosologico.
Con particolare rilievo lo studio, basato sulle esperienze cliniche degli autori, è diretto ad evidenziare i sistemi strumentali più moderni ed atti a garantire l'esatta diagnosi e prognosi clinica.
In quest'ambito esistono 3 gruppi di accertamenti possibili:
il primo è quello proprio degli esami che valutano i "parametri di cinetica cellulare";
il secondo apprezza i "parametri di morfologia cellulare";
il terzo, più specifico per la valutazione di una massa patologica, considera i "parametri di sviluppo tumorale".
L'attenta considerazione di questi dati, spesso frutto di nuove concezioni scientifiche, consente un sempre miglior approccio terapeutico verso le forme patologiche trattate.
PMID: 7984129
1994
- Stati cancerizzabili del cavo orale: Nota II. Patologia e Clinica. Rassegna critica della letteratura
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Cappelletto, M. :.
abstract
The authors examine some specific forms of precancerous states of the oral cavity, selecting them from among the 4 classes defined by the WHO Collaborating Centre for Oral Precancerous Lesions. The immunological system is given particular emphasis. In fact, as studies progress, it appears to be more and more involved not only in the increase in the incidence of such pathologies, but also in the most difficult, if not unknown, genesis of these pathologies. Highly significant examples of this involvement are: Kaposi's Sarcoma, Hairy Cell Leukoplakia, Lichen and Mycoses. Particularly significant aspects for Erythroplasia consist in the following: slow development, frequent and rapid changes in the clinical aspects and its strict connection with Bowen's Disease and Queirat's Erythroplasia. The latter lend further confirmation of its definite precancerous nature and as such, it requires radical surgical treatment. Compared to other forms, the Epidemic variety of Kaposi's sarcoma more frequently affects the oral-salivary glands and structures, the lymph nodes and the laterocervical area. Together with non-Hodgkin tumors, this represents the class of neoplasms most frequently occurring in subjects affected by AIDS. Its "atypical" aggressiveness involves the liver and pancreas and develops over much shorter time periods than the other varieties. In any case, when possible, the treatment required is the excision of the lesions. Neither radiation therapy nor polychemotherapy have yielded encouraging results as yet. In the case of Leukoplakia, it should be kept in mind that today, this pathology is defined "negatively" be exclusion that is the condition must exist that this lesion cannot be clinically or pathologically defined as another lesion. It thus follows that the clinician must maintain an extremely cautious approach in such cases. As concerns prognosis, particular attention should be given to raised, hardened, irregular and fissured forms, which manifest the greatest degenerative capacity. for the classic forms, the treatment adopted is complete exeresis, whereas the use of antiviral drugs is recommended for Hairy Cell Leukoplakia. Lichen Ruber Planus is a papuliferous eruption that is relatively common and affects the skin and mucosa often exclusively involving the oral cavity in the great majority of cases. Besides the clinical picture, the diagnosis of this disease is based on the triad consisting of hyperkeratosis, destruction of the cells of the stratum basale and subepithelial lymphocyte infiltration at distinctly low levels. In uncertain cases, however, the detection of Fluorescent Bodies grouped in large clusters near the hyaline membrane, acquires particular importance for the specification of the diagnosis.
Gli autori compiono ricerche di casistica patologica e clinica prendendo in esame alcuni specifici stati cancerizzabili del cavo orale scegliendoli nell'ambito delle 4 classi elaborate dal WHO Collaborating Centre for Oral Precancerous Lesions.
Particolare risalto è offerto alla trattazione del distretto immunitario che, col progredire degli studi, appare sempre più coinvolto, non solo nel semplice incremento di incidenza di tali patologie, ma nella genesi più recondita delle stesse.
Sotto tale ottica sono stati presi in considerazione il sarcoma del Kaposi (particolarmente nella sua varietà epidemica propria degli HIV positivi), le Leucoplachie, il Lichen Ruber Planus, le Candidiasi e la Papillomatosi florida orale.
La prima delle patologie prese in considerazione merita una menzione particolare.
E' questa una patologia emblematica la cui gravità varia in funzione dell'assetto clinico generale del paziente.
Si presenta, quindi, in effetti quasi come una precancerosi (lenta o con nessuna evoluzione e scarsi sintomi clinici) nel soggetto "sano e robusto", drammaticamente letale nell'immunodepresso.
PMID: 7984130
1994
- Una sperimentazione clinica in tema di danno dentario in corso di Celiachia: correlazioni e conseguenze in rapporto all'apparato stomatognatico.
[Relazione in Atti di Convegno]
Tanza, D.; Bertoldi, Carlo; Chiarini, Luigi; Balli, Fiorella; Bertolani, P.; Marchi, S.; Melli, P.
abstract
La Malattia Celiaca è un'entità patologica caratterizzata da atrofia dei villi intestinali glutine-dipendente spesso associata a malassorbimento.
Gli autori, dopo averne brevemente illustrato l'etiologia, la patogenesi e la diagnostica, passano ad analizzare la natura del particolare danno dentario che ad essa si associa.
Gli autori, in questo studio preliminare, evidenziano una particolare relazione tra danno dentario specifico ed età in cui è stata posta la diagnosi di Malattia Celiaca mentre, apparentemente, non si evidenzierebbero particolari incidenze cariose in questi soggetti, sia nei confronti dei Celiaci negativi per danno dentale che in rapporto alla popolazione controllo non affetta.
