Recommendations for post-rehabilitation care of maxillofacial prostheses

Aim: This study aimed to review the scientific literature to describe the main care and hygiene protocols for different types of maxillofacial prostheses (MFP). Methods: A bibliographic search on the PubMed / Medline database using the following keywords: ["maxillofacial prosthesis" OR "ocular prostheses" OR "palatal obturators"] AND ["Cleaning" OR "disinfection"] AND ["care"] AND ["color stability"] OR ["denture cleansers" OR "cleansing agents"]. Articles addressing materials, cleaning and disinfection protocols, and care related to MFP were included. The following exclusion criteria were applied: no adequate methodology, incompatibility with the area of interest, and unavailability for reading in full. Results: The papers were grouped into the following topics: facial prostheses, ocular prostheses, maxillofacial intraoral prostheses, and retention systems. Conclusion: Despite the MFP changes over time, its degradation decreases upon following the recommendations and post-adaptation care. The guidelines for cleaning and disinfection must be individualized to guarantee the longevity of the prosthesis and the patient health

Manejo de las fracturas maxilofaciales y sus complicaciones / Management of maxillofacial fractures and its complications

RESUMEN Antecedentes: el trauma maxilofacial corresponde a toda lesión traumática del macizo facial. Actualmente representa uno de los problemas de salud más importantes en el mundo. Nuestro objetivo es realizar un análisis de nuestra experiencia en las intervenciones realizadas en pacientes internados y sus complicaciones. Material y métodos: se realizó un estudio descriptivo, retrospectivo y observacional de 205 pacientes con fracturas maxilofaciales desde el año 2011 hasta el año 2019. Resultados: el 81,46% fueron hombres (n: 167) y el rango etario más afectado osciló entre los 21 y 30 años con el 38,54% (n:79). El accidente de tránsito 56,1% (n:115) fue el mecanismo de trauma más frecuente. Los tipos de fracturas faciales fueron: panfaciales 12,2% (n: 25), tercio superior 1,46% (n:3), tercio medio 72,2% (n:148) y tercio inferior 14,15% (n:29). Dentro del tercio superior, el 66,67% (n:2) fueron fracturas del seno frontal asociadas al hueso frontal, en el tercio medio las combinadas en un 54,73% (n:81) y en el tercio inferior, las complejas en el 34,48% (n:10). Fueron intervenidos 199 pacientes (97,07%). Solo el 11,56% (n:23) presentó alguna complicación. No se observaron complicaciones graves. Discusión: según nuestra serie, la mayoría de los pacientes fueron hombres jóvenes; la causa más frecuente, el accidente de tránsito, y el tercio medio, el más afectado, resultados estos similares a los de otros estudios publicados. El tratamiento quirúrgico fue principalmente reducción abierta y fijación con material de osteosíntesis de titanio, un procedimiento seguro y fiable, que permite restablecer la funcionalidad previa al traumatismo, con un índice muy bajo de complicaciones posoperatorias.

ABSTRACT Background: Maxillofacial trauma corresponds to all traumatic injuries affecting the facial bones. Nowadays, it represents one of the main healthcare issues worldwide. The aim of this study is to analyze our experience in the interventions performed in hospitalized and their complications. Material and methods: We performed a retrospective and observational study of 205 patients with maxillofacial fractures from 2011 to 2019. Results: 81.46% were men (n = 167) and 38.54% (n = 79) of the patients were between 21 and 30 years of age. Traffic collision was the most common mechanism of trauma (56,1%, n = 115). The types of facial fractures were panfacial (12.2%; n = 25), of the upper-third (1.43%; n = 3), of the middle-third (72.2%; n = 148) and of the lower third (14.15%; n = 29). In the upper third of the face frontal sinus fractures associated with the frontal bone were the most common (66.67%; n =2); in the middle-third combined fractures were most prevalent (54.73%; n = 81) while complex fractures were most frequent in the lower third (34,48%; n = 10). One-hundred and ninety-one patients were operated on (97.07%). Complications occurred in only 11.56% (n = 23) and were not serious. Discusion: In our series, most patients were young men, traffic collisions were the most common cause of trauma, and the middle third of the face was the most affected region. These results are similar to our publications. Surgical management, mostly by open reduction and fixation with titanium-based osteosynthesis material, is an effective, safe and reliable procedure, which allows the restoration of pre-trauma function, with very low rate of postoperative complications.

