Computer-aided design/computer-aided manufacturing of hydroxyapatite scaffolds for bone reconstruction in jawbone atrophy: a systematic review and case report

Garagiola, Umberto,Grigolato, Roberto,Soldo, Rossano,Bacchini, Marco,Bassi, Gianluca,Roncucci, Rachele,De Nardi, Sandro Korean Association of Maxillofacial Plastic and Re 2016 Maxillofacial Plastic Reconstructive Surgery Vol.38 No.-

Background: We reviewed the biological and mechanical properties of porous hydroxyapatite (HA) compared to other synthetic materials. Computer-aided design/computer-aided manufacturing (CAD/CAM) was also evaluated to estimate its efficacy with clinical and radiological assessments. Method: A systematic search of the electronic literature database of the National Library of Medicine (PubMed-MEDLINE) was performed for articles published in English between January 1985 and September 2013. The inclusion criteria were (1) histological evaluation of the biocompatibility and osteoconductivity of porous HA in vivo and in vitro, (2) evaluation of the mechanical properties of HA in relation to its porosity, (3) comparison of the biological and mechanical properties between several biomaterials, and (4) clinical and radiological evaluation of the precision of CAD/CAM techniques. Results: HA had excellent osteoconductivity and biocompatibility in vitro and in vivo compared to other biomaterials. HA grafts are suitable for milling and finishing, depending on the design. In computed tomography, porous HA is a more resorbable and more osteoconductive material than dense HA; however, its strength decreases exponentially with an increase in porosity. Conclusions: Mechanical tests showed that HA scaffolds with pore diameters ranging from 400 to $1200{\mu}m$ had compressive moduli and strength within the range of the human craniofacial trabecular bone. In conclusion, using CAD/CAM techniques for preparing HA scaffolds may increase graft stability and reduce surgical operating time.

Computer-aided design/computer-aided manufacturing of hydroxyapatite scaffolds for bone reconstruction in jawbone atrophy: a systematic review and case report

Umberto Garagiola,Roberto Grigolato,Rossano Soldo,Marco Bacchini,Gianluca Bassi,Rachele Roncucci,Sandro De Nardi 대한악안면성형재건외과학회 2015 Maxillofacial Plastic Reconstructive Surgery Vol.37 No.-

Background: We reviewed the biological and mechanical properties of porous hydroxyapatite (HA) compared toother synthetic materials. Computer-aided design/computer-aided manufacturing (CAD/CAM) was also evaluated toestimate its efficacy with clinical and radiological assessments. Method: A systematic search of the electronic literature database of the National Library of Medicine (PubMed-MEDLINE) was performed for articles published in English between January 1985 and September 2013. The inclusioncriteria were (1) histological evaluation of the biocompatibility and osteoconductivity of porous HA in vivo and in vitro,(2) evaluation of the mechanical properties of HA in relation to its porosity, (3) comparison of the biological andmechanical properties between several biomaterials, and (4) clinical and radiological evaluation of the precision ofCAD/CAM techniques. Results: HA had excellent osteoconductivity and biocompatibility in vitro and in vivo compared to other biomaterials. HA grafts are suitable for milling and finishing, depending on the design. In computed tomography, porous HA is amore resorbable and more osteoconductive material than dense HA; however, its strength decreases exponentiallywith an increase in porosity. Conclusions: Mechanical tests showed that HA scaffolds with pore diameters ranging from 400 to 1200 μm hadcompressive moduli and strength within the range of the human craniofacial trabecular bone. In conclusion, usingCAD/CAM techniques for preparing HA scaffolds may increase graft stability and reduce surgical operating time.

Photobiomodulation and Miescher's cheilitis granulomatosa: case report

Porrini, Massimo,Garagiola, Umberto,Rossi, Margherita,Bosotti, Moreno,Marino, Sonia,Gianni, Aldo Bruno,Runza, Letterio,Spadari, Francesco Korean Association of Maxillofacial Plastic and Re 2020 Maxillofacial Plastic Reconstructive Surgery Vol.42 No.-

