Article

Evolution of Topics in Maxillofacial Prosthetics Publications

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Purpose: To study the evolution of recent topics in maxillofacial prosthetics (MP) research. Materials and methods: Science mapping analyses were used to measure bibliometric similarities among articles extracted from the Web of Science from the last three decades. Results and conclusion: Keyword co-occurrence highlighted the rise of computer-aided design/computer-assisted manufacturing, mandibular reconstruction, and extraoral prostheses during the last decade. Citation analysis showed that surgery journals kept the leadership on MP publications, but that prosthodontics journals were closing the gap. The United States was the leading country in MP publications over the last three decades, but their lead is fast dissolving worldwide.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... 41 Indeed, surgery has always been the main driving force for maxillofacial prosthetics evolution. 36 The rationale behind the "surgery-first" trend is the patient's preference for a definitive versus a "provisional" treatment. ...
... (computer-aided design/computer-assisted manufacturing [CAD/CAM]).[36][37][38] However, facial prostheses are still the complementary and reliable alternative that fills the gap left by the limitations of surgery. ...
Article
Full-text available
The reconstruction of cephalic defect and more precisely from the face is not a recent issue. Indeed, the use of facial masks in a symbolic perspective was reported in ancient Egypt. Few references to facial prostheses are then found. It is really only with the work of the French surgeon Ambroise Paré that the first surgical techniques concerning facial epithetics are described. Techniques and materials tend to evolve over the centuries. But then came WWI, which marked a major turning point and brought to light the broken faces and the impact of maxillofacial trauma. Rehabilitation became a major issue in society. The war was a driving force for change from both a surgical and prosthetic point of view, revealing in particular such brilliant designers as the American sculptor Anna Coleman Ladd. Today, the profession is undergoing a major upheaval, linked to the growing development of biotechnological constructions. This historical review aims to retrace the evolution of the rehabilitation of facial substance loss over the ages and to outline the prospects for the foreseeable future. (Int J Maxillofac Prosthetics 2021;4:2-8)
... For a long time, maxillofacial prosthetics (MP) main driving force has remained its symbiotic relationship with maxillofacial surgery. 1 Indeed, surgical considerations have always led maxillofacial rehabilitation, while MP has stood as the alternative, the complementary and reliable option that fills the gap left beyond the limits of surgery. The rationale behind that trend is the patient's preference for a definitive surgical treatment over a "provisional" removable prosthesis. ...
... However, the current MP evolution is now driven by the development of materials (polymers, metals or ceramics) and technologies (computer-aided design/computer-assisted manufacturing, robotics…). [1][2][3] Thus the field of conventional MP is evolving, benefiting from the rise of converging technologies, such as nanotechnologies, biotechnologies, informatics and cognitivism (NBIC). The future of maxillofacial rehabilitation is no longer mutating from reparation to regeneration, even though fulfilling the patients' expectations for definitive treatments. ...
Article
Full-text available
Maxillofacial prostheses now benefit from the growing advances in converging technologies, such as nanotechnologies, biotechnologies, informatics and cognitivism (NBIC). Instead of being laid and passive, prostheses can now ensure true neurophysiological interactions with their wearers through complex phenomena of hybridization and vicariance. These new devices get closer to “maxillofacial amplification prostheses”, by improving the world perception through restored sensory properties and new extra-sensory properties. These technological devices also benefit from the bioengineering revolution that will soon allow the bioprinting of graft prostheses with an intimate integration to the organic maxillofacial support. In this article, the authors would like to present some major advances in cyborgology and bio-printing in maxillofacial hybridization contexts. (Int J Maxillofac Prosthetics 2019;1:20-26)
... For a long time, maxillofacial prosthetics (MP) main driving force has remained its symbiotic relationship with maxillofacial surgery. 1 Indeed, surgical considerations have always led maxillofacial rehabilitation, while MP has stood as the alternative, the complementary and reliable option that fills the gap left beyond the limits of surgery. The rationale behind that trend is the patient's preference for a definitive surgical treatment over a "provisional" removable prosthesis. ...
... However, the current MP evolution is now driven by the development of materials (polymers, metals or ceramics) and technologies (computer-aided design/computer-assisted manufacturing, robotics…). [1][2][3] Thus the field of conventional MP is evolving, benefiting from the rise of converging technologies, such as nanotechnologies, biotechnologies, informatics and cognitivism (NBIC). The future of maxillofacial rehabilitation is no longer mutating from reparation to regeneration, even though fulfilling the patients' expectations for definitive treatments. ...
... be considered in detail and most maxillectomy defect cases require an individualized treatment plan for prosthetic design and fabrication, especially in cases with a deep craniofacial defect. 34 Digital technology for maxillofacial prosthetics has spread 35,36 and become more reliable in the past ten years. 36 Although the optimal method for preparing maxillectomy models remains unclear, a conventional impression remains the most common approach for maxillary obturator fabrication. ...
Article
Full-text available
Purpose: Few studies have focused on the feasibility and accuracy of intraoral digital impressions for maxillectomy defects, especially for extensive soft tissue defects. Using intraoral scanners alone might be feasible for producing maxillary obturator prostheses, albeit with some limitations. It seems logical to investigate this ambiguity. Therefore, this systematic review aimed to assessing the feasibility and accuracy of using intraoral scanners (IOSs) to digitize maxillectomy defects Materials and Methods: PubMed, the Cochrane Oral Health Group Trials Register, and the Cochrane Central Register of Controlled Trials were electronically searched, and five prosthodontics journals were manually searched for English-language articles published as of December 2020 that assessed the feasibility and accuracy of using intraoral scanners to acquire digital impressions for maxillectomy defects. Results: Two in vitro studies, three clinical studies, six clinical reports, and three techniques were included (N=14). Aramany’s and Brown’s classifications were used to classify defects in twelve and one articles, respectively; the remaining article did not specify defect class. The 3M True definition IOS with Cone-beam computed tomography (CBCT), Computed tomography (CT), and/or optical scanners were used in both in vitro studies, mainly to evaluate accuracy. The Trios 3 scanner was used in nine studies as the main resource for data acquisition (75.0%), whereas the Trophy 3DI, Lava, and Cerec Omnicam scanners were used in three articles (25.0%). Four degrees of feasibility were identified: feasible (14.3%), feasible with limitations (28.6%), feasible with CBCT or CT (35.7%), and feasible with conventional impressions (21.4%). Accuracy was evaluated in four studies but was not mentioned in ten studies. Conclusion: The results revealed a low level of evidence for the feasibility and accuracy of using intraoral scanners to digitize maxillectomy defects. Additional multicenter clinical studies are needed to evaluate the feasibility and accuracy of digital workflow compared with the conventional approach
... Digital technology is one of the promising modalities that can be used to simplify the procedures of maxillofacial prosthetic rehabilitation. [2][3][4][5] In maxillofacial prosthetic rehabilitation, digital technology has been used more often for digitization, design, and rapid prototyping purposes than for evaluation prostheses and patients. 2 Since computer aided design and computer aided manufacturing (CAD/CAM) applications were introduced in dentistry, the technology has greatly evolved. ...
Article
Full-text available
Purpose: This study investigated the use of digital technology in maxillofacial prosthetics among practitioners involved in maxillofacial prosthetic rehabilitation in Japan. Materials and Methods: A self-administered survey questionnaire with 24 closed-ended and multiple choice questions was used. A total of 300 questionnaires were distributed at the 32nd meeting of the Japanese Academy of Maxillofacial Prosthetics that was held in Tokyo, Japan in June 2015. The survey questionnaire was distributed in a pack that included an introduction letter explaining the research aims, objectives, and informed consent. The data obtained were analyzed by descriptive statistical methods and reported as frequency and range. Results: In total, 105 respondents (77 men (73.4%), 28 women (26.6%); median age, 40 years; age range 21-66 years) completed the questionnaire (response rate, 35%). The majority of respondents were dentists (75.2%), followed by dental technicians (21.9%). The median duration of work experience for the respondents in their specialty was 14 years, and 97% of respondents had interested and adopted digital technologies in maxillofacial prosthetics. Digital technologies were used significantly in patient and practice management, diagnostic, and patient’s defect visualization (p < 0.001) but insignificant in treatment planning (p = 0.917). In contrast, there were significant increases in non-use of digital technologies in prosthesis design, prosthesis manufacturing, and patient and prosthesis evaluation (p < 0.001). Conclusion: Japanese dental practitioners are interested and willing to use digital technology in maxillofacial prosthetics. Most respondents use some or a substantial number of digital technologies in clinical practice. (Int J Maxillofac Prosthetics 2021;4:25-36)
... 6,9,10 In the last few years, the applications of digital technologies have generally been increased in maxillofacial prosthetics. [11][12][13] The use of computer aided design (CAD), 14,15 computer aided manufacturing (CAM), [16][17][18] and virtual surgical planning (VSP) 19,20 have advanced the field of oral and maxillofacial rehabilitation and offers new ways of design and reconstruction. This can potentially change the way maxillectomy and obturator production will be performed in the future. ...
