Prosthetic Nasal Reconstruction.

Prosthetic nasal reconstruction provides a restorative option for patients with nasal defects, and these can be retained with a variety of methods including adhesives and implants. These prostheses can significantly improve appearance, self-esteem, and quality of life for patients and they restore many functions of the external nose. Traditional fabrication methods are often used by the skilled professionals who make these custom prostheses, but digital technology is improving the workflow for design and fabrication of silicone nasal prostheses. Nasal prosthetic reconstruction requires multidisciplinary coordination between surgeons, maxillofacial prosthodontists, anaplastologists, and other members of the healthcare team. Prosthetic treatment can be considered as an alternative to, or an addition to treatment with surgical reconstruction.

Age-related knowledge deficit and attitudes towards oral implants: Survey-based examination of the correlation between patient age and implant therapy awareness.

BACKGROUND: Implantology, as a recognized therapeutic approach, is gaining prominence. The decision-making process and success of implant therapy are closely linked to patient knowledge and expectations. This study aims to explore the association between age and knowledge regarding oral implants. METHODS: Participants were categorized into three age groups (ag): ag 1 (35-44 years), ag 2 (65-74 years), and ag 3 (75 years and older). A total of 400 participants per age group were randomly selected using data from the residents' registration office of Berlin, Germany. Structured telephone interviews were conducted between 2016 and 2017, employing a 67-item questionnaire covering awareness, information level, cost estimation, attitudes, and experiences with oral implants. RESULTS: Despite a low overall knowledge level across all age groups, there was no significant correlation between age and knowledge about oral implants. Awareness increased with age. Information sources varied, with friends, acquaintances, and dentists playing key roles. Participants expressed diverse opinions on implants, with durability and stability identified as crucial characteristics. Significant differences in knowledge were observed between age groups regarding awareness, information sources, and perceptions of dentists offering implants. CONCLUSIONS: The study suggests a need for targeted educational programs, emphasizing age-appropriate information sources to enhance health literacy in oral implantology, particularly among older individuals. Educating physicians on oral implant basics is also crucial. Implementing these measures could empower individuals to make informed decisions about oral implant treatment, thereby contributing to improved oral health outcomes.

A Systematic Review on Maxillofacial Prosthesis with Respect to Their Color Stability.

The aim of this systematic review was to identify and analyze the findings of various studies that analyzed the changes in the color stability of maxillofacial prosthetic materials after the addition of various colorants and nanoparticles and assess the change in color after being subjected to either natural or artificial accelerated aging as well as outdoor aging. This systematic review was conducted in accordance with the guidelines of transparent reporting of systematic reviews and meta-analysis (PRISMA Statement). The primary objective of this systematic review was to evaluate the color stability of maxillofacial prosthesis. The secondary objective was to assess the effect of various colorants; pigments; opacifiers; UV absorbers-such as inorganic colorants (dry earth pigments); metal oxides; and organic colorants. The time period of the included studies extended from 2013 to 2023. Electronic database search identified a total of 217 studies. Ten studies were included to meet the research question. All 10 included studies analyzed the effect of various colorants and their exposure to various aging and weathering conditions. It was found that various pigments and nanoparticles had an effect on the color stability. Also weathering and aging conditions had a direct effect on the color stability as well. In terms of disinfection, although there was not much color difference observed, highest change in color stability was observed when rubbing or brushing of the prosthesis was carried out. In conclusion, the color stability of maxillofacial prosthetics is a critical factor that influences both patient satisfaction and the overall cosmetic look. The potential of pigments and nanoparticles to enhance the color stability of silicone-based maxillofacial prosthesis has received much research. By avoiding color fading and discoloration brought on by environmental variables including UV radiation, aging, and chemical exposure, the inclusion of various pigments and nanoparticles has been demonstrated to improve the color stability of silicone maxillofacial prostheses.

