Dentistry

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Advanced Oral Surgery
  • Implantology
  • Special Rehabilitation Surgery
  • Fixed, mobile and aesthetic prosthesis  
  • Periodontology
  • Oral Medicine and Pathology
  • Conservative Dentistry
  • Endodontics
  • Mandibular and Cervical Physiotherapy
  • Oral Hygiene and Prevention
  • Paediatric Dentistry
  • Orthodontics
  • Gnathology
  • Special Needs Dentistry

PROCEDURES PERFORMED PER YEAR: 50,000

The clinical activity of the Dentistry Unit covers all dental disciplines, from rehabilitation of the compromised masticatory function to smile aesthetics, medicine and pathology of the oral cavity, as well as early diagnosis of oral cancer. Particular importance is given to the prevention, thanks to the center of Oral Hygiene and Prevention, which also manages the follow-up of all patients undergoing treatment at the Unit and is in charge of early interception by means of salivary diagnostic tests and provides treatment of the most common paediatric oral diseases. For all treatments and procedures, cutting-edge instruments are used, such as laser, operating microscope, dental impression scanner and CAD-CAM technology for computerized prosthesis design.

The Dentistry Unit is also home to the Master's Degree Course in Dentistry and Dental Prosthetics, the Degree Course in Dental Hygiene, and the teaching activity of the Dental Clinic at the Faculty of Medicine and Surgery of the San Raffaele Vita-Salute University and the International MD Medicine Program offered in English.

 

treatmentS

Advanced Oral Surgery and Implantology

The advanced pre-implant surgery deals with tissue regeneration in order to recreate the ideal conditions for the positioning of Osseo-integrated implants to support new prosthetic dental elements. Nowadays it is possible to reconstruct the skeletal bases for horizontal and vertical defects through guided bone regeneration. If the bone defects are particularly severe (in relation to the amount of the defect or the anatomical complexity) it is possible to resort to autologous bone grafts (taken from the same patient) and coming from intraoral sites (angle and mandibular body) or from extraoral seats (parietal and iliac bone). The Unit has expertise in minimally invasive techniques in implant-prosthetic rehabilitation of severe maxillary atrophy with tilted and zygomatic implants.  

In this type of operations, the most innovative research methods and the most advanced computer-assisted technologies are used in the two most delicate phases for the patient: diagnostics and surgical therapy. The diagnosis, performed by 3D CT scan, allows to study with absolute precision the oral anatomy. Surgical and implant operations are instead designed thanks to software that guarantee the patient the minimum of invasion in the surgical phase, in the face of maximum clinical and aesthetic results. This methodology is called "guided implantology". The implantology techniques allow the realization of prostheses of a single tooth up to the rehabilitation of an entire mouth.

Main Pathologies Treated:

  • Maxillary Atrophy
  • Bone Deficiency

Top Procedures:

  • Minimally Invasive Prothesis Implantation
  • Bone Regeneration
  • Intraoral and Extraoral Bone Grafting
  • Elevation of the maxillary sinuses and nasal cavities with expansive methods that use osteotomes
  • Zygomatic Implantology
  • Osseo-integrated Implantology

Special Rehabilitation Surgery

The Osseo-integrated implantology in recent years has been the protagonist of substantial developments on the front of both materials and procedures of any kind. In addition, innovative techniques such as All-on-four / V-II-V / All-on-six and computer-assisted systems have substantially reduced waiting times and, above all, the discomfort felt by those who must receive the prosthesis, also facilitating the work of professionals who must apply it. The really revolutionary aspect, however, is that with these methods it is now possible to return to most patients with seriously compromised or edentulous teeth a fixed dentition in just one day.

The ALL-AT-ONCE protocol is active within the Unit which, thanks to the new technologies, offers the possibility to perform implant-prosthetic rehabilitation of edentulous patients in just 24 hours or at the same time of implant insertion. The implants insertion and the delivering of the prosthesis are performed in a few hours, allowing the patient to recover masticatory and aesthetic function.