Article
Full-text available
Purpose: Surgical obturators improve patients’ quality of life after maxillectomy by maintaining oral functions. As digital workflows are commonly used for planning maxillofacial surgeries and prostheses, the hypothesis of this study was that the fabrication of the immediate surgical obturator could benefit from the currently available open-source software. The aim of this study was to develop a protocol for fabricating before the surgery a prefabricated, personalized, and lightweight immediate surgical obturator with open-source software and limited amount of relining material. Materials and methods: The protocol steps consisted of digital simulation of maxillectomy defect based on CBCT segmentation of cadavers’ heads according to the surgical planning. Design of immediate surgical obturator by boolean subtraction tools using open-source software, scaling down the final designed immediate surgical obturator to 90%, and then 3D-printing it layer by layer in biocompatible resin to be relined and fitted intraorally after surgery. Results: The developed protocol was successfully achieved. Maxillectomy defect interest areas were successfully segmented using open-source software. Immediate surgical obturator was also successfully designed and 3D printed using biocompatible resin materials. The immediate surgical obturator was thus adapted to the defect with limited amount of relining material. Conclusions: This innovative method could give the patient an opportunity to benefit from a personalized, biocompatible and lightweight immediate surgical obturator.
... The development of digital technologies opens up some opportunities in the field of prosthetic appliances. 5 Intraoral scanners (IOS) allow accurate and more comfortable impressions, dental software guides the computer-aided design (CAD) of plates/splints, and milling or additive manufacturing permit the rapid and cheap computer-aided manufacturing (CAM) of the prosthesis. [6][7][8] The construction of a passive palatal plate can completely benefit from these advances. ...
... Technological development strongly drives the evolution of oral and cranio-maxillofacial surgery [1]. Among all the additive manufacturing (AM) processes, "three-dimensional printing" (3DP), often used synonymously with additive manufacturing, is playing an ever-growing role. ...
Article
Full-text available
Aim This systematic review aimed to evaluate the use of three-dimensional (3D) printed bone models for training, simulating and/or planning interventions in oral and cranio-maxillofacial surgery. Materials and methods A systematic search was conducted using PubMed® and SCOPUS® databases, up to March 10, 2019, by following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol. Study selection, quality assessment (modified Critical Appraisal Skills Program tool) and data extraction were performed by two independent reviewers. All original full papers written in English/French/Italian and dealing with the fabrication of 3D printed models of head bone structures, designed from 3D radiological data were included. Multiple parameters and data were investigated, such as author’s purpose, data acquisition systems, printing technologies and materials, accuracy, haptic feedback, variations in treatment time, differences in clinical outcomes, costs, production time and cost-effectiveness. Results Among the 1157 retrieved abstracts, only 69 met the inclusion criteria. 3D printed bone models were mainly used as training or simulation models for tumor removal, or bone reconstruction. Material jetting printers showed best performance but the highest cost. Stereolithographic, laser sintering and binder jetting printers allowed to create accurate models with adequate haptic feedback. The cheap fused deposition modeling printers exhibited satisfactory results for creating training models. Conclusion Patient-specific 3D printed models are known to be useful surgical and educational tools. Faced with the large diversity of software, printing technologies and materials, the clinical team should invest in a 3D printer specifically adapted to the final application.
... Nowadays, visualization of digitized data plays an important role in student and patient education, as well as in treatment planning, since maxillofacial treatment relies on the collaboration of a multidisciplinary team. 1 However, digitized visualization is traditionally limited to static 2D illustrations and 3D models without any connection to a real environment. 2 This limitation may prevent users from accessing relevant information within or around these structures. ...
Article
Aims: This technique article introduces an augmented reality (AR) application for students, patients or practitioners to visualize a maxillectomy defect, the associated obturator prosthesis and the eventual effects on patient’s facial appearance. Methods: Various three-dimensional (3D) virtual models related to maxillectomy defect and its prosthetic rehabilitation were used to illustrate the handheld AR application. The AR scene was created using Vuforia and Unity3D software. Within this scene, 3D virtual models were linked to the image target by detecting a symbol track marker. The final file was saved as an installable application and exported for android and iOS smart devices. Results: The image target containing the maxillectomy defect and its prosthetic rehabilitation were successfully visualized interactively in 3D mode using handheld AR maxillofacial prosthetic application. Conclusion: Augmented reality application for visualizing maxillofacial prosthetic data could interestingly be developed as pedagogical tools to explain prosthetic treatments.
Article
The work carried out made it possible to substantiate the need to apply a method for studying the frequency of beating of cilia of the mucous membrane of the nasal cavity and paranasal sinuses in patients with chronic rhinosinusitis when choosing treatment tactics in an ENT hospital. Analysis of the study of data on the functional and morphological state of the mucous membrane of the nasal cavity and maxillary sinus allows us to judge the severity of the pathological process before surgery, which is the fundamental factor in the algorithm for the treatment of chronic rhinosinusitis.
Article
The work carried out made it possible to substantiate the need to apply a method for studying the frequency of beating of cilia of the mucous membrane of the nasal cavity and paranasal sinuses in patients with chronic rhinosinusitis when choosing treatment tactics in an ENT hospital. Analysis of the study of data on the functional and morphological state of the mucous membrane of the nasal cavity and maxillary sinus allows us to judge the severity of the pathological process before surgery, which is the fundamental factor in the algorithm for the treatment of chronic rhinosinusitis.
Article
Statement of problem Head and neck care has been transformed by the introduction of advanced digital technologies that will continue to be important change drivers for maxillofacial prosthodontics. Insight into these changes is important in answering the question of whether maxillofacial prosthodontics is appropriately prepared to contribute effectively to future multidisciplinary care of the head and neck. Purpose The purpose of this survey was to gain insight into the perception of changes experienced by maxillofacial prosthodontists in relation to clinical practice. The findings of this survey may assist the future development of the subspecialty. Material and methods An exploratory cross-sectional survey was conducted by using a convenience sample of members of the American Academy of Maxillofacial Prosthetics. The survey considered 10 domains and 31 questions. Fully completed surveys (164) provided a 59% response. Descriptive statistics used percentage responses to reduce and characterize perceptions across respondents. Results Eighty-four percent of the respondents were from the United States. Results should be interpreted based on this cohort. Respondents reported a change in care delivered over the past 10 years (72%), with the most important causes of change attributed to surgery (60%) and advanced digital technologies (56%). Respondents perceived advanced digital technologies as being central to the future of maxillofacial prosthodontics (89%) and important in attracting younger colleagues (88%). Sixty-three percent believed training programs were not providing adequate education and training in the use of advanced digital technology. Conclusions The perception of maxillofacial prosthodontists regarding changes taking place in care delivery was that the most important changes in the past 10 years were attributed to surgery and advanced digital technologies, that persisting pressures related to few institutional positions, that the subspecialty was poorly visible, that remuneration for care was inadequate and referring disciplines did not understand the subspecialty, that advanced digital technologies were considered central to the future of maxillofacial prosthodontics and important to attract younger colleagues to the subspecialty, that barriers to advanced digital technology use included funding for equipment acquisition, institutional funding support, and remuneration for their use in care delivery, and that maxillofacial prosthodontic programs were not providing adequate education and training in advanced digital technologies.
Article
Full-text available
Bioprinting as a tissue engineering tool is one of the most promising technologies for overcoming organ shortage. However, the spread of populist articles among on this technology could potentially lead public opinion to idealize its readiness. This bibliometric study aimed to trace the evolution of bioprinting literature over the past decade (i.e., 2000 to 2015) using the SCI-expanded database of Web of Science® (WoS, Thomson Reuters). The articles were analyzed by combining various bibliometric tools, such as science mapping and topic analysis, and a Technology Readiness Scale was adapted to assess the evolution of this emerging field. The number of analyzed publications was low (231), but the literature grew exceptionally fast. The “Engineering, Biomedical” was still the most represented WoS category. Some of the recent fronts were “hydrogels” and “stem cells”, while “in vitro” remained one of the most used keywords. The number of countries and journals involved in bioprinting literature grew substantially in one decade, also supporting the idea of an increasing community. Neither the United States’ leadership in bioprinting productivity nor the role of universities in publications were challenged. “Biofabrication” and “Biomaterials” journals were still the leaders of the bioprinting field. Bioprinting is a young but promising technology.
Article
Full-text available
This article describes the complex dental treatment of a 43-year-old man with skeletal Class II, mandibular asymmetry, severe brachyfacial pattern, Class II Division 2, canting of the occlusal plane, and an increased curve of Spee. To achieve optimal results, we adopted a multidisciplinary approach to treatment, involving periodontics, oral surgery, orthodontics, maxillofacial surgery, and prosthetics specialists. After periodontal treatment, miniscrews were placed to correct the occlusal plane canting and the excessive curve of Spee with orthodontic treatment. The surgical treatment plan consisted of a bilateral asymmetric sagittal split osteotomy for mandibular advancement and genioplasty. The patient had an infection after the surgery at the site of the right fixation plate, so the plate was removed, and active orthodontic treatment was continued and finished. Mandibular first molar implants and maxillary ceramic crowns using the Digital Smile Design method (Digital Smile Design, Doral, FL) were placed at the end of orthodontic treatment. The patient was satisfied with the treatment results and with his facial and dental appearance, as well as his oral function. The 2-year follow-up pictures show a stable result both esthetically and functionally.
