Postoperative facial appearance of patients with extensive oral squamous cell carcinoma can be adequately preserved with in­house virtually planned mandibular reconstruction.

The present study aimed to assess the concordance of preoperative and postoperative hard and soft tissues in patients with advanced oral squamous cell carcinoma (OSCC) following virtual surgical planning (VSP) mandibular reconstruction. In the present study, a cohort of 32 patients with OSCC underwent in-house VSP, followed by guided mandibular reconstruction utilizing vascularized free tissue grafts sourced from the fibula or scapula. A morphometric analysis was conducted comparing preoperative and postoperative three-dimensional virtual models to evaluate discrepancies and identify potential risk factors associated with poor reconstruction outcomes. The outcome variables were the differences in root mean square (RMS) and mean surface distance (MSD) resulting from the application of an iterative closest point algorithm to the virtual data. The validity of soft tissue comparison data is limited due to its susceptibility to various confounding variables. The present study conducted a comprehensive re-evaluation of these variables. High tumor stage, positive N status and the use of adjuvant therapy contributed to more noticeable differences in preoperative and postoperative facial soft tissue appearance. The accuracy of postoperative bone reconstruction results was higher in patients who underwent neomandibular formation using a fibular graft compared with those who received a scapular graft. Preoperative and postoperative soft tissue analyses were conducted for comparison. The MSD showed a deviation of 3.2 mm (± 2.0 mm SD; range 1.3-9.5 mm), whereas the RMS was 5.3 (± 2.9 SD; range 2.1-14). In conclusion, in-house VSP and guided mandibular reconstructions can yield clinically accurate results, preserving patient appearance and offering the advantage of rapid feasibility.

Three-dimensional mandibular characteristics in skeletal malocclusion : A cross-sectional study.

PURPOSE: We aimed to comprehensively analyse a possible correlation between skeletal malocclusions, gender and mandibular characteristics in all three dimensions in adults and to identify mandibular characteristics that are typical for extreme skeletal patterns. METHODS: A 3D model of the skull was calculated in 111 adult patients (mean age = 27.0 ± 10.2 years; 49 women, 62 men) from available computed tomography or cone beam computed tomography scans of their heads. Based on the 3D models, the skeletal patterns were examined in (a) the transversal dimension regarding asymmetry according to menton deviation, (b) the sagittal dimension according to the Wits appraisal and (c) the vertical dimension according to the maxillomandibular plane angle. The mandibular characteristics assessed were linear (ramus height and width, body length), angular (ramus, gonial and body angle) and volumetric (ramus/mandibular volume, body/mandibular volume) parameters. RESULTS: No correlation between transversal skeletal asymmetry and mandibular characteristics were found, while sagittal (F(16, 174) = 3.32, p < 0.001, η2 = 0.23) and vertical (F(16, 174) = 3.18, p < 0.001, η2 = 0.23) skeletal patterns were shown to have a significant effect on the mandible. Gender correlated with mandibular characteristics independently from the skeletal pattern. Discriminant analysis revealed that class II and III patients differed in ramus and body angle with class II patients showing higher angles (ramus angle: class II = 89.8 ± 3.9° vs. class III = 84.4 ± 4.8°; body angle: class II = 87.7 ± 4.8° vs. class III = 82.1 ± 5.2°). Hypo- and hyperdivergent patients were discriminated by gonial angle, body angle and body/mandibular volume with hyperdivergent patients having a greater gonial and body angle and body/mandibular volume (gonial angle: hypodivergent = 114 ± 9.3° vs. hyperdivergent = 126.4 ± 8.6°; body angle: hypodivergent = 82.9 ± 4.4° vs. hyperdivergent = 87.7 ± 6.5°; body/mandibular volume: hypodivergent = 72.4 ± 2.7% vs. hyperdivergent = 76.2 ± 2.6%). CONCLUSION: When analysing 3D data for treatment planning of adult patients, the orthodontist should pay attention to angular and volumetric characteristics of the mandible to identify extreme skeletal sagittal or vertical malocclusions.

Desmoid fibromatosis in the pharyngeal wall: A case report and literature review.

Desmoid fibromatosis (DF) is one of the rarest locally aggressive growing benign tumor entities. We present an overview of the literature and a rare clinical case of a 22-year-old female patient, who was diagnosed with aggressive DF in the left pharyngeal wall at the age of 4 years old.

Predictability of maxillary positioning: a 3D comparison of virtual and conventional orthognathic surgery planning.