Assessment of the color stability of two silicone elastomers for maxillofacial prostheses upon exposure to cold beverages.

PURPOSE: This study investigated the color stability of different commercially available silicone materials for facial prostheses upon exposure to everyday beverages. It was hypothesized that the beverages would not alter the color of the silicone under conditions simulating daily exposure. METHODS: Sixty specimens were fabricated using two materials - VST-50 and Silfy - and exposed to commercially available cold mineral water, tea, or coffee. Specimen color was evaluated on days 1 and 15. The color was measured with a spectrophotometer based on CIELab system and color differences were calculated as ΔE. Statistical analysis was performed using the Kruskal-Wallis test and Mann-Whitney U test. RESULTS: The mean ΔE values after 15 days of exposure to mineral water, cold green tea, and coffee were 1.016, 3.480, and 3.636 for VST-50 and 0.440, 0.798, and 1.425 for Silfy, respectively. Both materials showed significant differences in color, and VST-50 showed a greater color change than Silfy, especially for coffee. CONCLUSION: Pigmented silicone elastomers have low color stability, leading to an overall color change in silicone prostheses when exposed to pigmented beverages. Color changes in such prostheses can be mitigated by selecting materials with better color stability to extend their longevity.

Microwave disinfection of facial silicone prostheses, part 2: Mechanical properties.

STATEMENT OF PROBLEM: Part 1 of this 2-part study determined that microwave disinfection did not degrade the color stability of facial silicone prostheses. However, investigations on the effects of microwave disinfection on the mechanical properties of different silicone elastomers are lacking. PURPOSE: The purpose of this in vitro study was to examine the mechanical properties of commonly used colored facial silicone elastomers before and after microwave disinfection over a simulated 1.5-year period. MATERIAL AND METHODS: Six commonly used facial silicone elastomers: MDX4-4210, MDX4-4210/Type A, M511, A-2186, VST-50, and A-2000 were combined with functional intrinsic silicone pigments and opacifier (red, yellow, blue, and white). A total of 288 specimens were fabricated (n=12). Half of the specimens were tested for mechanical properties as the baseline, while the other specimens were tested after microwave disinfection. Microwave disinfection was performed with 660 W, 6 minutes of exposure time, and microwaved for 18 cycles to simulate 1.5 years of usage (one 6-minute exposure monthly). For mechanical property testing, all specimens were tested for tensile strength and percentage elongation (ASTM D412), tear strength (ASTM D624), and hardness (ASTM D2240). For each property, a 2-way ANOVA (silicone type and microwave disinfection factors) and Tukey multiple comparison test were performed using the R statistical software program (α=.05). RESULTS: Following microwave disinfection, tensile strength and percentage elongation of A-2000 increased significantly (P<.05). MDX4-4210, MDX4-4210/Type A, and A-2000 showed significant increases in their hardness (P<.001). Tear strength also increased significantly for MDX4-4210 and VST-50 (P<.05). Among the materials tested (ranked from highest to lowest value,=not statistically significant different), for tensile strength, VST-50>A-2186=A-2000>MDX4-4210/Type A=M511=MDX4-4210 (P<.05). For percentage elongation, VST-50>MDX4-4210/Type A>A-2186>M511=A-2000=MDX4-4210=M511 (P<.05). For hardness, A-2000=A-2186>M511=VST-50>MDX4-4210>MDX4-4210/Type A (P<.05). For tear strength, VST-50>A-2186>A-2000>M511>MDX4-4210/Type A=MDX4-4210 (P<.05). CONCLUSIONS: Overall, the mechanical properties of all the silicones tested were not adversely affected by microwave disinfection. VST-50 showed the best mechanical properties among the materials tested both before and after microwave disinfection. Microwave energy is a safe method of disinfecting the silicone elastomers tested in this study.

Perception of color mismatch or conspicuous marginal adaptation in extraoral prostheses with eye-tracking.

