CLINICAL ACTIVITY

001
MAXILLARY SINUS SURGERY
On this specific topic our school has written a book that has been translated into English, German and Farsi and numerous chapters in recent English textbooks.
The elevation of the maxillary sinus is a reconstructive surgical technique widely practiced in implantology to reconstruct the bone of the upper arch at the level of premolars and molars, scientific research and literature have shown that biomaterials are a valuable alternative to bone harvesting.
However, exists also another very dangerous philosophy of thought: extracting teeth to place implants (avoiding any type of bone reconstruction) allowing the patient to have a dentures with immediate fixed load using the bone only at the level of incisors and canines teeth.
We have been using this method since 1999, but it has very precise indications: a good doctor customizes the treatment plan to the patient, reducing the invasiveness if possible, and does not propose the same treatment plan for all patients. In medicine and dentistry, you can’t treat everyone the same way. The road to strong, healthy dental implants is not always easy, but when necessary, a sinus lift procedure is definitely a step on the road to a full, healthy smile. This relatively common procedure allows you to enjoy all the benefits of dental implants, even after significant bone loss.
What is a sinus lift procedure?
A maxillary sinus lift, also called a sinus augmentation, is a procedure that allows the placement of dental implants. Some patients require dental implants but have experienced bone loss, thus not having sufficient bone support necessary for the implants. This procedure increases the amount of bone at the level of the jawbone allowing the placement of implants.
Who needs sinus augmentation?
Over the past 40 years, dental implants have become more easily accessible, making them an increasingly common dental procedure.
A maxillary sinus lift may be necessary if teeth are missing and there is insufficient bone in the back of the jaw to place the implants.
What tests should be performed before a maxillary sinus lift?
A CT scan (CBCT in technical terms) is indicated for the purpose of planning this surgery.
What happens during the procedure of sinus augmentation?
The maxillary sinus lift procedure is a simple and safe procedure.
The entire process requires an average of 45 to 60 minutes.
First, the patient will be sedated by conscious sedation/anxiolysis, and local anesthesia will be given.
Then, the surgeon will make a minimally invasive incision to expose the bone.
The next steps include making a small circle in the bone through which the sinus membrane is gently elevated and the insertion of a bone graft.
Upon completion, the procedure is finished, and the surgeon will close the incision with stitches.
What are the risks of a sinus augmentation procedure?
As after any surgery, the greatest risk is an infection of the sinus. Therefore, the surgeon will prescribe antibiotic prophylaxis before the surgery and postoperative antibiotic therapy.
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002
OSSEOUS AND REGENERATIVE SURGERY
Every time a tooth is extracted there is inevitably a bone loss which is greater in the first months after the extraction, and it stabilizes after about a year. In many cases, if after the extraction of the tooth the techniques of preservation of bone volumes through grafts that are placed immediately after extraction are not implemented, the patient after healing does not have adequate bone volumes to place the implants. However, there are surgical procedures for bone regeneration with biomaterials and biocompatible membranes that allow to restore the bone volumes lost due to normal and physiological resorption. The need to regenerate the bone can also be due to trauma, accidents in which the patient loses both bone and teeth, or damage caused by periodontal disease (pyorrhoea). Another mistake that is frequently made is to keep mobile teeth for too long, which cause further bone loss and when the decision to extract them is taken, it is too late and the patient finds himself in a condition of great bone deficit.

003
IMMEDIATE LOADING IMPLANTOLOGY
Among the innovative procedures that have marked an important step forward with respect to the original implant protocols, immediate loading stands out for its relevance in routine clinical applications. The evolution of the immediate loading protocol represents the most significant example of how and how much implant therapy in recent years has been influenced, guided, and transformed by new concepts of biology and biomechanics pertaining to other branches of science. Immediate loading in totally edentulous patients or with residual dentition, today offers unquestionable psychological and social advantages and increases operative efficiency by reducing operating times and minimizing surgical invasiveness.
Our School has published a book on immediate loading that has been translated into English and Chinese and has highlighted the benefits of this protocol over the past 20 years.
Traditional loading of a dental implant refers to the placement of the denture after the osseointegration has been achieved. However, in many clinical cases, the implant can be loaded immediately after its placement in the bone (immediate loading).
The choice of the most appropriate loading procedure, traditional or immediate, is made following a thorough clinical evaluation of the patient.




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004
PERIODONTOLOGY
Periodontopathy is a disease of bacterial etiology, known to patients as “pyorrhea”. It determines the progressive destruction of the bone and tissues surrounding the teeth in our oral cavity. After an accurate diagnosis, we proceed to define the treatment plan, which usually includes a phase of non-surgical therapy in which we perform scaling and polishing sessions aimed at removing all tartar and contaminants from the root surfaces.
Periodontal surgery allows for the restoration of the quantity of bone tissue lost using “guided tissue regeneration” (GTR) procedures, a surgical technique that allows for the recreation of an adequate level of supporting tissue. Different types of biomaterials are usually used to recreate the supporting bone, which serve as a framework and are then progressively replaced by the patient’s own bone over the course of a few months. These are periodontal microsurgical procedures that are performed under local anesthesia; they are minimally invasive, the postoperative period is uneventful, and the patient’s bone is not affected.