Main Pathologies Treated:

  • Partial and Complete Edentulism

Top Procedures:

  • Prothesis Implantation
  • Implant-Prosthetic Rehabilitation

Fixed, mobile and removable prosthesis

The Dentistry Unit has a multidisciplinary approach and collaborates with dental professionals with decades of experience, speakers in national and international conferences on the subject, and authors of numerous works and scientific publications. In this close and continuous collaboration with the team of specialists from the Oral Surgery and Implant Surgery division, partial and complete arches rehabilitations are performed on Osseo-integrated implants, with scrupulous attention to the achievement of both functional and aesthetic success.

Thanks to advanced technological equipment, smile design with digital planning is also available to patients. The dental laboratory deals with all the work related to dental prothesis, both fixed and mobile types, customized on each individual. Computer-aided rehabilitations are also performed, in which the insertion of the implants is guided by a virtual-three-dimensional model with an individually customised surgical template for the placement of the implants safely, precisely, and accurately.

Main Pathologies Treated:

  • Edentulism
  • Aesthetic of the Smile

Top Procedures:

  • Digital Smile Design
  • Aesthetic prosthesis Implantation
  • Impession of dental arches by digital techniques

Periodontology

Periodontology deals with the diagnosis and treatment of periodontal disease, regenerating the lost periodontal tissue or, where it is not possible, replacing the tooth with an "immediate" or "delayed" implant. Accumulation of bacterial plaque and tartar on the teeth, caused by poor oral hygiene, causes the appearance of inflammation of the gums (gingivitis) which manifests with redness, swelling and bleeding of the gingival mucosa.

If plaque and tartar are not removed, the inflammation worsens causing periodontitis (or pyorrhoea) that is characterized by high probing depths, bleeding, bone loss and gingival recessions. The consequence is the progressive mobility of the teeth until their loss.

In severe forms of periodontitis, where the gingival pockets are more profound, it is necessary to intervene with the incision of the gums (periodontal surgery), while recessions and loss of bone tissue can be treated by using gingival grafts taken from the palate with the use of regeneration techniques through the insertion of biomaterials, biomimetic proteins, growth factors and membranes.

Main Pathologies Treated:

  • Periodontitis

Top Procedures:

  • Periodontal techniques for the covering of exposed roots
  • Diagnosis and treatment of periodontal diseases and peri-implantitis
  • Periodontal Surgery

Oral Medicine and Pathology

The activity of the Oral Medicine division is centered on disturbances and non-oral dental diseases, in particular on the diagnosis, treatment and cure of pathological conditions and diseases of the oral mucosa. The activity in the field of Medicine and Oral Pathology is multidisciplinary and harmonized with the other specialized fields of medicine. Oral Medicine is able to solve many of the problems of oral health related to general diseases associated with symptoms, disorders and injuries that involve the oral cavity and interfere with the well-being of the patient. The conditions that most frequently require diagnosis and treatment of the oral medicine expert are inflammatory and immunopathological oral diseases such as recurrent ulcers, oral lichen planus, pemphigoid of the oral mucosa, pemphigus and the oral manifestations of lupus erythematosus and discoid.

Tongue related diseases are a further cause of very troublesome patient complaints: excessive bacterial patina, fungal infections, chronic burns such as burning mouth syndrome and oral dysesthesia. The Unit is also specialized in the prevention and early detection of oral cancers, through the control of risk factors and the application of rational diagnostic and therapeutic protocols against benign tumours, possibly precancerous lesions, such as leucoplakia and chronic red and / or erosive lesions, long-undiagnosed lesions.

Main Pathologies treated:

  • Oral Infections and Neoplastic Diseases
  • Oral precancerous and dry mouth problems

Top Procedures:

  • Prevention and early diagnosis of neoplastic oral diseases
  • Use of modern laser and optical technologies, also for tumours diagnosis

Conservative dentistry and Endodontics

Because of inflammatory processes or traumatic events, the dental pulp undergoes reversible transformations, cured by conservative (fillings, inlays), or irreversible interventions that instead provide root canal therapy or, as it is more widely known, devitalization. The purpose of root canal therapy is undoubtedly to allow the patient to retain the tooth which can then continue, no longer vital, to perform all of its functions.