I parametri statistici su cui si impernia questo studio, tuttavia, non ammettono livelli troppo "netti" di sicurezza per cui occorrerà proseguire le indagini scientifiche ed aumentare la numerosità della popolazione di studio al fine di pervenire ad un maggior grado di sicurezza ed affidabilità del modello matematico valutativo.
Codice: IT\ICCU\UFI\0356726
1993
- Galss corrosion layers on biactive glass granules of uniform size affect cellular function
[Relazione in Atti di Convegno]
Gatti, a. M.; Ducheyne, P.; Piattelli, A.; Schepers, E.; Trisi, P.; Chiarini, Luigi; Monari, Emanuela
abstract
A bioactive glass called Biogran was implanted as granules of very narrow size range (300-355mm) in rabbit's dorsal muscles and in sheep's mandibular bone in order to determine the glass degratation in biological fluids and its influence on cellular function.Afert 1 month implantation in rabbit and 3 months in sheep , the granules with the surrounding tissue were resected and prepared for the optical and scanning electron microscopy.the results in dorsal muscle tissue showed tha the glass granules were uniformily surrounded by a highly cellular reactive tissue.In bone, granules were found extensively surrounded by bone tissue, in a almost-obliterated defect.
1993
- IN-VIVO EVALUATION OF AN EXPERIMENTAL DENTAL HA-TI IMPLANT
[Articolo su rivista]
Gatti, Antonietta; Chiarini, Luigi; Monari, Emanuela; D., Tanza
abstract
A new design of Titanium dental implant, coated with Titanium oxide and with a Hydroxyapatite apex, was experimented in a Beagle dog's jaw for one year to evaluate the biocompatibility of the materials used and the biomechanical efficiency of the design. The explanted prosthesis and the surrounding bone were embedded in methylmethacrylate resin and the sections observed under Scanning Electron Microscopy (SEM), with an X-ray microprobe to check the interface with bone and the occurrence of ionic release. The results showed that the pin was well accepted by the bone. New bone grew on the metal surface developing a mechanical bond with the prosthesis. No ionic release of the metal was seen.
1993
- La chirurgia oro-maxillo-facciale nel paziente diabetico.
[Articolo su rivista]
Chiarini, Luigi; Riva, P.; Bertoldi, Carlo; Tapparini, L.; Tanza, D.; Bonati M., :
abstract
La sindrome diabetica, presupponendo un coinvolgimento grave di tutti i processi energetico-metabolici, determina sicure premesse per una maggior incidenza e gravità sia della patologia odontostomatologica sia delle complicanze post-operatorie in Chirurgia Oro-Maxillo-Facciale.
Gli autori illustrano, con accento pratico, i necessari sistemi di individuazione diagnostica e stadiazione del diabete mellito che emergono da studi che sono stati condotti per diversi anni.
La sindrome genera danno a livello orale interessando, in modo particolare, 4 compartimenti anatomo-fisiologici diversi.
Il primo di questi è il sistema immunitario, in modo particolare per quel che riguarda la sua frazione Cellulo-Mediata ed Antigen Presenting Capacity (APC).
La compromissione metabolica gioca un ruolo importante nell'ostacolare il fisiologico rinnovarsi dei tessuti, in particolare in caso di ferite.
L'alterazione quantitativa e qualitativa del secreto salivare (fino a quadri degenerativi delle ghiandole stesse) ne altera le capacità antiinfettive e maturative dentali.
La compromissione endocrino-metabolica può condurre a fenomeni caratterizzati da alterazioni evolutive di alcuni distretti (tra i quali quello osseo) e, persino, a quadri diseruttivi e dignatici.
Gli autori, quindi, individuano i principali problemi che l'Odontostomatologo ed il Chirurgo possono incontrare nell'"affrontare" un soggetto affetto dalle varie forme di Diabete Mellito indicandone, nel contempo, le vie di soluzione terapeutica più opportune.
Grande riguardo deve essere usato verso tali pazienti soprattutto in rapporto agli interventi chirurgici. In tali casi può essere indicata una terapia alimentare tramite cibi preconfezionati a qualità e quantità calorica note.
Viene valutato anche l'"impatto" dei più comuni farmaci di interesse Odontostomatologico e Chirurgico Oro-Maxillo-Facciale (anestetici locali, antibiotici, FANS e cortisonici) rispetto al diabetico consigliandone, sconsigliandone o modulandone l'impiego a seconda della tipologia affettiva del paziente, della famiglia farmacologica considerata e della terapia cronica (insulina o ipoglicemizzanti orali) impostata.
Codici: CDU: 616.314 – Cod. CNR: P 00024563.
1993
- Patologia sinusale odontogena: inquadramento e terapia
[Relazione in Atti di Convegno]
Chiarini, Luigi; Tanza, D.; Bertoldi, Carlo; Cantoni, E.
abstract
Gli autori hanno considerato un campione di 736 pazienti trattati i quali presentavano un qualche grado di affezione ai seni mascellari.
Nell'ambito di questo campione sono state selezionate 5 popolazioni che presentavano un'origine patologica sinusale odontogena diversa l'una dalle altre coi carismi del "doppio cieco" (coloro che sceglievano non conoscevano a quale popolazione appartenessero i nominativi estratti e coloro che esaminavano ignoravano la patologia precisa originale e il nome dei pazienti controllati).
L'approccio terapeutico era stato, nei dettagli, diverso ma solo nella prima popolazione era stata mantenuta una breccia comunicante oro-sinusale (comunque sempre inferiore ai 0,5 cm di diametro massimo) cercando di risolvere quest'ultima, come indicato da diversi autori, con metodi non chirurgici.