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005
MUCOGINGIVAL ESTHETIC SURGERY
Gingival recession occurs when the gumline “recedes,” progressively exposing the root, a portion of the tooth that is normally covered by the gingiva. The patient may notice gum recession because one or more teeth become more sensitive in the collar portion, for example, when brushing or eating cold foods and drinks, or because they appear longer than normal. The exposure of a greater portion of the tooth may depend on periodontal disease, but recession can also occur in patients who are not affected by it; in particular, the causes may be anatomical (prominent roots, insertion of frenulums, particularly thin tissues) or related to an excessively aggressive brushing conducted with incorrect technique.


There are several surgical techniques that allow to achieve the correction of recessions, with or without the grafting of tissues taken from the oral cavity or the use of biomaterials; however, it is better to intervene when there is a residual portion of keratinized gingiva (the thicker light pink gingiva that normally surrounds the teeth).
The dentist will evaluate the indications for the most appropriate therapeutic approach for each individual case, allowing on the one hand to protect the exposed roots from abrasion and bacterial contamination, and on the other hand to restore the harmony between teeth and gums which is essential for a beautiful smile.
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006
DIGITAL DENTISTRY
On this specific topic our School has written a book that has been translated into English and several chapters in very recent English textbooks.
It has been the introduction of the innovative design software, together with the possibility to prepare stereolithographic models of the maxillae for the simulation of the interventions and the surgical templates that have transformed the traditional implantology reducing the invasiveness and improving the postoperative course of the surgical interventions.
The doctor can better use the diagnostic information derived from the CBCT analysis and from an accurate three-dimensional design, transferring this knowledge to the clinic after simulating the surgery and preparing in clinical cases of immediate load the provisional fixed prosthesis before the surgical phase itself.
Computer-aided navigation in implantology is therefore based on the following assumptions: pre-surgical planning of the finalization of the case, planning of the technical aspects of the surgical intervention and obtaining models on which to build precise surgical templates and fixed provisional prostheses to be delivered to the patient immediately after surgery.
Delve deeper into the topic with articles by Prof. Testori

007
ORAL SURGERY
Oral surgery is a branch of Odontology that deals with surgery of the oral cavity at the mucosal, osseous and dental levels.
Oral surgery procedures are performed under locoregional anesthesia and include several clinical situations:
- simple and complex tooth extractions
- extractions of included dental elements
- simple and included extractions of third molars (wisdom teeth)
- apicoectomies (removal of the apex of teeth) with retrograde filling of dental elements with chronic apical periodontitis (granulomas)
- surgical disinclusions of included teeth to be orthodontically repositioned in their natural position
- labial and lingual frenectomies
- periodontal surgery
- preprosthetic soft tissue surgery (e.g., sinking of the fornix) and bone surgery (e.g., removal of bone exostosis)
Delve deeper into the topic with articles by Prof. Testori
008
MODERN ESTHETICS IN DENTISTRY
The smile and the look are the first form of non-verbal communication that makes us empathically connect with others. A bright and healthy smile plays a key role in making the individual feel more attractive and confident. The objective of esthetic odontology is to intervene on the teeth by changing their color, shape, position and length, thus eliminating any defects and making the smile more beautiful and harmonious. Each case is obviously personalized according to the dento-facial proportions of the individual patient to respect the concept of individuality as much as possible. Probably the least aggressive solution yet able to guarantee very high aesthetic results is the application of aesthetic “dental veneers”, thin ceramic foils, with a thickness that can vary from 0.3 to 0.7 mm, applied on the outer surface of the teeth. . This solution does not require filing the teeth.
Implantology makes it possible not to file down neighboring teeth and to make single teeth on implants. In selected cases, the best treatment is immediate loading, i.e., placing the implants and temporary crowns in the same session and then finalizing the case with all-ceramic crowns that do not contain metal.




009
CONSCIOUS SEDATION
This extremely effective and reliable form of sedation will put you in a state of deep relaxation. Time will seem to pass quickly, and the treatment will be over before you know it. You will be able to respond to requests and instructions as needed, allowing the surgeon to progress as he or she normally would with the cooperating patient.
Sedation is not just for patients who are anxious about dental procedures, but for anyone who does not want to notice what is being done.
During conscious sedation, relaxing medications are administered intravenously.
This is a safe procedure that we have been applying for years, according to the guidelines of the Ministry of Health.
010
IMPLANT PROTECTION PLAN
Our School has created a new implant/ periodontal maintenance protocol called the Implant Protection Plan (IPP).
The collaboration and perseverance of the patient in terms of home oral hygiene are in any case essential to maintain the results of periodontal therapy: learning the correct maneuvers to remove plaque is not always easy, especially in adulthood, but it is essential for the preservation of the health of the teeth and tissues that surround them. Equally important is to eliminate/reduce cigarette smoking and try to control other factors (diabetes, stress, diet) that are a risk factor for oral diseases.
Finally, we must remember that there is a pathology similar to periodontitis that can affect patients with dental implants: this is peri-implantitis, a disease that leads to the destruction of the bone surrounding the endobony implants.
Screening and periodontal therapies in patients who are candidates for implantology are therefore very important, as well as periodic check-ups and professional hygiene and, once again, the collaboration of the Patient.

