Patient- and clinician-reported outcomes for the additively manufactured sub-periosteal jaw implant (AMSJI) in the maxilla: a prospective multicentre one-year follow-up study.

The clinical outcomes of maxillary rehabilitation with the additively manufactured sub-periosteal jaw implant (AMSJI; CADskills BV) were evaluated in edentulous patients with a Cawood-Howell atrophy classification ≥5 in all regions of the maxilla. Fifteen consecutive patients were included in the study and followed up for 1 year. They were interviewed using a survey protocol and were examined clinically and radiographically preoperatively (T0) and at 1 (T1), 6 (T2), and 12 (T3) months after permanent upper prosthesis placement. The patients reported an increased oral health-related quality of life. The overall mean Oral Health Impact Profile-14 score at T0 was 17.20 (standard deviation (SD) 6.42). When results at T0 were compared to those at T1 (mean 8.93, SD 5.30), a statistically significant difference was seen (P = 0.001). At T3, the mean value was 5.80 (SD 4.18). Compared to T0, there was also a statistically significant difference at T3 (P = 0.001). General satisfaction based on the numerical rating scale was a mean 49.93 at T1, which was less than patient expectation prior to treatment at T0 (52.13). A higher overall value was seen at T3 (53.20) when compared to T0. Within the constraints of the short follow-up, the AMSJI appears to be a promising tool for patients with extreme jaw atrophy. The high patient expectations were met without complications.

Pain management at iliac donor sites after grafting of alveolar clefts.

The aim of this study was to answer the question: which analgesic protocol is most efficient and most effective in overcoming pain and promoting functional recovery after iliac bone grafting in cleft alveolus patients? A systematic review of the literature was performed. The population consisted of cleft lip and alveolus patients with or without cleft palate undergoing iliac crest bone grafting; the outcomes analysed were represented by the duration of hospital stay, subjective pain rating, and degree of impaired mobility. A total of 15 articles were selected for review. The following protocols were subject to comparison in this review: simple classic intravenous/per-oral analgesia, local anaesthetic infiltration in the donor site, anaesthetic-soaked sponge, neural blocks and continuous infusion at the donor site. The results of the included studies were individually reported identifying trends in the efficiency of the different pain-management techniques. Although hospital stay varied from same-day discharge to almost a week, other factors besides pain influenced this outcome. School was resumed after an average of 12.6 days and sport activities after maximum one month regardless of the used protocol. Even though the age of patients had a statistically significant influence on hospital stay durations, it did not determine the latter. The pain management protocols after iliac bone grafting of alveolar clefts selected for analysis have their advantages and drawbacks. All protocols seem effective meaning they reach adequacy in managing pain at the donor site. The efficiency of the protocols could not be assessed due to the lack of data and inconsistency in pain assessment scales. Further investigation through randomized controlled studies is required.

Mechanical evaluation of a patient-specific additively manufactured subperiosteal jaw implant (AMSJI) using finite-element analysis.

Edentulism with associated severe bone loss is a widespread condition that hinders the use of common dental implants. An additively manufactured subperiosteal jaw implant (AMSJI) was designed as an alternative solution for edentulous patients with Cawood and Howell class V-VIII bone atrophy. A biomechanical evaluation of this AMSJI for the maxilla in a Cawood and Howell class V patient was performed via finite-element analysis. Occlusal and bruxism forces were incorporated to assess the loading conditions in the mouth during daily activities. The results revealed a safe performance of the implant structure during the foreseen implantation period of 15 years when exerting average occlusion forces of 200 N. For the deteriorated state of class VIII bone atrophy, increased stresses on the AMSJI were evaluated, which predicted implant fatigue. In addition, excessive bruxism and maximal occlusion forces might induce implant failure due to fatigue. The models predicted bone ingrowth at the implant scaffolds, resulting in extra stability and secondary fixation. For all considered loading conditions, the maximal stresses were located at the AMSJI arms. This area is most sensitive to bending forces and, hence, allows for further design optimization. Finally, the implant is considered safe for normal daily occlusion activities.

Patient- and clinician-reported outcomes of lower jaw contouring using patient-specific 3D-printed titanium implants.

The main aim of this study was to assess patient-reported outcomes of jawline contouring with patient-specific three-dimensional (3D) -printed titanium alloy implants using validated Face-Q questionnaires. Four FACE-Q questionnaires (Appearance Appraisal Scale, Quality of Life Scales for Psychological and Social Function, and Adverse Effects Scale) were sent to 21 patients consecutively operated on by the same surgeon between 2014 and 2019. Thirteen patients responded. Mean Rasch Transformed Scores for Satisfaction, Psychological Function and Social Function (0-100) were 70.6, 73.2, and 71.1, respectively. These values are difficult to interpret, however, as comparative literature and prospective follow-up scores are lacking. The second objective was to correlate clinician-reported morphology improvement by panel scoring (Likert scale) with patient-reported appearance appraisal. As for satisfaction, we can conclude that an objective acceptable result does not corroborate patients' perceptions (Spearman Rho test rs = -0.021). Psychological factors and results from previous surgeries probably modulate patients' views. The mean score for the Adverse Effect Scale (15-45) was low (18.6), indicating that the intraoral drop-in fit of customized titanium implants does not cause major side effects.