Background: Miescher's cheilitis granulomatosa (MCG) is a rare chronic inflammatory disease and is known as the monosymptomatic clinical form of Melkersson-Rosenthal syndrome (MRS). It is characterised by swelling of one or both lips and more frequently affects the upper lip. Histopathological findings show the presence of numerous inflammatory infiltrates and granuloma formations. Pharmacological treatments and surgery have provided results that are positive yet insufficiently stable in the long term. The clinical case described is of a 68-year-old female patient with a diagnosis of MCG of the upper lip. Case presentation: The patient was diagnosed and treated at the Oral Medicine and Oral Pathology outpatient clinic of Maxillofacial and Odontostomatology Unit, Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico. The patient was recommended localised treatments of photobiomodulation (PBM) using a diode laser with a 635 nm and 980 nm dual-wavelength (λ) approach, a 600-micron fibre, and a handpiece with a 1-cm-diameter lens at 300 mW. Three treatments a week were administered for four weeks for a total of 12 treatment sessions (T₁-T₁₂). After that, the patient had a long follow-up period of about 2 years. The therapeutic results were clear from the initial stages of treatment. There was an immediate, gradual, and consistent reduction in labial swelling. A reduction in the size of the lip by about 35% at T₁₀-T₁₂ was observed, returning the size and volume of the upper lip within the normal clinical range. The painful symptoms subsided after the seventh treatment (T₇). The histopathological check at 3 months and the follow-up in particular confirmed the disease was in remission with satisfactorily stable treatment results. Moreover, the patient did not use any other treatments on the area from the early laser treatments through to the end of the follow-up period. Conclusions: Our experience describes a clinical case of MCG treated with PBM and effectively resolved with a reduction of the lip swelling. The real success of the treatment emerged over time, showing that the tissue healing was stable. In absence of any collateral phenomena, this confirms the effective and documented therapeutic potential of PBM for chronic inflammatory infiltrates.

Current status of the surgery-first approach (part I): concepts and orthodontic protocols

Choi, Dong-Soon,Garagiola, Umberto,Kim, Seong-Gon Korean Association of Maxillofacial Plastic and Re 2019 Maxillofacial Plastic Reconstructive Surgery Vol.41 No.-

The "surgery-first" approach, defined as a team approach between surgeons and orthodontists for orthognathic surgery without preoperative orthodontic treatment, is aimed at dental decompensation. A brief historical background and indications for the surgery-first approach are reviewed. Considering the complicated mechanism of postoperative orthodontic treatment, the proper selection of patients is a vital component of successful surgery-first approach.

Hyperpigmentation of the hard palate mucosa in a patient with chronic myeloid leukaemia taking imatinib

Gian Paolo Bombeccari,Umberto Garagiola,Francesco Pallotti,Margherita Rossi,Massimo Porrini,Aldo Bruno Giannì,Francesco Spadari 대한악안면성형재건외과학회 2017 Maxillofacial Plastic Reconstructive Surgery Vol.39 No.-

Background Imatinib mesylate is an inhibitor of the tyrosine kinase Bcr–Abl and a first-line treatment for Philadelphia chromosome-positive chronic myeloid leukaemia (CML). Dermatological side effects include superficial oedema, pustular eruption, lichenoid reactions, erythroderma, and skin rash. Depigmentation of the skin and/or mucosa is uncommon, and hyperpigmentation is rare. Case presentation We present the case of a 63-year-old Caucasian male with widespread hyperpigmentation of the hard palate associated with a 9-year history of imatinib therapy to treat CML. He did not complain of any symptoms. Clinical examination did not reveal any abnormal pigmentation of the skin or other region of the oral mucosa. He did not smoke cigarettes or drink alcohol. His medication regimen was a proton pump inhibitor, a beta-blocker, cardioaspirin, atorvastatin, and imatinib 400 mg/day. Histopathologically, melanin and haemosiderin deposits were evident in the lamina propria. The lesion persisted, with no clinical change, through several follow-ups. We reviewed the literature to explore the possible relationship between oral hyperpigmentation and long-term imatinib mesylate treatment. Conclusions We diagnosed oral pigmentation associated with imatinib intake based on the medical history and clinical features of the pigmented macules. Oral pigmentation may have a variety of causes, and differential diagnosis requires nodal analysis. Clinicians should be aware of possible oral mucosal hyperpigmentation in patients taking imatinib mesylate. Such pigmentation is benign and no treatment is needed, but surveillance is advisable.