Article
Full-text available
Surgical resection of mandible owing to benign, malignant neoplasm, osteoradionecrosis is common. The resection can be total or segmental depending on the lesion. Loss of mandibular continuity causes deviation of remaining mandibular segment towards the resected side and rotation inferiorly due to muscle pull and scar contracture affecting mastication and esthetics. Surgical reconstruction may not be always possible. Prosthetic rehabilitation plays a major role in these patients. This case series describes different types of guiding flange (GF) prosthesis with modifications for three hemimandibulectomy patients at different time interval after surgery. The article details GF prosthesis combined with physiotherapy to correct deviation of mandible thereby improving mastication, esthetics and speech and thus enhancing the quality of life.
Article
Full-text available
Objectives This study aims to describe morphological peculiarities of maxillary and mandibular first molars in Europeans, Asians and Europeans with cleft lip and palate. Material and methods Reflex microscopy was used to obtain three-dimensional morphometric landmarks from 40 models (11 Europeans and 13 Asians without cleft lip and palate, 16 Europeans with unilateral cleft lip and palate). The cases were examined using traditional morphometry and geometric morphometry, and visualized using thin-plate splines. Results Classic morphometry showed no right/left differences in the study groups and no significant differences with regard to the cleft side in patients with cleft lip and palate. In Asians, a significantly greater mesiodistal width was found. Geometric morphometry showed an enlarged centroid size in Asians (maxilla and mandible). In cleft patients, the cleft site did not appear to impact the morphology of first molars. Conclusion Unilateral clefting did not affect the size and shape of molars; however, characteristic ethnicity-based differences were in fact identified. The results are relevant for orthodontic treatment with preadjusted appliances, and prosthetic CAD/CAM restorations.
Article
Full-text available
Purpose This paper aims to present a new design in the area of basal osseointegrated implant (BOI) for oral and maxillofacial surgery using a patient-specific computer-aided design (CAD) and additive manufacturing (AM) approach. The BOI was designed and fabricated according to the patient’s specific requirement, of maxilla stabilisation and dental fixation, a capacity not currently available in conventional BOI. The combination of CAD and AM techniques provides a powerful approach for optimisation and realisation of the implant in a design which helps to minimise blood loss and surgery time, translating into better patient outcomes and reduced financial burdens on healthcare providers. Design/methodology/approach The current study integrates the capabilities of conventional medical imaging techniques, CAD and metal AM to realise the BOI. The patient’s anatomy was scanned using a 128-slice spiral computed tomography scanner into a standard Digital Imaging and Communication in Medicine (DICOM) data output. The DICOM data are processed using MIMICS software to construct a digital representative patient model to aid the design process, and the final customised implant was designed using Creo software. The final, surgically implanted BOI was fabricated using direct metal laser sintering in titanium (Ti-64). Findings The current approach assisted us to design BOI customised to the patient’s unique anatomy to improve patient outcomes. The design realises a nerve relieving option and placement of porous structure at the required area based up on the analysis of patient bone structural data. Originality/value The novelty in this work is that developed BOI comprises a patient-specific design that allows for custom fabrication around the patients' nerves, provides structural support to the compromised maxilla and comprises a dual abutment design, with the capacity of supporting fixation of up to four teeth. Conventional BOIs are only available for a signal abutment capable of holding one or two teeth only. Given the customised nature of the design, the concept could easily be extended to explore a greater number of fixation abutments, abutment length/location, adjusted dental fixation size or greater levels of maxilla support. The study highlights the significance of CAD packages to construct patient-specific solution directly from medical imaging data, and the efficiency of metal AM to translate designs into a functional implant.
Article
Full-text available
The authors performed distraction osteogenesis using The Maxillary Distractor System (SYNTHES) to maxillary hypoplasia patient with cleft lip palate, and consequently improved the aesthetic complexion of the patient. Velopharyngeal insufficiency developed after bone elongation; the authors improved the insufficiency with conservative therapies such as articulatory training using the bulb attached palatal lift prosthesis. And then the authors got successful and accepted postoperative speech outcome.
Article
Full-text available
This clinical report describes the prosthetic management of the surgical reconstruction of a patient after mandibular resection. Complete oral rehabilitation was achieved with a maxillary complete denture and a mandibular implant-supported fixed prosthesis with a custom titanium framework and a long unilateral cantilever.
Article
Full-text available
Background This study surveyed non-United States maxillofacial prosthodontists (MFP) to determine their practice profile and rationale for pursuing an MFP career. Methods Email addresses for the MFP were obtained from the International Society for Maxillofacial Rehabilitation, American Academy of Maxillofacial Prosthetics, and International Academy for Oral Facial Rehabilitation. Emails with a link to the electronic survey program were sent to each participant. Chi-square and Mann–Whitney-U tests were used to investigate the influence of formal MFP training on professional activities and type of treatments provided. ResultsOne hundred twelve respondents (response rate 39%) from 33 nationalities returned the survey. The top three reasons for pursuing an MFP career were personal satisfaction, prosthodontics residency exposure, and mentorship. The predominant employment setting was affiliation with a university (77%). There were significant differences between respondents with and without formal MFP training regarding provision of surgical treatments (P = 0.021) and dental oncology (P = 0.017). Most treatments were done together with otolaryngology, oral surgery (68%) and head and neck surgery (61%). Practitioners not affiliated with a university spent significantly more time in clinical practice (P = 0.002), whereas respondents affiliated with universities spent significantly more time in teaching/training (P = 0.008) and funded research (P = 0.015). Conclusions Personal satisfaction is the most important factor in a decision to choose an MFP career. Most of the MFPs work at a university and within a multidisciplinary setting. There were differences regarding type of treatments provided by respondents with and without formal MFP training.
Article
Full-text available
CASE DESCRIPTION A 12-year-old neutered male domestic shorthair cat had been treated for a mass arising from the lingual aspect of the caudal right mandibular body. Cytoreductive surgery of the mass had been performed twice over a 2-year period, but the mass recurred following both surgeries. The mass was diagnosed as an osteosarcoma, and the cat was referred for further evaluation and treatment. CLINICAL FINDINGS Clinical findings were unremarkable, except for a 2-cm-diameter mass arising from the lingual aspect of the right mandible and mild anemia and lymphopenia. Pre- and postcontrast CT scans of the head, neck, and thorax were performed, revealing that the osteosarcoma was confined to the caudal right mandibular body, with no evidence of lymph node or pulmonary metastasis. TREATMENT AND OUTCOME The stereolithographic files of the CT scan of the head were sent for computer-aided design and manufacture of a customized 3-D–printed titanium prosthesis. Segmental mandibulectomy was performed, and the mandibular defect was reconstructed in a single stage with the 3-D–printed titanium prosthesis. The cat had 1 minor postoperative complication but had no signs of eating difficulties at any point after surgery. The cat was alive and disease free 14 months postoperatively. CLINICAL RELEVANCE Reconstruction of the mandible of a cat following mandibulectomy was possible with computer-aided design and manufacture of a customized 3-D– printed titanium prosthesis. Cats have a high rate of complications following mandibulectomy, and these initial findings suggested that mandibular reconstruction may reduce the risk of these complications and result in a better functional outcome. © 2017, American Veterinary Medical Association. All rights reserved.
Article
Full-text available
Purpose: The purpose of this study was to determine whether failed alloplastic temporomandibular joint replacement (TMJR) devices can elicit the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) reaction seen in some patients with metal-on-metal hip arthroplasties. Materials and methods: This study involved analysis of paraffin-embedded sections of peri-implant tissue from failed TMJ implant cases obtained from 3 independent sources. Hematoxylin and eosin staining, conventional and polarized light microscopy, back-scattered electron imaging, and energy-dispersive x-ray analysis were used. Immunohistochemical methods were used to identify T and B lymphocytes and macrophages. Results: The total TMJR device specimens showed primary macrophage and lymphocytic responses similar to responses reported previously for failed total hip implants, including ALVAL. No chronic or acute inflammation was apparent in the failed hemiarthroplasty TMJR cases. Conclusion: In this limited preliminary study, the local tissue responses to the failed TMJR implants showed similar primary macrophage and lymphocyte responses to previously reported failed metal-on-metal and metal-on-polyethylene orthopedic total joint replacement devices. No such local inflammatory responses were seen with the failed TMJR hemiarthroplasty devices.