Computer-aided design and manufacturing construction of a pilot guide for a bone-anchored epithesis to replace an absent pinna.

Bone-anchored epitheses have acquired an important role in auricle reconstruction. The purpose of this technical note is to present a fully in-house digital workflow for the design and three-dimensional (3D) printing of an optimal ear epithesis guide. Two hemifacial microsomia patients with grade IV microtia were treated accordingly. The upper dental arch was optically scanned and a cone beam computed tomography scan of the cranium was obtained. The composite and soft tissue models created were exported into 3D sculpting software. The unaffected ear was virtually mirrored onto the affected side and two ideal implant positions were defined in relation to bone thickness, contralateral symmetry, and housing of the retaining bar. A bite wafer was virtually designed on the upper dental arch and connected to the mirrored ear. The pilot guide was 3D-printed and allowed for correct positioning and orientation during surgery. The prosthetic pinna was manufactured in a conventional way. A bar with retaining clips was used to anchor the prosthetic pinna. Clinically satisfactory results were obtained in two grade IV microtia cases. The fully digital workflow presented to design and 3D-print an optimal ear epithesis guide offers a good alternative to the existing techniques.

Surgically assisted rapid maxillary expansion with bone-borne versus tooth-borne distraction appliances-a systematic review.

The objective was to test the hypothesis of no difference in skeletal and dental arch expansion and relapse after surgically assisted rapid maxillary expansion with a bone-borne compared with a tooth-borne appliance. The PubMed, Embase (Ovid), Cochrane Library, and Google Scholar databases were searched in combination with a hand-search of relevant journals up until December 2017. No language restriction was applied. Two short-term randomized controlled trials with a low risk of bias fulfilled the inclusion criteria. No meta-analysis could be performed due to considerable heterogeneity. There were no statistically significant differences in the skeletal and dental arch expansion and relapse. Dental arch expansion was significantly greater than skeletal expansion with both treatment modalities. However, dissimilar evaluation methods, different outcome measures, unknown vertical level of force application with the bone-borne devices, and various methodological confounding factors posed serious restrictions to reviewing the literature in a quantitative systematic manner. Hence, conclusions drawn from the results of this systematic review should be interpreted with caution. Further well-designed long-term randomized clinical trials including a standardized protocol and three-dimensional analysis of the level of force application and morphological outcome are therefore needed before one treatment modality can be considered superior to the other.

Mandibular feminization osteotomy-preliminary results.

Strong mandibular angles and a heavy chin are perceived as masculine features, so surgical feminization of female or transgender faces may warrant mandibular base narrowing (borders and angles) and a reduction in chin width and height. With this in mind, we have devised an interdental midline osteotomy (triangular in shape and with a caudal base) to accompany a box-shaped impaction osteotomy of the chin symphysis and horizontal triangular resection of the lateral mandibular border. The reduction of the intergonial width and of the mandibular border and chin widths takes place upon closure of the midline defect. Between November 2016 and August 2017, five patients agreed to the mandibular feminization osteotomy and were followed up thereafter for 6-13 months. All expressed satisfaction with the results; no dental, periodontal, or temporomandibular joint-related complications were encountered. This technique is a viable alternative to buccal decortication, chin reduction osteotomy, and masseter reduction surgery.

Evolutionary steps in the design and biofunctionalization of the additively manufactured sub-periosteal jaw implant 'AMSJI' for the maxilla.

The purpose of this prospective registry case-series study was to determine the biological, mechanical, and aesthetic improvements made to the additively manufactured sub-periosteal jaw implant (AMSJI) after timed installation. A total of nine patients received maxillary AMSJIs in three sessions over a 2-year period. Architectural changes, topological optimization, and amendments to biofunctionalization were performed after each phase through the use of computer-aided design, finite element analysis, and growing clinical experience. Biological improvements included sandblasting (large grit alumina) and acid-etching; increased hydrophilicity by plasma surface activation; deletion of the crestal connecting struts; relocation of the anterior post in front of the anterior part of the basal loop; protection of the Schneiderian membrane from fixation screw penetration; high polishing of the posts; major platform switch with equigingival connections; the use of removable posts that require local anaesthesia and do not inflict major biological damage; scaffolding for secondary stability; and the provision of an incision guide. Mechanical improvements included the creation of a generic design based on finite element analysis and the resulting topological optimization, a shortening of the wings, and a reduction in the number of fixation screws. Aesthetic improvements included relocation of the anterior post, as described above, and pink anodization of the posts.

