How do patients perceive resident participation in facial cosmetic treatment?

PURPOSE: The main objective of this study was to determine patient attitudes toward resident participation in their facial cosmetic treatment. MATERIALS AND METHODS: The study design was a cross-sectional study which consisted of an anonymous questionnaire regarding the patient's opinion of resident involvement in their care. Patients who presented to a single academic center seeking facial cosmetic care were surveyed over a period of 10 months. The primary outcome variables were degree of training, analysis of resident involvement impacting quality of care, and resident gender. RESULTS: Fifty patients were surveyed. All participants agreed that they would be comfortable if a resident observed their consultation or treatment and 94% agreed they would be comfortable if a resident interviewed and examined before meeting with the surgeon (n = 47). When asked if they would prefer a resident to be far along in their training if they were involved in the surgical care, the majority, 68% (n = 34), agreed. Only 18% (n = 9) of the patients reported feeling a resident's involvement in their surgery may lower the quality of their care. CONCLUSION: Patient perception of resident participation in their cosmetic treatment is favorable, but it appears patients do prefer that residents be well into their training years.

Effect of biologic materials on the outcomes of horizontal alveolar ridge augmentation: A retrospective study.

PURPOSE: The purpose of this study was to investigate if the addition of biologic agents to a particulate bone graft enhances horizontal ridge augmentation outcomes in terms of bone dimensions, bone density, and successful implant placement. MATERIALS AND METHODS: A retrospective chart review was done to assess the clinical and radiographic outcomes in 52 horizontal ridge augmentation sites in 43 patients. Information was gathered regarding surgical technique, type of graft material, biologic agents used (PRP or rhPDGF-BB), method of space maintenance, and achieved alveolar ridge width and bone density changes as quantified on CBCT scans. RESULTS: The use of tenting screws, a resorbable membrane, and a combination of particulate allogenic and xenogenic bone graft material provided an average horizontal bone gain of 3.6 mm in the 52 augmented sites. There was no statistically significant difference observed in the amount of horizontal bone gain between sites treated with the addition of biologic agents (n = 21), or with a particulate bone graft alone (n = 31). A marginally statistically significant difference was found in the density of the grafted bone with the addition of biologics (p value = .0653). CONCLUSION: The addition of biologic agents to the graft materials did not have a significant effect on the amount of horizontal bone gain or successful implant placement; however, it marginally enhanced the bone density of the grafted area.

The Opinion of Different Observer Groups About the Esthetic Impact and Need for Surgical Correction of Varying Submental Lengths.

PURPOSE: This study evaluated the opinion of different observer groups about the influence of the submental length on perceived attractiveness and when surgical correction was deemed necessary. MATERIALS AND METHODS: The submental length of an idealized silhouette of a white male profile was altered incrementally between 5 and 95 mm. Images were rated for attractiveness on a Likert scale by pretreatment orthognathic surgery patients (n = 75), laypersons (n = 75), and clinicians (maxillofacial surgeons and orthodontists) (n = 35). RESULTS: For perceived attractiveness, the ideal submental length was approximately 50 mm (range, 40 to 75 mm). A submental length shorter than or equal to 30 mm was deemed unattractive by all 3 groups. Overall, a submental length less than 40 mm generally was judged less attractive than a comparable increase in length. Clinicians were generally least likely to suggest surgery for varying submental lengths. For this group, the cutoff at which the majority suggested surgery was a submental length of 25 mm or less. For the patient and layperson groups, the corresponding cutoff values were a length shorter than or equal to 30 mm or equal to 95 mm. CONCLUSIONS: A submental length of approximately 50 mm (range, 40 to 75 mm) was viewed by most observers as attractive. At 30 mm or less, it was generally deemed progressively less attractive. Clinicians were less likely to suggest corrective surgery than were the patient and layperson groups. For comparative proportional relationships, the submental length should be between the lower lip-chin height and lower facial height, assuming an otherwise proportional facial profile.

Recognition of the Asymmetrical Smile: A Comparison of Orthodontists, Oral and Maxillofacial Surgeons, and Laypersons.