Article
Full-text available
Statement of problem: Several factors affect the prosthetic outcome of patients with mandibular defects. However, it is questionable whether fixed or removable implant-supported prostheses meet the expectations and satisfaction of the patients. The perspectives of these patients are important in managing the prosthetic treatment strategies. Purpose: The purpose of this prospective clinical study was to evaluate the satisfaction and oral health-related quality of life of patients with marginal mandibulectomies with implant-retained overdentures and fixed metal-acrylic resin prostheses. Material and methods: Twenty-two participants with marginal mandibulectomies were included in the study. They completed an oral health impact profile questionnaire designed for patients with edentulism (OHIP-Edent) for the assessment of quality of life and visual analog scales (VASs) to validate their general satisfaction before treatment. Ten participants received 4 implant-retained fixed metal-acrylic resin prostheses, whereas 12 participants were treated with 2 implant-supported overdentures. Six months after delivery of their prostheses, the participants completed the OHIP-Edent questionnaire and VAS again. For the statistical analyses, Student t tests together with descriptive statistics (mean, standard deviation, frequency) were used in the 2 intergroup parameter comparisons that showed normal distribution. The Mann-Whitney U test and Kruskal-Wallis test were used for intergroup comparisons, and the Wilcoxon signed rank test was used for intragroup comparisons. Results: Compared with pretreatment mean values, a statistically significant (P<.05) decrease in mean scores of all OHIP-Edent values and an increase in VAS scores were found in both groups. After patients were treated, their OHIP-Edent values in the group with an overdenture prosthesis were higher than those in the group with a fixed metal-acrylic resin prosthesis (P<.05). Conclusions: These results demonstrate that implant-retained overdentures and fixed metal-acrylic resin prostheses provide better function and, thus, oral health-related quality of life for patients with marginal mandibulectomies.
Article
Full-text available
Obturator prosthesis is a common treatment method for maxillectomy patients for maintaining their oronasal separation and resuming their social lives. After tumor resection, the remaining anatomical structures have a significant effect on prosthesis retention. The present study describes the rehabilitation of two maxillectomy patients after cancer surgery using a prosthesis consisting of a denture and a special retentive obturator that is positioned in the anatomical undercuts of the nasal cavity. These patients have undergone total and subtotal maxillectomy surgery after the diagnosis of squamous cell carcinoma. The systemic and local health status of the total maxillectomy patient was not suitable for zygomatic implant surgery. Only one osseointegrated dental implant was placed into the left maxillary tuberosity area in the subtotal maxillectomy patient. In addition, the quality, vertical height, and horizontal width of the remaining bone structures in the maxilla limited the use of osseointegrated dental implants. Mechanical prosthesis retention was provided using a multiunit retentive mechanism composed of an orthodontic forsus fatigue resistant device (OFFRD), two Herbst appliances, and an acrylic piece associated with healthy keratinized mucosa. The OFFRD could easily apply a consistent force and push the acrylic pieces toward the retentive undercut under the control of the two Herbst appliances. Two OFFRD units in different directions were designed for the total maxillectomy patient, while only one OFFRD unit was placed on the opposite side of the osseointegrated implant in the subtotal maxillectomy patient. A sufficient retention was obtained for both patients. The patients were satisfied, and no major complications were observed in periodic controls.
Article
Full-text available
Background: Colour degradation is a major problem in maxillofacial silicone elastomers. Recent studies have focused on colour stability and the mechanical properties of the silicone elastomers. A colour match is also essential for the acceptance of the prosthesis by the patient. The aim of this study is to assess the colour degradation of the silicone elastomer after being moulded in different colours of dental stones at two different vulcanization temperatures. Methods: Five different colours of dental stones were used to fabricate a total of 120 silicone blocks using a Cosmesil M511 maxillofacial silicone elastomer. Vulcanization was completed at two different temperatures (25 and 100° Celsius). Colour measurements were obtained with a Conica Minolta spectrophotometer. The CIEDE2000 formula was used to calculate the colour differences (∆E00). Two-way ANOVA, one-way ANOVA with Bonferroni corrected post-hoc p values and independent samples t-test were used for the statistical analyses. Results: High temperature vulcanization causes lightening of the maxillofacial silicone elastomers without regard to the dental stone colour (p = 0.001). Specimens moulded in green stone lightened least at room temperature (p = 0.999). Compared to the control group, at high temperature, all specimens moulded in coloured dental stones darkened significantly (p < 0.001 for white, blue and yellow; p = 0.006 for green; p = 0.045 for reddish-brown). In the high temperature group, the shift to a green chroma was significant in the white, yellow and green dental stones groups (p = 0.001, p = 0.002, p < 0.001, respectively). The mean b* of the high temperature control group was higher than that of the room temperature control group (p < 0.001). The only ∆E00 score lower than the perceptibility threshold for dental materials (∆E00 = 1.30) was between the room temperature control group and the room temperature green dental stone group (∆E00 = 0.96). Conclusions: Green and blue dental stones cause less colour degradation in silicone elastomers. Reddish-brown dental stones cause the most colour degradation in silicone elastomers. At 100 °C, the colour of the silicone elastomer lightens and yellows even if the elastomer is vulcanized in a stainless steel mould. White, yellow and reddish-brown dental stones make the silicone elastomer appear more yellow even if the elastomer is vulcanized at room temperature.
Article
Full-text available
Bone regeneration is currently one of the most important and challenging tissue engineering approaches in regenerative medicine. Bone regeneration is a promising approach in dentistry and is considered an ideal clinical strategy in treating diseases, injuries, and defects of the maxillofacial region. Advances in tissue engineering have resulted in the development of innovative scaffold designs, complemented by the progress made in cell-based therapies. In vitro bone regeneration can be achieved by the combination of stem cells, scaffolds, and bioactive factors. The biomimetic approach to create an ideal bone substitute provides strategies for developing combined scaffolds composed of adult stem cells with mesenchymal phenotype and different organic biomaterials (such as collagen and hyaluronic acid derivatives) or inorganic biomaterials such as manufactured polymers (polyglycolic acid (PGA), polylactic acid (PLA), and polycaprolactone). This review focuses on different biomaterials currently used in dentistry as scaffolds for bone regeneration in treating bone defects or in surgical techniques, such as sinus lift, horizontal and vertical bone grafts, or socket preservation. Our review would be of particular interest to medical and surgical researchers at the interface of cell biology, materials science, and tissue engineering, as well as industry-related manufacturers and researchers in healthcare, prosthetics, and 3D printing, too.
Article
Full-text available
Background: A real-time surgical navigation system potentially increases the accuracy when used for quad-zygomatic implant placement. Purpose: To evaluate the accuracy of a real-time surgical navigation system when used for quad zygomatic implant placement. Materials and methods: Patients with severely atrophic maxillae were prospectively recruited. Four trajectories for implants were planned, and zygomatic implants were placed using a real-time surgical navigation system. The planned-placed distance deviations at entry (entry deviation)points, exit (exit deviation) points, and angle deviation of axes (angle deviation) were measured on fused operation images. The differences of all the deviations between different groups, classified based on the lengths and locations of implants, were analysed. A P value of < 0.05 indicated statistical significance. Results: Forty zygomatic implants were placed as planned in 10 patients. The entry deviation, exit deviation and angle deviation were 1.35 ± 0.75 mm, 2.15 mm ± 0.95 mm, and 2.05 ± 1.02 degrees, respectively. The differences of all deviations were not significant, irrespective of the lengths (P = .259, .158, and .914, respectively) or locations of the placed implants (P = .698, .072, and .602, respectively). Conclusion: A real-time surgical navigation system used for the placement of quad zygomatic implants demonstrated a high level of accuracy with only minimal planned-placed deviations, irrespective of the lengths or locations of the implants.
Article
Full-text available
The purpose of this article is to describe a deformation corrected workflow for maxillofacial prosthesis modelling based on the improved Laplace and iterative closest point–based iterative algorithms. For incomplete maxillofacial data with local deformed symmetrical features, the Laplace algorithm with rotation invariants was demonstrated that the operations can recover the local deformation while preserving the surface geometric detail; the M-estimation iterative closest point–based iterative algorithm integrated with the extended Gaussian image ensures the precision of the symmetry plane, making the outer point having almost no effect on the minimum process. The additional experiments also verified the ability of deformation corrected maxillofacial prosthesis modelling. Case study confirmed that this workflow is attractive and has potential to design the desired maxillofacial prosthesis for correcting the deformed oral soft tissue. The results of this study improve the quality of maxillofacial prostheses modelling. This technique will facilitate modelling of maxillofacial prostheses while helping the patients predict the effect before the prosthesis is manufactured. In addition, this deformation corrected workflow has great potential for improving the development of maxillofacial prosthesis modelling software.
Article
This paper reports the results obtained after completing the solid-state characterization of two commercially available silicone polymer samples used in maxillofacial prostheses. The samples were prepared by the same technique, one being freshly prepared, while other having approximately 11 years. As investigational tools, FTIR spectroscopy was used, thermal analysis in air atmosphere and later a preliminary kinetic parameters evaluation by using the Coats-Redfern method.
Article
Patients may face functional, aesthetic, and social distress because of the palatal defects. Prosthetic rehabilitation of maxillectomy or developmental defect can be challenging for prosthodontists. Prognosis of the prosthetic appliances can be affected not only by patients' own ability to adapt to the prosthesis but also by the factors like the remaining teeth, bony structure, and existing mucosa. Maxillary defects are usually developed by surgical intercession of the benign or malignant conditions and trauma cases. Speech, mastication and aesthetics can be hampered by any extent of palatal defect. During obturation of palatal/maxillectomy defects, the primary intent of the prosthodontist should be the shutting of the maxillectomy defect and parting of the oral cavity from the sinonasal openings by use of different bulb designs. In the present case, dentogenic concept has been applied while fabricating the two-piece hollow bulb obturator for restoration of the defect. Well known fact about the gravitational force is that it acts on maxillary obturator and reduces its retentive qualities, this can be counteracted to some extent by making the obturator hollow. Dentogenic concept is the skill, training, and procedure of generating the chimera of natural teeth in artificial teeth during prosthodontic restorations.