Veniva, quindi, valutata l'incidenza delle recidive sinusitiche tramite un modello statistico di scala "nominale".
I risultati si dimostrarono inferiori alle aspettative solo in rapporto alla popolazione precedentemente descritta che presentava un numero di recidive nettamente discoste dalle popolazioni con comunicazione oro-sinusale risolta immediatamente per via chirurgica.
Codice: IT\ICCU\UFI\0353014
1993
- Proposta di una metodica di ancoraggio del manufatto protesico agli impianti osteointegrati
[Articolo su rivista]
Chiarini, Luigi; Ferronato, G.; Bertoldi, Carlo; Tanza, D.; Pollastri, G.
abstract
Le metodiche implanto-protesiche vanno sempre più acquistando una precisa collocazione tra i vari sistemi di riabilitazione occlusale di bocche parzialmente o totalmente edentule.
Scopo del lavoro qui presentato non è quello di compiere una disamina critica approfondita sui vari tipi di impianti, bensì quello di proporre un sistema di ancoraggio della sovrastruttura protesica ai pilastri implantari eliminando alcune problematiche tipiche dei sistemi tradizionali laddove questo ancoraggio si ottiene mediante avvitamento del manufatto protesico e non mediante cementazione dello stesso.
Lo studio è stato condotto su una casistica di 28 pazienti.
La presenza di una vite di ancoraggio è, per ragioni intuibili, sicuramente da preferire rispetto alla cementazione della sovrastruttura protesica.
Tale sistema presenta, tuttavia 2 ordini di inconvenienti qualora il sistema di ancoraggio preveda una vite occlusale:
1) La presenza della vite, soprattutto nelle regioni antero-laterali inferiori (canini e premolari) non è sicuramente ben accettata da un punto di vista estetico;
2) La vite di ancoraggio della sovrastruttura protesica tende a fratturarsi, specie nel caso in cui gli elementi dentali del manufatto presentano un'altezza elevata;
Senza contare, poi, che per cercare di rimediare all'inestetismo di cui al punto 1 vengono spesso integrate alla protesi implantare opere conservative in resina (con funzioni occlusive e disclusive) che, in quanto tale, tende a consumarsi rischiando di alterare l'assetto occlusale che il protesista aveva impostato.
Per ovviare a questi inconvenienti gli autori propongono un sistema di ancoraggio della sovrastruttura protesica basato sull'esecuzione di una prima struttura in metallo (oro da ceramica) a travata molto bassa (detta "sottostruttura") da fissare, mediante avvitamento, direttamente agli impianti. Successivamente la sovrastruttura protesica in oro-ceramica verrà fissata alla sottostruttura mediante piccole viti posizionate sul lato linguale (quindi non visibili) che vadano ad avvitarsi in appositi alloggiamenti preparati su quest'ultima.
Il sistema suddetto si presenta estremamente versatile, non si è verificato più alcun caso di frattura delle viti di ancoraggio e la stabilità della sovrastruttura si è rivelata assolutamente valida.
1993
- Uso di innesti ossei autologhi, di materiale eterologo od alloplastico nella ricostruzione del pavimento orbitario
[Relazione in Atti di Convegno]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Cantoni, E.
abstract
Gli autori, dopo aver esaminato l'anatomia, la fisiologia e la clinica delle lesioni fratturative del pavimento orbitale, affrontano la tematica terapeutica con particolare riguardo al protocollo d'impiego dei mezzi da innesto disponibili quali, per esempio, la Dura Madre Purificata, l'Idrossilapatite, le Mesh in titanio o vitallium, la Cartilagine Eterologa, la Cartilagine Autologa e l'Osso Autologo.
Le potenzialità dei suddetti mezzi sono, quindi, analizzate e poste a confronto.
In tale ottica risulta che il tessuto osseo autologo è quello che, più di ogni altro materiale, soddisfa più da vicino i requisiti ideali dell'innesto dimostrando, soprattutto, una stabilità biologica e dimensionale superiore anche in rapporto ai maggiori difetti.
Questo non solo perchè si tratta di un tessuto autologo: infatti, altri tessuti di tale derivazione, quali la cartilagine auricolare, presentano svantaggi rispetto all'osso poichè, nel suddetto caso, sono legati principalmente alla connaturata tendenza alla torsione ed alla deformazione.
Codice: IT\ICCU\RML\0039257
1993
- Utilizzo delle microplacche nelle fratture dello zigomo.
[Relazione in Atti di Convegno]
Chiarini, Luigi; Tanza, D.; Bertoldi, Carlo; Cantoni, E.
abstract
Gli autori, dopo aver affrontato le caratteristiche del mezzo osteosintetico in questione ed averlo rapportato alle aree lesive inerenti al complesso zigomatico, ne analizzano più da vicino le caratteristiche biomeccaniche.
Propongono quindi un protocollo operativo dell'impiego delle placche per le lesioni fratturative coinvolgenti il complesso zigomatico. Tale protocollo vede opportuno l’impiego di microplacche a livello periorbitario e di miniplacche a livello del pilastro zigomatico ed ogniqualvolta vi sia una perdita di sostanza ossea e quindi necessttà maggiore di esercitare una fissazione interna rigida.
Codice: IT\ICCU\RML\0039257
1993
- Verifica statistica dell'impostazione terapeutica nel trattamento delle epulidi.