Advanced Three-Dimensional Technologies in Craniofacial Reconstruction.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the evolution of three-dimensional computer-aided reconstruction and its current applications in craniofacial surgery. 2. Recapitulate virtual surgical planning, or computer-assisted surgical simulation, workflow in craniofacial surgery. 3. Summarize the principles of computer-aided design techniques, such as mirror-imaging and postoperative verification of results. 4. Report the capabilities of computer-aided manufacturing, such as rapid prototyping of three-dimensional models and patient-specific custom implants. 5. Evaluate the advantages and disadvantages of using three-dimensional technology in craniofacial surgery. 6. Critique evidence on advanced three-dimensional technology in craniofacial surgery and identify opportunities for future investigation. SUMMARY: Increasingly used in craniofacial surgery, virtual surgical planning is applied to analyze and simulate surgical interventions. Computer-aided design and manufacturing generates models, cutting guides, and custom implants for use in craniofacial surgery. Three-dimensional computer-aided reconstruction may improve results, increase safety, enhance efficiency, augment surgical education, and aid surgeons' ability to execute complex craniofacial operations. Subtopics include image analysis, surgical planning, virtual simulation, custom guides, model or implant generation, and verification of results. Clinical settings for the use of modern three-dimensional technologies include acquired and congenital conditions in both the acute and the elective settings. The aim of these techniques is to achieve superior functional and aesthetic outcomes compared to conventional surgery. Surgeons should understand this evolving technology, its indications, limitations, and future direction to use it optimally for patient care. This article summarizes advanced three-dimensional techniques in craniofacial surgery with cases highlighting clinical concepts.

Estados emocionales en pacientes con rehabilitación protésica bucomaxilofacial / Emotional States in Patients with Bucomaxilofacial Prosthetic Rehabilitation

RESUMEN Introducción: Las emociones son reacciones psicofisiológicas que representan modos de adaptación a ciertos estímulos o eventos, como enfermedades o traumas, que se relacionan con la necesidad de tratamiento protésico bucomaxilofacial. Objetivo: Identificar los estados emocionales en pacientes antes y después de la rehabilitación protésica bucomaxilofacial. Métodos: Se realizó un estudio observacional descriptivo transversal, en 48 pacientes atendidos en el Hospital General Universitario "Carlos Manuel de Céspedes y del Castillo", entre junio de 2018 a junio de 2019, a los cuales se le aplicaron instrumentos de evaluación psicológica antes y después del tratamiento rehabilitador. Se estudió la experiencia emocional, la ansiedad y depresión. Resultados: Antes del tratamiento protésico los pacientes presentaron: tristeza (66,66 por ciento), sufrimiento (60,41 por ciento), abatimiento (54,16 por ciento), angustia (43,75 por ciento) y apatía (41,66 por ciento) con un alto nivel de intensidad vivencial. Luego de la rehabilitación protésica bucomaxilofacial, disminuyeron los estados emocionales: la ansiedad disminuyó en el 58,33 por ciento de los participantes y la depresión en el 52,08 por ciento. Conclusiones: Los pacientes con necesidad de protésica bucomaxilofacial experimentan tristeza, sufrimiento, abatimiento, angustia, apatía y altos niveles de ansiedad y depresión como estado antes del tratamiento. Estas emociones disminuyen luego de la rehabilitación protésica bucomaxilofacial(AU)