Article
Loss of part of the face is associated with physical disability, social isolation and immense psychological trauma. Proper rehabilitation of such a patient is a challenging yet satisfying task for a maxillofacial prosthodontist. Facial prostheses are commonly fabricated of silicone because of many favorable properties, though it predisposes to fungal growth.This report is of a patient with history of uncontrolled diabetes and associated invasive fungal infection, leading to a complex oro-facial defect, which was rehabilitated successfully with a silicone facial prosthesis lined by a material more resistant to fungal growth along with a cast partial obturator. Other design and procedural modifications were also made to suit the needs of the case. Wise selection of materials, keeping in mind the properties of materials, is important in successful rehabilitation.
Article
Purpose: This study compared masticatory and swallowing functional outcomes in maxillectomy patients who underwent surgical and prosthetic rehabilitation or prosthetic rehabilitation only following surgical resection. Materials and methods: This comparative cross-sectional study involved 20 maxillectomy patients and compared their masticatory and swallowing functions following combined surgical and prosthodontic management vs an exclusively prosthodontic approach. Masticatory performance was measured by an originally modified sieve method using hydrocolloid material, and video fluoroscopic examination was employed for swallowing assessments. Results: Masticatory performance was significantly better in the patient group treated with flaps and removable denture prostheses compared to patients treated with obturator prosthesis alone. Swallowing outcomes were comparable in both groups. Conclusion: Flap reconstruction followed by an obturator prosthesis seems to be a preferable option when planning for functional rehabilitation in maxillectomy patients. Further research is needed to substantiate the functional outcomes noted in this study.
Article
Cleidocranial dysplasia is a hereditary congenital disorder that results in delayed ossification of midline structures, and is caused by mutations in the RunX2 (runt-related transcription factor 2) gene located on the short arm of chromosome 6. Successful treatment depends on multidisciplinary assessment and a comprehensive staged treatment plan. We present a case series of 12 patients who were managed with a specifically tailored combination of surgery, orthodontics, and prosthodontics to provide a functional dentition and restore their smile and facial contour. Successful dental rehabilitation can be challenging in this group because patients often have multiple dental anomalies and a reduced quantity and density of alveolar bone. Rehabilitation with early intervention and a carefully planned multidisciplinary approach has been successful in the long term.
Article
Dental and immunological features of the influence of various prosthetic structures of orthopedic prostheses on tissues and organs of the maxillofacial region were evaluated by the parameters of expression of oral fluid biomarkers. Healthy people without tumor and somatic diseases and patients with neoplasms of maxillofacial area in need of dental rehabilitation were examined before and in 2 weeks and 3 months after treatment. Certain regularities in the reaction of biomarkers to orthopedic prostheses were observed: a decrease in activity of MMP-2 and MMP-8 and their inhibitors or an increase in MMP-9; an increase in activity of biomarkers at early terms and a decrease in delayed terms after prosthetics.
Article
The clinical report describes a case of a 14-year-old patient with a traumatic amputation of the left auricle and severe hypertrophic scarring. The management of peri-implant soft tissue was challenging, but successful in the rehabilitation of a patient with auricular prosthesis retained by implants. The prosthesis restored the patient's facial aesthetics and contributed not only to function, but also to psychosocial well-being.
Article
Aims: Complete maxillary edentulism and prosthetic rehabilitation with removable full dentures are known to affect speech intelligibility. The aim of this study was to prospectively investigate the long-term effect of time on speech intelligibility in patients being rehabilitated with newly fabricated full maxillary dentures. Materials and methods: Speech was recorded in a group of 14 patients (male = 9, female = 5; mean age ± standard deviation [SD] = 66.14 ± 7.03 years) five times within a mean period of 4 years (mean ± SD: 47.50 ± 18.16 months; minimum/maximum: 24/68 months) and in a control group of 40 persons with healthy dentition (male = 30, female = 10; mean age ± SD = 59 ± 12 years). All 14 participants had their inadequate removable full maxillary dentures replaced with newly fabricated dentures. Speech intelligibility was measured by means of a polyphone-based speech recognition system that automatically computed the percentage of accurately spoken words (word accuracy [WA]) at five different points in time: 1 week prior to prosthetic maxillary rehabilitation (both with and without inadequate dentures in situ) and at 1 week, 6 months, and a mean of 48 months after the insertion of newly fabricated full maxillary dentures. Results: Speech intelligibility of the patients significantly improved after 6 months of adaptation to the new removable full maxillary dentures (WA = 66.93% ± 9.21%) compared to inadequate dentures in situ (WA = 60.12% ± 10.48%). After this period, no further significant change in speech intelligibility was observed. After 1 week of adaptation, speech intelligibility of the rehabilitated patients aligned with that of the control group (WA = 69.79% ± 10.60%) and remained at this level during the examination period of 48 months. Conclusion: The provision of new removable full maxillary dentures can improve speech intelligibility to the level of a healthy control group on a long-term basis.
Article
Background: Maxillectomy defects significantly impair quality of life. Prosthetics can overcome some of these issues, but has limitations. The role of the osteocutaneous radial forearm free flap (OC-RFFF) has been established for reconstruction of smaller maxillectomy defects, but its role in larger defects is not well defined. We aim to evaluate outcomes after midface reconstruction utilizing the OC-RFFF. Methods: Retrospective review of prospective database collected between 2005 and 2014 of midface reconstruction using OC-RFFF in a tertiary care centre. Donor site complications and acute and long-term recipient site complications were measured. Health related quality of life was assessed using the University of Washington Quality of Life (UW-QOL) Questionnaire. Results: A total of 68 midface defects were reconstructed using the OC-RFFF. Acute recipient site complications included three flap failures (4%), and two additional microvascular revision cases for vascular compromise. Late recipient complications included fistula (n = 10, 14%), ectropion (n = 7, 10%), diplopia (n = 6, 9%) and exposed hardware (n = 5, 7%). Resection of cheek skin or orbital rim correlated with orbital complications. The incidence of fistula was not affected by defect size or prior radiation. There were two donor site infections and no instances of forearm fracture. Patients undergoing OC-RFFF repair had mean scores for UW-QOL outcomes higher than published rates of obturator quality of life. Conclusion: The OC-RFFF is suited to a variety of midface defects and can be combined with hardware to reconstruct the orbital floor. Recipient site complications are common, but donor site morbidity is low and outcomes, including HR-QOL, are acceptable.
Article
Background: The unique anatomy of the orbita and the different behavior of each malignant tumor cause us to perform the various types of orbital exenteration that yields to varying defect each of which has own specific demands in terms of the reconstruction. Current classification of orbital exenteration defects seems not to be adequate to provide detailed description. This study reviews 50 exenteration defects to offer a more effective anatomical classification system. Methods: Over a 15 years period, 50 orbital exenteration defects in 47 patients were reconstructed. Defects were categorized according to the resected orbital wall, dura, and ethmoid resection. If the maxillectomy was performed, A or B was added to define the type of maxillectomy as partial (intact palate) or total maxillectomy, respectively. According to these criteria, 4 types of defect patterns were determined including Type 0 (n = 5) with intact orbital wall, Type I (n = 9) with sino-orbital fistula, Type II (n = 4) with crania-orbital fistula with intact dura, Type III (n = 6) with crania-orbital fistula associated with dura defect, and Type IV (n = 8) with cranio-nasal-orbital fistula. There were 12 partial (A) and 6 total maxillectomy (B) defects along with the orbital exenteration. Results: There was no major complication except one. The minor wound-healing problems occurred in 7 patients. Nine patients (19%) used prosthesis. Twenty-two (46.8%) patients chose a patch to cover the area. The remaining 16 patients were not able to use any type of prosthesis because of the reconstruction methods. Conclusion: The authors believe that the authors' anatomical classification system provides more precise description of the defect which eventually enhances the success rate of both reconstruction and resection.
Article
Purpose: The purpose of this article was to describe a fully digital workflow used to perform computer-guided flapless implant placement in an edentulous patient without the use of conventional impressions, models, or a radiographic guide. Materials and methods: Digital data for the workflow were acquired using an intraoral scanner and cone-beam computed tomography (CBCT). The image fusion of the intraoral scan data and CBCT data was performed by matching resin markers placed in the patient's mouth. Results: The definitive digital data were used to design a prosthetically driven implant position, surgical template, and computer-aided design and computer-aided manufacturing fabricated fixed dental prosthesis. Conclusion: The authors believe this is the first published case describing such a technique in computer-guided flapless implant surgery for edentulous patients.