[Relazione in Atti di Convegno]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Cantoni, E.
abstract
Gli autori compiono uno studio retrospettivo matematico basandosi su 350 pazienti trattati chirurgicamente affetti dai diversi istotipi di epulide.
Scelgono, con i carismi del "doppio cieco", due popolazioni di soggetti: la prima (G1) caratterizzata da mobilità patologica dell'elemento dentario in rapporto alla lesione epulidea o con reperto radiologico corrispondente (che può associarsi, o meno, al quadro di mobilità);
la seconda (G2) sempre composta da soggetti affetti da Epulide, ma che non presentano il quadro suddetto.
Nell'ambito di ognuna delle suddescritte due popolazioni vengono scelti due gruppi.
Esistono, a questo punto, 4 popolazioni (2 afferenti a G1, dette C3 e C4 e 2 afferenti a G2, dette C5 e C6).
C3 e C5 sono trattate con epulidectomia associata ad avulsione, C4 e C6 con epulidectomia semplice.
I confronti, ovviamente, vengono eseguiti tra C3 e C4 e tra C5 e C6.
Il modello statistico-matematico, basato sulle Tabelle di Contingenza con il test CHI-quadro, atto a valutare l'eventuale similitudine delle varie popolazioni in rapporto alle recidive al trattamento, dimostra una maggior incidenza di recidive nella popolazione C4.
Con altri campionamenti ed altri test gli autori giungono a dimostrare che l'avulsione dell'elemento in rapporto all'epulide costituisce un trattamento radicale in grado di azzerare le differenze tra i gruppi, ma che, se suddividiamo correttamente i soggetti nell'ambito di G1 e G2, lo stesso risultato si può ottenere sui G2 senza ricorrere alla menomazione dell'apparato dentale.
Codice: IT\ICCU\UFI\0353014
1992
- Analgesia con agopuntura ed elettroagopuntura in chirurgia orale ed in altri campi dell'odontostomatologia
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Magi, C.; Spaccasassi, C.; Bellesia, R.
abstract
Gli autori fanno ampio riferimento alle basi dottrinarie dell'agopuntura cinese e dell'applicazione della medesima in anestesiologia in genere ed in quella Odontoiatrica in particolare.
Passano quindi ad illustrare la loro sperimentazione clinica condotta su 24 pazienti di entrambi i sessi con fascia d'età compresa tra i 23 ed i 41 anni.
Suggeriscono alcuni criteri che sono emersi essere utili al fine del corretto ricorso all'agopuntura od all'elettroagopuntura. in Odontostomatologia.
Tra essi,quello dominante, è un’accurata scelta dei pazienti in rapporto a personalità che dimostrano di comprendere le basi della metodica che cui devono sottoporsi.
I risultati conseguiti sono non pienamente soddisfacenti in rapporto alle pulpotomie/pulpectomie degli elementi dentali (soprattutto poliradicolati) ed alle terapie dentali in rapporto ai terzi molari.
Vista la sostanziale modestia dei risultati, le procedure di agopuntura possono ritenersi indicate esclusivamente in quelle situazioni in cui non si possa agire diversamente.
1992
- Applicazione del laser CO2 in chirurgia orale: fisica della radiazione laser e sue caratteristiche
[Articolo su rivista]
Chiarini, Luigi; Ferronato, G.; Pollastri, G.; Tanza, D.; Bertoldi, Carlo
abstract
Gli autori, dopo aver presentato le caratteristiche fisiche e biologiche della radiazione "Light Amplification by Stimulated Emission of Radiation" (LASER) ne illustrano l'utilizzo nell'ambito della Chirurgia Orale.
In tale ambito i principali vantaggi espressi talla tecnologia Laser stanno nell'induzione di una buona emostasi nel campo operatorio (anche senza l'impiego di anestetici locali dotati di vasocostrittore), nei ridotti (rispetto alle tecniche tradizionali) fenomeni di fibrosclerosi secondaria, negli scarsi fenomeni di necrosi tissutale (con sterilizzazione della zona di incisione) che implicano una minor reazione infiammatoria ed un minor edema post-operatorio.
Per tali ultimi motivi, nella quasi totalità dei casi trattati, non è necessario prescrivere farmaci antinfiammatori ed analgesici.
Unico svantaggio degno di nota risulta essere l'allungamento della durata dell'intervento che, tuttavia, potrà essere ricondotta entro limiti pienamente accettabili con l'acquisizione, da parte del chirurgo, di una buona manualità operativa.
1992
- Aspetti patologici e terapeutici delle neoproliferazioni delle ghiandole salivari
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Magi, C.
abstract
In questo lavoro gli autori vogliono studiare i protocolli terapeutici ed, in particolare, le metodologie chirurgiche che si sono imposte negli ultimi anni in rapporto all'istotipo, al comportamento clinico ed alla sede di insorgenza dei neoplasmi che possono colpire le ghiandole salivari.In particolare, sono presi in esame le "vexatae questiones" inerenti il "problema dello "svuotamento funzionale linfonodale del collo" ed il "sacrificio eventuale di tronchi nervosi" (soprattutto in riferimento al VII nervo cranico).Gli autori rilevano come, in questi ultimi casi, l'atteggiamento chirurgico possa e debba essere conservativo ogni qualvolta i paramentri T, N e l'istotipo neoplasico lo consentano.Al di là delle standardizzazioni, comunque necessarie, un ruolo insostituibilmente importante sarà giocato dall'esperienza clinica dell'operatore.