STATEMENT OF PROBLEM: Color matching and marginal integrity are major challenges when providing extraoral maxillofacial prostheses. Which of the color and marginal harmony features are more important for the extraoral prostheses to be inconspicuous is unclear. Studies on the perception of these prostheses with objective evaluation criteria are lacking. PURPOSE: The purpose of this observational study was to investigate the significance of color mismatch and conspicuous marginal adaptation in the perception of extraoral maxillofacial prostheses using eye-tracking technology. The secondary aim was to evaluate the perception of extraoral maxillofacial prostheses with regard to the observers' sex. MATERIAL AND METHODS: Twenty-seven face images, in 3 groups, representing well-fitting orbital prostheses with a color mismatch (IC), prostheses with a good color match but distinct marginal adaptation (IM), and symmetrical face images, were viewed for 5 seconds by 52 laypeople. Time to first fixation (TFF), fixation duration (FD), and fixation count (FC) at defined areas of interest were recorded and analyzed by an eye-tracking device. Because of the nested structure of data, a sex- and age-adjusted random intercept linear mixed effects model was used to assess the difference between IC, IM, and SI. Bonferroni corrected P values were used for pairwise comparisons. The difference between observers' sex was evaluated with random intercept mixed model by adjusting for age for each image. For repeated measurement analysis, the lm4, lmerTest, and emmeans libraries in R version 4.3.1 (R Foundation for Statistical Computing) were used (α=.05 for all tests). RESULTS: Significant differences were found between the symmetrical image group and other study groups at the facial prosthesis region in all parameters (each P<.001). Observers first focused on the facial prostheses in IC (0.72 seconds) and in IM (0.789 seconds). Longer fixation durations, 1.909, 1.989 seconds for IC and IM (PIC<.001, PIM<.001), respectively, and a higher fixation count for IC (5.28) (P<.001) and for IM (5.45) (P<.001) were recorded on facial prostheses compared with other areas of interest. Women were more focused on the prosthesis than men in the IC and IM groups considering FD (PIC=.003, PIM<.001) and FC values (PIC=.016, PIM<.001, PSI<.001). Fixation duration for women and men was 2.097 seconds and 1.739 seconds in the IC group, 2.219 seconds and 1.78 seconds in the IM group, and 1.364 seconds and 1.222 seconds in the SI group, respectively. CONCLUSIONS: Since the color mismatch and distinct marginal adaptation of maxillofacial prostheses were recognized using eye-tracking technology, both features appeared to be equally significant to be considered in fabrication procedures.

[Modern methods of adhesive fixation of facial epitheses]. / Sovremennye metody adgezivnoi fiksatsii epitezov litsa.

This review presents an analysis of domestic and foreign literature on the issues of fixation of facial epitheses and combined maxillofacial prostheses, such as the use of craniofacial implants installed in the zygomatic bone, brow arches, orbital walls, mastoid process of the temporal bone with beam or magnetic beam fixation systems. The advantages and disadvantages of such fastening systems are described. The analysis and systematization of available data on medical adhesive compositions that can be used in maxillofacial prosthetics to hold facial epitheses has been carried out. Much attention is paid to the chemical composition of pressure-sensitive adhesives, water-based and silicone-based. Examples of such compositions are given. The physicochemical properties of medical adhesive systems that cause adhesive-cohesive interaction are described. This review presents the results of comparative studies to assess the fixing properties of various adhesives, as well as to study the formation of biofilm on the surfaces of prostheses and skin when using different adhesives.

Need for Innovations in Maxillofacial Prosthodontics in Pakistan.

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Maxillofacial rehabilitation of an acid attack survivor - The journey from scar to smile.

Acid attack is a form of violent assault involving the act of throwing acid or any corrosive substance such as sulfuric acid, nitric acid, and hydrochloric acid with the intention to disfigure, maim, torture, or kill. A combination of surgical intervention along with prosthetic management using maxillofacial prosthesis serves a good treatment modality for rehabilitation in such cases. The advent of technological advancements has made the rehabilitation procedure easier, faster, and comfortable both for the patient and prosthodontist.

