Vol. 5 n° 1 2006



Vol. 5 n° 1 2006
International Journal of Maxillo Odontostomatology
Honorary President
Giovanni Dolci
Editor in Chief
Luigi Mastroianni
Scientific Director
Mauro Orefici
Editorial Office
Romano Amato
Advisory Board
F. Nardi (Anatomia Patologica), C. Ciarla, E. Cipriani (Anestesiologia Maxillo Odontostomatologica), M. Bobò, M. Cipollone,
V. Contreas, G. Iannetti, A. Moro (Chirurgia Maxillo Odontostomatologica), B. Condorelli, C. Maggiore, M. Procaccini, M. Ripari
(Clinica Odontostomatologica), A. Schindler (Fisiopatologia della Deglutizione), V. De Cicco, C. Di Paolo (Gnatologia), A. Lacarbonara,
R. Marasca (Laserterapia), F. Chiarenza (Management Sanitario), C. Angioni, A. Di Corato (Maxillo Odontostomatologia
Forense), A.M. Fornabaio (Odontoiatria Preventiva), F. Ambrosi, F. Cianfriglia, R. Morello, G. Spriano (Oncologia), E. Accivile,
M. Fraccon (Ortodontia), F. Ottaviani (Patologia delle Ghiandole Salivari), M. Capogreco, U. Romeo, F. Spadari (Patologia
Odontostomatologica), M. De Luca (Parodontologia), V. Lacarbonara, R. Gatto (Pedodonzia), A. Barlattani, C. Braconi, F. Di Carlo,
P. Palattella, M. Quaranta (Protesi), A. Paoletti, P. Zotti (Radiologia), A. D’Epiro, M. Donvito, (Sanità Militare),
A. D’Alessandro (Scienza dell’Alimentazione), M. Angelino, E. Ortolani, P. Vallogini (Urgenze Maxillo Odontostomatologiche)
Northern Italy
Central Italy
Southern Italy
Walter Ghinzani
Maurizio Ripari
Domenico Cicciù
F. Basulta Valela
C. Scully
R. Cavesian, J. Dichamp
J. F. Chassagne, P. B. Tardieu
O. Fromovich, O. Nahlieli
W. Chen, M.L. Urken
F. Marchall
Co-Directors: Pasquale Capaccio, Giovanni Davide Galeota
Co-Editors in Chief: Giovanni Ballarani, Antonio Manieri
Administrative Secretary: Andrea Sileo
Scientific Secretary: Vincenzo Palazzo
Technical Director: Massimo Stanzione
Asclepion (Formazione continua in Sanità)
Via Cipro 4H - 00136+ Roma - Tel. 06.3251700
C.O.d.A. (Cenacolo Odontostomatologico dell’Adriatico)
Via Parioli, 41 - 00197 Roma - Tel. 06.8091721
CRAL Ospedale G. Eastman, Roma
Corso P. Umberto, 35 - 65122 Pescara - Tel. 085.373328
Santa Apollonia
Managing Editor
Maurizio Vergnani
Direction, Editorial Office, Graphic Office,
Advertising Office, Administration: Piazza Confienza 3, 00185 Roma,
tel. - fax 06.
e-mail: [email protected]
Web Site: www.simo-santapollonia.it
Pubblicazione Scientifica Trimestrale
aut. 461 del 5 agosto 2002 Tribunale di Roma
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International Journal of Maxillo Odontostomatology
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Capaccio P, Minetti AM, Manzo R,
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Maxillo Odontostomatol 2003; 2:9-12.
Orsini M, Orsini G, Benlloch D, et al.
Comparison of calcium sulfate and
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membranes plus autogenous bone graft
in the treatment of intrabony periodontal defects: a split-mouth study. J
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McNeill C. Current controversies in
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Chicago: Quintessence, 1992:52-65.
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International Journal of Maxillo Odontostomatology
International Journal of Maxillo Odontostomatology
Santa Apollonia
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Forthcoming events
Alessandro Quaranta, Lorenzo Benedetti, Giovanni Ballarani,
Marlene Fabrizi, Giorgio Pompa
Page 3-8
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Philippe B. Tardieu, Luc Vrielinck, Nico Roose
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Vol. 5 - N° 1
International Journal of Maxillo Odontostomatology
formazione continua in sanità
O d o n t o
nel Servizio Sanitario
8 9 10 11
Esiste una Scuola Odontoiatrica Italiana che Ł patrimonio di tutti.
Esiste anche una Gloriosa Tradizione Ospedaliera:
ambizione della SIMO Ł di esserne la voce.
St. Apollonia 2006: S.I.M.O. 4° National Meeting
by Emerenziana Veneziano
On February, 9th, 10th and 11th 2006, close by historic G. Eastman Hospital, 4° National Meeting was set.
On Thursday, opening day, in front of G. Eastman large
square, third Mobile Dental Surgery was showed to the
Authorities. It has been conceived and strongly desired by
Society Chairman, Prof. Mauro Orefici who has been already
planned and made possible, thanks to Regione Lazio, the
achievement, in 2004, of the first two Mobile Dental
Surgeries, an absolutely novelty in Italy, in Europe and
maybe in all the world. This last “creature”, dental hospital
on wheel, it has been supplied with an orthopantomographic
system, thanks to this we can have a complete diagnosis of
treated patients at home, and this will save them of having
to come necessarily in pubblic or private radiological consulting rooms. Ceremony has continued inside assembly
3° Mobile Dental Surgery blessing
Mr Luigi Mastroianni, S.I.M.O. Vice-Chairman, opening speech
600 van Mobile Unit blessing
Ribbon cutting by Regione Lazio Equal Chances Chairman, H. Mrs
Tibaldi Alessandra
Vol. 5 - N° 1
room where long-standing wood of furnishings, of walls
and of floor, of the walnut wood in primis which makes the
environment precious, light up and heat the background
even when the thermometer goes down like in these days.
Authorities have listened, to with interest, the programmes
outlined by the Society, even if everybody has noticed the
absence of hospital sanitary managements and the administrative ones. So we have had the doubt that, maybe
S.I.M.O. aims, they have not been completely understood or
not well explained by Society Board and by all active members. They sacrifice their time and their energies for a praiseworthy reason, that is to say to simplify different ways to
weak classes patients and particularly vulnerable ones allowing them to treat odontostomagnatic apparatus like all
people want care its oral health without come to that terrible
International Journal of Maxillo Odontostomatology
situations that can be resolved only with extensive drainage,
with an enormous damage to patients’ mouth and to Pubblic
finances. The day’s ended with the award, to memory of
“Virgo Fidelis” Arma dei Carabinieri chorus performance
4° National Meeting Opening, authorities desk
Mr Mauro Orefici, S.I.M.O. Chairman, consigns, in memory of Prof. Mario
Martignoni, name-plate and title to his sons Massimiliano and Marco
Prof. Mario Martignoni, of S.I.M.O. great title for his career
with the delivery, to his sons Massimiliano and Marco, of a
memento name-plate.
Then, like culmination, Virgo Fidelis chorus performance
has given great emotion and enthusiasm to the audience.
Archibishop Alberto Tricarico, Apostolic Nuncio, Rome
Vice-Major Mrs M. Pia Garavaglia, Prisoners’ Rights
Guarantor Mr Marroni Angiolo, Mr Claudio Mastrocola,
Quality Department Chief of Health Service Ministry, Mrs
Alessandra Tibaldi Work, Equal Chances and Youth Policies
Chairman, Mr Michele Donvito Military Health Service
General Manager, Mrs Ileana Argentin Rome Major Delegate
for Disabled People, Mrs Silvia Castorina Ziparo Health
Vol. 5 - N° 1
Service Ministry Physician Manager and Mr Giovanni Dolci
Dental Department of La Sapienza University in Rome are
present. Friday the Board of Directors has shown the report
of achieved aims after one year, thanks to Regione Lazio
S.I.M.O. pilot project Mobile Dental Surgery, either about
disabled people services, or about oncological prevention in
square markets, with about 3000 treated patients. Then,
interesting reports and intermeeting courses, like results of
G. Eastman hospital physicians, nurses, dental mechanics,
x-ray technicians experiences, are carried out. On Saturday,
are present: Mr Alberto Barlattani, dentistry course Chairman
at Tor Vergata University in Rome, Mr Giorgio Iannetti
Maxillo-Facial Surgery School Principal at La Sapienza
University in Rome, Mr Vito Contreas Military Health
Service Vice-General Director, Mr Francois Chassagne
Maxillo-Facial Surgery, Face Plastic Surgery and Stomatology Consultant Physician in University hospital in Nancy
(France). So, the most significant annual event of a scientific society’s ended. Its most of great protagonists are hospital experts, achieved private self-employees and distinguished university ones, but first of all are all young members
Those present at the Meeting Italian National anthem performance
International Journal of Maxillo Odontostomatology
Those present at the Meeting
with willingness also which want and they can emerge in
spite of their surnames are not binded to famous people.
This is for this reason that S.I.M.O. is great, because it
gives, to everybody wants, possibility to express itself and
to carry on its voice in national and international dental
world through meetings, courses and pubblications.
I wish good work to everybody and I want to thank the
Board of Directors to wake up again in all people the same
spirit with which George Eastman has created the dental
hospital in Rome.
