Foto del docente

Claudio Marchetti

Full Professor

Department of Biomedical and Neuromotor Sciences

Academic discipline: MED/29 Maxillofacial Surgery


Keywords: alveolar atrophies guided tissue regeneration orthognathic surgery biomaterials stem cells craniofacial malformations cysts of the jaw head and neck tumors virtual surgery titanium mesh

1.Bone augmentation by means of grafts derived from culture and growth of human stem cells may represent a fast and effective solution to allow implantology in atrophied jaws. 2.Micro-vascularized free-flaps obtain a reconstruction of both hard and soft tissues ablated for being affected by tumors; they may be molded to resemble the resected portion of the affected jaws, recovering their previous morphology and function. 3. In sinus lift procedure, synthetic osteoconductive biomaterials demonstrated to be effective as scaffold for the bone formation starting from the host place.4. Surgical treatment of neoplastic pathologies of the maxillo-facial complex. 5. Histological assessment of regenerated bone using a mix of autologous bone and osteoconductive material or osteoconductive material alone below a titanium mesh.

Bone reconstruction after a remarkable bone loss due to huge facial trauma, severe atrophies, or wide resection for benign or malign tumor ablation results an essential phase for the recover of the patient physiognomy . Obtaining an adequate bone height and thickness by means of grafts from human stem cells culture and /or osteoconductive bone substitutes may be considered a fast and effective alternative solution to allow implant placement. This new therapeutic approach makes faster the accomplishment of a successful implant-borne prosthetic rehabilitation, enabling patient to recover a good chewing and aesthetical function within six months, notably reducing infection risk and post-surgery discomfort and pain.

2. The free-flaps achievement entails the recover of a vascular pedicle subsequent anastomized with micro-surgery to vessels of the neck and face, previously identified. Micro-vascularized free-flaps allow a recovery of both hard and soft tissues, and may be shaped to resemble the resected portion of the affected jaws. Most frequently these reconstructive procedures are applied during or subsequently to oncologic oral-maxillo-facial surgeries with the aim of completely removing the tumor and, at the same time, repairing tissue loss, that extremely impairs oral functions, such as chewing, swallowing and speaking . This technique limit the great problems related to ablation of essential organs such as the tongue, the mandible, the nose pyramid.

The use of stereolytographics models from the three-dimensional TC reconstruction , precisely reproducing the anatomical situation of the patient jaws, enable us to correctly study the caseto be treated and to mould pre-operatively the ostesyntetic plates needed, reducing the surgical timing and the complication rate.

3. The surgical procedure of great sinus lift entails the lift of sinusal membrane and the application below of different kind of bone grafts mixed with biomaterials, to allow mineralized tissue to be created for implant placement. Autologous bone is up to date the gold standard material for its own reliability and osteogenic, osteoinductive and osteoconductive features. Different osteoconductive biomaterials, reported in literature, seem to be useful substitutes of autologous bone when mixed with it. These materials, deeply studied in the last years, although provided of just osteoconductive features and prone to a slow resoption process, revealed themselves to be very effective as scaffold for the invasion of autologous bone cells from the recipient site.

4. Reduction of relapse percentage and widening of 5 years survival are the goals of our studies about oncologic issue. A well-timed diagnosis and the identification of oncogenic markers are the end-points of the research project at point 5.

Titanium meshes have been used for the first time by Von Arx in 1996 for pre-implantological bone reconstruction. Some studies, published in the last years, reported a a high percentage of success with this technique. The aim of our project about this issue is the assessment of the real correspondence between stereolithographic model and the clinical situation of the patient, verifying the reduction of surgical timing, and the lowering of complication rate.

In the test group the mesh will be moulded pre-operatively on stereolythographic models obtained from TC three-dimensional reconstruction , while, in the control group, the meshs will be moulded intra-operatively, according to standard protocol . Furthermore, it'll be evaluated the effectiveness of a mix of autologous bone and biomaterials respect to biomaterial alone below a titanium mesh in terms of quantity and histological quality of regenerated bone in atrophied ridges .