Implant-Abutment Connections and Their Effect on Implant Survival Rates and Changes in Marginal Bone Levels (Δ): A Systematic Review and Meta-Analysis of 45,347 Oral Implants.

Purpose: To quantify the cumulative oral implant survival rates and changes in radiographic bone levels based on the configuration of the implant-abutment connection type over time. Materials and Methods: An electronic literature search was conducted in four databases (PubMed/MEDLINE, Cochrane Library, Web of Science, and Embase), and records were refereed by two independent reviewers based on the inclusion criteria. Data from included articles were grouped by implant-abutment connection type into four categories ([1] external hex; [2] bone level, internal, narrow cone < 45 degrees; [3] bone level, internal wide cone ≥ 45 degrees or flat; and [4] tissue level) and duration of follow-up (short-term 1 to 2 years, mid-term 2 to 5 years, and long-term > 5 years). Meta-analyses were performed for cumulative survival rate (CSR) and changes in marginal bone level (ΔMBL) from baseline (loading) to last reported follow-up. Studies were split or merged as appropriate based on the implants and follow-up duration in the study and trial design. The study was compiled under PRISMA 2020 guidelines and registered in the PROSPERO database. Results: A total of 3,082 articles were screened. Full-text review of 465 articles resulted in a total of 270 articles (representing 16,448 subjects with 45,347 implants) included for quantitative synthesis and analysis. Mean ΔMBL (95% CI) was as follows: short-term external hex = 0.68 mm (0.57, 0.79); short-term bone level, internal, narrow cone < 45 degrees = 0.34 mm (0.25, 0.43); short-term bone level, internal wide cone ≥ 45 degrees = 0.63 mm (0.52, 0.74); short-term tissue level = 0.42 mm (0.27, 0.56); mid-term external hex = 1.03 mm (0.72, 1.34); mid-term bone level, internal, narrow cone < 45 degrees = 0.45 mm (0.34, 0.56); mid-term bone level, internal wide cone ≥ 45 degrees = 0.73 mm (0.58, 0.88); mid-term tissue level = 0.4 mm (0.21, 0.61); long-term external hex = 0.98 mm, 0.70, 1.25); long-term bone level, internal, narrow cone < 45 degrees = 0.44 mm (0.31, 0.57); long-term bone level, internal wide cone ≥ 45 degrees = 0.95 mm (0.68, 1.22); and long-term tissue level = 0.43 mm (0.24, 0.61). CSRs (95% CI) were: short-term external hex = 97% (96%, 98%); short-term bone level, internal, narrow cone < 45 degrees = 99% (99%, 99%); short-term bone level, internal wide cone ≥ 45 degrees = 98% (98%, 99%); short-term tissue level = 99% (98%, 100%); mid-term external hex = 97% (96%, 98%); mid-term bone level, internal, narrow cone < 45 degrees = 98% (98%, 99%); mid-term bone level, internal wide cone ≥ 45 degrees = 99% (98%, 99%); mid-term tissue level = 98% (97%, 99%); long-term external hex = 96% (95%, 98%); long-term bone level, internal, narrow cone < 45 degrees = 98% (98%, 99%); long-term bone level, internal wide cone ≥ 45 degrees = 99% (98%, 100%); and long-term tissue level = 99% (98%, 100%). Conclusion: The configuration of the implant-abutment interface has a measurable effect on the ΔMBL over time. These changes can be observed over a period of at least 3 to 5 years. At all measured time intervals, similar ΔMBL was noted for external hex and internal wide cone ≥ 45-degree connections, as were internal, narrow cone < 45-degree and tissue-level connections.

Improvement of speech by facial prosthesis in a midfacial defect with a gunshot injury: A case report.