Diode laser surgery in the treatment of oral proliferative verrucous leukoplakia associated with HPV-16 infection

Bombeccari, Gian Paolo,Garagiola, Umberto,Candotto, Valentina,Pallotti, Francesco,Carinci, Francesco,Gianni, Aldo Bruno,Spadari, Francesco Korean Association of Maxillofacial Plastic and Re 2018 Maxillofacial Plastic Reconstructive Surgery Vol.40 No.-

Background: Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder, characterized by multifocal expression, progressive clinical evolution, and a high rate of malignant transformation. Evidence-based information regarding optimal PVL management is lacking, due to the paucity of data. The present report describes a case of PVL associated with HPV-16 infection and epithelial dysplasia treated by diode laser surgery, and the outcome of disease clinical remission over a 2-year follow-up period. Case report: A 61-year-old Caucasian male with oral verrucous hyperkeratosis presented for diagnosis. The lesions were localized on the maxillary gingiva and palatal alveolar ridge. Multiple biopsy specimens have been taken by mapping the keratotic lesion area. Microscopic examination was compatible with a diagnosis of PVL with focal mild dysplasia, localized in the right maxillary gingiva. Polymerase chain reaction (PCR) was done for human papillomavirus (HPV) detection which revealed presence of HPV DNA, and the genotype revealed HPV 16 in the sample. The PVL in the right gingival area was treated on an outpatient basis by excision with a diode laser. This approach resulted in good clinical response and decreased morbidity over a 2-year follow-up period. Conclusions: This case illustrates the benefit of a conservative approach by diode laser treatment than wide surgical excision for management of the PVL lesions associated with mild dysplasia and HPV-16 infection.

Mentolabial angle and aesthetics: a quantitative investigation of idealized and normative values

Naini, Farhad B.,Cobourne, Martyn T.,Garagiola, Umberto,McDonald, Fraser,Wertheim, David Korean Association of Maxillofacial Plastic and Re 2017 Maxillofacial Plastic Reconstructive Surgery Vol.39 No.-

Background: This study is a quantitative evaluation of the influence of the mentolabial angle on perceived attractiveness and threshold values of desire for surgery. Methods: The mentolabial angle of an idealized silhouette male Caucasian profile image was altered incrementally between $84^{\circ}$ and $162^{\circ}$. Images were rated on a Likert scale by pretreatment orthognathic patients (n = 75), lay people (n = 75) and clinicians (n = 35). Results: A mentolabial angle of approximately $107^{\circ}$ to $118^{\circ}$ was deemed the most attractive, with a range of up to $140^{\circ}$ deemed acceptable. Angles above or below this range were perceived as unattractive, and anything outside the range of below $98^{\circ}$ or above $162^{\circ}$ was deemed very unattractive. A deep mentolabial angle ($84^{\circ}$) or an almost flat angle ($162^{\circ}$) was deemed the least attractive. In terms of threshold values of desire for surgery, for all groups, a threshold value of ${\geq}162^{\circ}$ and ${\leq}84^{\circ}$ indicated a preference for surgery, although clinicians were least likely to suggest surgery. The clinician group was the most consistent, and for many of the images, there was some variation in agreement between clinicians and lay people as to whether surgery is required. There was even more variability in the assessments for the patient group. Conclusions: It is recommended that in orthognathic and genioplasty planning, the range of normal variability of the mentolabial angle, in terms of observer acceptance, is taken into account as well as threshold values of desire for surgery. The importance of using patients as observers in attractiveness research is stressed.

Arthrogryposis multiplex congenita with maxillofacial involvement: a case report

Stefano Cirillo,Daniele Regge,Umberto Garagiola,Alessandro Tortarolo,Giuseppe Carlo Iorio,Orges Spahiu,Maria Grazia Piancino 대한악안면성형재건외과학회 2023 Maxillofacial Plastic Reconstructive Surgery Vol.45 No.-