Alloplastic temporomandibular joint replacement systems: a systematic review of their history.

This systematic review provides an overview of the historical evolution of the prosthetic temporomandibular joint and addresses the challenges and complications faced by engineers and surgeons, in an effort to shed light on why only a few systems remain available. A better understanding of the history of temporomandibular joint prostheses might also provide insights into the origin of the negative public opinion of the prosthesis, which is based on outdated information. A computerized search using the PubMed Central, ScienceDirect, Wiley Online, Ovid, and Cochrane Library databases was performed following the PRISMA guidelines. Out of 7122 articles identified, 41 met the inclusion criteria for this systematic review. Although several historical reviews have been published previously, none has covered such an extensive time period or has described all designs. Furthermore, besides providing a historical overview, this review discusses the rationale behind the evolution in design and biomaterials, which have largely contributed to the outcomes of the prosthetic systems.

Biomaterials in temporomandibular joint replacement: current status and future perspectives-a narrative review.

The alloplastic total temporomandibular joint (TMJ) prosthesis has a long history, with many different materials and designs used. While several of these materials have proven valuable over time, many others have not been suitable for implantation, resulting in failure and the need for explantation of the implant. Because of the failure of several of these systems, the use of alloplastic prostheses has reduced dramatically, despite their advantages over autogenous restoration. The aim of this narrative review is to discuss the criteria that must be met by a biomaterial in order for it to be considered suitable for implantation, as well as the common complications that can occur. Currently used materials are highlighted, as well as potential future materials that might prove better suitable for implantation. Several surface modification techniques are proposed as an alternative to the materials used in current TMJ prosthesis systems.

Additively manufactured sub-periosteal jaw implants.

Severe bone atrophy jeopardizes the success of endosseous implants. This technical note aims to present the innovative concept of additively manufactured sub-periosteal jaw implants (AMSJIs). Digital datasets of the patient's jaws and wax trial in occlusion are used to segment the bone and dental arches, for the design of a sub-periosteal frame and abutments in the optimal location related to the dental arch and for the design of the suprastructure. The implants and suprastructure are three-dimensionally (3D) printed in titanium alloy. The provisional denture is 3D-printed in polymer. AMSJIs offer an alternative approach for patients with extreme jaw bone atrophy. This report refers to the use of this technique for full maxillary rehabilitation, but partial defects in either jaw and extended post-resection defects may also be approached using the same technique. This customized, prosthesis-driven reverse-engineering approach avoids bone grafting and provides immediate functional restoration with one surgical session.

Ideal proportions in full face front view, contemporary versus antique.

AIM: To compare the facial proportions of contemporary harmonious faces with those of antiquity, to validate classical canons and to determine new ones useful in orthofacial surgery planning. MATERIAL AND METHODS: Contemporary beautiful faces were retrieved from yearly polls of People Magazine and FHM. Selected B/W frontal facial photographs of 31 men and 74 women were ranked by 20 patients who had to undergo orthofacial surgery. The top-15 female faces and the top-10 male faces were analyzed with Scion Image software. The classical facial index, the Bruges facial index, the ratio lower facial height/total facial height and the vertical tri-partite of the lower face were calculated. The same analysis was done on pictures of classical sculptures representing seven goddesses and 12 gods. RESULTS: Harmonious contemporary female faces have a significantly lower classical facial index, indicating that facial height is less or facial width is larger than in male and even than in antique female faces. The Bruges index indicates a similar difference between ideal contemporary female and male faces. The contemporary male has a higher lower face (48%) compared to total facial height than the contemporary female (45%), although this is statistically not significant (P=0.08). The lower facial thirds index remained quite stabile for 2500 years, without gender difference. A good canon for both sexes today is stomion-gnathion being 70% of subnasale-stomion. CONCLUSION: The average ideal contemporary female face is shorter than the male face, given the fact that interpupillary distance is similar. The Vitruvian thirds in the lower face have to be adjusted to a 30% upper lip, 70% lower lip-chin proportion. The contemporary ideal ratios are suitable to be implemented in an orthofacial planning concept.

Donor face reconstruction in a case of facial allotransplantation: technical note.

Families of organ donors are much more reluctant to approve donation of the corneas, face, and hands than of internal organs. The idea to "sacrifice" the face of a dead loved one is shocking to many. Moreover, most national laws, including Belgian laws, demand respect for the corpse. When mourners view an open coffin, visible parts such as the hands and face should appear normal. Hence, careful donor face reconstruction is required in a case of facial allotransplantation. We present a technique for donor face reconstruction that is both expedient and cost-effective. Instead of laboratory-cured silicone or acrylic polymers with internal and external coloration, an A-silicone impression material with a 2-minute set time and external colouring is used.