Article
The aim of this study was to achieve a polymeric scaffold, ex-vivo, using 3D printing technology and then subjecting it to various tests to check its optimal property. Initially there was selected a lower jaw with a bone defect that would have prevented any treatment based prosthetic implant. The mandible was first scanned using an optical scanner (MAESTRO DENTAL SCANNER MDS400). The scanning parameters using optical scanning system are: 10 micron accuracy, resolution 0.07 mm, 2 rooms with High-Resolution LED structured light, two axes. The scan time of the mandible was 4-5 min. Later the same mandible was scanned using CBCT's CRANEX 3DX. The images obtained using CBCT's were correlated with those obtained by optical scanning. Further on, there was achieved the digital design of the future scaffold with the conventional technique of wax addition directly on the mandibular bone defect. After that, this was again scanned using scanning system MAESTRO DENTAL SCANNER MDS400, and using CBCT's CRANEX 3DX. The images obtained were correlated with all the scanned images of original mandible bone defects. There were made two polymeric scaffolds using 3D printing system an (D20 Digital Wax System 3D Printer). After printing, scaffold sites were introduced for 30 minutes in an oven curing. Later the pieces obtained were processed to remove small excesses of work. There were obtained 3 blocks of polymers that have a good adaptation to the bone profile. Often, in oral implantology and maxillofacial surgery appear bone defects. They prevent an optimal treatment of bio-functional and aesthetic restoration. Using 3D printing technology one can achieve scaffold sites of different biocompatible materials that have optimal properties to replace bone defect and restore the defective area. These scaffold sites have an intimate adaptation to the defect. 3D printing techniques used to restore bone defects can quickly and efficiently give the possibility to have a successful implantology prosthetics treatment.
Article
Objective: The aim of this study was to assess and present, using sialo-cone beam computed tomography (sialo-CBCT) examination, cases of submandibular gland (SM) chronic obstructive sialadenitis (COS) caused by dental rehabilitation. Data sources: Clinical and radiographic data of all patients referred for SM sialo-CBCT imaging in the Oral and Maxillofacial Imaging Unit with recurrent SM swelling between January 2012 and July 2015 were reviewed. Cases with suggested iatrogenic cause were selected and described. A literature review of similar cases was also performed. Results: Seventy-one patients with salivary gland (SG) swelling were referred for SM sialo-CBCT. Of these, 16 had implant-supported fixed partial prostheses and seven had full mandibular overdentures. In five patients, COS was diagnosed and a causal relationship between their dental rehabilitation and symptoms was suggested. A literature search revealed 11 cases of SM COS secondary to anterior mandibular rehabilitation. Conclusion: Clinicians rehabilitating the anterior edentulous mandibular region should be aware that both fixed and removable devices may block the orifices of the SM, causing COS.
Article
s Purpose The aim of this retrospective study was to compare the performance of implants placed following alveolar distraction osteogenesis (ADO) or autogenous onlay bone graft (AOBG) based on implant survival, peri-implant bone resorption and clinical parameters. Materials and methods From February 2008 to July 2012, 17 patients (6 females and 11 males) with implant placement following ADO (group 1, 8 patients) or AOBG (group 2, 9 patients) were included in this retrospective study. In all, 37 implants were placed in group 1 and 22 implants were placed in group 2. Implant survival rate, peri-implant bone resorption, probe depth (PD), the modified plaque index (mPI), and the modified sulcus bleeding index (mSBI) were analyzed to evaluate implant prognosis. Results Successful reconstruction of vertical alveolar defects and uneventful implant placement were achieved in all patients in both groups. After a mean follow-up time of 47.9±13.3 months, the implant survival was 97.3% (36/37) in group 1 and 95.5% (21/22) in group 2. No statistically significant differences were observed. The peri-implant bone resorption was 1.29±0.59 mm in group 1, which was slightly higher than the 1.24±0.87 mm in group 2 at last follow-up. The difference was also not statistically significant. Favorable peri-implant conditions were indicated by PD, mPI and mSBI in both groups. Conclusions Both ADO and AOBG could be used for correction of vertical alveolar defects with reliable implant prognosis. Comparably high implant survival rates and favorable peri-implant conditions were attained.
Article
The aim of this manuscript is to present a new technique, utilizing current technological advances, for immediate reconstruction and dental rehabilitation of segmental mandibular defects with a screw retained prosthesis. One case is reviewed, along with a detailed review of the surgical and prosthetic techniques used.
Article
Learning objectives: After studying this article, the participant should be able to: 1. Have a clear understanding of the evolution of concepts of velopharyngeal dysfunction, especially as it relates to patients with a cleft palate. 2. Explain the subjective and objective evaluation of speech in children with velopharyngeal dysfunction. 3. On the basis of these diagnostic findings, be able to classify types of velopharyngeal dysfunction. 4. Develop a safe, evidence-based, patient-customized treatment plan for velopharyngeal dysfunction founded on objective considerations. Summary: Velopharyngeal dysfunction is improper function of the dynamic structures that work to control the velopharyngeal sphincter. Approximately 30 percent of patients having undergone cleft palate repair require secondary surgery for velopharyngeal dysfunction. A multidisciplinary team using multimodal instruments to evaluate velopharyngeal function and speech should manage these patients. Instruments may include perceptual speech analysis, video nasopharyngeal endoscopy, multiview speech videofluoroscopy, nasometry, pressure-flow, and magnetic resonance imaging. Velopharyngeal dysfunction may be amenable to surgical or nonsurgical treatment methods or a combination of each. Nonsurgical management may include speech therapy or prosthetic devices. Surgical interventions could include palatal re-repair with repositioning of levator veli palatini muscles, posterior pharyngeal flap, sphincter pharyngoplasty, or soft palate or posterior wall augmentation. Treatment interventions should be based on objective assessment and rating of the movement of lateral and posterior pharyngeal walls and the palate to optimize speech outcomes. Treatment should be tailored to specific anatomical and physiologic findings and the overall needs of the patient.
Article
Background: Shallow upper buccal sulcus deformity in cleft lip and palate patients is one of the common secondary deformities after primary cleft lip and palate repair; this deformity may prevent or complicate orthodontic and prosthodontic procedures causing aesthetic and functional problems. A number of methods are described to increase the anterior maxillary sulcus in these patients. Purpose: This study assessed the use of a carbon dioxide laser (CO2) to increase the sulcus depth. Method: Fifteen patients with cleft lip and palate (eight unilateral and seven bilateral) were studied. The surgical procedure was performed using CO2 laser. The vestibular depth and lip length were measured at three time points namely before surgery (T0), 1 week following surgery (T1), and 4 months following surgery (T2). After data collection, statistical analyses were done using PASW(®) version 18 SPSS. Results: The mean values of vestibular depth were 9.46 ± 1.92, 13.83 ± 1.88, and 13.23 ± 1.76 mm for T0, T1, and T2, respectively. The vestibular depth significantly increased after 4 months of follow-up (p = 0.001). The mean amount of vestibular depth gain was not significantly different in unilateral and bilateral cleft groups (p = 0.908). The mean value of upper lip length increased by a mean of 1.23 mm and was statistically significant (p = 0.001). Conclusions: Upper buccal sulcus reconstruction with CO2 laser provides successful and stable results. CO2 laser application is suggested as an alternative to conventional vestibuloplasty.
Article
The aim of the present study was to evaluate retrospectively the clinical and radiographic behaviour of four commercially-available short implants with different macrodesigns and microdesigns in areas in which the height of the bone was reduced. We took into account the success and survival, peri-implant crestal bone loss, and the level of probing at which the gum bled. Patients were included if they had been given one or more short implants (≤8.5 mm long) in the posterior jaws at least three years earlier. Three hundred and ninety-one short implants were placed in 170 subjects, and were divided in four groups based on the brand of implant. The implants were evaluated one, two, and three years after they had been inserted. Short implants had a three-year survival and success rate of 90% in all groups, and bone loss was acceptable after three years with no significant differences between them. These results support the use of short implants as an effective and safe treatment. However, within the limitations of this study, the design of the implant does seem to influence the behaviour of peri-implant bone at the crestal level.
Article
Purpose Implant fracture is a serious complication, which leads to treatment failure. The purpose of this study is to estimate the incidence of implant fractures and identify factors associated with fracture. Materials and Methods This is a retrospective cohort study. Sample was derived from two implant centers. The predictor grouped into the following categories: demographic, location of implants, physical characteristic of implants, implant-abutment connection, type of prosthesis, type of retention and outcome variable (time to implant fracture). Kaplan Meier test was used to estimate survival of implants. Cox regression model was applied to evaluate time to event effect of variables in implant fracture. Results Thirty-seven of 18,700 implants (0.002 %) had fractures. The one-year and five-year risk for implant fractures were 0.38 per 1000 and 1.46 per 1000 respectively. Implant fractures happened in the premolar and molar area (94.6%) more than the anterior of the jaws. Pearson’s correlation test did not show any correlation with age, implant diameter, implant length and the time of fracture (P>0.05). Analysis of the data by log Rank test revealed a significant difference for survival between cemented and screw-retained crowns. (P=0.001) Cox regression model demonstrated hazard ratio (HR) 0.23 in taper implants than cylindrical fixtures and in screw retained crowns (HR=296.54) than cemented ones. Conclusion According to this study, conical implants and screw-retained prostheses may have less survival due to implant fracture.