ABSTRACT Introduction: Emotions are psychophysiological reactions that represent modes of adaptation to certain stimuli or events, such as illnesses or trauma, related to the need for bucomaxilofacial prosthetic treatment. Objective: To identify emotional states in patients before and after prosthetic bucomaxilofacial rehabilitation. Methods: A cross-sectional, descriptive and observational study was carried out in 48 patients cared for at Carlos Manuel de Céspedes y del Castillo General University Hospital, between June 2018 and June 2019, and who were applied psychological assessment instruments before and after they received rehabilitation treatment. Emotional experience, anxiety and depression were studied. Results: Before prosthetic treatment, patients presented sadness (66.66 percent), suffering (60.41 percent), weariness (54.16 percent), anguish (43.75 percent), and apathy (41.66 percent), with a high level of life experience-related intensity. After bucomaxilofacial prosthetic rehabilitation, emotional states decreased: anxiety decreased in 58.33 percent and depression decreased in 52.08 percent of the participants. Conclusions: Patients in need of bucomaxilofacial prosthesis experience sadness, suffering, weariness, anguish, apathy and high levels of anxiety and depression as a state before treatment. These emotions decrease after oral bucomaxilofacial prosthetic rehabilitation(AU)

Maxillofacial rehabilitation of nasal defect with nasal prosthesis using donor method: A case report.

Maxillofacial prosthetics is the branch of prosthodontics which involves rehabilitation of the defects in the maxillofacial region involving the hard and soft tissue with the prosthesis. Facial defects that occur in the midfacial regions are commonly due to trauma and neoplasms like basal cell carcinoma which involves the nose. Reconstruction of the nose is an important esthetic challenge due to its esthetic and retention problems. This article emphasis rehabilitation of the nasal defect of a patient with nasal prosthesis using donor method.

Prótese bucomaxilofacial na Educação Superior em Odontologia: perspectivas curriculares / Maxillofacial Prosthesis in Higher Education in Dentistry: Curricular Perspectives

Introdução: A falta de contato dos estudantes com Prótese Bucomaxilofacial (PBMF) durante a graduação pode ser um fator agravante para o desinteresse na área. O objetivo do presente estudo é apresentar um panorama da disciplina de PBMF nos projetos pedagógicos dos cursos de Odontologia na Região Sudeste do Brasil. Metodologia: Estudo exploratório, quantitativo e transveral. Foram analisadas as grades curriculares disponibilizadas nos sítios web oficial das instituições de ensino superior (IES) cadastradas no portal e-MEC do Ministério da Educação. Buscou-se informações referentes às variáveis: categoria administrativa da IES, inserção e oferta da disciplina, natureza do componente curricular, método de ensino, carga horária média e formação curricular do coordenador da disciplina. Os dados foram analisados e tabulados por meio do software GraphPad Prism 8.1.2. Resultados: Os resultados desta pesquisa refletem a análise da grade curricular de 144 IES. Apenas 8 IES (5,55%) ofertam a disciplina de PBMF. Dentre estas, a maioria (62,5%) em universidades públicas, de forma obrigatória (66,6%), com conteúdo teórico, prática-laboratorial e prática-clínica (44,4%) e carga horária média de 54,56h. Conclusões: A implementação do componente curricular se encontra bastante reduzida e mais prevalente em universidades públicas. Assim, sugere-se a atualização dos curriculos do curso de Odontologia do sudeste brasileiro... (AU)

Introduction: The lack of contact of students with Maxillofacial Prosthesis (PBMF) during graduation can be an aggravating factor for the lack of interest in the area. The objective of the present study is to present an overview of PBMF discipline in the pedagogical projects of Dentistry courses in the Southeast Region of Brazil. Methods: Exploratory, quantitative and crosssectional study. The curricula available on the official websites of higher education institutions (HEIs) registered in the e-MEC portal of the Ministry of Education were analyzed. Information on the variables was sought: administrative category of the HEI, insertion and provision of the discipline, nature of the curricular component, teaching method, average workload and curricular training of the subject coordinator. Data were analyzed and tabulated using GraphPad Prism 8.1.2 software. Results: The results of this research reflect the analysis of the 144 HEI curriculum. Only 8 HEIs (5.55%) offer the discipline of MFP. Most (62.5%) in public universities, compulsorily (66.6%), with theoretical content, laboratory practice and clinical practice (44.4%) and average workload of 54.56h. Conclusions: The implementation of the curricular component is quite reduced and more prevalent in public universities. Thus, it is suggested to update the curricula of the Dentistry course in southeastern Brazil... (AU)

Mimicked scaffolds based on coated silk woven fabric with gelatin and chitosan for soft tissue defect in oral maxillofacial area.