Gunshot wounds in the maxillofacial region may cause serious defects that result in functional and esthetic disabilities. A 14-year-old male patient was referred to the prosthodontics clinic for provisional prosthetic restoration 5 months after an injury involving the midline midfacial region. An interim extraoral silicone maxillofacial prosthesis (MFP), also known as an epithesis, replacing the nose and upper lip, was fabricated to enhance appearance and speech intelligibility. The effect of the prosthesis insertion on speech outcome was assessed over 6 months. Blood pulse oxygen saturation levels and heart rate were monitored to assess ventilation following the prosthesis insertion. Results of the Assessment of Articulation Subtest revealed the patient produced the target speech sounds of 31 more words correctly at 6 months follow-up. Bilabial, labiodental, and postalveolar speech sounds in the phonetic inventory improved. Fabrication of an extraoral silicone MFP, modifying substructure design, and prosthesis usage over time contributed to the significant enhancement of speech intelligibility and did not significantly change the blood pulse oxygen saturation levels and heart rate. It led to an improvement in overall aesthetic outcomes and was a useful tool for the patient's social integration.

Maxillary Obturator Prosthesis Made with Polyetherketoneketone Using Optical Impression and CAD/CAM System.

This report describes the case of a 68-year-old man who visited our department complaining of poor denture retention and difficulty masticating due to damage to the retainer of a maxillary obturator. The patient had never been satisfied with the fit of this prosthesis, which had been placed two years earlier. The obturator and the mucosal surface of the denture base were incompatible, which had caused the retainer to detach. The maxillary defect was categorized as H3S0D0T0 according to the HS classification. The diagnosis was a masticatory disorder due to a damaged retainer and an incompatible denture base. Optical impressions and occlusal records were taken and a maxillary obturator fabricated using a CAD/CAM system. Dental CAD software was used to design and complete the tooth arrangement. The CAM system was used to mill a polyetherketoneketone disc based on the obtained data and composite resin used to face the teeth and gingiva. The maxillary obturator was placed after only three visits, spanning from impression taking to denture completion. The use of digital data allowed the time to denture completion to be shortened in addition to the number of hospital visits to be reduced. Compared to conventional impression taking, optical impressions also prevent discomfort, decreasing stress for the patient.

A 20-year clinical survey of radiotherapy prostheses at the Clinic for Maxillofacial Prosthetics of Tokyo Medical and Dental University Hospital.

PURPOSE: To identify secular trends in the use of radiotherapy prostheses in the Clinic for Maxillofacial Prosthetics at Tokyo Medical and Dental University Hospital and to ascertain patient characteristics and future needs. METHODS: The study included all patients who visited the clinic between January 1, 2000, and December 31, 2019. Data on numbers of cases, gender and age, numbers and types of radiotherapy prostheses, primary cancer site, and time required for prosthesis fabrication during the study period were collected from medical records and retrospectively analyzed. RESULTS: During the 20-year study period, 1,066 prostheses were fabricated for 1,135 cases. In most years, at least 60% of cases were male. The mean age increased from 60.6 to 67.1 years during the study period, and the number of cases older than 70 years increased over time. The most common cancer site was the tongue, and the most common type of radiotherapy prosthesis was a spacer. The mean time for spacer fabrication was 11 days. CONCLUSION: During a recent 20-year period, mean age and the proportion of elderly patients requiring savers increased. When treating elderly patients, prosthodontists responsible for fabricating radiotherapy prostheses must collaborate effectively with radiation oncologists.

Using deep learning approaches for coloring silicone maxillofacial prostheses: A comparison of two approaches.