Article
Purpose: The mandible is an essential esthetic and functional component of the lower third of the face and its reconstruction has been always a challenge, especially after severe post-traumatic injuries. The purpose of the present report was to introduce a new approach of mandibular reconstruction in a patient who had lost the entire mandible except for the rami after being severely injured in a blast. Materials and methods: A new approach using a titanium mandibular rami implant technique was applied using computer-aided 3-dimensional virtual planning and rapid prototyping technology. A prosthetic component was supported by the mandibular implant, which achieved occlusion and dedicated function for the patient. Results: This method offered precise adaptation of the implant and prosthesis and an easier surgical procedure, providing a shortened operation time, no donor site morbidity, and more predictable outcomes. Conclusion: This new technique allows reconstruction of large-scale mandibular defects that is not possible by conventional surgical methods.
Article
Introduction The orthopedic literature has seen an increasing incidence of prosthetic joint infections (PJI) associated Propionibacterium acnes (P. acnes). These infections present significant diagnostic and management challenges to the treating surgeons. In this review, we report on the cases of P. acnes related temporomandibular prosthetic joint infections (TMJ PJI) that have been diagnosed and treated at our institution. Methods Following IRB approval, we obtained information through a retrospective chart review. Records were retrieved from clinic visits between January 1st 2010 and January 1st 2015 using the appropriate ICD-9 codes. Data extracted included patient demographics, prostheses details, prosthetic infection history, interventions, diagnostic procedures, and culture processing methods. Results Of the 7 subjects that fit the search criteria, 4 subjects (1 with bilateral prostheses) had cultures positive for P. acnes. The 5 TMJ PJI’s with cultures positive for P. acnes had tissue cultures obtained in the operating room and processed using Mass spectrometry. Symptoms identified in these 4 subjects were vague and included pain and intermittent swelling; clinical and radiographic findings were non-specific. Treatment regimens included oral and parenteral antibiotics and operative interventions. Conclusions In this case series, we report on the management of four cases of P. acnes related TMJ PJI. When patients with TMJ prostheses report vague symptoms of swelling and pain that do not fit the typical infection scenario, the surgeon should consider P. acnes as a source of infection. Additional case series and retrospective reviews will be necessary prior to developing prospective trials that will aid in the prevention and management of this infection.
Article
Purpose The purpose of this study was to evaluate the stress distrubution on the temporomandibular joint (TMJ) prosthesis and contralateral natural TMJ with finite element analysis. Methods A TMJ implant was used to create a 3-dimensional model by computer. This model was integrated to a mandible model which created by computer by using computerized tomography images, similar to real TMJ replacement procedure. Masticatory loads were applied to the model. The loads transmitted to the TMJ prosthesis and contralateral healthy joint was evaluated by means of finite element analysis. Results At the model without TMJ prosthesis, maximum von Misses stress was found to be 252.697 N/mm² at the condyle and 5.418 N/mm² at the disc. At the model with unilateral TMJ prosthesis, maximum stress at the joint prosthesis was found to be 792.681 N/mm². At the contralateral natural joint, maximum stress was found to be 268.908 N/mm² at the condyle and 8.357 N/mm² at the disc. Conclusion At the TMJ model with unilateral total TMJ prosthesis, increased stress values was observed at the disk and the condyle of the contralateral natural TMJ.
Article
Background: In recent years, implant dentistry has become a routine part of many general dental practices in Australia. However, there has been little information regarding its extent and scope. This investigation aimed to address this issue by surveying Australian general dental practitioners (GDPs) and relevant specialists regarding their practice of implant dentistry. Methods: Anonymous electronic surveys were designed online using SurveyMonkey(™) and delivered to the following professional bodies: all seven State/Territory branches of the Australian Dental Association, the Australian and New Zealand Academy of Periodontists, the Australian and New Zealand Academy of Oral and Maxillofacial Surgeons, and prosthodontist members of the Australian Prosthodontic Society. The surveys were completed online via SurveyMonkey(™) in 2014. Results: The response rates were 7.61% (n = 801) for GDPs, 41.76% (n = 38) for prosthodontists, 34.16% (n = 55) for periodontists, and 34.07% (n = 46) for oral and maxillofacial (OMF) surgeons. Among the respondents, 66.37% (n = 521) of GDPs, 86.11% (n = 31) of prosthodontists, 82.98% (n = 39) of periodontists, and 97.67% (n = 42) of OMF surgeons indicated that they currently practise implant dentistry. A strong perceived need for further education in this field was also expressed by the respondents. Conclusions: Implant dentistry presently appears to be practised by a significant proportion of GDPs across Australia. This is likely to continue to grow in the future. This article is protected by copyright. All rights reserved.
Article
The current evidence of good practice in the delivery of long-term supportive care to patients who have been treated for head and neck cancer is sparse. We recruited 10 survivors so that we could follow their experience after their acute treatment was over. There were six men (mean (range) age 72 (54-86) years) and four women (mean (range) age 69 (67-73) years). After ethics committee approval had been given, we used structured interviews and questionnaires to investigate the impact of the resection and reconstruction, the patients’ perceived needs, and their use of supportive care services. Their experiences were in line with current treatment of head and neck cancer. Whether they would survive the cancer was an initial fear (up to a year postoperatively), and some subjects reported problems more than five years after treatment, particularly with swallowing, quality of saliva, and intelligible speech. This small group of survivors of head and neck cancer maintained a good quality of life physically, socially, and emotionally. Limitations were put down to their age rather than their diagnosis of cancer or their rehabilitation. Analysis of their perceived needs showed that supportive care services were readily available and were valued by the patients, and that all their needs were met.
Article
Object: Reconstruction of a cranial vault defect is a frequent challenge in neurosurgery. Polyetheretherketone (PEEK) is used in many types of prostheses and has been employed for 10 years in our institution (University Hospital of Toulouse - France). The objectives of this study are to describe the benefits and drawbacks of reconstructing the cranial vault defect with a PEEK prosthesis. Methods: Clinical data of the 37 patients who received a reconstruction with a custom-made PEEK prosthesis from 2007 to 2015 were retrospectively analysed. Operative technique, post-operative complications and patient's satisfaction with the aesthetic result - on a scale ranging from 1 (very dissatisfied) to 5 (very satisfied) - were studied. Results: Average follow-up was 4.3 years (from 2 months to 9 years). The placement of the prosthesis was performed 195 days on average (from 0 to 1051 days - sd 258 days) after the initial bone flap removal. One infection (2.7%) was described, which required the removal of the prosthesis. Six patients (16%) were re-operated by the maxillo-facial surgery team to treat a lack of temporal projection related to muscle atrophy, using a fat cell autograft taken from the abdominal region. Overall, 30 (81%) answered the question about their aesthetic satisfaction, with good results on the satisfaction scale (average 4.5; from 3 to 5). Conclusion: The use of a PEEK prosthesis in cranial vault defect reconstruction is a reliable technique with a high patient satisfaction rate and with few complications. Corrections of the temporal muscle atrophy by fat grafting may be performed in addition, without increasing the rate of complications.
Article
While the oral health-related quality of life (OHRQoL) is known to be reduced in patients with cleft lip and palate (CLP), its inter-dependency with the soft tissue characteristics of the CLP area remains unclear. This study aimed to evaluate the soft tissue characteristics in the treated cleft area in order to investigate whether gingival esthetics correlate with OHRQoL. Thirty-six patients with unilateral or bilateral CLP (46 cleft areas) were investigated after secondary/tertiary alveolar bone grafting and orthodontic/prosthetic implant treatment using an adapted score to rate gingival esthetics (clinical esthetic score, CES). The patient’s OHRQoL was determined using the German short version of the Oral Health Impact Profile questionnaire (OHIP-G14). The results showed a significantly better rating in patients with their own teeth in situ (12.05 ± 1.10) than in patients with implants (6.95 ± 4.78) or prosthetics (4.00 ± 3.58). The best OHRQoL values were achieved by patients with their own teeth integrated into the cleft area (1.32 ± 2.31), followed by patients with implants (2.33 ± 2.33) and prosthetics (3.75 ± 5.87). A significant (P = 0.017) correlation was found between OHIP-G14 and CES scores, suggesting an increased OHRQoL in cases with higher oral esthetics in the cleft area. The therapeutic strategy contributes to both gingival esthetics and OHRQoL. The patient’s subjective perception of OHRQoL can be attributed to objective gingival esthetic ratings.
Article
The most common causes of mandibular defects are ablative surgery of benign or malignant tumors, severe trauma, inflammatory diseases, and osteoradionecrosis. War injuries are another cause for mandibular defect. Reconstruction of the mandible is considered a challenge to the maxillofacial surgeon due to the accompanying functional and cosmetic importance. The object of this article was to show the role of nonvascularized bone graft in the reconstruction of segmental defect of the mandible resulted from projectiles and its snags. Seventeen patients underwent reconstruction of defect in the body of the mandible using non-vascularized iliac bone graft,in sixteen patients the grafts were fixed by reconstruction plate and in one by stainless-steel wire. In the emergency phase in which life-saving measures were done, in the immediate phase, treatments of associated facial and systemic injuries were carried out. The delayed phase includes the reconstruction of the residual defects and rehabilitation. A total of 17 male patients with a mean age of 34.5 years underwent reconstructive surgery, the time lapse between the injury and the delayed phase of treatment ranged from 20 days to 3 months. The size of the defects ranged from 4 to 7 cm. Treatment was considered successful in 15 patients (88.2%) in whom the grafts were incorporated to mandible with improvement of facial contour and symmetry and satisfactory occlusion of the remaining teeth. Nonvascularized bone graft is considered a feasible option for the reconstruction of a relatively small mandibular defect, especially in ascetic conditions for its role in improving facial appearance and to less extent functional benefit and more advanced method for the reconstruction needed to be introduced especially in war injuries.