Mrs Ileana Argentin, Rome Major Delegate for Disabled People
Mobile Dental Surgeries, a very-good reciprocity
between science and social life
Press Office, Work, Youthful and Equal Chances Policies’ Chamber
Today, Santa Apollonia Day - dentists and suffering from
toothache Patron Saint - Regione Lazio Chairman of Work,
Youthful and Equal Chances Policies, MRS Alessandra
Tibaldi, has inaugurated the third Mobile Dental Surgery: a
four-wheeled dental hospital.
The Chairman has been enthusiast about Regione Lazio S.I.M.O.
Pilot Project; a project that means, in a year, prevention at home
for 2923 patients, of whom 2450 among disabled people, and
thanks to this success it will be presented in Regione Lombardia
and in Regione Sicilia also as soon as possible.
This first experience has showed an important aspect: first
one is about social character and concerns the easiness of
access to service and to mouth care of these patients and
Vol. 5 - N° 1
their families, with the consequent reduction of psychosocial effects like suffering and hardship caused by disease;
the second one is about economic field merely: a real saving
in terms of service and social expenditure. In fact, oral diseases individuation, in early phase, it permits to avoid future higher direct expenses (i. e. hospitalization, surgical expense.
etc.) and, on the other hand, it permits to save even indirectly, eliminating secundary costs at family and social
expenses (transfer, leaves, etc.).
Like Mrs Tibaldi, lawyer Angelo Marroni, Prisoners’ Surety,
is enthusiast because thanks to Mobile Dental Surgery this
another “weak” class will take advantage of preventive dental services.
International Journal of Maxillo Odontostomatology
And something remains
by Maurizio Ortu
Sport like instrument of Disabled People Social Integration is
the subject of a Lions District Meeting set in L’Aquila on
March, 4th 2006 c/o Dompé Meeting Room. In the symposium
new methods, new discoveries and new experiments are showed; they permit to the authorized personnel, a best professional approach to citizen exigencies. Present athletes’ proves,
Mr Luigi Mastroianni, Mr Maurizio Ortu, Mr Giorgio Mataloni, Mr G. Davide
Galeota, Mr Mauro Orefici, during Lions recognition name plate donation to S.I.M.O.
guys who are sportsmen at high level because they are competitors for their national teams at Para Olympic Games, they
practise sports like sailing, basketball and positively parashutting, paragliding, skiing and much more, have transmitted to
those present the extraordinary energy they conceal, the desire
to have fun and to compete we find in all guys of the world.
If the others do anything why do not I? this is the question
made by one of them to those present. Images showed by
neo-graduate women of Motor Sciences Faculty are the best
answer to this question. In this faculty, indeed, it works
daily to improve everybody limits, that is to say to permit
guy to stand up, round his pereambulator and to start to push
it. Various experts and physicians contribution, world-famous
also, has agreed to the idea to pay attention on individual
ones, on that people daily search the door, rightly, in a world
that only in the last years, recognized their merits and the
necessity of no-self-sufficients social defence, making possible their treatment. At the meeting end, outdoor, many
people on Mobile Dental Surgery represented, so, the only
one messagge. It was a very great pleasure for the Lions, as
from Mr Giorgio Mataloni, District Governor, to give it
hospitality making the Authorities curious and the partecipants also with this unique and hypertechnological mean of
transport and of treatment.
Mr Gabriele De Cata, Mr Maurizio Ortu, Mr G. Davide Galeota, Mr Fausto Appia, Mr Luigi Zugaro, Mr Mauro Orefici, Archibishop in L’Aquila
Giuseppe Molinari, Chief of Police in L’Aquila Mr Sergio Visone, Mr Luigi Mastroianni, Mr Giovanni Paqua
Vol. 5 - N° 1
International Journal of Maxillo Odontostomatology
Here comes the Mobile Dental Surgery, the new frontier of prevention.The idea of S.I.M.O. chairman, Maxillo Odontostomatology
Italian Society, Prof. Mauro Orefici
by Andrea Lowelok (from “Professionisti Newspaper” Wednesday, January, 4
A Mobile Dental Surgery to approach again citizen-patient
to sanitary prevention, with a sort of service at home from
the original Lazio Region, to other Regions like idea to
export. This is the project of S.I.M.O., Maxillo-Odontostomatology Italian Society, that has already received funds
from Region Lazio. For S.I.M.O. Chairman, Prof. Mauro
Orefici considerable increase of degenerative-chronic disease and of tumors, growing incidence of chronic diseases and
their complications makes possible that financial burden of
these pathologies to pass the buck to SSN change with considerable increase of chronic degenerative diseases and of
tumors. Growing incidence of chronic diseases and their
complications enables that financial weight of these pathologies relieves itself on National Health Service and on citizen budget, and in a decade it will be untenable.
About chronic oral diseases, they are, for a large part, preventable and, this justifies necessity to define company prevention plan together with national one. All developped
nations, just for chronic degenerative diseases expenses, are
active to put into practice welfare, structural, sanitary reforms,
so that to allow possibility of prevention application on a
large scale. Financial Act 2005 foresees that one of Region
aim, to obtain national sanitary fund 5% difference, is national prevention plan and national training plan start.
To start a prevention plan and an encouragement of sanitary
priorities, turning towards all citizens but in particular weak
classes and vulnerable ones like children, old, disabled,
excluded people, is a duty it can’t be disregarded. In Italy
45% of people doesn’t go to the dentist, so, only 55% of
people with a risk factor submits to screening for diagnosis
of oral tumors. It needs of a coordination that permits good
oral health, uniformly, in all national and regional territory
just to guarantee prevention and early diagnosis services
and, then, to obtain good quality life with a cut of maxilloodontostomatological pathologies.
Among Lazio Region strategies about maxillo-odontostomatological prevention, it emerges an experiment made by
S.I.M.O., the only one in its field in Italy and in Europe.
It is the first to think of carry out maxillo-odontostomatological prevention and training at home patients, in associations, home for the aged, in Rsa, in municipalities squares
“clinical research applied on territory”.
S.I.M.O., with respect for its institutional independence and
Vol. 5 - N° 1
2006, Anno I n° 34)
with respect for the laws in force, acts with collaboration spirit and solidarity with national and foreign institutions, with
particular care to carried out researches spreading and achieved knowledges. It promotes, also, sanitary education and
scientific and technic staff training and bringing up to date in
specific field. Now it is important to confront and to coordinate different experiences and organization choices, in its
own organization independence ambit. This research “mobile dental surgeries: clinical research and application on territory” maxillo-odontostomatologia international Journal of
maxillo-odontostomatology vol. 4 n. 3 page 67-87 has passed, in advance, with good marks, experiment phase.
Nowadays we are at second year of project that if involved
all Lazio Region provinces is certainly a transition year.
Success of achieved consents, carried out services, sanitary,
economic and social saving, even if in general scepticism,
have, really, kept to the letter of Ministerial instruction about
necessity of citizen prevention and training at home use.
S.I.M.O. and Lazio Region experimental study, with its successful outcome, aims to suppose the establishment of oral diseases prevention services with hospital at home because of
National Health Service lack in prevention, diagnosis, treatment and rehabilitation of oral diseases specialized public
structures. Mobile dental surgeries for weak classes patients
and vulnerables ones. Now it is necessary to define a role and
staff activity to put an end the whole experimental plan of
S.I.M.O. and Lazio Region maxillo-odontostomatological prevention project at home: “hospital at home”: so, we must recognize priorities in different specific field above mentioned,
From developping age, through schools to disabled people,
from old aged one, with presence of family houses and
excluded aged people institutes, prisoners to get the common citizen.
All of this, Mr Orefici ends, through a well defined
Operative Centre c/o George Eastman Hospital RM A Asl,
Region Lazio leader company for maxillo-odontostomatological prevention at home thanks to Mobile Dental
Surgeries planned by some doctors for this aim just into the
most glorious hospital in Italy. For this aim during the 4°
National Meeting it has been inaugurated the first qualification course for dental operators on Mobile Dental Surgeries:
Mobile Units, just to create a model for an efficacious prevention at national level also.
International Journal of Maxillo Odontostomatology
Initiative will carry out thanks to an Agreement Contract among Regional Prisoners’ Surety, Regional
Director’s Office of Penitentiary Management and Maxillo-Odontostomatological Italian Society (S.I.M.O.)
In Lazio prisons three S.I.M.O. (Maxillo-Odontostomatological Italian Society) Mobile Dental Surgeries will carry out
clinical and therapeutical operations about prisoners to
point out and to treat oral and teeth diseases. The initiative,
the first and the unique one in Europe, starts thanks to an
Agreement Contract signed by Mr Angiolo Marroni,
Regional Surety of Prisoners’rights, by Mr Ettore Ziccone,
Regional Director’s Office of Penitentiary Management and
by Prof. Mauro Orefici, S.I.M.O. Chairman. Service, which
will help to improve oral hygiene conditions, is appointed to
create a favourable climate of opinion, to inform and to train
to good health and to stamp out oral cavity pathologies of
Lazio prisoners. To carry out this activity S.I.M.O. (no-profit Society founded in “George Eastman” Dental Hospital in
Rome), with Lazio Region funds, will utilize doctors, dentists, dental nurses which, just from a long time, carry out
prevention activity of oral cavity diseases among weak classes. Service, will be carried out by three Mobile Dental
Surgeries, Mobile Units equipped with chair, turbine,
hydraulic system, surgical operations kits, sterilizer and
digital x-ray machine. In one of these there is a last generation orthopantomographic system to make digital orthopanoramics for clinical diagnosis.