Aim: This study aimed to compare the performance of two deep learning algorithms, attention-based gated recurrent unit (GRU), and the artificial neural networks (ANNs) algorithm for coloring silicone maxillofacial prostheses. Settings and Design: This was an in vitro study. Materials and Methods: A total of 21 silicone samples in different colors were produced with four pigments (white, yellow, red, and blue). The color of the samples was measured with a spectrophotometer, then the LFNx01, aFNx01, and bFNx01 values were recorded. The relationship between the LFNx01, aFNx01, and bFNx01 values of each sample and the amount of each pigment in the compound of the same sample was used as the training dataset, entered into each algorithm, and the prediction models were obtained. While generating the prediction model for each sample, the data of the corresponding sample assigned as the target color were excluded. LFNx01, aFNx01, and bFNx01 values of each target sample were entered into the obtained models separately, and recipes indicating the ratios for mixing the four pigments were predicted. The mean absolute error (MAE) and root mean square error (RMSE) values between the original recipe used in the production of each silicone and the recipe created by both prediction models for the same silicone were calculated. Statistical Analysis Used: Data were analyzed with the Student t-test (α=0.05). Results: The mean RMSE values and MAE values for the ANN algorithm (0.029 ± 0.0152 and 0.045 ± 0.0235, respectively) were found significantly higher than the attention-based GRU model (0.001 ± 0.0005 and 0.002 ± 0.0008, respectively) (P < 0.001). Conclusions: Attention-based GRU model provided better performance than the ANN algorithm with respect to the MAE and RMSE values.

A Contemporary Review of the Role of Facial Prostheses in Complex Facial Reconstruction.

BACKGROUND: Maxillofacial prostheses provide effective rehabilitation of complex facial defects as alternatives to surgical reconstruction. Although facial prostheses provide aesthetically pleasing reconstructions, multiple barriers exist that prevent their routine clinical use. The accessibility of facial prostheses is limited by the scarce supply of maxillofacial prosthodontists, significant time commitment and number of clinic appointments required of patients during prosthesis fabrication, short lifespan of prostheses, and limited outcomes data. METHODS: A literature review was completed using PubMed and Embase databases, with search phrases including face and maxillofacial prostheses. Patient cases are included to illustrate the use of facial prostheses to reconstruct complex facial defects. RESULTS: The clinical use of facial prostheses requires a multidisciplinary team including a reconstructive surgeon, a maxillofacial prosthodontist, and an anaplastologist, if available, to provide patients with aesthetically appropriate facial prostheses. Developing technology including computer-aided design and three-dimensional printing may improve the availability of facial prostheses by eliminating multiple steps during prosthesis fabrication, ultimately decreasing the time required to fabricate a prosthesis. In addition, enhanced materials may improve prosthesis durability. Long-term outcomes data using validated measures is needed to support the continued use of facial prostheses. CONCLUSIONS: Facial prostheses can be used to reconstruct complex facial defects, and bone-anchored prostheses are associated with high patient satisfaction. Multiple barriers prevent prostheses from being used for facial reconstruction. New technologies to assist the design and fabrication of prostheses, and cost reduction measures, may allow their use in the appropriately selected patient.

Opacifiers on color stability of maxillofacial silicone under aging and Indian weathering conditions: An in vitro study.