Soft tissue defects in the oral maxillofacial area are critical problems for many patients and, in some cases, patients require an operation coupled with a performance scaffold substitution. In this research, mimicked anatomical scaffolds were constructed using gelatin- and chitosan-coated woven silk fibroin fabric. The morphologies, crystals, and structures were observed and then characterized using scanning electron microscopy, X-ray diffraction, and differential scanning calorimetry, respectively. Physical performance was evaluated from the swelling behavior, mechanical properties, and biodegradation, while the biological performance was tested with fibroblasts and keratinocytes, after which cell proliferation, viability, and histology were evaluated. The results revealed that a coated woven silk fibroin fabric displayed a crystal structure of silk fibroin with amorphous gelatin and chitosan layers. Also, the coated fabrics contained residual water within their structure. The physical performance of the coated woven silk fibroin fabric with gelatin showed suitable swelling behavior and mechanical properties along with acceptable biodegradation for insertion at a defect site. The biological performances including cell proliferation, viability, and histology were suitable for soft tissue reconstruction at the defect sites. Finally, the results demonstrated that mimicked anatomical scaffolds based on a gelatin layer on woven silk fibroin fabric had the functionality that was promising for soft tissue construction in oral maxillofacial defect.

Reconstrucción 3D en maxilectomía parcial: reporte de caso / 3D reconstruction in partial maxilectomy: case report

Reporte de caso de un paciente con antecedentes de Fibroangioma Nasofaringeo (FANF), que fue sometido a múltiples cirugías. Entre ellas se realizó una maxilectomía parcial izquierda en otra institución. El paciente fue examinado por los equipos de Cirugía General (Cabeza y Cuello y Plástica), Oftalmología e Ingeniería clínica para eventual tratamiento reconstructivo mediante prótesis 3D. Los huesos maxilares, proveen soporte entre la base del cráneo y los arcos dentales, separan cavidades y determinan la proyección facial. Para la rehabilitación de las secuelas mencionadas anteriormente, la alternativa quirúrgica reconstructiva se perfila como la mejor opción. La rehabilitación con prótesis 3D requiere un enfoque multidisciplinario y tiene como objetivo restaurar el contorno facial y la rehabilitación funcional del macizo facial.

Necesidad de implementar la consulta de prótesis bucomaxilofacial en la provincia Camagüey / Need to implement the consultation of oral-maxillofacial prosthesis in Camagüey

Objetivo: valorar por la importancia social y docente la necesidad de implementar la consulta de prótesis bucomaxilofacial en la provincia Camagüey. Métodos:se realizó una búsqueda de la literatura en las bases de datos electrónicas PUBMED, MEDLINE, COCHRANE, HINARI y SciELO con los descriptores: necesidad de prótesis bucomaxilofacial, defectos bucomaxilofacial y rehabilitación bucomaxilofacial; para conducir un análisis crítico de la evidencia disponible sobre la necesidad de prótesis bucomaxilofacial en Cuba y en especial en la provincia Camagüey. Resultados: en estudios de necesidad de prótesis bucomaxilofacial de la población cubana se encontró una tasa de incidencia que osciló entre 3,1 y 8,1 por cada 10 000 habitantes. El sexo masculino predominó con promedio ente 60 y 75 porciento de la población estudiada y el grupo de edades fueron los mayores de 60 años con más del 30 porciento. El origen de estos defectos varió en dependencia del tipo de lesión para los pacientes que presentaron defectos oculares, su principal causa fue de origen traumática, el defecto maxilar tuvo como principales causas: congénita, traumática y adquirida por enfermedad de tipo oncológica. Los traumas, enfermedades de origen oncológico y congénito resultaron las principales causas de lesiones craneales y mandibulares. Conclusiones: se constató la necesidad de prótesis bucomaxilofacial a nivel nacional y provincial, las características clínicas y epidemiológicas de estos pacientes, las implicaciones económicas y docentes, por lo que es necesario y lógico entender la gran importancia que ofrece la creación del servicio de prótesis bucomaxilofacial en la provincia Camagüey(AU)