BACKGROUND: Virtual surgery planning (VSP) is believed to reduce inaccuracies in maxillary positioning compared to conventional surgery planning (CSP) due to the elimination of face-bow transfer and laboratory steps. However, there is still a lack of comparative studies for the accuracy of splint-based maxillary positioning in CSP versus VSP. Therefore, the objective of this retrospective, observational study was to compare if splints produced by VSP and CSP reach postoperative outcomes within clinically acceptable limits. METHODS: The planned and actual postoperative results of 52 patients (VSP: n = 26; CSP: n = 26) with a mean age of 24.4 ± 6.2 years were investigated by three-dimensional (3D) alignment with planning software. The conventional treatment plan was digitized, so that the evaluation of both methods was performed in the same manner using the same coordinate system. Inaccuracies were measured by sagittal, vertical and transversal deviations of the upper central incisors and the inclination of the maxillary occlusal plane between the planned and achieved maxillary positions. RESULTS: Both methods demonstrated significant differences between the planned and actual outcome. The highest inaccuracies were observed in vertical impaction and midline correction. No significant differences between CSP and VSP were observed in any dimension. Errors in vertical and sagittal dimension intensified each other. CONCLUSIONS: In conclusion, splint-based surgeries reached similar results regardless of the applied planning method and splint production.

Orthodontic incisor decompensation in orthognathic therapy-success and efficiency in three dimensions.

OBJECTIVES: Sufficient dental decompensation is crucial for treatment success in combined orthodontic-surgical treatment. The study's objective was to determine the treatment success and efficiency in sagittal, vertical, and transversal decompensation. METHODS: This longitudinal, observational study enrolled 52 adult patients, who underwent orthodontic-surgical treatment. Incisor inclinations and positions as well as skeletal changes were assessed pre-treatment (T1), pre-surgical (T2), and post-surgical (T3) by lateral cephalograms and CBCT scans. RESULTS: Incisor decompensation was insufficient in all three dimensions. Sagittal: treatment efficiency did not differ between class II and III patients. Vertical: patients with open bite demonstrated pre-surgical bite deepening and insufficient surgical reduction of the maxillomandibular plane angle. Transversal: Dental midline deviations were not adapted to the skeletal asymmetry so that menton deviations were not properly corrected. CONCLUSIONS: Incisor decompensation was not as successful as requested in all three dimensions and the treatment ideal was seldom achieved. CLINICAL RELEVANCE: To improve the skeletal outcome, the orthodontist has to treat the patient with the desired surgical movements in mind and should critically evaluate the pre-surgical incisor decompensation before referral to the surgical team.

Comprehensive 3D analysis of condylar morphology in adults with different skeletal patterns - a cross-sectional study.

BACKGROUND: The correlation between individuals' condylar morphology and their skeletal pattern is of great interest for treatment strategies ranging from orthodontic orthopaedics to orthognathic surgery. The objective of the present study was to investigate this relationship three-dimensionally. METHODS: A total of 111 adult patients (mean age = 27.0 ± 10.2 years) who underwent head computed tomography or cone beam computed tomography scans were included. Based on these data, 3D models of the skull and the condyles were calculated. The craniofacial skeleton was evaluated (1) transversally regarding skeletal symmetry (menton deviation), (2) sagittally regarding skeletal classes (Wits appraisal) and vertically regarding the inclination of the jaws (maxillomandibular plane angle). The condylar morphology was assessed (a) linearly by the condylar width, height and depth; (b) angularly by the antero-posterior and medio-lateral condylar inclination; and (c) volumetrically by the ratio of the condylar volume/mandibular volume (C/Mand). RESULTS: (1) Transversal: Asymmetric patients showed significantly higher discrepancies in the volumetric ratio C/Mand on the deviation and non-deviation side compared to symmetric patients. (2) Sagittal: Class III subjects demonstrated longer, more voluminous condyles with higher antero-posterior and medio-lateral inclination angles compared to Class II participants. (3) Vertical: Hyperdivergent subjects had smaller condyles with higher antero-posterior inclination angles than those of hypodivergent subjects. No interactions of skeletal class and vertical relationships regarding condylar morphology were observed. CONCLUSIONS: This study demonstrates a clear correlation between pronounced skeletal patterns and condylar morphology in an adult population. The description of radiographic condyle characteristics in relation to the craniofacial morphology improves orthodontic treatment planning and could be helpful in the diagnosis of temporomandibular joint pathologies.

From 3D imaging to 3D printing in dentistry - a practical guide.

3D imaging in dentistry plays an essential part in diagnostics and treatment planning. To transform digital images into a real object that can be experienced haptically may provide new opportunities to practitioners regarding patient communication, skills training, and treatment planning. Therefore, the aim of this article is to provide a practical guide from 3D imaging to 3D printing using low-cost printers and open source software; the authors used 3D Slicer software and a Meshmixer printer, including the printer's own software. The article presents step-by-step instructions on how to perform rapid prototyping via fused deposition modeling (FDM) and stereolithography (SLA). As an example, we printed the skull of a patient with Saethre-Chotzen syndrome who was undergoing maxillofacial surgery. The protocol explained here should enable the technically interested clinician to produce patient-specific 3D models in-house, prefabricate osteosynthesis plates, and take advantage of the benefits of 3D printing for dentist-patient communication.