In prisons will take part beyond Mobile Dental Surgery, a
team with doctor, nurse and driver. Screening will examine
prisoner’s fitness to receive a dental hygiene treatment or
dental one. “Among Surety’s priorities there is Prisoners”
Health Right Defence-Mr Angiolo Marroni said- because
this is one of the most violated in prisons. Oral cavity pathologies are at the third place for incidence in prison. An incidence, that thanks to the Contract and to Lazio Region funds
we hope to depress.
We are always looking for collaborations which can improve prisoners’ life quality, a fundamental aspect of prison life
which passes by these measures of treatment and prevention
also. We have very pleasure about the initiative in all Lazio
prisons-Director, Mr Ettore Ziccone said- and it is in strict
continuity with that one of last February with foresees the
Vol. 5 - N° 1
possibility to have dental prosthesis free for Rebibbia Prisoners’. “Health Right is a duty which society must show for
all citizens. Mr Mauro Orefici, S.I.M.O. Chairman saidcivilization level of a society is measured thanks to lavish
care to defend everybody’s rights. Activity we show, we
hope it will be soon established, is an important step toward
clinical application on territory and dental hospital at home”.
Signature moment Regional Surety of Prisoners’ rights Mr Angiolo
Marroni, Regional Director’s Office of Penitentiary Management Mr
Ettore Ziccone and Prof. Mauro Orefici, S.I.M.O. Chairman.
International Journal of Maxillo Odontostomatology
05-08/04/2006 - Portland, Oregon (USA)
Oregon Dental Association
17898 SW McEwan Road
Portland, Oregon 97224-7798, USA
Exhibits Manager: Cindy Fletcher
E-mail: [email protected]
Tel: +1 503 6203230 ext. 102
Toll free: 800 4525628 ext.102
Fax: +1 503 6204169
Website: www.oregondental.org
Exhibition Venue: Oregon Convention Center
05-08/04/2006 - Rome (Italy)
Information: Pro Odonto Congress srl
Contact Person: Ms. Gallusi
Via Monte delle Gioie 24, 00199 Roma
Tel. +39 06 86211131
Fax. +39 06 86212026
08/4/2006 - ROME (Italy)
E-mail: [email protected]
Website: www.simo-santapollonia.it
07-09/04/2006 - Singapore
KoelnMesse GmbH
Messeplatz 1
50679 Cologne, Germany
Tel. +49 221 821 2374 // 2314
Fax +49 221 821 3325
E-mail: [email protected]
International Contact: Mr. Denis Steker
E-mail: [email protected]
Website: www.idem-singapore.com
Exhibition Venue: Suntec Singapore International Convention
& Exhibition Centre (Level 6)
Vol. 5 - N° 1
15-18/04/2006 - Moscow (Russia)
Dental-Expo Ltd.
Usievicha 8A - 125319 Moscow, Russia
Tel/Fax +7-095 155-79-00, 155-79-03, 152-15-40
E-mail: [email protected] // [email protected]
Website: www.dental-expo.ru
Exhibition Venue: Crocus Expo
17-20/04/2006 - Moscow (Russia)
Dental-Expo LTD
Contact: Mr. Ilia Brodetski
E-mail: [email protected] // [email protected]
Usievicha 8A -125319 Moscow, Russia
Phone/Fax +7 095 155 7900 // 155 7903 // 152 1540
Website: www.dental-expo.ru
Exhibition venue: Crocus Expo
20-22/04/2006 - Washington (USA)
Information: District of Columbia Dental Society
502 C Street, N.E.
Washington, DC 20002-5810 USA
Tel: +1 202 547 7613
Fax: +1 202 546 1482
E-Mail: [email protected]
Website: www.dcdental.org
27-30/04/2006 - New Orleans, Louisiana (USA)
Information: AAOP - American Academy of Orofacial Pain
19 Mantua Road, Mt. Royal
New Jersey 08061 - 1006, USA
Referent: Wendy Stevens
Tel. +1 856 423 7222 262
E-mail: [email protected]
Website: www.aaop.org
Exhibition Venue: Sheraton New Orleans Hotel
International Journal of Maxillo Odontostomatology
06/05/2006 - Narni-Terni-Umbria-Italy
E-mail: [email protected]
Website: www.simo-santapollonia.it
06-09/05/2006 - Las Vegas, Nevada (USA)
Information: AAO - American Association of Orthodontists
Attn: AAO Senior Meetings and Exhibits Manager
401 North Lindbergh Boulevard
St. Louis, Missouri
USA 63141-7816
Tel: +1 314 993 1700
Fax: +1 314 997 1745 // 692 8178
Toll free: 800 424 2841
Website: www.aaortho.org
Website: www.AAOmembers.org
E-mail: [email protected]
Exhibition Venue: Sands Expo, Halls B
11-13/05/2006 - Vienna (Austria)
Information: Osterreichischer Dentalverband
Eschenbachgasse 11
A-1010 Vienna, Austria
Tel +43 1 587 363322
13/05/2006 - Pescara (Italy)
E-mail: [email protected]
Website: www.simo-santapollonia.it
18-20/05/2006 - Birmingham (UK)
Information: BDA Events team
Tel: +44 20 7563 4590
Fax: +44 20 7563 4591
Elise Cole
E-mail: [email protected]
Website: www.bda-events.org
Vol. 5 - N° 1
18-20/05/2006 - Rimini (Italy)
Information: Associazione Amici di Brugg
Via A. Cantore, 45
16149 Genova
Tel/Fax:+39 010 6451539
E-mail: [email protected]
Website: http://www.amicidibrugg.it
Exhibition Information: PROMUNIDI S.r.l., Mr. Luigi De Vecchi
Tel: +39 02 70061221
Fax: +39 02 70006546
E-mail: [email protected]
E-mail: [email protected]
27/05/2006 - Rome (Italy)
Centre: George Eastman Hospital - Rome
E-mail: [email protected]
Website: www.simo-santapollonia.it
10/06/2006 - Torino (Italy)
E-mail: [email protected]
Website: www.simo-santapollonia.it
21-24/06/2006 - Ponza (Italy)
E-mail: [email protected]
Website: www.simo-santapollonia.it
International Journal of Maxillo Odontostomatology
*Antonio D’Alessandro, MD,DDS, **Antonella Barone, PhD Oral Hygiene, *Annalisa Aggio, PhD Biology,
**Mario Capogreco, MD,DDS, **Mario Giannoni, MD,DDS
Both pregnant women and Medical Doctor, Dentist,
Dental Hygienist, Nutritionist and Obstetric know that
maternal dental problems seem to be increased during
gestation and lactation. This finding might explained as
an aggravation of latent or pre-existing oral diseases, linked to the difficulty to carry out a correct oral hygiene, to
early pregnant nausea and vomiting and to hormonal
influence on oral tissues. Race, education and job seem to
be very determinant. It is supposed that some obstetric problems of mothers and babies are a consequence of pregnant oral condition. Pregnant women oral health could
be guarantee by an adequate assistance from the Dentist,
the Nutritionist and the Dental Hygienist. It is to set out of
the term of an effective management of public and private
health services in the way to guarantee to the mother and
to the babies the best health conditions.
Key words: Pregnancy, Oral health, Nutrition.
The pregnancy is a modified physiological condition able to
induce, in whole woman body and in oral tissues in particular, a wide series of metabolic changes, with clinical conseCorresponding author: Antonio D’Alessandro, MD,DDS
Dipartimento di Medicina Interna e Sanità Pubblica
Via S.Sisto, 22 - I - 67100 L’Aquila
Tel. +39 0862 432889 - Fax +39 0862 432858
e-mail: [email protected]
Vol. 5 - N° 1
Università degli Studi di L’Aquila
Dipartimento di Medicina Interna e Sanità Pubblica
Università degli Studi di L’Aquila
Dipartimento di Scienze Chirurgiche
quences for the oral cavity, also linked to food habits and
oral hygiene behavioural.
Both pregnants and health operators well know as oral diseases might be increased during gestation and lactation.
In spite of this, pregnancy is not a determinant factor under
a pathogenetic point of view, but a natural condition which
plays an important role in the aggravation of latent or preexisting oral diseases (1).
In the offspring too, a correct development of the buccal
sphere is strictly related to food habits and to maternal oral
health situation.
After the 5° month of gestation, pre-existing gingivitis or
periodontal disturbances might be compound in consequence of the hormon-dependent modification hyper-vascularization mediated, linked to an increase of steroidal specific
This condition inhibits the practice of a correct and constant
oral hygiene, because of gingival bleeding and dentinal
The pregnant gingivitis is widely diffuse in far eastern
women, and it is related to the pregnancy month and sexual
hormone (2).
GI (Loe and Silness Gingival Index) and PPD (Probing
Pocket Depth) appear increased in pregnants with hormonal changes during the early months.