PURPOSE: Studies have shown that an asymmetrical smile is a relatively common problem. Yet, many patients are unaware of having this condition. Because having an asymmetrical smile can affect the final esthetic result of orthodontic therapy or orthognathic surgery, such patients need to be aware of the problem. The purpose of this study was to determine what amount of smile asymmetry is clinically evident to orthodontists, oral and maxillofacial surgeons (OMSs), and the lay public. MATERIALS AND METHODS: A total of 56 OMSs, 117 orthodontists, and 123 laypersons participated in the study. They were asked to view a randomly arranged series of computer-generated male and female facial photographs with the smile symmetrical or altered in 0.5-mm increments from 1 to 4 mm and to indicate whether the person had an asymmetrical smile. RESULTS: The OMSs and orthodontists were able to recognize relatively smaller amounts of asymmetry than the laypersons (2 mm vs 3 to 3.5 mm). CONCLUSIONS: Although the clinicians performed better than the laypersons, both groups were able to recognize relatively small amounts of asymmetry. Because such a condition is generally not correctable and can affect the esthetic result, patients undergoing orthodontic therapy or orthognathic surgery need to be made aware of the situation before treatment.

Patients' Preference for Receiving Informed Consent Information Regarding Third Molar Surgery.

PURPOSE: It is important that patients have adequate information about a surgical procedure and its risks and benefits before giving consent to proceed. The purpose of this study was to determine patients' satisfaction with various methods of presenting such information and their preferred method. MATERIALS AND METHODS: Patients presenting for removal of impacted third molars were shown an informational video discussing the diagnosis of impacted teeth, the potential risks of not having them removed, their treatment, the surgical complications, and the anesthetic options and risks. They subsequently met with the treating doctor, who again reviewed the material shown in the video and answered any questions before patients signed the informed consent document. Patients then completed a brief questionnaire asking them to rate their satisfaction with the 2 presentation methods and to indicate their preferred method. RESULTS: A total of 50 patients (18 male and 32 female patients; average age, 26 years) completed the questionnaire. Of these patients, 58% had a high school education whereas 42% had some college or a college degree. Sixty-six percent of patients found the video very helpful, and 78% found the oral presentation very helpful. However, when asked which format provided the best information, 62% indicated the video whereas 38% indicated the oral presentation. CONCLUSIONS: Because there was no clear consensus among patients regarding the best format, providing both a video and an oral presentation is the ideal situation.

A needle in a haystack: Report of a retained archwire fragment in the pterygomandibular space.

This clinical report describes a retained archwire fragment, discovered during a new-patient examination of a young woman seeking orthodontic retreatment. The diagnostic process, care coordination, and patient management decisions are discussed, along with a brief exploration of clinical considerations associated with this incident. A suggested emergency prevention and response protocol is also presented.

Discontinuation of Denosumab as a Potential Cause of Generalized External Cervical Root Resorption: A Case Report.

Generalized occurrence of external root resorption in an adult patient is a rare finding. This case report describes external cervical root resorption extensively affecting the dentition that may be associated with the use and subsequent cessation of denosumab for the treatment of osteoporosis.

What do patients fear most about having oral surgery?

OBJECTIVE: Considerable emphasis has been placed on the fear that patients undergoing oral surgery have of the local anesthetic injection. However, other potential factors such as fear of pain during the operation, fear of the operation itself, and fear of postoperative pain are often not considered. The purpose of this study was to determine how patients rank their fear of these four factors. Such information can be helpful in improving patient management. METHOD AND MATERIALS: Patients 18 years of age and older presenting to the Oral Surgery Clinic of the Virginia Commonwealth University School of Dentistry for tooth extraction were asked to complete a brief questionnaire ranking their fear of the four previously noted factors, as well as to include their age, gender, and level of education. RESULTS: One hundred patients (52 females and 48 males), ranging in age from 18 to 93 years, completed the survey. Sixty-one had a high school education, 22 had some college education, and 17 had a college degree or higher. Twenty-five ranked pain from the local anesthetic as their greatest fear, 26 ranked pain during the operation as their greatest fear, 18 ranked the operation as their greatest fear, and 31 ranked fear of postoperative pain the highest. There were some significant differences in the rankings between females and males. CONCLUSIONS: The results of this study show that patients have fear of pain during and after the procedure as well as of the local anesthetic injection. To maximize patient comfort, how all these factors will be properly managed needs to be discussed preoperatively.

Are There Differences in Technical Assessment Grades Between Adjunct and Full-Time Dental Faculty? A Pilot Study.