The use of fillings obtained from new composite resins, loaded with glass-polymer particles, make it possible to obtain results with a high standard of both functional and aesthetic quality.

Prosthetic restorations that use fillings in composite or polycarbonate resins are of great interest for conservative activity. They allow the recovery of dental elements, especially of the posterior areas (premolars and molars), also significantly destroyed by carious processes, without having to resort to traditional prosthetic techniques (encapsulation with gold-resin or ceramic crowns).

The use of the operating microscope allows an execution and a finishing that, besides contributing to the aesthetic result, plays a fundamental role in the long-term success of the restorations.

Main Pathologies Treated:

  • Caries and Dental Pulp Pathologies, Trauma, Fractures and Chipping

Top Procedures:

  • Dental Reconstructions with Aesthetic Materials

 Orthodontics in Paediatric and Adult Patients

Orthodontics (from the Greek "ortos" upright and "odontos" tooth) is the medical science, within the field of dentistry, which deals with the control, development and growth of the teeth and the anatomical structures related to it. The aim of orthodontics is the achievement and maintenance of a correct alignment of the teeth, of the oral and perioral soft tissues, of the oro-masticatory musculature, for the achievement of a dento-facial morpho-functional development as best as possible.

Orthodontic therapy consists of a preventive phase, an interceptive phase, an orthopaedic phase, and finally a treatment period with fixed orthodontics followed by a restraint.

This team is equipped with cutting-edge diagnostic systems, developed on the basis of the latest scientific research, which allow accurate orthodontic check-ups. These include the fingerprint, the teleradiography of the skull in latero / lateral projection, the orthopantomography of the dental arches, the radiology of the latest generation with low radiant dose, and - of very recent discovery - the identification of the personal growth peak (genetic test).

  • Paediatric and Adolescent Patients

It is in fact possible to define the time span in which the peak of maximum development of the child / adolescent will occur, so as to concentrate it that timeframe the treatments, which will therefore be more effective, less long and consequently less expensive.

Therapy varies in different ages of the patient. There are three age groups in which the orthodontist's intervention may be necessary:

  • 0-6 years of Age: The prevention phase starts with the collaboration of the Orthodontist with the Paediatrician and others, creating a multidisciplinary team (Otolaryngologist, Physiatrist, Allergologists etc.) In this phase it is necessary to intercept the bad habits, functional anomalies, anomalous eruptive pathways and important skeletal problems as well as to work to promote a correct and harmonious evolution of the dental arches. The interceptive Orthodontics plays an important preventive function in that it allows to identify in time some severe malocclusions, avoiding the worsening of the situation.
  • 6-12 year of Age: Orthopaedic therapy, to be performed during peak growth, aims to modify skeletal disharmony if possible. The devices used in this phase can be mobile (which the child can easily put on and take off alone) or fixed. The goal of this phase is to stimulate and / or restrain the growth of the maxilla or mandible to restore skeletal harmony.
  • Over 12 years of Age: The therapy with fixed equipment has as its objective the achievement of an ideal alignment of the teeth, after the skeletal problem has been solved and mitigated.
  • Adult Patients

It is necessary to modulate the therapeutic needs by adapting to the aesthetic needs of patients in adulthood. To this end we have designed and produced virtually invisible devices that adults are willing to wear, that allow good hygiene, do not affect the articulation of words, and consequently the social and working life. Thanks to the invisible Orthodontics devices it is possible to realign the teeth gradually and effectively without upsetting the social habits and food intake, obtaining excellent results that last over time.

Main Pathologies Treated:

  • Control, Development and Growth of the teeth and the anatomical structures
  • Malocclusions in paediatric and adult patients

Top Procedures:

  • Treatment of malocclusions in paediatric and adult age, also with invisible templates
  • Teeth realignment, also with invisible templates

 Gnathology/Mandibular and Cervical Physiotherapy

This field deals with disorders of the masticatory apparatus such as the temporomandibular joint (junction between the jaw and skull), muscles and support of the two dental arches, which in many cases limit the patient's quality of life due to the pain that is generated during masticatory movements, leading to the impossibility to open the mouth completely in more severe cases. Moreover, the abnormal contact between the dental arches can generate or be the effect of skeletal compensations, until the appearance of algic problems (neck and / or back and headaches).