Background: among the different fields that make up the dentistry prosthesis is the maxillofacial prosthesis, somatoprothesis or oral-maxillofacial prosthesis, as it is indiscriminately denominated. This allows the morph-functional rehabilitation of intra and parabuccal structures by artificial means. Objective: to assess for the social and educational importance the need to implement the oral maxillofacial prosthesis consultation in the Camagüey province. Methods: this narrative review article aims to conduct a critical analysis of the available evidence on the need for oral and maxillofacial prosthesis in Cuba and mainly in the Camagüey province. An electronic literature search was carried out in search engines such as: electronic databases PUBMED, MEDLINE, COCHRANE, SciELO and HINARI with descriptors such as: need for an oral-maxillofacial prosthesis, oral-maxillofacial defects and oral-maxillofacial rehabilitation. Results: in studies of the need for oral and maxillofacial prosthesis in the Cuban population, an incidence rate that ranged from 3.1 to 8.1 per 10,000 inhabitants was found. The male sex predominated with an average of 60 percent and 75 percent of the population studied, and the age group were those over 60 years old with more than 30 percent. The origin of these defects varied depending on the type of lesion for patients who had ocular defects, its main cause was of traumatic origin, the main cause of the maxillary defect was: congenital, traumatic and acquired due to oncological disease. Conclusions: the need for oral and maxillofacial prostheses was confirmed at national and provincial level, as well as the clinical and epidemiological characteristics of these patients, and the economic and teaching implications. Therefore, it is necessary and logical to understand the great importance that the creation of the oral and maxillofacial prosthesis service offers in Camagüey province (AU)

Bionic mechanical design and 3D printing of novel porous Ti6Al4V implants for biomedical applications.

In maxillofacial surgery, there is a significant need for the design and fabrication of porous scaffolds with customizable bionic structures and mechanical properties suitable for bone tissue engineering. In this paper, we characterize the porous Ti6Al4V implant, which is one of the most promising and attractive biomedical applications due to the similarity of its modulus to human bones. We describe the mechanical properties of this implant, which we suggest is capable of providing important biological functions for bone tissue regeneration. We characterize a novel bionic design and fabrication process for porous implants. A design concept of "reducing dimensions and designing layer by layer" was used to construct layered slice and rod-connected mesh structure (LSRCMS) implants. Porous LSRCMS implants with different parameters and porosities were fabricated by selective laser melting (SLM). Printed samples were evaluated by microstructure characterization, specific mechanical properties were analyzed by mechanical tests, and finite element analysis was used to digitally calculate the stress characteristics of the LSRCMS under loading forces. Our results show that the samples fabricated by SLM had good structure printing quality with reasonable pore sizes. The porosity, pore size, and strut thickness of manufactured samples ranged from (60.95± 0.27)% to (81.23±0.32)%, (480±28) to (685±31) µm, and (263±28) to (265±28) µm, respectively. The compression results show that the Young's modulus and the yield strength ranged from (2.23±0.03) to (6.36±0.06) GPa and (21.36±0.42) to (122.85±3.85) MPa, respectively. We also show that the Young's modulus and yield strength of the LSRCMS samples can be predicted by the Gibson-Ashby model. Further, we prove the structural stability of our novel design by finite element analysis. Our results illustrate that our novel SLM-fabricated porous Ti6Al4V scaffolds based on an LSRCMS are a promising material for bone implants, and are potentially applicable to the field of bone defect repair.

Bone Reconstruction Planning Using Computer Technology for Surgical Management of Severe Maxillomandibular Atrophy.

Digital imaging technology and refined software programs have significantly improved a clinician's ability to assess and evaluate anatomic structures and quantify both defect size and required graft volume. This article summarizes the computed tomography-based technology used in these applications to illustrate their current use as exemplified by computer-assisted planning and treatment of severe maxillofacial atrophy treated using both interpositional and mesh-onlay grafting methodology.