A cone-beam CT based technique to augment the 3D virtual skull model with a detailed dental surface.

Cone-beam computed tomography (CBCT) is used for maxillofacial imaging. 3D virtual planning of orthognathic and facial orthomorphic surgery requires detailed visualisation of the interocclusal relationship. This study aimed to introduce and evaluate the use of a double CBCT scan procedure with a modified wax bite wafer to augment the 3D virtual skull model with a detailed dental surface. The impressions of the dental arches and the wax bite wafer were scanned for ten patient separately using a high resolution standardized CBCT scanning protocol. Surface-based rigid registration using ICP (iterative closest points) was used to fit the virtual models on the wax bite wafer. Automatic rigid point-based registration of the wax bite wafer on the patient scan was performed to implement the digital virtual dental arches into the patient's skull model. Probability error histograms showed errors of < or =0.22 mm (25% percentile), < or =0.44 mm (50% percentile) and < or =1.09 mm (90% percentile) for ICP surface matching. The mean registration error for automatic point-based rigid registration was 0.18+/-0.10 mm (range 0.13-0.26 mm). The results show the potential for a double CBCT scan procedure with a modified wax bite wafer to set-up a 3D virtual augmented model of the skull with detailed dental surface.

La gubia ósea como instrumento escultor del pliegue nasolabial. Nota técnica / Bone rongeur as nasolabial fold sculptor instrument. A technical note

Los pliegues nasolabiales prominentes son uno de los aspectosque más preocupan a los pacientes candidatos a un lifting facial, y han sidodescritas muchas técnicas que intentan atenuar este signo distintivo del envejecimiento.Las sustancias de relleno tienen limitaciones inherentes. Las diseccionesamplias del SMAS y su posterior suspensión no tienen efecto despuésde transcurridas 24 horas. La suspensión de la almohadilla grasa malar tieneun efecto que se extiende como máximo a los dos años de duración. La extirpacióndirecta de la grasa lateralmente al surco nasolabial, aunque debehacerse con mucha cautela, es la única técnica que proporciona resultadospermanentes. Técnicamente, esta resección grasa se ha descrito realizadavaliéndose de pinzas y tijeras, con cánulas de liposucción o con curetas. Esteprocedimiento requiere un control muy preciso, táctil y visual, de la localizacióny profundidad de la extirpación, control que puede mejorarse usandouna gubia ósea con una mano para extirpar la grasa a eliminar de ladermis, mientras la otra mano maneja el colgajo cutáneo de la mejilla, paraun control alternativo interno y externo del efecto escultural de la extirpacióny para permitir una guía táctil externa(AU)

Prominent nasolabial folds are of concern to many facelift candidates. Many techniques have been described which tacklethis distinct sign of ageing. Crease fillers have inherent limitations.Extended SMAS dissection and suspension has no effect after 24hours. Malar fat pad suspension has an effect which extendsmaximally to 2 years. Direct fat excision lateral to the crease mustbe done cautiously. However, it is the only technique providingpermanent results. Fat removal can be done with tweezers andscissors, with liposuction canules, and with curettes. Tactile andvisual control over location and depth of the resection is required.Such is possible when using a bone rongeur in one hand to reducethe fat mount which has been dissected off the dermis. The otherhand turns over the cheek flap for alternating internal and externalcontrol of the sculpturing effect, and for external tactile guidance(AU)

The Furlow Z-plasty in two-staged palatal repair modifications and complications.

OBJECTIVES: To report the modifications and complications of the Furlow palatoplasty for two-stage closure of the palate. PATIENTS AND METHODS: Prospective study of a consecutive series of 45 primary closures of the soft palate portion of clefts extending into the hard palate; mean (S.D.) age at repair 12 (2) months; median follow-up 4 years 4 months (range 2 months to 9 years). The hard palatal part of the cleft was closed in 18 patients at the mean age of 3 years 11 months. RESULTS: The main modifications that we made were the use of quilting sutures, lateral V-Y closures, and fibrin glue application, and the omission of lateral releasing incisions. Patients stayed in hospital for a median of 4 days (range 3-8 days). Two patients had postoperative partial obstruction of the airway and were given steroids. In six patients, a smaller portion of the oral layer of the wound broke down; it healed by secondary intention in five, but resulted in partial dehiscence in one. There were no oronasal fistulas in the 18 patients who had delayed closure of the hard palate part of the cleft. Secondary pharyngoplasty was not necessary in any patient. CONCLUSION: Furlow's technique has been modified for use in the two-stage closure of complete cleft palates (with or without cleft lip or alveolus) with an acceptable rate of complications.