STATEMENT OF PROBLEM: Resistance to long-term color change is a desirable property for facial prosthetic elastomers. Evidence for the color stability of maxillofacial silicones under aging and hot and humid Indian weathering conditions is lacking. PURPOSE: The purpose of this in vitro study was to evaluate the effect of adding opacifiers on the color stability of maxillofacial silicone under human aging and Indian weather conditions. MATERIAL AND METHODS: A total of 93 specimen disks were obtained from the A-2186, platinum-based, room-temperature vulcanized, maxillofacial silicone elastomer by using a Ø30×6-mm stainless-steel die. The specimens were divided into 3 main groups (n=30), C (control), T (titanium dioxide), and B (barium sulfate), and 1 additional specimen (n=1) from each group was stored in a closed box and further subgrouped as outdoor weathering (COut, TOut, BOut), acidic perspiration (CAcid, TAcid, BAcid), sebum (CSebum, TSebum, BSebum) (n=10), and visual comparison (CVis, TVis, BVis) (n=1). Baseline L∗, a∗, b∗ values were recorded by using a spectrophotometer and visual perception. The specimens were subjected to human and extraoral aging conditions, and the values were recorded again after 6 months. Data were analyzed statistically by using analysis of variance (ANOVA) and post hoc analysis with the Tukey post hoc test. RESULTS: In group C, the mean color change for COut was 3.69 ±0.49; CAcid, 3.58 ±0.68; and CSebum, 7.53 ±0.22 (P<.001). In group T, the mean color change for TOut was 2.60 ±0.24; TAcid, 2.35 ±0.13; and TSebum, 4.91 ±0.44 (P<.001). In group B, BOut was 1.59 ±0.28, BAcid was 1.46 ±0.28, and BSebum was 4.03 ±0.71 (P<.001). The specimens containing barium sulfate showed the maximum color stability. The least color stability was observed in all specimens exposed to sebum solution and was significantly different (P<.001) from the outdoor weather and acidic perspiration specimens. Visually perceivable color changes were observed in specimens exposed to the sebum solution. CONCLUSIONS: The addition of titanium dioxide and barium sulfate as opacifiers resulted in clinically acceptable color change when exposed to outdoor weathering and acidic perspiration but not in sebum solution.

The effect of preoperative clindamycin in reducing early oral implant failure: a randomised placebo-controlled clinical trial.

OBJECTIVES: To assess the effect of preoperative oral clindamycin in reducing early implant failure in healthy adults undergoing conventional implant placement. MATERIALS AND METHODS: We conducted a prospective, randomised, double-blind, placebo-controlled clinical trial in accordance with the ethical principles and Consolidated Standards of Reporting Trials statement. We included healthy adults who underwent a single oral implant without previous infection of the surgical bed or the need for bone grafting. They were randomly treated with a single dose of oral clindamycin (600 mg) 1 h before surgery or a placebo. All surgical procedures were performed by one surgeon. A single trained observer evaluated all patients on postoperative days 1, 7, 14, 28, and 56. Early dental implant failure was defined as the loss or removal of an implant for any reason. We recorded the clinical, radiological, and surgical variables, adverse events, and postoperative complications. The study outcomes were statistically analysed to evaluate differences between the groups. Furthermore, we calculated the number required to treat or harm (NNT/NNH). RESULTS: Both the control group and clindamycin group had 31 patients each. Two implant failures occurred in the clindamycin group (NNH = 15, p = 0.246). Three patients had postoperative infections, namely two placebo-treated and one clindamycin-treated, which failed (relative risk: 0.5, CI: 0.05-5.23, absolute risk reduction = 0.03, confidence interval: - 0.07-0.13, NNT = 31, CI: 7.2-∞, and p = 0.5). One clindamycin-treated patient experienced gastrointestinal disturbances and diarrhoea. CONCLUSIONS: Preoperative clindamycin administration during oral implant surgery in healthy adults may not reduce implant failure or post-surgical-complications. CLINICAL RELEVANCE: Oral clindamycin is not efficacy. TRIAL REGISTRATION: The present trial was registered (EudraCT number: 2017-002,168-42). It was approved by the Committee for the Ethics of Research with Medicines of Euskadi (CEIm-E) on 31 October 2018 (internal code number: 201862) and the Spanish Agency of Medicines and Medical Devices (AEMPS) on 18 December 2018.

Effect of ultraviolet protective agents on maxillofacial silicone elastomer, part 1: Color stability after artificial aging.