The evidence is probably linked both to the gingival bleeding after tooth brushing and to vomiting (3).
The pregnant vomiting is linked to the increased sympathetic activity, to the loss in gastric secretion and motility, to
the release of endometrium catabolism substances and to
the psychologic factors.
International Journal of Maxillo Odontostomatology
D’Alessandro A. et al.
Nausea, vomiting and hypervascularization are linked to
placental hormones -HCG and PRL release too; the estrogens cause thickness of oral epithelium and its exfoliation,
oedema and mucosal bleeding (4).
High progesteron serum concentration is related to decreased
T lymphocyte activity, increased PGE synthesis, histamine
release from mast cells and overgrowth of anaerobic subgingival bacteria.
The clinical attachment loss is higher in jobless women and
it is linked to the race too; the higher GI the lower level of
education was found.
Gingival inflammation is higher in elder women and in women
with a low professional level.
Pregnant gingivitis is linked to gingival hypertrophy; both
them decrease at the late pregnancy, by eliminating local
irritation factors (5).
Pregnant’s epulis was found in a low percentage of subjects but,
instead of this, deep periodontal lesions seemed to be as to not
pregnant one, in groups of patients with similar characteristic.
Because pregnancy aggravate pre-existing or latent oral disturbances, promoting oral health in pregnant women might
contribute to primary prevention of the main oral disease
and could have a particularly positive social impact.
About hard oral tissues, there are not clinical evidences concerning what are usually believed about caries incidence
during pregnancy (6).
In fact, there is not any kind of mineral depletion in maternal dental tissues.
So, health operators have to explain to the mothers that “the
body can’t take calcium from the teeth to construct newborn’s bones” and as the true reasons of dental caries must
be find in the increase of daily sugary snacks and in the
change of oral hygiene behavioural, induced by vomiting,
nausea and gingival bleeding.
In fact, in the early pregnancy, the food snacks reduce the
hormonal-induced gastric symptoms; afterwards they compensate the slower gastric empty time, the reduced gastric
extension and filling linked to foetal growth and the glycemic level changes induced by the unforeseeable foetal energetic expenditure.
Experiments on animals revealed as a marked calcium lack
in food daily intake cannot inhibit offspring enamel mineralization, but it might delay it.
On the contrary, very high calcium amounts, administered by
special diets, are toxic for animal foetus which reveals low
birth weight and lack of dental and bone calcification units.
In these conditions, surviving calcification units start to
expand later vs controls (7).
Vol. 5 - N° 1
Moreover, higher caries risk is linked in pregnant women to
a lower saliva buffer capacity induced by lower salivary flow
rate, increased number of oral cariogenic microorganisms,
decrease in salivary pH vomiting and estrogen-induced.
Gastric acid reaches the oral cavity by vomiting and it predisposes to dental caries and erosions.
Estrogens and androgens are known to regulate carbonic anhydrase VI (CA) gene expression in the saliva; CA protects the
teeth by accelerating the neutralization of hydrogens ions in the
enamel pellicle on dental surfaces, but more findings are necessary to confirm its true role in the caries development (8).
Nevertheless, a proper nutrition and an adequate oral hygiene can minimize all these problems.
In this way, telephone interviews to study the self-assessment of oral dental conditions, the hygiene behaviour and
dental visiting habits of pregnant women seem to be useful
to plan public pre-natal prevention programmes to improve
the oral health of mother and babies (9).
Under the point of view of the relationships between oral
health and pregnancy, periodontal diseases might be a risk
factor for systemic maternal or foetal diseases and for obstetric disturbances.
In fact, the periodontal diseases seem to be linked to preterm labor, pre-term premature rupture of membranes, and
pre-term low birth weight babies (10).
Emerging evidence has shown as smoker malnourished
women having less visits to the dentist are particularly susceptible to pre-eclampsia, and pregnancy granuloma.
To prevent possible severe repercussions on pregnancy outcome, future mothers should receive a nutritional support
and a regular professional oral hygiene.
Without a professional help, simple self oral hygiene and
correct nutrition seem to be difficult to carry out.
In this way, a daily rinse with a solution of sodium fluoride
0.05% and clorexhedine 0.12% reduces significantly the
presence of Streptococcus mutans in the oral cavity of the
mother and in the oral cavity of the baby, until he will be
two years old.
Instead of this, 58% of american mothers had no dental and
dietary assistance during pregnancy, and they were not informed about risks of active and passive cigarette smoking (11).
For these reasons, a large part of them meet the dentist
exclusively for acute dental pain.
The factors able to induce the mothers to meet the dentist
for periodic controls are individual (married, who met dentist also before pregnancy and with flossing habit), financial
(dental insurance), and related to the level of education.
On the other side, the dentist is sometimes worried to ope-
International Journal of Maxillo Odontostomatology
D’Alessandro A. et al.
rate on pregnant, because of the fear of pre-term labor or
legal outcome.
The request of a nutritional counselling by the mother is
very rare.
Instead of this, a correct nutrition during pregnancy is
important to determine a right amount of energy, protein,
calcium, phosphorus and vitamin A, C, and D.
It is able to correct both the nutritional deficiency and the
food excess, and the related excess in body weight, with the
metabolic and obstetric consequences both in the mother
and in the baby.
Moreover, a correct development of foetal oral tissues is linked to mother dietary habits, to geographical location, to
occupation, and to cultural and ethnic factors (12).
Dietary patterns of mothers have changed dramatically
during the past two decades, because the trend of consumption of food for population in general and for mothers in
particular is in the direction of unhealthier eating habits, as
food rich in fat, cholesterol, refined sugar and salt and poor
in fibre and polyunsaturated fatty acids.
This food patterns and the sensible reduction in physical
activity consequent to the constant use of cars, elevators,
mobile telephones, remote controls and so on, contribute to
diet-related chronic diseases, such as obesity, diabetes,
hypertension, hearth disease and dental caries.
The best outcome of pregnancy, as lower mother and baby
mortality and morbidity are observed when the baby weight
is higher than 3.5 kg and lower than 4.0 kg.
This condition is very rare when the mother is obese or diabetic: baby birth-weight is strictly related to pregnancy out
of range increase of body weight and to mother pre-pregnancy Body Mass Index (kg/m2).
On the contrary, when the mother BMI is lower of range at the
begin of the pregnancy, higher amounts of energy are requested.
The correct development of oral tissues is also linked to a
correct mother nutrition.
It is request a safety increase of 6.0 g of protein a day; further increases have no benefits and might be dangerous for
the baby. All kind of lipid are important in pregnancy, but
arachidonic acid and docohexanois acid are essential for
foetal brain and retina develop and it might have a lack in the
babies not breastfed.
The vitamin D need is increased because the mineralization
of foetus bones and oral tissues and its dietary recommended increase is 10mg a day.
Vitamin C allowance (45 mg/die in not pregnant women)
must be increased of 10 mg/die and of further 10mg/die in
smoker mothers; folic acid allowance (200 mg/die) have to
Vol. 5 - N° 1
be doubled to prevent spina bifida and anencephalia; an
addition of vitamin B12 is necessary in vegetarian women;
an addition of 400mg/die of calcium and phosphorus is
necessary to prevent depletion of mother storings; no increases of sodium are needed (13).
Because many mothers have not adequate storage of iron, in
consequence of the difficulty to absorb iron from foods, it
might be necessary drug supplementation (30 mg/die).
The contribute of fluoride to the develop of foetal oral tissues is not clear.
Maternal alcohol abuse might contribute to the newborn
foetal alcohol syndrome (FAS), characterized by congenital facial anomalies traditionally associated with hearing
disorders, and significant impairments in neurodevelopment
and physical growth.
Such disorders can contribute to the learning, behavioral,
and emotional difficulties seen in FAS patients and warrant
early, nutritional intervention (14).
Instead of the nutritional supplement of polinsaturated fatty
acids (PUFA) and vitamin E seem to protect foetus against
mother alcohol abuse, this way seems to be difficult to carry
out in alcohol-dependent mothers (15).
All evidences seem to demonstrate as a correct diet and a
adequate professional control of oral health during pregnancy represent an important way for global and dental
health both in the mother and in the baby.
In this way a nutrition educational programme to promote a
healthy diet and to correct unsound food beliefs and habits and
a dental continuous assistance, with a correct dental hygiene, are
urgently needed from government or private health services.
E ben noto come i problemi orali sembrino aumentati
durante la gravidanza e l’allattamento. Ciò è legato all’aggravamento di condizioni patologiche pre-esistenti, all’obiettiva difficoltà nell’attuazione di una corretta igiene
orale, alla nausea ed al vomito ed alle influenze ormonali
sui tessuti orali. Razza, lavoro svolto e scolarità sembrano
essere parimenti importanti. Inoltre, sembrerebbe che alcune
complicanze ostetriche siano legate alle condizioni orali
materne. Per questi motivi, la gestante ha bisogno dell’assistenza dell’Odontoiatra, del Nutrizionista e dell’Igienista
Dentale. Il loro intervento dovrebbe essere proposto da
strutture sanitarie pubbliche e private.
Parole chiave: Gravidanza, Salute orale, Nutrizione.