Experimental variation of the level and the ratio of angiogenic and osteogenic signaling affects the spatiotemporal expression of bone-specific markers and organization of bone formation in ectopic sites.

OBJECTIVES: The aim of the present study was to test the hypothesis that the ratio of angiogenic and osteogenic signaling affects ectopic bone formation when delivered in different amounts. MATERIALS AND METHODS: Porous composite PDLLA/CaCO3 scaffolds were loaded with rhBMP2 and rhVEGF in different dosage combinations and implanted into the gluteal muscles of 120 adult male Wistar rats. Bone formation and expression of alkaline phosphatase and Runx2 were quantified by histomorphometry. Spatial distribution across the scaffolds was assessed by using a grid that discriminated between the periphery and center of the scaffolds. RESULTS: The evaluation showed that the combined delivery of bone morphogenetic protein BMP2 and VEGF in different dosage combinations did not enhance the overall quantity of ectopic bone formation compared to the delivery of BMP2 alone. The addition of VEGF generally upregulated Runx2 after 4 weeks, which may have retarded terminal osteogenic differentiation. However, slow combined delivery of 1.5-2.0 µg BMP2 combined with 50 ng VEGF165 over a period of 5 weeks supported a more even distribution of bone formation across the implanted scaffolds whereas higher amounts of VEGF did not elicit this effect. CONCLUSIONS: The findings suggest that structural organization rather than the quantity of ectopic bone formation is affected by the dosage and the ratio of BMP2 and VEGF levels at the observed intervals. CLINICAL RELEVANCE: The development of carriers for dual growth factor delivery has to take into account the necessity to carefully balance the ratio of growth release.

Clinical efficacy of grafting materials in alveolar ridge augmentation: A systematic review.

PURPOSE: To evaluate the efficacy of grafting materials in lateral and vertical ridge augmentations. MATERIALS AND METHODS: A systematic review of the literature on the clinical use of grafting materials of the years 1995 to April 2015 was conducted using electronic search of PubMed and Cochrane libraries and hand search of eight print journals. A total of 184 papers were included, comprising 6182 patients. Parameters evaluated were observation period [months], bone formation [histologic area%], defect fill [%], horizontal and vertical gain [mm], loss of augmented volume [mm], complication rate [%], and implant survival rate [%]. Results are expressed as weighted means ± SD. RESULTS: Results were obtained after a weighted mean observation period of 27.4 months (range 3-168 months). Bone formation in the augmented areas varied from 33.2 ± 14.9% for allogeneic grafts to 56.0 ± 25.6% for mixtures of autogenous and other grafting materials. Defect fill in dehiscence defects ranged from 51.0 ± 13.6% (synthetic) to 85.8 ± 13.4% (xenogeneic) for the different materials, with an overall weighted mean of 79.8 ± 18.7%. Weighted mean horizontal gain for all particulate grafting materials was 3.7 ± 1.2 mm, with variation between 2.2 ± 1.2 mm (synthetic) and 4.5 ± 1.0 mm (mixtures of autogenous bone with allogeneic/xenogeneic grafting material) without statistical significance. Weighted overall mean vertical gain was 3.7 ± 1.4 mm. Vertical gain was substantially higher when space-making barrier materials such as titanium meshes were used; however this was also associated with strong increase in complication rate. Block grafts achieved higher horizontal gain by approximately 1 mm. The use of block grafts achieved significantly increased vertical gain compared to particulate material only when autogenous block grafts from extraoral donor sites were used. CONCLUSION: Horizontal and vertical gain by 3.7 mm on average can be achieved using particulate materials. This can be increased by using titanium meshes. Substantial vertical gains beyond this dimension require the use of extraoral bone block grafts.

Sleep-related breathing disorders and dentistry: What is the relationship?

Non-restorative sleep has considerable consequences for daily life. A sleep disorder is recognized by symptoms such as daytime fatigue and performance or concentration disorders. Furthermore, it increases the risk of developing cardiovascular, metabolic, and neurologic diseases. The diagnosis and therapy of sleep disorders is not only in the sleep medicine doctor's hands. A multidisciplinary approach reflects the affected patients' choice. Dentists can make an important contribution, especially to the therapy of sleep-related breathing disorder.

The submental island flap for the treatment of intraoral tumor-related defects: No effect on recurrence rates.