Maxillofacial prostheses challenges in resource constrained regions.

BACKGROUND: This study reviewed the current state of maxillofacial rehabilitation in resource-limited nations. METHOD: A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries. RESULTS: Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach. CONCLUSIONS: In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities. Implications for Rehabilitation More information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments. The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations. The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.

The Role of Maxillofacial Prosthetics for the Surgically Treated Patient at National Cancer Institute-Designated Comprehensive Cancer Centers.

OBJECTIVES/HYPOTHESIS: The current role of maxillofacial prosthetic care for head and neck cancer patients is not well understood. Additionally, perceived barriers for service provision are unknown. The purpose of this study was to evaluate the current role of maxillofacial prosthetic care at National Cancer Institute (NCI)-designated comprehensive cancer centers and to identify perceived barriers to care. STUDY DESIGN: Multicenter, cross-sectional survey of head and neck division leaders at NCI-designated comprehensive cancer centers. METHODS: Each head and neck division leader from the 47 NCI-designated comprehensive cancer centers was invited to participate. The main outcomes of this study were: 1) to evaluate the current role of maxillofacial prosthetics for the surgically treated head and neck cancer patient within NCI-designated comprehensive cancer centers and 2) to identify perceived barriers to care. Measured outcomes were obtained from an anonymous online survey and reported. RESULTS: Twenty-eight of the 47 head and neck service chiefs responded (60% response rate). Respondents expressed preference for prosthetic rehabilitation for hard palate/upper gum, auricular, and nasal defects. Local flap or free tissue transfer was preferred for lower gum and soft palate defects. Cost-related factors were among the most reported perceived barriers to maxillofacial prosthetic care. CONCLUSIONS: Maxillofacial prosthetics have an important role in the rehabilitation of the head and neck cancer patient. Perceived barriers for services exist, particularly as it relates to cost. Providers should be aware that these issues are likely to be more severe in regional or community centers. LEVEL OF EVIDENCE: NA Laryngoscope, 129:409-414, 2019.

Bionic mechanical design and 3D printing of novel porous Ti6Al4V implants for biomedical applications / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

In maxillofacial surgery, there is a significant need for the design and fabrication of porous scaffolds with customizable bionic structures and mechanical properties suitable for bone tissue engineering. In this paper, we characterize the porous Ti6Al4V implant, which is one of the most promising and attractive biomedical applications due to the similarity of its modulus to human bones. We describe the mechanical properties of this implant, which we suggest is capable of providing important biological functions for bone tissue regeneration. We characterize a novel bionic design and fabrication process for porous implants. A design concept of "reducing dimensions and designing layer by layer" was used to construct layered slice and rod-connected mesh structure (LSRCMS) implants. Porous LSRCMS implants with different parameters and porosities were fabricated by selective laser melting (SLM). Printed samples were evaluated by microstructure characterization, specific mechanical properties were analyzed by mechanical tests, and finite element analysis was used to digitally calculate the stress characteristics of the LSRCMS under loading forces. Our results show that the samples fabricated by SLM had good structure printing quality with reasonable pore sizes. The porosity, pore size, and strut thickness of manufactured samples ranged from (60.95± 0.27)% to (81.23±0.32)%, (480±28) to (685±31) μm, and (263±28) to (265±28) μm, respectively. The compression results show that the Young's modulus and the yield strength ranged from (2.23±0.03) to (6.36±0.06) GPa and (21.36±0.42) to (122.85±3.85) MPa, respectively. We also show that the Young's modulus and yield strength of the LSRCMS samples can be predicted by the Gibson-Ashby model. Further, we prove the structural stability of our novel design by finite element analysis. Our results illustrate that our novel SLM-fabricated porous Ti6Al4V scaffolds based on an LSRCMS are a promising material for bone implants, and are potentially applicable to the field of bone defect repair.

U.S. Maxillofacial Prosthetics Programs: Fellows' and Directors' Perspectives.