International Journal of Maxillo Odontostomatology
D’Alessandro A. et al.
1. Laine MA.
Effect of pregnancy on periodontal and dental health.
Acta Odontol Scand 2002; 60: 257-64.
2. Lieff S, Boggess KA, Murtha AP, Jared H,
Madianos PN, Moss K, Beck J, Offenbacher S.
The oral conditions and pregnancy study: periodontal
status of cohort of pregnant women.
J Periodontol 2004; 75: 116-26.
3. Meneghini C, Battaglia T, Piccoli A.
Periodontal pathology during pregnancy.
Clin Ter 2003; 154: 105-9.
4. Gajendra S, Kumar JV.
Oral health and pregnancy: a review.
NY State Dent J 2004; 70: 40-4.
5. Pihlstrom BL, Michalowicz BS, Johnson NW.
Periodontal diseases.
Lancet. 2005; 366:1809-20.
6. Lydon-Rochelle MT, Krakoviak P, Hujoel PP,
Peters RM.
Dental care use self-reported dental problems in relation
to pregnancy.
Am J Public Health 2004; 94: 765-71.
7. Mills LW, Moses DT.
Oral health during pregnancy.
MCN Am J Matern Child Nurs 2002; 27: 275-80.
8. Kivela J, Laine M, Rajaniemi H.
Salivary carbonic anhydrase VI and its relation to salivary flow rate and buffer capacity in pregnant and non
pregnant women.
Arch Oral Biol 2003; 48: 547-51.
Vol. 5 - N° 1
9. Christensen LB, Jeppe-Jensen D, Petersen PE.
Self-reported gingival condition and self-care in the oral
health of Danish women during pregnancy.
Clin Periodontol 2003; 30: 949-53.
10. Carta G, Persia G, Falciglia K, Iovenitti P.
Periodontal disease and poor obstetrical outcome.
Clin Exp Obstet Gynecol 2004; 31: 47-9.
11. Breedlove G.
Prioritinzing oral health in pregnancy.
Kans Nurse 2004; 79: 4-6.
12. Sarlati F, Akhondi N, Jahanbakhsh N.
Effect of general health and sociocultural variables on
periodontal status of pregnant women.
J Int Acad Periodontol 2004; 6: 95-100.
13. Tanaka K, Miyache Y, Sasaki S, Ohya Y,
Miyamoto S, Matsunaga I, Yoshida T, Hirota Y, Oda H.
Active and passive smoking and tooth loss in japanese women:
baseline data the Osaka maternal and child health study.
Ann Epidemiol 2005; 15: 358-64.
14. Taani DQ, Habashneh R, Hammad MM, Batieha A.
The periodontal status of pregnant women and its rela-
tionship with socio-demographic and clinical variables.
Oral Rehabil 2003; 30: 440-5.
15. Sulik KK.
Genesis of alcohol-induced craniofacial dysmorphism.
Exp Biol Med 2005; 230: 366-75.
International Journal of Maxillo Odontostomatology
*Francesco Briguglio, DS, *Manuela Lapi, DDS, *Enrico Briguglio, MD,DDS, *Roberto Briguglio, MD,DDS
This study analyses the actual use of burs in oral surgery.
They can be used in different surgical fields: teeth inclusion, cysts, periapical pathology, implants, guided bone
regeneration, periodontal surgery and maxillary sinus
augmentation. Essential factors in the selection of the
right bur to use are construction material, surface, shape,
speed and the requested handpiece. Besides the operative
phases in which they can be used are indicated. At last a
particular consideration is given to the characteristics of a
new polivalent bur used for a clinical case now solved and
here presented.
Key words: Bur, Oral surgery, Osteotomy, Osteoplasty,
Università di Messina
Cattedra di Parodontologia
3) High speed Handpieces (until 400.000 gr./min.), utilized
in odontectomy, odontoplasty and osteoplasty.
Before using a bur it is essential to know its characteristics:
shape, surface, size, resistance to fracture and building
materials which are steel or tungsten carbide. Steel burs are
cheaper and need low speed handpieces, but they lose their
cutting edge quickly. Tungsten carbide burs are very expensive and resistant and need a high speed handpiece, but they
do not lose their cutting edge even if they are used on hard
tissues like enamel. As regards bur surface, they can be multiblade, generally used for osteotomy, and diamonded, used
for odontectomy (Tables 1, 2).
Burs shapes are connected with the result you need to get,
the anatomical characteristics of the surgical site and the
concerned tissue (Table 3).
In dentistry burs are the most frequently used instruments in
oral surgery where their applications concern sectors such
as the extraction of included third molar or of other included teeth, cystectomy, periapical surgery, sinus lifting,
implantology and periodontal surgery (1, 2, 3, 4, 5, 6).
Since their utilization regards bone or dental tissue, we are
going to analyse differences and indications of handpieces
in these particular fields:
1) Low speed Handpieces (until 40.000 gr./min.), utilized in
osteotomy like in the third molar extraction or in apicectomy:
2) Very low speed Handpieces (until 4.000 gr./min.), utilized in implantology.
Lapi, DDS
Via Vittorio Emanuele Orlando, 4
98028 Santa Teresa di Riva, Messina
Tel/Fax +39090696777 Tel +393493646214
e-mail: [email protected]
Table 1. Tungsten carbide burs: features and indications
Corresponding author: Manuela
Vol. 5 - N° 1
Table 2. Tungsten carbide burs: features and indications
International Journal of Maxillo Odontostomatology
Briguglio F. et al.
Table 3. Tungsten carbide burs: features and indications
About the last characteristic taken in consideration, that is
bur dimension, we must consider that burs are produced
according to codified standards (ISO-ADA). In some situations, however, the length of a bur can determine a successful operation which allows the surgeon a quicker work, that
is to say less labour and stress both for the operator and for
the patient, that involves a smaller trauma and a better
postoperative course.
After mentioning the main burs normally used, the present
study presents a recently tested new polivalent bur (HXU
254, Fresissima). It consists of a single integral 30 mm long
monoblock, with a 6,5 mm active end. Its troncoconical
shape, thin stem and absence of any soldering explain its
large versatility. We may shortly say that HXU 254 can be
mainly used for:
- Third molars surgery
- Generally extractive surgery
- Endodontic surgery: both osteotomy and apical section
- Periodontal resective surgery
- Roots surgery
The cutting-crown operation is to be remembered as one of
the non-surgical indications. In the case of a part of osteointegrated implant resection, a trephine bur is to be preferred
because, being of different sizes, it is possible to get the
most suitable one for the implant taken in consideration.
Figure 1. Clinical aspect of the operating field
Figure 2. The elevation of the flap and the exposition of the tooth crown
In the present clinical case the new bur HXU 254 was used
to extract a third molar mandibular partially included. A clinical vision of the operating field is in the Figure 1. After
producing anaesthesia, a total thickness marginal flap was
elevated to obtain the exposition of the crown (Figure 2).
Then using a new bur, an osteotomy and an osteoplasty was
carried out till to allow the extraction of the tooth (Figure 3).
Finally the flap was repositioned and sutured.
The present study represents a contribution to dental surge-
Vol. 5 - N° 1
Figure 3. The odontectomy using the HXU 254 bur
International Journal of Maxillo Odontostomatology
Briguglio F. et al.
gery and provides a scheme for the utilization of burs. It is
obviously necessary to make a reference about the use of
high and low speed handpieces, the tissue which is to be
removed and the shape of the above mentioned instruments.
All their characteristics are related to the suitable operation.
Finally the characteristics of the new polivalent bur are
exposed together with the description of a clinical case.
Questo studio analizza l’attuale utilizzo degli strumenti
rotanti in chirurgia orale. Essi possono essere usati nei
diversi settori della chirurgia: inclusioni dentarie, patologie periapicali, implantologia, rigenerazione ossea guidata, chirurgia parodontale, chirurgia del seno mascellare.
Sono da considerarsi fattori essenziali nella scelta della
giusta fresa: il materiale di costruzione, la superficie, la
forma, la velocità e il manipolo necessario.
In conclusione particolare attenzione viene data alle
caratteristiche di una nuova fresa, usata per un caso clinico ora risolto e qui presentato.
Parole chiave: Strumento rotante, Chirurgia orale, Osteotomia, Osteoplastica, Odontotomia.
4. Lindhe J.
1. Bartolucci EG, Young Cho J.
Atlante di chirurgia parodontale.
2. Brusati R, et al.
5. Panzoni E.
PICCIN, 1986:81-88.
MASSON, 1985:48-56.
Edi ERMES, 1998:439-460.
I.C.A., 1992:45-55.
Chirurgia endodontica.
Trattato di tecnica chirurgica.
3. Calandriello M, Carnevale G, Ricci G.
Edizioni Martina, Bologna, 1996:444-528.
Vol. 5 - N° 1
6. Sailer HF, Pajarola GF.
Chirurgia orale.
Masson, 1997:178-190.