1992
- Atteggiamento del chirurgo odontostomatologo nei confronti dei pazienti affetti da epatopatia
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Iori, R.; Bonati, M.; Tanza, D.; Ferronato, G.
abstract
Il fegato è un organo dotato di attività proteiformi e complesse la cui funzionalità è indispensabile alla vita della persona.La fisiopatologia epatica sarà, quindi, tanto ampia quanto importante.Gli autori presentano una trattazione di piglio pratico delle principali patologie epatiche unitamente al protocollo diagnostico clinico-laboratoristico-strumentale corrispondente.L'organo epatico leso, infatti, rappresenta per il paziente un rischio costante. Quest'ultimo può concretizzarsi, più facilmente, sotto l'aspetto di disturbi della coaugulazione sistemica e/o con una crisi epatica (fino all'epatolisi) in caso di ipossia relativa dell'organo, già di per se stesso, leso.Gli autori presentano i protocolli necessari a prevenire siffatte emergenze patologiche ed, eventualmente, a terapizzarle.Illustrano, inoltre, un protocollo terapeutico farmacologico atto a fornire all'Odontostomatologo ed al Chirurgo Oro-Maxillo-Facciale un'ampia e pertinente scelta di farmaci non epatotossici.
1992
- Attività osteoconduttrice del Bop: risultati sperimentali.
[Relazione in Atti di Convegno]
Gatti, Antonietta; Chiarini, Luigi; Tanza, D.; Monari, Emanuela; Giacobbi, F.
abstract
n/a
1992
- Compatibilità bio-fisica tissutale nella realizzazione di osteosintesi con filo riassorbibile in chirurgia maxillo-facciale
[Relazione in Atti di Convegno]
Bertoldi, Carlo; Chiarini, Luigi; Tanza, D.
abstract
Gli autori illustrano i risultati longitudinali di studi iniziati anni addietro circa l'impiego di filo riassorbibile nella realizzazione di osteosintesi in determinati casi Chirurgici di pertinenza Maxillo-Facciale.
Il filo studiato è il Maxon®, un monofilamento sintetico riassorbibile completamente in circa 6 mesi ed a base di acido glicolico.
Gli autori, discutendo un caso clinico particolarmente significativo in proposito, illustrano l'impiego di tale presidio che, nel rispetto delle realtà bio-meccaniche nell'ambito in cui si era reso necessario il suo utilizzo, si è dimostrato (e confermato) privo di inconvenienti particolari (eccettuati quelli flogistici praticamente normali per i materiali glicolici).
La sue caratteristiche meccaniche, inferiori, certo, a quelle proprie dei fili metallici, si sono dimostrate, tuttavia sufficienti, quando impiegato in realtà compatibili, a contenere i modelli di forza espressi ed a permettere ai tessuti coinvolti l'adattamento necessario alla nuova realtà anatomica conseguita con l'osteosintesi.
1992
- Hemimandibular reconstruction via an autologous transplant of vascularized fibula. A report of a clinical case. (Ricostruzione di un emicorpo mandibolare mediante trapianto autologo di perone vascolarizzato. Presentazione di un caso clinico.
[Articolo su rivista]
DE SANTIS, Giorgio; Chiarini, Luigi; Cantoni, Luca; Riccio, M.
abstract
The authors illustrate the advantage of vascularised as opposed to conventional edges in the reconstruction of the jaw, focusing in particular on the use of a fibular autologous transplant. After a rapid description of the surgical technique used to remove the graft, they report a case of mandibular reconstruction in a young patient who had been involved in a shooting accident which had led to the loss of the left of this jaw.
1992
- I Tumori maligni dei seni paranasali: inquadramento, diagnosi e terapia
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Magi, C.
abstract
Gli autori, dopo aver brevemente presentato le caratteristiche di incidenza e d'istologia delle principali neoformazioni maligne inerenti i seni paranasali, passano alla valutazione dei principali parametri di diagnosi, staging e trattamento.Tra i principali strumenti diagnostici si dimostra che la TC e l'RMN svolgono un ruolo di primo piano e così anche nello staging, contribuendo a definire i limiti della massa neoplastica e la sua localizzazione.Da un punto di vista terapeutico il ruolo primario è svolto sicuramente dal Chirurgo, anche se i moderni protocolli radioterapici e polichemioterapici stanno producendo risultati, fino a poco tempo fa, impensabili con le precedenti tecniche.Gli autori illustrano e discutono le metodologie chirurgiche in rapporto ai principali casi di invasione neoplastica.La Chirurgia Oro-Maxillo-Facciale e la scienza protesica svolgono, infine, un ruolo combinato e, spesso, integrato nella fase riabilitativa.
1992
- Impianti osteointegrati su innesto vascolarizzato
[Relazione in Atti di Convegno]
Chiarini, Luigi; DE SANTIS, Giorgio; Cantoni, E.; Tanza, D.; Bertoldi, Carlo; Tassinari, M.
abstract
La ricostruzione dei settori ossei del distretto Maxillo-Facciale, dopo resezioni per patologie tumorali o displastiche o dopo perdite di sostanza per gravi traumatismi, ha sempre rappresentato un settore operativo di notevole importanza, difficoltà e frequenza.Nei casi in cui, poi, la regione interessata si riveli particolarmente estesa, comprendendo una parte od anche un'intera arcata alveolare, oltre a tutti i problemi comuni a tutti i tipi di innesto ( dimensioni, modellabilità, vitalità, ecc.), subentra la problematica inerente la riabilitazione delle potenzialità fisiologiche orali.In questo lavoro gli autori studiano l'impiego dell'innesto rivascolarizzato di perone nella riabilitazione globale di soggetti con carenze di ampi settori ossei mandibolari.Il perone rivascolarizzato nelle ricostruzioni mandibolari si è dimostrato un lembo altamente versatile, trofico, con caratteristiche morfologiche che si prestano perfettamente alla sostituzione della mandibola mancante.In particolare, per quanto concerne la riabilitazione con impianto finale di fixture edossee, l'aspetto strutturale (bicorticale con canale midollare interno) offre un substrato particolarmente adatto permettendo il posizionamento degli impianti in bicorticalismo.Codice: IT\ICCU\UFI\0353309
1992
- In vivo study of a new polymeric material.