Some dental students preferentially schedule graded assessments with adjunct faculty members in expectation of obtaining a higher grade. The aim of this pilot study was to compare the grades given by full-time and adjunct faculty members in clinical periodontics to determine if a difference in grading existed. Grades for students given by seven full-time and 11 adjunct faculty members for various technical and competency assessments in D3 and D4 clinical periodontics courses in academic year 2015-16 were compared. Associations between grades and faculty type were sought using mixed model regression to account for correlations among a student's scores. A total of 845 technical assessment and competency scores from 208 students in the two classes were included in the analysis. Scores were for four procedures: periodontal examination and treatment planning, scaling and root planing, evaluation of initial therapy, and periodontal maintenance. Full-time faculty members graded 58% of the assessments, and 42% were scored by adjunct faculty members. Grades for the adjunct faculty were on average 0.14 (out of 5) higher than those for the full-time faculty (p<0.0001). The number of graded assessments was also significantly associated with a higher average score, suggesting potential student bias toward selecting faculty members who grade more favorably (p<0.0001). These students generally received higher grades from adjunct faculty members, whereas the grades given by full-time faculty members were closer in average and more consist with each other. The results point to the need for more calibration training for adjunct faculty members.

Influence of Self-Assessment on Dental Students' Performance on Technical Assessments in Periodontics.

Self-assessments were introduced into a third-year clinical periodontics course to enable dental students to self-assess and receive faculty feedback prior to technical assessment. The aims of this study were to determine if there was an improvement in the pass rate and average grade on the technical assessments following implementation of self-assessments and to analyze the accuracy of the student self-assessments by comparing them with faculty assessments. Scores from 106 third-year dental students for four periodontal procedures were included in the analysis. Faculty and student self-assessment scores, along with self-assessment and final technical assessments scores, were compared, as were the average number of self-assessment attempts for the various procedures and the pass rates. The average number of self-assessments per student was 6.5 compared to 4.2 for the technical assessments. There was no significant difference between students' self-assessment scores and faculty scores (average difference=0.005; p=0.7894). However, there was a significant increase in overall scores between students' self-assessments and technical assessments (average difference: 0.30 out of 5; p=0.0001). There was also a significant difference in pass rate between self-assessments and technical assessments (92.3% and 99.7%, respectively). The individual technical assessment with the greatest improvement was for scaling and root planing (average difference=0.47; p=0.0001), which also had significantly more self-assessments (2.3 vs. 1.2-1.7, p=0.0001). These results suggest that self-assessment and the subsequent faculty feedback provided students with information that enabled them to improve their performance on technical assessments.

How Important Are Letters of Recommendation? A Survey of Oral and Maxillofacial Surgery Residency Program Directors.

PURPOSE: Letters of recommendation are currently part of the application process for residencies in oral and maxillofacial surgery. However, the value placed on the information contained in such letters by program directors is unclear. The purpose of this study was to determine what role letters of recommendation play in the decision-making process. MATERIALS AND METHODS: In this cross-sectional study, a questionnaire was sent to 122 current and former program directors asking them to rate the importance they gave to letters of recommendation compared with other application attributes through a visual analog scale that ranged from 0 ("not important") to 100 ("very important"). Respondents also specified the format in which they would prefer recommendations be sent and, if they preferred letters, to state why. Responses were summarized with descriptive statistics (counts and percentages). The average perceived importance of applicant attributes and components of recommendations was compared using random-effects models to adjust for multiple responses from the same respondent. Post hoc pairwise comparisons were performed using Tukey adjustment. RESULTS: Of the 122 questionnaires sent, 14 were not deliverable. Forty-one of the 108 remaining program directors answered, for a response rate of 38%. Only 10% of respondents indicated that they do not consider letters of recommendation. However, they rated class rank, comprehensive basic science score, and leadership qualities more important than letters of recommendation. They preferred letters of recommendation from a faculty member rather than from a dean or non-oral surgeon and favored letters over a standard recommendation form, which they believed provided information not found in supporting documents. CONCLUSIONS: Despite some deficiencies found with letters of recommendation, and the varying importance given to the information they contain, program directors still find that they provide some useful information.

Does Viewing a Third Molar Informed Consent Video Decrease Patients' Anxiety?