International Journal of Maxillo Odontostomatology
Unita Sanitaria Locale
A.S.P. - Azienda di Sanit Pubblica
Ordine Provinciale di Roma
dei Medici Chirurghi e degli
O.C.I. - Odontoiatri Cattolici Italiani
Collegio dei Docenti di Odontoiatria
formazione continua in sanità
S.I.M .O
G iovanni
Academy of laser
dentistry introductor
R oberto M arasca
TecnologiCAD CAM:
rapidit di esecuzion
avanzate in
e perfezione estetica
G iulio D e C inti
Roma, 26 maggio
Ospedale G. Eastman Ospedale G. Eastman
ventisette maggio
Esiste una Scuola Odontoiatrica Italiana che è patrimonio di tutti. Esiste anche una Gloriosa Tradizione Ospedaliera:
ambizione della SIMO è di esserne la voce.
*Alessandro Quaranta, MD,DDS, **Lorenzo Benedetti, MD *Giovanni Ballarani, MD,DDS,
*Marlene Fabrizi, DDS, *Giorgio Pompa, MD,DDS
Recently, computerized guided image methods combining
a pre-operative 3D plan for inserting dental implants with
a dental navigation system were introduced.
This procedure allows the visualization of image based diagnostic data of patient’s jaws and makes it possible to use a
dental implant navigation system (DenX’s, IGI System®).
The surgeon can plan, using the system’s clinical planning tool, the drilling position, orientation and depth of
each implant.
The aim of this study is to describe the Den-X system that
can help the clinician during the pre-operative planning
and also during the intra-operative procedure.
During the period of March-May 2005, 7 healthy no-smoking patients (age 40-55 years) were rehabilitated with a
total of 13 fixtures (Imtec Implants® U.S.A.) using the
DenX System (Moshav Ora, Israel), that tracks the actual
position of the handpiece in real-time. The tracking method used by this system is an optical three linear camera
tracker Flashpoint 5000 system (Image Guided Technologies. Boulder®, Colorado USA) upgraded by DenX for
greater accuracy and reliability.
All the surgical procedures were performed flapless, and
the clinician was guided by the video data on position,
angulation and depth for each implant.
All the radiographic control examinations performed after
4 weeks showed the correct implants position and the absence of complications due to incorrect fixture placement.
In conclusion, we can say that adoption of image-viewing
software and motion tracking devices to guide the surgeon
during the implant placement allows the correct insertion of
fixtures improving the functional and aesthetic results, minimizing intra-operative risks and prosthetic complications.
Università degli Studi La Sapienza, Roma
Dipartimento di Protesi
DenX’s IGI System, Italia
Implant placement guided by prosthetic-driven procedures
allows to resolve part of the surgical and prosthetic complications and limits (1).
The CT Scan data can be used during the surgical stage
through a stent provided with drill guides (2, 3).
The main limitation of this procedure is due to the lack of
control during the implant placement and to the fact that
guides can’t be modified during the procedure (3, 4, 5, 6).
Recent developments allowed to move data from TC Scan
to the surgical site in real time obtaining a system of navigation based on transfer magnetic devices, but it still lacks
of satisfactory accuracy (7, 8).
More recently, computerized guided image methods combining a pre-operative 3D plan for inserting dental implants
with a dental navigation system were introduced.
The system we adopted allows the visualization of image based
diagnostic data of patient’s jaws and makes it possible to use a
dental implant navigation system (DenX’s, IGI System®).
The surgeon can plan, using the system’s clinical planning
tool, the drilling position, orientation and depth of each
implant (Figure 1).
Key words: Image Guided Navigational Implantology, CT
Scan, Implants, System accuracy
Corresponding author: Alessandro
Via Ariosto, 24
00185 Rome, Italy
Tel +390677200498
e-mail: [email protected]
Vol. 5 - N° 1
Figure 1. Confident® clinical planning tool showing the drilling position, orientation and depth
International Journal of Maxillo Odontostomatology
Quaranta A. et al.
The system uses marker-based referencing methods to
transfer the tool coordinate system to the patient (Figure 2).
Figure 2. The system splint providede with ceramic spheres enclosed
fits in patient’s cross arch
Figure 3. The handle handpiece is provided with a set of IR LEDs
A visual and audio guide helps the clinician during the surgical procedure, and the surgeon can move the drill in the
correct position with the support of the navigation system.
The DenX system helps the clinician during the pre-operative
planning and also during the intra-operative procedure.
An accuracy of 0.2-0.3 mm has proved to be attainable regarding intra-operative navigation systems (9, 10) and the system
manufacturer claims a total system accuracy of about 0.1 mm.
During the period of March-May 2005, 7 healthy no-smoking
patients (age 40-55 years) were rehabilitated with a total of 13
fixtures (Imtec Implants® U.S.A.) using the DenX System
(Moshav Ora, Israel), that tracks the actual position of the
handpiece in real-time. The tracking method used by this
system is an optical three linear camera tracker Flash-point
5000 system (Image Guided Technologies. Boulder®, Colorado
USA) upgraded by DenX for greater accuracy and reliability.
The system located the Handpiece’s 3D position by tracking
a set of IR LEDs, linked to the handle handpiece (Figure 3).
Implant size, position and orientation was based on CT data
developed with IGI Software from DenX Ltd.
The CT scan protocol was a Dentascan CT protocol (0.5
mm slice thickness, 0.5 mm table feed, fast incremental
scanning, 120 kV, 33 mAs, 512*512 matrix) (Figure 4).
Patient’s maxilla or mandible position were recorded by
special ceramic spheres enclosed in an acrylic splint placed
in patient’s cross arch.
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Figure 4. Patient fits the acriylic splint during the CT Scan Exam
The splint was fit by each patient during the CT Scan process,
and was also mounted by the patient in the surgical phase.
International Journal of Maxillo Odontostomatology
Quaranta A. et al.
Figure 7. Patient 1: two fixtures placed on th left side
Figure 8. Patient 2: three fixtures placed on the left side
Figures 5, 6. Video and audio guide during the surgical procedure
This allowed to set an interface between the scan and the
real position of patient’s jaw.
Pre-operative procedures started recording the handpiece
with the ceramic spheres on the acrylic surgical stent.
The surgical protocol started with local anaesthesia in the
implant sites, following the operator placed the acrylic
splint in patient’s mouth and registered the handpiece and
jaws position.
All the surgical procedures were performed flapless, and the
clinician was guided by the video data on position, angulation and depth for each implant (Figures 5, 6).
No suture was needed (Figures 7, 8, 9) and postoperative
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Figure 9. Patient 2: two fixtures placed on the right side
International Journal of Maxillo Odontostomatology
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medications included a light non-sterhoyd anti-inflammatory drug and antibiotics for 1 week.
No intra or post-operative injuries or accidents were reported.
All the radiographic control examinations performed after 4
weeks showed the correct implant position and the absence of
complications due to incorrect fixture placement (Figure 10, 11).
The distance between implants and vital structures (i.e.
mental foramen, alveolar nerve, maxillary sinus) were safe.
All the patients reported complete satisfaction and minimal
swelling, absence of pain and discomfort in the immediate
and 1 week post-operative interviews.
All the fixtures showed normal osseointegration and were
restored with a delayed loading protocol (Figure 12).
Figure 12. Patient 1: Implant-supported bridge loaded after 6 weeks
Figure 10. Patient 1: X-Ray control exam performed at 1 month
Successful placement of dental implants depends on surgery
planning and an optimal performed surgical procedure that
comes after the treatment plan (11, 12). Adoption of imageviewing software and motion tracking devices to guide the
surgeon during the implant placement allows the correct
insertion of fixtures improving the functional and aesthetic
results, minimizing intra-operative risks and prosthetic complications.
Figure 11. Patient 2: Ortopanthomograph control exam performed at 1 month
Vol. 5 - N° 1
Recentemente, sono stati introdotti metodi di immagine
computerizzata guidata che in associazione ad uno studio
pre-operatorio si mostrano adatti all’inserimento di impianti dentali attraverso un sistema di navigazione in 3D.
Questa procedura permette la visualizzazione dell’immagine ottenuta in base ai dati diagnostici relativi ai mascellari del paziente, rendendo così possibile l’uso del sistema
di navigazione impiantare (DenX’s, IGI System®).
Utilizzando il sistema di progettazione clinica, il chirurgo
può impostare la posizione della fresa e l’orientamento tridimensionale nonché la profondità d’inserimento di ciascun impianto.
Lo scopo del presente lavoro è quello di descrivere il sistema DenX, che può aiutare il chirurgo sia durante la fase
pre-operatoria che intra-operatoria.
International Journal of Maxillo Odontostomatology
Quaranta A. et al.
Tra Marzo e Maggio 2005 sono stati riabilitati 7 pazienti
non fumatori (di età compresa tra i 40 e i 55 anni) per un
totale di 13 impianti (Imtec Implants® USA) utilizzando il
sistema DenX (Moshav Oral, Israel), che segue in tempo
reale la posizione della mano dell’operatore. Il meccanismo
su cui si basa il sistema è rappresentato da una telecamera
a fibre ottiche lineari Flashpoint 5000 (Image Guided
Technologies. Boulder®, Colorado USA) consigliata dalla
DenX per la sua precisione ed attendibilità.
Tutte le fasi chirurgiche sono eseguite senza l’esecuzione
di un lembo, e per quanto riguarda la posizione, l’angolazione e la profondità di ciascun impianto, l’operatore è
guidato dalle immagini che appaiono sul video. I controlli radiografici eseguiti dopo 4 mesi hanno evidenziato il
1. Vannier MW, Hildeboldt CF, Cononver G, Knapp
RH, Yokoyama-Crothers N, Wang G.