[Abstract in Atti di Convegno]
Monari, Emanuela; Gatti, Antonietta; Chiarini, Luigi
abstract
n/a
1992
- Inquadramento nosologico e terapeutico delle epulidi
[Relazione in Atti di Convegno]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Cantoni, E.
abstract
Gli autori, dopo aver considerato la struttura e l'eventuale etiopatogenesi dei diversi tipi clinico-istologici dell'Epulide, compiono uno studio retrospettivo sui casi trattati riscontrando vantaggioso un modello d'approccio terapeutico, in prima istanza, sostanzialmente conservativo in rapporto all'elemento dentale coinvolto (salvo specificate controindicazioni concernenti, principalmente, un ineliminabile ampio coinvolgimento del tessuto parodontale).
Delineano, inoltre, quella che potrebbe essere una comune linea etiopatologica evolutiva coinvolgente i vari istotipi epulidei e che avrebbe alla base la forma Giganto-Cellulare ed Angiomatosa ed, al termine, l'Epulide Fibromatosa.
Codice: IT\ICCU\RML\0031868
1992
- L'apicectomia: indicazioni e metodologie d'impiego
[Relazione in Atti di Convegno]
Chiarini, Luigi; Tanza, D.; Bertoldi, Carlo; Cantoni, E.
abstract
L'apicectomia è la tecnica chirurgica per mezzo della quale si realizza la sezione dell'apice radicolare con bonifica dello spazio anatomico circostante a quest'ultimo.
Gli autori, dopo aver individuato i significati ideali e le precise indicazioni alla terapia apicectomica, compiono uno studio su basi retrospettive dai cui risultati emerge quali devono essere le metodologie d'impiego, in relazione ai diversi casi e distretti in cui si è chiamati ad intervenire.
Vengono analizzate varie vie d'accesso tramite lembi mucoperiostei quali quello Lineare Rettilineo (verticale od orizzontale), il Lineare Semilunare, il Lembo Rettangolare, l'Incisione a Lembo Trapezoidale e l'Incisione a Lembo Angolare. Per ognuna di esse vengono individuati pregi e difetti assieme, eventualmente, al "campo di applicazione" ottimale.
Emerge, così, che l'Incisione Rettilinea Verticale può fornire risultati accettabili quando impiegata in rapporto a lesioni estremamente limitate sui settori anteriori (e per un singolo elemento dentale), l'Incisione Semilunare si dimostra valida in rapporto a piccole lesioni dei settori dentali anteriori, l'Incisione a Lembo Trapezoidale consente di intervenire su più elementi dentari e si dimostra in grado di fornire risultati estremamente positivi (sia dal punto di vista chirurgico che trofico) soprattutto sui settori anteriori e l'Incisione a Lembo Angolare risulta elettiva per i settori posteriori anche in rapporto a lesioni apicali estese.
Al riguardo, poi, del problema dell'otturazione retrograda, considerandone il significato, se ne distinguono i casi ed i materiali utilizzabili ed i frangenti in cui detta procedura potrà essere considerata inutile. Tra i materiali studiati stanno la Guttaperca, gli Amalgami, i Compositi ed i materiali a base di Poliacidi (Es.: Cementi Vetroionomerici).
I Vetroionomerici ed i Compositi, ad esempio, saranno impiegabili elettivamente in quei casi in cui non sia possibile garantire all'otturazione retrograda un sottosquadro ritentivo efficace, mentre, diversamente, risultati soddisfacenti sono ottenuti tramite gli Amalgami "non Gamma 2" e privi di Zinco.
Risulta, inoltre, che l'otturazione retrograda può essere evitata in quei casi in cui non si ha obiettività mentre, è presente soggettività algica alla pressione in corrispondenza all'apice dentale. In tali casi, una volta raggiunto l'apice, sarà sufficiente il curettage dello stesso.
L'esecuzione di questi protocolli ha prodotto risultati positivi con una media superiore al 90% dei casi.
Codice: IT\ICCU\RML\0031868
1992
- L'utilizzo della metodica di Kazanjian nelle insufficienze del fornice vestibolare
[Articolo su rivista]
Chiarini, Luigi; Ferronato, G.; Bertoldi, Carlo; Tanza, D.
abstract
L'aumento della durata media della vita ha reso ulteriormente pressante la necessità di poter far fronte sempre più efficacemente alle problematiche inerenti l'età anziana.
Tra esse, in campo Odontostomatologico, si pone in primo piano la necessità di garantire una corretta riabilitazione funzionale ed estetica di tipo protesico.
Il riassorbimento della cresta alveolare rappresenta una delle patologie più tipiche dell'anziano e si associa, nella gran parte dei casi, ad un quadro di edentulismo (parziale o totale).