The treatment of these problems makes use of resin nocturnal equipment (bite decompression) or continuous 24 hours devices (splint stabilisers). The bite decompression aims to minimize the pressure put on the articular muscle structure, while the splint stabilisers serve diagnostic therapeutic purposes, stimulating a new mandibular position to be used after the resolution of the symptomatology. Particular attention is paid to the prevention of factors that interact to determine the TMJ disorders.

Main Pathologies Treated:

  • Masticatory parafunctions (bruxism and window)
  • Malocclusions
  • Postural vices

Top Procedures:

  • Treatment of cervical and gnathological problems with realization of orthopaedic and orthodontic specific devices

Paediatric Dentistry

This section of the Dentistry Unit deals with prevention and dental therapy from the first years of life to adolescence of patients. Its primary role is the prevention of any pathology of the mouth in the developmental age in close collaboration with other paediatric Units. Dialogue is fundamental with the paediatrician, the otorhinolaryngologist, the physiatrist, the psychologist and any other professional who follows any pathologies of the child, because collaboration gives better results. When caring for children, it is necessary to do so together and as soon as possible: the first visit is beneficial to be done around two years of age, according to European and international guidelines.

At two years of age all the problems are small (dental caries and malocclusions), but above all the child heals quickly and resumes healthy growth that will accompany his whole life. It must be noted that in order to bring children so small, it is necessary to prepare the right environment both in terms of dialogue (collaboration with child psychologists) and in making available the possibility of performing the most complex therapies in pharmacological sedation under Day Hospital regime.

Main Pathologies Treated:

  • Oral prevention
  • Early caries
  • Gingivitis
  • Incorrect alignment of teeth and dental arches

Top Procedures:

  • Early caries and malocclusions treatment
  • Milk teeth exchange monitoring
  • 'Tell-show-do’ technique

Oral hygiene and prevention

The Center of Oral Hygiene and Prevention is dedicated to the application of specific treatments for the prevention and the treatment of periodontal pathologies, as well as to the implementation of personalized and specific prevention protocols of the carious pathology from the age of development to adulthood. Particular attention is paid to aesthetic treatments, with the adoption of professional dental whitening methods both in the unit (with the use of laser and / or halogen lamps), and at home (individualized masks). A Pilot Center is also active for the follow-up and maintenance of the new minimally invasive implanta-prosthetic rehabilitations performed with "all on four" and "all on six" methods.

Main Pathologies Treated:

  • Prevention and treatment of periodontal pathologies

Top Procedures:

  • Innovative techniques for dental bleaching (laser or halogen light) and oral hygiene

Special Needs Dentistry

The Centro San Luigi Ville Turro of Dentistry (part of the San Raffaele Hospital), directed by prof. Enrico Gherlone, deals mainly with Special Dentistry (Special Care Dentistry), which is the branch of dentistry dedicated to individuals with special needs: patients with intellectual disabilities, patients suffering from chronic diseases that reduce mobility and collaboration, people with diseases that render dental treatment critical, socially disadvantaged people. The purpose of special dentistry is to allow these types of patients to be treated in an equal manner to the rest of the population, and to carry out a normal treatment plan.

Particular attention is paid to screening visits for oral diseases in HIV-positive patients, in collaboration with the Infectious Diseases Unit.

Main Pathologies Treated:

  • Rehabilitation of the cervicofacial district in patients operated as a result of neoplasia
  • Focus on patients with general health problems or severe disabilities that may hinder traditional treatment, adopting personalized medical assistance in pre- and post-operative phases with an eventual sedation

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • 5 Leica Operating Microscopes
  • Diode Laser
  • CEREC CAD-CAM chairside systematic (Intraoral scanner, grinding and milling unit, sintering furnace)
  • Argon-Plasma Reactor