PURPOSE: Before having impacted third molars removed, patients are frequently asked to view a brief video describing the operation and its benefits and risks. The purpose of this study was to determine whether such information reduces or increases patients' anxiety level. PATIENTS AND METHODS: In this prospective cohort study, 100 patients presenting for consultation regarding removal of their impacted third molars completed a form asking them to grade their anxiety level before and after viewing the informational video as calm, slightly anxious, moderately anxious, or very anxious. RESULTS: Thirty-one percent reported increased anxiety after viewing the video. Only 12% showed a decrease, and in 57%, there was no change (28% were still slightly, moderately, or very anxious). Scoring of the pre- and post-viewing anxiety levels showed a statistically significant increase in anxiety after viewing. CONCLUSIONS: Viewing the video increased or did not reduce the anxiety level in a significant number of patients. Therefore, it is important to complement this video with positive verbal and written reinforcement of such aspects as patient comfort, procedural safety, and adequate pain control.

Upper Lip Asymmetry During Smiling: An Analysis Using Three-Dimensional Images.

OBJECTIVE: The aim of this study was to use three-dimensional images to determine the presence of upper lip asymmetry at rest and during smiling in a group of individuals with no history of orthodontics or facial cosmetic surgery. METHODS: Standardized three-dimensional frontal resting and smiling images of 54 volunteers were analyzed using the 3dMDvultus software (3dMD, Atlanta, GA). Measurements were made from the soft tissue nasion, ipsilateral ala, subnasale, and menton to the right and left commissures of the lip. A 2.5 mm or greater difference between the right and left sides was defined as an asymmetry. The agreement on the presence or absence of asymmetry between the subjects' states of rest and smiling was determined by the McNemar's chi-squared test. Statistical significance was defined as p<0.05. RESULTS: Menton was the most stable facial landmark to evaluate the upper lip symmetry at rest and during smiling (p=0.002). Using menton as a landmark, only one of the 54 subjects showed asymmetry while resting, but 12 (22%) showed asymmetry when smiling. CONCLUSION: As part of treatment planning for orthodontics or orthognathic surgery, patients should be evaluated for the upper lip symmetry during resting and smiling. The presence of asymmetry during smiling is a significant clinical problem that needs to be recognized so that patients can be informed about the effect it can have on the final esthetic result.

Do Implant Surgical Guides Allow an Adequate Zone of Keratinized Tissue for Flapless Surgery?

PURPOSE: A major advantage of guided implant surgery using 3-dimensionally printed guides is the ability to perform accurate flapless surgery. A drawback of a flapless technique is the inability to manipulate soft tissue to ensure sufficient gingiva around the implant. The purpose of this study was to determine how often flapless surgery using surgical guides results in less than 2 mm of keratinized tissue surrounding the implant. MATERIALS AND METHODS: This retrospective analysis included 27 maxillary and 27 mandibular implant sites that underwent treatment planning for implant-guided surgery using 3Shape Implant Studio (3Shape, Copenhagen, Denmark). Intraoral scan images were used to measure the width of the keratinized tissue on the buccal aspect of each implant site in both arches and the lingual aspect in the mandibular arch. Three examiners measured the amount of buccal and lingual keratinized tissue in millimeters at each implant site. Analysis of variance (P < .05) and correlation coefficients were used to determine statistically significant differences in keratinized tissue among sites. RESULTS: No statistically significant difference was found either between the widths of buccal keratinized tissue in the maxillary anterior (4.06 ± 1.42 mm) and posterior (4.93 ± 2.54 mm) areas (P = .293) or between the amounts of buccal and lingual keratinized tissue in the mandible (P = .995). The keratinized tissue width in the maxillary buccal area was significantly different (4.48 ± 2.04 mm) from that in the mandibular posterior buccal (1.98 ± 1.41 mm) and lingual (1.98 ± 1.23 mm) areas (P < .001). Over 77% of maxillary implant sites had greater than 3 mm of gingiva, and just over 20% had sufficient gingiva in the mandible. CONCLUSIONS: Adequate keratinized tissue was found in most of the planned maxillary implant sites, whereas most of the mandibular posterior implant sites had inadequate keratinized tissue. Therefore, elevation of a flap to preserve and reposition existing keratinized tissue around implants should be considered when planning to use tooth-borne surgical guides in the posterior mandible.

The Use of Botulinum Toxin for the Treatment of Myofascial Pain in the Masticatory Muscles.

Although the use of botulinum toxin has been recommended for the management of myofascial pain and dysfunction, the precise mechanism of its action remains undetermined and studies on its effectiveness are equivocal. Moreover, even if such treatment may temporarily relieve the symptoms, it does not address the cause of the problem. Also, its use is not free of potential complications. On this basis, botulinum toxin does not seem to be a logical treatment of myofascial pain and dysfunction.