Maxillofacial prosthetics (MFP) programs in the U.S. select only a limited number of applicants for fellowship positions. The aims of this study were to survey MFP fellows about which factors influenced their choice of programs and to survey MFP directors about what they considered critical factors in the selection process. Surveys were sent to all eight directors and 13 fellows at all eight U.S. MFP programs in June 2015. The directors' questions asked about general information, resident selection process, letters of recommendation, interview process, and decision process. The fellows' questions addressed their demographics, program-related factors, and future goals. The directors' surveys were sent directly to the directors, and the fellows' surveys were sent to the directors for distribution. The survey response rate for the directors was 87.5% (N=7), and that of the fellows was 53.8% (N=7). In selecting fellows for programs, responding directors reported the interview process was most important, followed by letters of recommendation, personal statement, and prosthodontic program grades. Responding fellows reported that location, variety of treatment, patient volume provided, and clinical education were crucial components in their choice of program. This information may be useful to MFP programs and fellows in the continuing development of this specialty.

Combination of skin flap and silicone prosthesis for rehabilitation of a large orbital defect: A case report.

Exenteration surgery greatly affects a person in terms of function, esthetics, and psychological trauma. In such cases, restoration by silicone orbital prosthesis is a well-accepted treatment option. However, this is a difficult task, necessitating personalized design of method for each patient. This case report describes the technique for fabrication of a silicone orbital prosthesis for a male patient with left orbital defect due to exenteration of a Grade 3 squamous cell carcinoma of the left eye and surrounding tissues. The patient was delivered with a satisfactory silicone orbital prosthesis having good retention and finish. Multidisciplinary management and team approach are crucial in providing precise and effective rehabilitation for improving the patient's quality of life and help them return to their normal social life.

The paradigm shift for drug delivery systems for oral and maxillofacial implants.

Along with the development of nanotechnological strategies for biomaterials associated with the prevention of infections, a myriad of clinically unproven techniques have been described to date. In this work, the aim was to perform a critical analysis of the literature available concerning antibacterial biomaterials for oral implantology and to provide a practical derivation for such a purpose. As anti-adhesive strategies may affect osseointegration, they should no longer be recommended for inclusion in this class of biomaterials, despite promising results in biomedical engineering for other, non-bone load bearing organs. Targeted, antibacterial drug delivery is most likely desirable in the case of intraosseous implants. Interfering factors such as the oral cavity environment, saliva, the bacterial microbiome, as well as, the characteristics of the alveolar mucosa and peri-implant space must be taken into account when calculating the local pharmacokinetics for antibacterial coatings. Effective release is crucial for tailoring antibacterial implant longevity providing minimal inhibitory concentration (MIC) for the desired amount of time, which for oral implants, should be at least the cumulative time for the osseointegration period and functional loading period within the tissues. These parameters may differ between the implant type and its anatomical site. Also, the functional drug concentration in the peri-implant space should be calculated as the amount of the drug released from the implant surface including the concentration of the drug inactivated by biological fluids of the peri-implant space or saliva flow throughout the effective release time.

Craniomaxillofacial patient-specific CAD/CAM implants based on cone-beam tomography data - A feasibility study.

Customized implants have simplified surgical procedures and have improved patient outcome in craniomaxillofacial surgery. Traditionally, patient-specific data is gathered by conventional computed tomography (CT). However, cone-beam CT (CBCT) can generate a 3D reconstruction of the area of interest with a lower dose of radiation at reduced cost. In this study, we investigated the feasibility of using CBCT data to design and generate customized implants for patients requiring craniomaxillofacial reconstruction. We used CBCT to generate 62 implants for 51 consecutive patients admitted to our department between January 2015 and December 2017. The indications for reconstruction and types of reconstruction were very variable. In all cases, the implants were well fitted and no implant-related complications were detected. Pre-surgical planning was faster and more efficient as we did not have to consult a radiologist. Although CBCT data is more difficult to process than conventional CT data for the implant provider, the clinical advantages are pronounced and we now use CBCT as standard in our department. In conclusion, we have shown that using CBCT to design and manufacture customized implants for reconstruction of the craniomaxillofacial area is feasible and recommend this approach to other departments.