Il risultato di ciò sarà la necessità di provvedere, nei casi di edentulia, alla preparazione di un manufatto protesico opportuno o al riadattamento di un'opera preesistente che ha perso la necessaria stabilità. In quest'ultimo caso, in particolare, sarà necessario intervenire con ulteriore tempestività poichè una protesi "con sella gengivale crestale" che ha perso l'adattamento ai tessuti molli su cui poggia genera, anche "in situ", molti problemi tra cui, non ultima, un'accelerazione dei processi di riassorbimento dell'osso della cresta alveolare.
Da qui la necessità di condurre interventi precoci onde evitare che si ingenerino situazioni la cui soluzione attuabile possa rivelarsi molto complessa.
Tra gli interventi di chirurgia preprotesica attuabili al fine di incrementare i substrati ossei e di mucosa aderente per riconferire stabilità ad eventuali protesi mobili un ruolo non certamente secondario è ricoperto dalla metodica di Kazanjian.
Gli autori, in questo lavoro, vogliono affrontare il problema dell'insufficienza di fornice in rapporto all'intervento di Kazanjian.
Il lavoro di ricerca si è svolto su un campione di 23 individui di ambo i sessi e di ètà compresa tra i 48 ed i 73 anni.
La metodica studiata è stata attuata in caso di edentulia dei settori anteriori inferiori (da canino a canino) con insufficienza verticale del fornice.
Si è deciso di valutare un insuccesso una perdita, dopo 6 mesi dall'intervento, della dimensione verticale del guadagno ottenuto superiore all'80% (poichè la lunghezza del lembo era stata mantenuta dell'80% in più della necessità di guadagno nell'approfondimento del fornice, la perdita dell'80% complessivo del guadagno conseguito originariamente con l'intervento corrisponde, circa, alla metà dell'accrescimento dimensionale ricercato).
Gli insuccessi sono stati 3 (12,5%), in altri 8 casi (32,5%) la perdita del guadagno conseguito è stata valutata tra il 50% e l'80% mentre nei restanti 12 pazienti (55%) i risultati sono stati considerevoli con mantenimento dell'altezza del fornice dal 50% al 100% e, conseguente, buona stabilità protesica.
Da ciò possiamo dedurre che l'intervento di Kazanjian rappresenta, in rapporto anche ad altre tecniche descritte in letteratura, un'alternativa semplice, poco invasiva e foriera di buoni risultati quando applicata ai settori anteriori-inferiori.
1992
- Le atrofie parziali della cresta alveolare: inquadramento nosologico e nuova proposta terapeutica
[Articolo su rivista]
Chiarini, Luigi; Ferronato, G.; Bertoldi, Carlo; Tanza, D.
abstract
Gli autori, dopo una breve disamina sulle classificazioni delle atrofie parziali della cresta alveolare e sulle tecniche chirurgiche finora utilizzate per la risoluzione di queste patologie, propongono una nuova metodica imperniata sull'utilizzo del Tissue-Expander descrivendone il sistema d'impiego, i vantaggi e gli svantaggi di questa tecnica e concludono con le seguenti considerazioni:
1) L'uso del Tissue-Expander è di facile attuazione, richiedendo un intervento di tipo ambulatoriale in anestesia locale e risultando, quindi, agevolmente attuabile rispetto ad un'ampia gamma di pazienti;
2) Il Tissue-Expander induce la formazione di una capsula fibrosa contentiva e d'un valido substrato trofico per il materiale da impiantare;
3) Permette di ben controllare le retrazioni elastica e cicatriziale evitando, quindi, eventuali successive variazioni dimensionali dell'innesto.
1992
- Le odontopatie in ambito di ereditarietà genetica e cromosomica. Nota I: aspetti fisiopatologici
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Magi, C.
abstract
La disciplina Odontostomatologica non può essere considerata una realtà a sè stante.
Già di per se stesse le funzioni nelle quali è decisamente coinvolto l'apparato di cui essa si occupa ne legittimano un'attribuzione d'importanza che supera certamente un immeritato intento di segmentazione disciplinare.
Tale aspetto trova abbondante riscontro tanto nella clinica delle patologie ereditarie quanto nel compiersi dei meccanismi fisiopatogenetici delle stesse.
1992
- Le odontopatie in ambito di ereditarietà genetica e cromosomica. Nota II: inquadramento nosologico
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Tanza, D.; Magi, C.
abstract
Nella storia della Medicina troppo spesso la disciplina Odontostomatologica è stata considerata una realtà a sè stante anche se non scevra d'importanza.
Essa, particolarmente, era ritenuta latrice di uno scarso valore di interconnessione con altre specialità Medico/Chirurgiche al fine di conseguire un miglioramento diagnostico/terapeutico tanto della prima quanto nei confronti delle seconde.
Oggi, dopo attenti studi concernenti l'ambito fondamentale dell'ereditarietà (considerata sia nei suoi aspetti fisiologici che patologici e, in rapporto a questi ultimi, non solo dal punto di vista più classico clinico/descrittivo ma anche da un'angolazione più moderna biochimica/metabolica), gli autori, con il presente lavoro, si propongono di offrire un contributo all'opportunità di rivendicare, per la disciplina Odontostomatologica, un documentato rilievo diagnostico, terapeutico e di ricerca scientifica nel campo delle patologie ereditarie.