Three-dimentional dental imaginig by spiral CT.
Oral Surg Med Oral Pathol, Oral Radiol Endodont 84:
561-570, 1997.
2. Schiroli G, Di Carlo F, Quaranta A.
Sistema di posizionamento stereoguidato degli impianti.
Casi Clinici. Dental Cadmos 2/2005:33-41.
3. Sarment D, Al-Shammari K, Kazor CE.
Stereolithographic surgical templates for placement of
dental implants in complex cases.
Int J Period Res Dent 2003 23 (3):287-95.
4. Fortin T, Coudert JL, Chapleboux G, Lavallee S.
Computer-Assisted dental implant surgery using computed tomography.
J Image Guide Surg 1: 53 – 58, 1995.
5. Sarment DP, Misch CE.
Scannographic templates for novel pre-implant planning
Int Magaz Oral Impl 2002;1-3:16-22.
6. Birkfellner W, Watzingere F, Wanschitz F, et al.
Systematic distortions in magnetic position digitizer.
Medical Physics 25: 2242-2248, 1998.
7. Randelzhofer P. et al.
Navigazione tridimensionale in implantologia orale: uno
studio preliminare.
Int J Periodontics Rest Dent 2001;6:617-25.
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corretto posizionamento degli impianti e assenza di complicanze.
Concludendo, si può affermare che l’uso del software descritto, che si basa su un sistema di navigazione guidata,
offre al chirurgo un valido aiuto durante il posizionamento
d’impianti, permettendone il corretto inserimento; consente, inoltre, di ottenere risultati funzionali ed estetici senz’altro migliori, minimizzando i rischi intra-operatori e le complicazioni legate alle fase protesica.
Parole Chiave: Sistema di implantologia guidata, TC Denta-scan, Impianti, Precisione del sistema
8. Birkfellner W, Solar P, Bergmann H, Watzingere F,
Wanschitz F, et al.
In vitro assessment of a registration protocol for image
guided implant dentistry.
Clin Oral Impl Res 12: 69-78 2001.
9. Brief J, Hassfeld S, Redlich T, Ziegler C,
Muenchenberg J, Daueber S, Pernozzoli A,
Krempien R, Slacik P, Opalek M, Boesecke R,
Mühling J.
Robot Assisted Insertion of Dental Implants
A clinical evaluation, CAR 2000, 932 – 937.
10. Hassfeld St, Brief J, Stein W, Ziegler C, Redlich T,
Raczkowsky J, Krempien R, Mühling J.
Navigationsverfahren in der Implantologie - Stand der
Technik und Perspektiven.
Implantologie 4: 373-390 (2000).
11. Münchenberg J, Brief J, Hassfeld S, Raczkowsky
J, Rembold U, Wörn H.
Expert Sup-ported Operation Planning in the Maxillofacial Sur-gery (1998), Proceedings of Computer Assisted Radiology and Surgery (CAR'98).
June, 1998, Tokyo, Japan.
12. Stein W, Hassfeld S, Brief J, Bertovic I, Krempien
R, Mühling J.
CT-Based 3D-Planning For Dental Implantology.
Proceedings of Medicine Meets Virtual Reality
(MMVR'98), San Diego, 1998.
International Journal of Maxillo Odontostomatology
S. I. M.O.
Presidente Onorario GIOVANNI DOLCI
ReferenteG iancarlo
C ortese
Giordano , W. hinzani
Coordinatori Scientifici
E. ePgazzano
, G. ortese
10 giugno 2006
Nell ambito del Covegno sar
presente l odontoambulanza
E s i s t e u n a S c u o l a O d o n t o i a t r i c a I t a l i a n a c h e è p a t r i m o n i o d i t u t t i . E s i s t e a n c h e u n a G l o r i o s a Tr a d i z i o n e O s p e d a l i e r a :
ambizione della SIMO è di esserne la voce.
*Philippe B. Tardieu, DDS, **Luc Vrielinck, MD,DDS, ***Nico Roose, MSC
The SAFE System constitutes a new approach to dental
implant placement by allowing transfer to the mouth of an
implant plan based on CT scan data. The system consists
of dedicated tools for guided implant treatment, one single
SurgiGuide is used for drilling guidance and implant placement.
SAFE is an acronym for Secure, Accurate, Flexible and
Ergonomic. The ease of execution, security of intervention
and obtained accuracy are important positive aspects that
lead us to believe that the SAFE System is likely to have a
profound positive impact on our practice.
Key words: Implantology, Safe System®, CT Scan data
Since the 1990s, many medical teams have approached the
problem of implant case planning with the assistance of
computer applications. Thanks to the tools created by
Materialise, we were able to establish the basics of a complete therapeutic protocol including not only case planning
in 2 and 3 dimensions based on CT scan data, but also the
transfer of projects into the mouth through the realization of
customized surgical guides by means of stereolithography.
We rapidly became aware that the tools of “classical”
implantology were not adapted to this new approach and
since greater accuracy, security and ease of use are now
required during implant placement, new tools should be
designed. This realization was a major step toward the conception of the SAFE System.
Corresponding author: Philippe
B. Tardieu, DDS
49, avenue Alsace-Lorraine - 38000 Grenoble
Tel. 0476469721 - Fax 0476469710
e-mail: [email protected]
Vol. 5 - N° 1
Paris VII University, PG in Implantology Nice-Sophia Antipolis
University, Adjunct Associate Professor New York University
Maxillo-facial Surgery, Dpt: Mond-Kaak en Aangezichtsheelkunde,
Ziekenhuis Oost-Limburg (ZOL), Campus St Jan, Belgium
Medical Research Engineer, Medical Production Manager Materialise
N.V. Medical Department Technologielaan, Leuven, Belgium
Implant planning requires time as well as minute attention
to detail, as it determines the entire surgical phase. For this
reason, the SimPlant programmes is used (1) . The position,
inclination, depth, diameter and length of each implant can
be changed as needed. Once the planning has been performed, it can be sent to Materialise for the fabrication of the
surgical guides (2, 3). An order form allows the surgeon to
request a customized guide according to his indications. He
remains the designer of the surgical device. The guide is
produced by means of the stereolithography process. The
SAFE System assists the surgeon only during the surgical
procedure (4). Prosthetic realization can afterwards be implemented conventionally.
Description of the SAFE System®
The SAFE System consists of dedicated tools for guided
treatment of patients with implants. By using only one single surgical guide, one can guide position, angulation and
depth for the drilling of the osteotomies as well as for the
actual implant placement. It is a universal system that is not
limited to the use of stereolithographic guides and it may be
adjusted to any type of surgical guide. Moreover, all types
of stereolithographic guides are compatible with the system:
tooth-supported, bone-supported, mucosa-supported, mixed
supported and even implant-supported.
To prepare implant osteotomies using “classical” methods,
a series of 5 different drills is used: a round burr, a drill with
a primary diameter of about 2mm, a two-staged pilot drill, a
twist drill with final diameter of about 3mm, and a countersink. Utilizing the SAFE System, only 2 drills are needed: a
pilot drill and a calibrating drill (e.g. the pilot drill and the
final drill). Because of the guiding of the drills, a round burr
to prepare the site can be excluded. The pilot drill creates a
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primary osteotomy of 2mm in diameter over the first 4mm
of its cutting length. Additionally, due to its stepped design
it simultaneously increases this diameter to 3mm. The final
drill regulates the osteotomy to 3.15mm in diameter. The
drill is designed to have this final diameter only over the
first 4mm of its cutting length, and a reduced diameter over
the rest to prevent overheating during its rotation in the
bone by not having friction over the entire cutting length.
The thread, gouge drawing and surface processing of these
drills were modified in order to increase their cutting capacity; to prevent overheating during the osteotomy, irrigation
with a cool saline solution is necessary. Because of the stepped design of both drills, both drills can be guided through
one and the same drilling tube. As an extra feature, the two
drills in the SAFE System have depth control stops. Seven
different drill lengths are available: 10, 13, 15, 18, 20, 23,
and 25mm.
The most used are 13, 15 and 18mm. In order to control the
depth for each osteotomy, the depth control is added to the
surgical guide in the design phase. By adjusting the height
position of the tubes in the surgical guide, each possible
depth can be accounted for.
Implant Placement
In classical implantology, implant holders or fixture mounts
are used to control manual and visual implant placement.
Since at this stage the most serious position errors can still
occur, guidance of the actual implant placement is essential.
Indeed, during manual placement the implant may sometimes deviate from the drilling axis, because self-tapping
implants will choose the way of minimal resistance, e.g.
when the density gradient between dense cortical bone and
a rather soft, spongy bone is too large. In certain cases, the
surgeon may attempt to compensate for this problem by
creating a conical hole with a countersink. In the SAFE
System, the implant is directed to its planned position
without the need for visual control, thanks to the use of a
dedicated implant holder that passes through a guiding
cylinder. This implant holder also has a depth control stop
consisting of a flange located at its proximal end. Currently,
several lengths of implant holders are available: 4, 5, 6, 7,
8, 9, 10 and 15mm. The most used are 7 and 9mm.