[Risk factors generally neglected in oral surgery and implantology: the high LDL-cholesterol and the insufficient level of vitamin D]. / Des facteurs de risque généralement négligés en chirurgie orale et en implantologie : le taux élevé de LDL-cholestérol et le taux insuffisant de la vitamine D.

INTRODUCTION: Vitamin D deficiency is widespread throughout the world. Vitamin D has an important role in the regulation of phosphocalcic metabolism as well as in a large number of biological and metabolic processes. According to some studies, there is a correlation between vitamin D and LDL-cholesterol levels. A deficiency of vitamin D and / or a high level of LDL-cholesterol could represent risk factors for bone healing and osteointegration of dental implants. The purpose of our study is to demonstrate the reality of the problem of deficiency or deprivation in vitamin D in a population of patients requiring oral and / or implant surgery. MATERIAL AND METHODS: 46 cases of patients having undergone oral surgery together with preoperative blood test were analyzed. The results of the dosages of 25-hydroxy-vitamin D (25-OH-D), total cholesterol, LDL-cholesterol, HDL-cholesterol were collected and compared with reference values. Statistical tests were performed to determine the possible correlations between the 25-OH-D level and other blood parameters. RESULTS: 38 patients out of 46 (82.6 %) are defective in vitamin D, and 7 patients out of 46 (15.2 %) are deficient. LDL-cholesterol levels were high in 15 patients out of 33 (45.5 %). There was a non-significant correlation between LDLcholesterol and vitamin D levels. Total cholesterol was high in 42 % of patients. We observed a significant correlation between total cholesterol and vitamin D levels. CONCLUSION: According to our study, it appears that a preoperative assessment including the dosage of vitamin D, total cholesterol and LDLcholesterol may be of interest in patients requiring oral and / or implant surgery by correcting if necessary blood parameters and promoting bone metabolism.

INTRODUCTION: La déficience en vitamine D est largement répandue dans le monde. Or la vitamine D a un rôle important dans la régulation du métabolisme phosphocalcique ainsi que dans un grand nombre de processus biologiques et métaboliques. Selon certaines études, il existerait une corrélation entre le taux de vitamine D et le taux de LDL-cholestérol. Une déficience en vitamine D et/ou un taux élevé de LDL-cholestérol pourraient représenter des facteurs de risques de cicatrisation osseuse et d'ostéointégration d'implants dentaires. Le but de notre étude est d'objectiver, dans une population de patients devant bénéficier d'une chirurgie orale et/ou implantaire, la réalité du problème de déficience ou de carence en vitamine D. Matériel et méthode : 46 dossiers de patients ayant bénéficié d'une intervention chirurgicale buccodentaire et d'une prise de sang ont été analysés. Les résultats du dosage de 25-hydroxyvitamine D (25-OH-D), cholestérol total, LDL-cholestérol, HDL-cholestérol ont été recueillis et comparés aux valeurs de références. Des tests statistiques ont été réalisés afin d'établir les corrélations éventuelles entre le taux de 25-OH-D et les autres paramètres sanguins. Résultats : 38 patients sur 46 (82,6 %) sont déficients en vitamine D, et 7 patients sur 46 (15,2 %) sont carencés. Le taux de LDLcholestérol est élevé chez 15 patients sur 33 (45,5 %). Il existe une corrélation non significative entre le taux de LDL-cholestérol et le taux de vitamine D. Le taux de cholestérol total est élevé chez 42 % des patients. Nous observons une corrélation significative entre le taux de cholestérol total et le taux de vitamine D. CONCLUSION: D'après notre étude, il apparaît qu'un bilan préopératoire incluant le dosage de la vitamine D, du cholestérol total et du LDLcholestérol pourrait s'avérer intéressant afin de corriger si nécessaire ces paramètres sanguins et favoriser le métabolisme osseux dans un contexte de chirurgie orale et/ou implantaire.