Article
This report describes the case of a 42-year-old woman who consulted with a maxillofacial specialist for pain and an exophytic lesion in the maxilla. Biopsy examination disclosed a bone cyst with abundant giant cells, and head and neck computed tomography was performed. A diagnosis of brown tumor in the maxilla and mandible was made, and primary hyperparathyroidism (parathyroid adenoma) was determined as the origin of the bone lesions. The patient underwent a left superior parathyroidectomy, which resolved the hormonal disorder (as determined by normal calcium and parathyroid hormone levels) and the brown tumors, which appeared to have mineralized at 1-year follow-up computed tomography. Dental implant rehabilitation was performed at the sites of the absent tumors. A systematic review of articles published in the English-language medical literature through the PubMed and Medline databases yielded 40 articles (published from 1969 through 2016) on 45 cases of hyperparathyroidism associated with the location of a brown tumor in the mandible or maxilla.
Article
An alternative technique to reconstruct atrophic alveolar vertical bone after implant placement is presented. The technique consists of an osteodistraction or direct surgical repositioning of an implant-bone block segment after segmental osteotomies that can be used in esthetic or non-esthetic cases. Initially, casts that transfer the implant position are obtained and the future ideal prosthetic position is determined to guide the model surgery. After the model surgery, a new provisional prosthesis is made, and an occlusal splint, which is used as both a surgical guide and a device for osteodistraction, is custom-fabricated. The surgery is then performed; for the mobilization of the implant-bone block segment, two vertical osteotomies are performed and then joined by a horizontal osteotomy. The implant-bone block segment is then moved to the planned position. If a small movement is planned, the implant-bone segment is stabilized; in cases that require larger movements, the implant-bone segment may be gradually moved to the final position by an osteodistraction. This technique has a good predictability of the final implant-bone segment position, and relatively fast esthetic rehabilitation; it may be considered in cases of dental implants in regions of vertical bone atrophy.
Article
Purpose: The decision by prosthodontic residency program directors to employ the Match process highlights the need to understand applicant priorities that influence their choice of which programs to rank highly. The purpose of this study is to determine the factors that were most important to residents when choosing from among nonmilitary based prosthodontics dental residency programs in the United States. Materials and methods: Following completion of a pilot study, all currently enrolled prosthodontic residents at nonmilitary residency programs were invited to participate via the internet. The study consisted of a survey instrument asking residents to rank 26 possible factors that might impact an applicant's choice of residency program. In addition, the instrument collected other possible influencing variables including gender and debt load. Mean rank scores were compared to determine the most and least important factors. Kruskal-Wallis test was used to compare specific factors between the possible influencing variables. Results: Two hundred and thirty residents completed the survey instrument, representing a 54.1% response rate of possible participants. With regard to factors influencing program choice, reputation of the residency program was the factor ranked the highest by participants, followed in descending order by the program director's personality, curriculum content, access to use of the latest digital technology, and opportunities for dental implant placement. Quality of schools for children, community outreach opportunities, and the ability to moonlight were ranked as the least important factors. Male and female residents ranked factors such as tuition/stipend, curriculum content, and community outreach opportunities significantly differently. Depending on debt load, residents ranked the factors tuition/stipend, ability to moonlight, curriculum content, and safety of the area where the program is differently. Conclusions: Current prosthodontic residents valued the reputation of the program as the most important factor when applying to residency. Participant gender and debt load influence the factors chosen by residents as more or less important. These data will assist prosthodontic educators position their programs in the best possible light to attract applicants to their programs.
Article
Purpose: Although digital aids can help surgeons compensate for the shortcomings of traditional mandibular reconstruction techniques to perform surgery more precisely and effectively, the use of these digital techniques has often been fragmented, divided, and incomplete. This article describes the workflow of a fully digital mandibular reconstruction to explore the proper indications and discusses innovations based on the accuracy and effectiveness of digital techniques. Materials and methods: A restoration-oriented mandibular reconstruction was performed by applying different digital techniques. Preoperative virtual surgery and rapid prototyping were used to aid the vascularized iliac bone graft surgery, which offered a solid basis for the ensuing treatment. Subsequently, implant rehabilitation was accomplished with the assistance of computer-assisted design and manufacture, laser treatment, and selective laser melting techniques. Result: The workflow of the fully digital mandibular reconstruction successfully achieved a restoration-oriented treatment. These predictable, accurate, and effective digital techniques improved the consistency of pretreatment design and follow-up treatment. The treatment sequence achieved high predictability and reproducibility owing to the use of digital techniques. Conclusion: This study shows that a digital workflow can be predictable, accurate, and effective, which suggests that it could be a valid digital protocol for developing a treatment sequence for patients with jaw defects caused by trauma, congenital anomalies, or mandibular tumor resection.
Article
Purpose: The Patient Concern Inventory(©) (PCI) is a clinical tool of self-reported patient concerns to be used by the clinician to structure the patient-oncologist visit. It was developed in the United Kingdom to address the issues of quality of life (QOL) in head and neck cancer (HNC) patients. The purpose of the study reported here was to determine the prevalence of PCI(©) items, the associations between PCI(©) items and QOL, and to explore the importance of oral/dental issues in the patient's well-being. Methods: The PCI(©) and the University of Washington (UW-QOLv4) instruments were self-administered by an HNC population in a cross-sectional study. Following an a priori sample size estimate, consecutive HNC patients attending at the University of Florida's Oral Medicine and the ENT Clinics had the study described, eligibility assessed, and if eligible, were invited to participate in the study. Participants completed the PCI(©) and UW-QOL. PCI(©) issues prevalence was determined, and for those with a ≥10% prevalence: 1) Fisher's exact test was used to test for statistical differences between treatments, and 2) multivariable regression was used to test each of the prevalent PCI(©) issues across four QOL measures, health in the last 7 days, overall QOL in the last 7 days, and the physical and social domain scores. Results: Twenty of 45 PCI(©) issues had a prevalence ≥10%. Of the 15 prevalent items statistically associated with a QOL measure, four issues are the clinical responsibility of the dental profession: 1) chewing/eating, 2) dental health/teeth, 3) mouth opening, and 4) salivation. An additional four (eight total, 50%) are of clinical concern for dental clinicians: 5) pain in head/neck, 6) swallowing, 7) speech/voice/being understood, and 8) taste. Conclusions: Dental concerns represent almost half of all PCI(©) concerns observed in 10% or more of the sample patients. Prosthodontists should support our maxillofacial prosthodontics specialists in joining other oral oncologists and advocate for comprehensive, integrated dental support for HNC patients by assuring dental involvement/inclusion with the multidisciplinary oncology team and a research agenda to established best patient-centered outcomes.
Article
Craniofacial endosseous implants are regularly used to support prostheses in the rehabilitation of complex defects, but reported success rates vary. To review our own clinical practice over 10 years, and particularly to examine the impact of radiotherapy and the timing of placement on the survival of implants, we retrospectively audited the records for all patients who had endosseous implants for prosthetic rehabilitation in our unit between 2005 and 2015. We reviewed 167 records, which gave 451 implants, of which, 222 (49%) were auricular, 98 (22%) nasal, and 131 (29%) orbital. Most were placed after ablative operations for cutaneous malignancy (n = 103 patients, 62%). The failure rate of implants placed in bone that was irradiated either before or after placement was significantly higher than that of those placed in non-irradiated bone (univariate analysis: 11% compared with 2%, p < 0.001: Kaplan-Meier survival analysis: p < 0.001). The timing of placement in relation to radiotherapy (before compared with after) seemed to have no impact on success (p = 0.96). Our findings are in keeping with previous reports, and the principal observation is that radiotherapy adversely affects success. We work closely with our maxillofacial prosthetists and place implants at the time of ablation. Our findings seem to support this practice regardless of whether or not the patient will later require adjuvant radiotherapy.
Article
With the development of 3D printing and computer graphics technology, mouth rehabilitation has increasingly adopted digital methods. This research proposes a new method to transform the appearance of facial model after complete denture prosthesis. A feature template with few feature points is first constructed according to the facial muscle anatomy and facial deformation after complete denture prosthesis. Next, the traditional as-rigid-as-possible (ARAP) method is optimised by clustering based on facial muscles. The optimised ARAP method is then used for real-time and interactive simulations. Finally, by classifying the degrees of elasticity in the model with additional weights, the simulation can be customised to the skin of individual patients. Different degrees of elastic deformation and post-operative models are superimposed for match analysis. Compared with our previous study, the error is reduced by 24.05%. Results show that our method can deform facial models accurately and efficiently.