Background Arthrogryposis multiplex congenita is a rare condition that mainly involves the lower limbs, characterized by severe joint deformity and contracture, muscular atrophy, and functional impairment. Its clinical manifestations are heterogenous and may involve the maxillofacial district as well. Case presentation This case report describes a 20-year-old patient with arthrogryposis multiplex congenita with skeletal crossbite, facial asymmetry, reduced mouth opening and absence of lateral mandibular movement on the left side. After clinical evaluation, the following exams were required: postero-anterior cephalometric tracing, head and neck electromyography, computerized axiography, computed tomography scan, and maxillofacial magnetic resonance imaging. Orthognathodontic evaluation indicated skeletal asymmetry, reduced condylar movements on the left side and abnormally low electromyography activity of the masticatory muscles on the left side. Computed tomography and magnetic resonance imaging revealed unilateral left mandibular hypoplasia, hypotrophy, and fatty infiltration of masticatory muscles on the left side, as well as immobility of the left condyle during mouth opening, and hypoplasia of the left articular disk, which was however not displaced. Surgery was not indicated and conservative orthognathodontic treatment with function generating bite was suggested to balance the occlusal plane, as well as stretching exercises. Conclusions A rare case of arthrogryposis multiplex congenita with maxillofacial involvement illustrates that a patient-centred, multidisciplinary approach with accurate diagnosis is required to formulate the best treatment plan. Because of the considerable damage to the masticatory muscles, conservative orthognathodontic therapy may be the best treatment option.

Comparison of the Physical Properties and in vivo Bioactivities of Flatwise-Spun Silk Mats and Cocoon-Derived Silk Mats for Guided Bone Regeneration

강예진,조유영,권해용,채원식,양원근,Umberto Garagiola,김성곤,Horatiu Rotaru 한국고분자학회 2020 Macromolecular Research Vol.28 No.2

The main flaw of silkworm cocoon originated membranes for guided bone regeneration (GBR) techniques is that the maximum size of the membrane is determined by the size of the cocoon. Flatwise-spun silk does not have any limitation to its production size. The objective of this study was to compare flatwise-spun silk mats with cocoon-derived silk mats for a GBR technique. Tensile strength, scanning electron microscopy, Fourier transform infrared (FT-IR) spectroscopy and sericin contents analysis were done for in vitro test. Bone regeneration ability was tested in the critical sized defect of the animal model. In this study, flatwise-spun silk mats showed lower tensile strength and similar tensile strain to a cocoon-derived commercialized silk mat (TDI). Compared to TDIs, the flatwise-spun silk mats showed a similar second derivative spectrum, but they showed an increased abundance of the random coil and helix structures in the FTIR spectra because of a higher content of sericin. In animal model experiments, the bone volume (BV) after the application of a flatwisespun silk mat was similar to the volume observed after the application of a TDI. Both groups showed a significantly higher BV compared to an unfilled control group (P<0.05). Considering that there was no size limitation in producing flatwise-spun silk mats, their clinical indications could be much wider than cocoon-derived silk mats.

Validation of a new three-dimensional imaging system using comparative craniofacial anthropometry

Naini, Farhad B.,Akram, Sarah,Kepinska, Julia,Garagiola, Umberto,McDonald, Fraser,Wertheim, David Korean Association of Maxillofacial Plastic and Re 2017 Maxillofacial Plastic Reconstructive Surgery Vol.39 No.-

Background: The aim of this study is to validate a new three-dimensional craniofacial stereophotogrammetry imaging system (3dMDface) through comparison with manual facial surface anthropometry. The null hypothesis was that there is no difference between craniofacial measurements using anthropometry vs. the 3dMDface system. Methods: Facial images using the new 3dMDface system were taken from six randomly selected subjects, sitting in natural head position, on six separate occasions each 1 week apart, repeated twice at each sitting. Exclusion criteria were excess facial hair, facial piercings and undergoing current dentofacial treatment. 3dMDvultus software allowed facial landmarks to be marked and measurements recorded. The same measurements were taken using manual anthropometry, using soluble eyeliner to pinpoint landmarks, and sliding and spreading callipers and measuring tape to measure distances. The setting for the investigation was a dental teaching hospital and regional (secondary and tertiary care) cleft centre. The main outcome measure was comparison of the craniofacial measurements using the two aforementioned techniques. Results: The results showed good agreement between craniofacial measurements using the 3dMDface system compared with manual anthropometry. For all measurements, except chin height and labial fissure width, there was a greater variability with the manual method compared to 3D assessment. Overall, there was a significantly greater variability in manual compared with 3D assessments (p < 0.02). Conclusions: The 3dMDface system is validated for craniofacial measurements.