Using the SAFE System®
To illustrate the surgical steps, we have chosen an implant
placement case in which a bone-supported surgical guide
with SAFE System was used. During the first step, an incision is made in the mucosa and the underlying bone surface
is exposed, clearing it of any fibrous remnants (Figure 1).
The next step consists of applying the stereolithographic
guide on the bone surface and securing it into position, if
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Figure 1. Incision in the mucosa for exposing the bone surface.
needed with the use of osteosynthesis screws. The guide is
equipped with titanium guiding cylinders in which drilling
tubes are screwed, made of surgical grade stainless steel.
Screwing is accomplished with a mere quarter turn, thereby
making it easier to perform the manipulation in the mouth
(Figure 2). This device allows the transfer of the planned
Figure 2. SAFE System surgical guide placement on the bone.
implant project from the computer to the mouth of the
patient with high accuracy (Figure 3) and, as in the presented example, to perform the placement of 3 implants of different lengths: 13, 10 and 7mm. In order to drill a 13mm
hole, the pilot drill of 13mm is used (Figure 4). For an
implant of 10mm, the pilot drill of 10mm is used for an
implant of 7mm, the same drill is used (Figure 5). This is
possible because the height of the guiding tube is adapted
for the latter implant. In every case, drilling is performed
until the drill is blocked by the depth control stop.
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Figure 3. Clinical transfert of 3 implants planned with 13, 7 and 10
mm lengths
Afterwards, the same operation is repeated using the final
drills (Figure 6).
Following drilling, the drilling tubes are unscrewed and
removed from the stereolithographic guide (Figure 7). The
guiding cylinders glued in the stereolithographic guide are
then used for the implant placement. By using different
lengths of implant holders for the different implants, also
the depth of the implant placement can be securely controlled. As the depth control for drilling as well as implant placement is provided in the design of the stereolithographic
guide, surgeons receive indications of which components drills and implant holders - to use for each implant to be
positioned. As all the planning has been performed beforehand, the planning can be transferred to the operating room
utilizing an easy to use dynamical surgical tray. All needed
components can be positioned in a dynamic tray in an orde-
Figure 4. Drilling with a pilot drill of 13mm for the 13mm implant
Figure 6. Final Drillling
Figure 5. A pilot drill of 10mm is used for both the 10mm implant
for the 7mm implant
Figure 7. Once the drilling has been finished, the drilling tubes are unscrewed and removed to get a direct access to Titanium guiding cylinders
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red way following the tooth positions of the implants to be
placed (Figure 8). Implants are placed using guiding cylinders and appropriate implant mount (Figure 9).
To finish the surgery, the surgeon can choose all possible
options: screwing on of healing caps and covering the
implants with the gingiva (Figure 10), placement of healing
abutments during surgery (Figure 11), and immediate loading of implants with prosthetic elements in occlusal position (Figure 12).
Various clinical studies or on cadavers or on dry models (5)
show a deviation varying from 3.5mm for manual implant
placement to 0.3mm using the SAFE System. A recent
unpublished study on animals done by Dr. Luc Vrielinck
shows an accuracy of 100 microns at the entry point of
implants with the SAFE System.
Figure 8. All needed components are in the dynamical surgical tray, in
an ordered way following the tooth positions of the implants to be placed
Figure 9. All the implants are placed during a single surgical step with
the assistance of the SAFE System implant holders
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Figure 10. The surgery can end with the placement of healing caps
Figure 11. The surgery can end with the placement of healing abutments
Figure 12. The system also allows immediate loading
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The Planning Phase
The surgery planning is made using CT information within
the SimPlant software (Figure 13).
cal stop, depth control can be added in the design of the
guide. By adapting the height of the tube within the
SurgiGuide, compared to the actual platform of the planned
implant, one can adapt the SurgiGuide for use of a certain
length of drill and fixture mount for each implant individually. If all implants are positioned at the same level compared to the bone crest, and all implant lengths are within
the same length range, this depth control makes it possible
to drill all osteotomies with one and the same drill length. If
the depth and length of the implants differs, more components might be needed to accomplish the surgery.
Since the depth control is taken care of during the design of
the SurgiGuide, the design decides which components are to
be used for which implant positions. As such, every
SurgiGuide will be accompanied with a Surgery Guideline
explaining the different components to be used.
Before Surgery
Figure 13. Main SimPlant 9 screen. Implant position will be adapted
using rotation and traslation tools. Number and size of implants will be
Besides the bone quality and density, the ideal tooth set-up
can be taken into account by having a radio-opaque scan
prosthesis in the patient’s mouth during CT scan. This template is called a ScannoGuide ®. The position is defined by
combining the ideal emergence of each implant with anatomical restrictions like bone quality. Also the length of each
implant is defined at this point.
To avoid problems for SurgiGuide design and/or design of
the restorative bridge, it is checked whether the implants
(and their restorative spaces) are sufficiently far from each
other and from any remaining tooth. If implants are too
close to remaining teeth, it might be impossible to position
guiding tubes in the SurgiGuide at the lowest possible level
above the supporting surface, because of the proximity of
the neighbouring tooth.
Using the surgery guideline, the dynamical surgical tray
available in the SAFE Surgical Kit can be filled with the
correct components for surgery (Figure 14). By positioning
the needed drills and fixture mounts for each planned
implant at the correct tooth position in the surgical tray, the
transfer from the planning towards the actual surgery is simplified. If needed, titanium implant containers are available
to accommodate the change from implant brand specific
fixture mount to the SAFE fixture mount.
The completely prepared surgical tray can be sterilised as a
whole within the autoclave. As such, the complete surgery
is prepared beforehand, and errors caused by making important decisions in a stressful environment like the surgery
theatre are avoided.
SurgiGuide Design
After sending the treatment plan to Materialise, all planning
aspects are transferred to the design of the SurgiGuide.
As with regular SurgiGuides, SurgiGuides with the SAFE
System also transfer position and angle of the different
implants towards the surgery. Additionally, depth control is
taken care of during design of the guides. Because all surgical components, like drills and fixture mounts, are available
in different lengths and are equipped with collars as physi-
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Figure 14. Dynamic tray
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The teeth supported SurgiGuide is positioned in the patient’s mouth (Figure 15).
Figure 17. Staged drill
Figure 15. Teeth supported SurgiGuide in position
After the SurgiGuide is secured, a trephine is used through
the SurgiGuide to remove soft tissue and if needed to flatten
the bone to the level where the implant platform is expected
(Figure 16).
Figure 18. Final drill
Figure 16. Use of a trephine to punch the mucosa
The drilling tubes are positioned in the SurgiGuide, and
according to the planning and the surgery guideline, pilot
drilling and final drilling are performed through one and the
same drilling tube (Figure 17, 18).
Before driving the implants into the jaw, it must be decided
whether tapping is necessary or not, depending on the density of the bone at the implant sites.
The implants are driven in position guided by the correct
SAFE fixture mounts through the SurgiGuide (Figure 19).
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Figure 19. Implant placement using SAFE implant mounts
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To take into account mechanical considerations, the best
option is to drive all implants partially into position before
screwing the first implant completely down.
Once all implants are driven into position, the implant holders and the SurgiGuide can be removed (Figure 20).
The surgery can be finished in different ways, whether one
Figure 20. After placing the implant mounts down to the flange,they are
chooses to place healing caps (Figure 21) or to go for an
immediately loaded temporary prosthesis.
The use of the SAFE System has many advantages over the
current available systems. First of all, it is the only system
available on the market to provide drilling and implant placement guidance in position, angulation and depth with only
one surgical template. One drilling tube assures guidance of
both (and all) drills. After unscrewing the drilling tubes, the
implant placement can be guided through the titanium guiding tubes incorporated in the surgical template. Depth control is added by physical stops on drills as well as on the
implant holders, combined with the height of the tubes in
the design of the template. To accommodate the easy transfer of the implant planning towards the surgery theatre, an
easy to use dynamical surgical tray is available.
The current available system has been designed for standard
external hex implants. Several implant manufacturers with
internal retention implants are already adapting their components to make them compatible with the SAFE System.
This system leads us to accurately control implant placement (6). This procedure opened the way to micro opening
surgery, to trans-sinusal implant placements (6) and to the
Immediate Smile® procedure (7) where the bridge is fabricated before implants placement, without taking an impression of implants. In this case the screw retained bridge is
placed during the same appointment as implant placements.
Il SAFE system costituisce un nuovo approccio per la
locazione dell’impianto dentale permettendo un transfer
alla bocca di un piano di impianto basato sul CT scannerizzazione dati.
Il sistema consiste in strumenti atti al trattamento dell’impianto guidato, un singolo Surgiguide è usato per la trapanazione guidata e il posizionamento dell’impianto.
Safe è un acronimo di Sicuro, Accurato, Flessibile ed Ergonomico.
La facilità di esecuzione, la sicurezza di intervento e l’ottenuta accuratezza sono aspetti positivi importanti e ci portano a credere che il Safe System probabilmente avrà un profondo e positivo impatto sulla nostra attività pratica.
Figure 21. Healing abutments placed for a painless transmucosal one
stage surgery
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Parole chiave: Implantologia, Safe System, Dentascan
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