1992
- Mielolipomatosi: Presentazione di un caso a localizzazione mandibolare
[Articolo su rivista]
Chiarini, Luigi; Bertoldi, Carlo; Criscuolo, M.; Ferronato, G.
abstract
Il Mielolipoma consiste in un raro tumore benigno che colpisce, nella maggior parte dei casi, il surrene.Data, quindi, tale assoluta maggior incidenza, abbiamo ritenuto lecito e necessario far riferimento, nella successiva descrizione anche extra-surrenalica di tali forme, a questa prima, relativamente più folta, messe di dati, fatte salve le diversità, supposte o reali, che tra i due gruppi esistono.La Mielolipomatosi non deve essere considerata un esempio di displasia, bensì, più benignamente, di metaplasia-amartoma.E' quindi ovvio come, al cospetto di un processo espansivo di siffatta natura, si imponga la necessità di una diagnosi certa, gravida di conseguenze cliniche e terapeutiche, le quali, poi, si estrinsecheranno anche in funzione del sito anatomico colpito.Gli autori, sulla base dei vari aspetti pato-fisiologici di queste forme, hanno elaborato un protocollo diagnostico cui succede un momento terapeutico che, nel nostro ambito, deve essere attivo e non imperniato su una strategia permanente di "attesa".Inoltre riteniamo che, dallo studio della Mielolipomatosi, emerga sempre più lecita l'ipotesi tesa a considerare la forma patologica presa in esame come un'entità non troppo discosta da ciò che l'organismo, nel suo insieme e con le sue logiche, può attuare come reazione ad un evento stressigeno opportuno e perdurante nel tempo.
PMID: 1461236
1992
- Risposte dell'osso in presenza di alcuni bioceramici attivi in forma granulare.
[Relazione in Atti di Convegno]
Gatti, Antonietta; Chiarini, Luigi; Monari, Emanuela; D., Tanza
abstract
Tre tipi di materiali a diversa bioattività sono stati inseriti in nicchie create chirurgicamente in mandiboila di pecora. Dopo 5 mesi i materiali sono stati espiantati e trattati per l'osservazione alla microscopia elettronica a scansione e alla microsonda a raggi X. Si sono riscontrate tre diverse interfacie con l'osso e tre diversi comportamenti bioconduttivi.
1992
- Use of fibula free flap in mandible reconstruction: Cases reports (L’impiego del perone vascolarizzato nella ricostruzione della mandibola: presentazione dei casi clinici)
[Relazione in Atti di Convegno]
DE SANTIS, Giorgio; Chiarini, Luigi; Riccio, M.
abstract
From January 1990 to December 1991, 4 patients were treated by the authors with fibula free flap for mandible reconstruction. Two cases were oncological, 1 posttraumatic and 1 infected pseudoarthrosis. The age of the patients ranged from 25 to 54, the average lenght of the mandible defect was 12.25 cm. In 1 case the anterior arch of the mandible was reconstructed and in the other 3 cases the reconstruction involved the hemimandible including the T-M joint (1 case). No early general, local or microsurgical complications were observed. We had only 1 late complication due to the recurrence of the infection in a case of recurrent infected pseudoarthrosis. Bone fixation was obtained with K. wires (2 cases) and with miniplates (2 cases). In 1 case together with the bone flap a fair amount of F.A.L. muscle was taken to better contour the soft tissue loss. All microsurgical anastomoses were performed on the facial artery and homonymous veins. All osteotomies sites healed primarily, in 1 case osteointegrated implants have been positioned in the graft to be fitted with conventional dentures. Simmetry and contour of the mandible were judged to be good and excellent in all patients as well as mandible range of motion. Fibula free flap has the advantage of bicortical shape, ample lenght, possibility of segmentation and contour, distant location of donor site (to allow a team approach) and low donor site morbidity. For these reasons we consider it the flap of choice in mandible reconstruction expecially when the bony defect is prevalent and soft tissue loss is limited.
1991
- Utilizzo clinico del tissue-expander nelle atrofie totali di cresta alveolare mandibolare
[Relazione in Atti di Convegno]
Chiarini, Luigi; Tanza, D.; Bertoldi, Carlo; Cantoni, E.; Pollastri, G.; Galetti, R.
abstract
L'atrofia della cresta alveolare è una patologia che si manifesta con un quadro più o meno marcato di riassorbimento dei processi alveolari dei mascellari.Vari tipi di approccio chirurgico sono stati proposti, tra essi la tecnica ad innesto osseo Onlay, l'Osteotomia a "Visiera", quella a "Sandwich" ed altri metodi ancora.I risultati, però, denunciano un certo "gap" con ciò che ci si aspettava di ottenere.Gli autori, con questo lavoro, vogliono verificare le tecniche per la risoluzione delle atrofie della cresta alveolare tramite i Tissue-Expander ed i materiali Alloplastici.A distanza di un anno dall'intervento, i test radiologici hanno evidenziato un riassorbimento del materiale alloplastico, sotto carico protesico "a sella", paragonabile a quello fisiologico (osso crestale del soggetto). Questa tecnica, inoltre, consente il carico protesico precoce, una buona protezione del fascio vascolo-nervoso mandibolare, la quasi totale assenza di dislocazione del materiale alloplastico impiantato e di lesioni trofiche (con conseguenti deiscenze) a carico dei tessuti molli.Ulteriori studi saranno, tuttavia, necessari con particolare riguardo ai casi estremi (necessitanti di più ampie dilatazioni tissutali) di atrofia crestale.Codici: BNI: 91-9015; IT\ICCU\CFI\0166089