STATEMENT OF PROBLEM: Silicone elastomers have been widely used for rehabilitation of facial defects for more than 50 years. However, color change is the most common problem limiting the service life of facial prostheses. Whether the addition of ultraviolet protectives may enhance color stability of these materials is unclear. PURPOSE: The purpose of this in vitro study was to investigate the effect of ultraviolet protectives on the color stability of maxillofacial silicones after artificial aging. MATERIAL AND METHODS: Six color groups (unpigmented, white, yellow, red, blue, and mixed) of addition-type maxillofacial silicone were prepared. Four ultraviolet protectives benzophenone-3, ethylhexyl methoxycinnamate, titanium dioxide, and ethylhexyl salicylate at 0.5% and 1% concentrations by weight were incorporated into the silicone before polymerization. The specimens were artificially aged in an accelerated weathering chamber for 300 and 600 hours and in a thermocycling device. The color change values (E) of the maxillofacial silicones were evaluated. Data were statistically analyzed by using 4-way ANOVA. The differences were compared by the Tukey honestly significant difference test (α=.05). RESULTS: Benzophenone-3 and ethylhexyl methoxycinnamate protectives did not reduce the ΔE values, and the 1% titanium dioxide groups exhibited lower ΔE values than the 0.5% titanium dioxide groups. Ethylhexyl salicylate protective generally reduced the ΔE values significantly in all color and aging groups when compared with the control groups (P<.05). In all control and ultraviolet protective groups, the highest ΔE values were seen with the red color in 300 and 600 hours of aging. Generally, no significant difference (P>.05) was seen in the ΔE values, which were clinically acceptable among the thermocycled color groups. After 600 hours of accelerated aging, the ΔE values were found to be higher than the values of 300-hour aging. CONCLUSIONS: Ethylhexyl salicylate protective incorporated into maxillofacial silicones may improve color stability.

Titanium versus zirconia complete arch implant-supported fixed prostheses: A comparison of plaque accumulation.

STATEMENT OF PROBLEM: Complete arch implant-supported zirconia prostheses appear to have less plaque accumulation than titanium prostheses, but a comparison of the materials and the possible influence on the adjacent soft tissue is lacking. PURPOSE: The purpose of this clinical study was to compare the plaque accumulation and soft-tissue inflammation of complete arch implant-supported fixed maxillary prostheses fabricated with either a titanium framework or monolithic zirconia. MATERIAL AND METHODS: Twenty participants with a complete arch implant-supported fixed maxillary prosthesis were enrolled in the study. The participants were divided into 2 groups according to the prosthesis material, titanium (Ti) or zirconia (Zir). The prosthesis had to have been in function for at least 6 months, and participants were examined during at least 3 maintenance appointments at 3-month intervals. Clinical information collected in each appointment included standardized photographs to record the Plaque Area Index (PAI) of the intaglio surface of the prosthesis; clinical parameters including modified Plaque Index (mPI), modified Bleeding Index (mBI), implant mobility (MOB), probing depths ≥5 mm (PD), suppuration (SUP), keratinized tissue band ≥2 mm (KT), and an intraoral photograph of the maxillary arch without the prosthesis to evaluate the redness of the soft tissues. RESULTS: MOB was not present at any implant at any time point. SUP could not be analyzed because it was an infrequent finding. Both groups exhibited significant increases in mBI over time. No significant differences were observed for PD between the groups at any time point. Implants in the Ti group had significantly higher KT values than those in the Zir group; levels remained constant over time for both groups. Zirconia prostheses had slightly lower PAI levels than Ti prostheses. The PAI in the Zir group significantly decreased over time (P=.035); in the Ti group, they remained constant (P=.45). Higher PAI levels were correlated with increased levels of erythema; both groups had a significant decrease in erythema values over time (P=.04). CONCLUSIONS: Zirconia complete arch implant-supported fixed maxillary prostheses displayed a significant decrease in plaque accumulation in individuals who had received periodic maintenance and oral hygiene instructions. Ti prostheses had significantly higher plaque levels than zirconia prostheses at all time points, which was not reduced by maintenance and oral hygiene measures. The present study suggests that patients receiving zirconia prostheses respond well to plaque control measures, while plaque control for those with titanium prostheses may be more challenging.