OBJECTIVES: The submental island flap has become increasingly popular in the treatment of intraoral defects following tumor ablation. However, there was concern that the elevation of the pedicled flap might interfere with the efficiency of level I-lymph node dissection and decrease the oncologic prognosis of the patients. MATERIALS AND METHODS: In a prospective clinical study over five years the outcome of 45 consecutive patients with intraoral cancer of various T-stages treated with submental island flaps was evaluated and compared to 45 patients with a T-status analogous oral cancer treated with free radial forearm flaps. RESULTS: All submental island flaps beside three were successful (93.3%). The obtained functional results were pleasing and the donor morbidity low. Patients treated with submental island flaps exhibited no enhanced risk of local tumor recurrence or lymph node metastasis (p<0.86). In contrast, the operation time, time of intensive care and hospitalization were reduced (p<0.001). DISCUSSION: We conclude that the submental island flap is an effective and predictable option of small and medium-sized oral defect treatment. It is a valuable alternative to free flap soft tissue reconstructions such as radial forearm or perforator flaps. It seems particularly beneficial to patients with relevant comorbidities as often present in the oral cancer population. The application of the submental island flap does not reduce the oncological prognosis of oral cancer patients.

Reduced somatosensory impairment by piezosurgery during orthognathic surgery of the mandible.

PURPOSE: This clinical trial aimed to test the hypothesis that piezosurgery causes reduced nerval irritations and, thus, reduced somatosensory impairment when used in orthognathic surgery of the mandible. METHODS: To this end, 37 consecutive patients with Angle Class II and III malocclusion were treated using bilateral sagittal split osteotomies (BSSO) of the mandible. In a split mouth design, randomized one side of the mandible was operated using a conventional saw, while a piezosurgery device was used on the contralateral side. In order to test the individual qualities of somatosensory function, quantitative sensory testings (QSTs) were performed 1 month, 6 months and 1 year after surgery. RESULTS: A comparison of the data using a two-way analysis of variance (ANOVA) revealed a significant reduction in postoperative impairment in warm detection threshold (WDT) (P = 0.046), a decreased dynamic mechanical allodynia (ALL) (P = 0.002) and a decreased vibration detection threshold (VDT) (P = 0.030) on the piezosurgery side of the mandible as opposed to the conventionally operated control side. In the remaining QSTs, minor deviations from the preoperative baseline conditions and a more rapid regression could be observed. CONCLUSIONS: Piezosurgery caused reduced somatosensory impairment and a faster recovery of somatosensory functions in the present investigation.

A review of pathogenesis, diagnosis, treatment options, and differential diagnosis of odontogenic infections: a rather mundane pathology?

Odontogenic infections are common in the dental practice and their treatment should be a standard procedure for every dentist. For optimal management of septic intraoral problems, the practitioner must understand the underlying causes and etiologies of odontogenic infections. Therefore, the purpose of this article is to outline basic inflammatory processes involved in the development of odontogenic and intraoral infections including relevant pathogens, biochemical processes mediated by pro-inflammatory molecules, the basics of abscess formation, the host response, and the clinical appearance of intraoral septic processes. Furthermore, treatment modalities of odontogenic infections and associated lesions are discussed and a brief explanation of possible complications and their management is provided.

Point-of-care testing on admission to the intensive care unit: lactate and glucose independently predict mortality.

BACKGROUND: The aim of the study was to retrospectively investigate whether parameters of routine point-of-care testing (POCT) predict hospital mortality in critically ill surgical patients on admission to the intensive care unit (ICU). METHODS: Arterial blood analyses of 1551 patients on admission to the adult surgical ICU of the Technical University Munich were reviewed. POCT was performed on a blood gas analyser. The association between acid-base status and mortality was evaluated. Metabolic acidosis was defined by base excess (BE) <-2 mmol/L and, wherever applicable, subdivided into lactic acidosis by lactate >50% of BE, anion gap (AG)-acidosis by AG >16 mmol/L, hyperchloraemic acidosis by chloride >115 mmol/L. Metabolic alkalosis was defined by BE ≥3 mmol/L. Logistic regression analysis identified variables independently associated with mortality. RESULTS: Overall mortality was 8.8%. Mortality was greater in male patients (p=0.012). Mean age was greater in non-survivors (p<0.0005). Nine hundred and eighty-six patients showed no metabolic acid-base disorder (mortality 7.3%), thereof 26 patients with pCO(2)>55 mm Hg (mortality 23.1%). Three hundred and seventy-seven patients presented with acidosis (mortality 11.4%), thereof 163 patients with lactic acidosis (mortality 19%). Mortality for alkalosis (174 patients) was 12.1%. Mean blood glucose level for non-survivors was higher compared to survivors (p<0.0005). Logistic regression analysis identified lactate, glucose, age, male gender as independent predictors of mortality. CONCLUSIONS: Lactate and glucose on ICU admission independently predict mortality. BE and AG failed as prognostic markers. Lactic acidosis showed a high mortality rate implying that lactate levels should be obtained on ICU admission. Prevalence of hyperchloraemic acidosis was low. Metabolic alkalosis was associated with an increased mortality. Further studies on this disturbance and its attendant high mortality are warranted.