Automated three-dimensional analysis of facial asymmetry in patients with syndromic coronal synostosis: A retrospective study.

Craniosynostosis, characterized by premature fusion of one or more cranial sutures, results in a distorted skull shape. Only three studies have assessed facial asymmetry manually in unicoronal synostosis patients. It is therefore important to understand how uni- and bicoronal synostosis affect facial asymmetry with a minimum risk of human bias. An automated algorithm was developed to quantify facial asymmetry from three-dimensional images, generating a mean facial asymmetry (MFA) value in millimeters to reflect the degree of asymmetry. The framework was applied to analyze postoperative 3D images of syndromic patients (N = 35) diagnosed with Muenke syndrome, Saethre-Chotzen syndrome, and TCF12-related craniosynostosis with respect to MFA values from a healthy control group (N = 89). Patients demonstrated substantially higher MFA values than controls: Muenke syndrome (unicoronal 1.74 ± 0.40 mm, bicoronal 0.77 ± 0.21 mm), Saethre-Chotzen syndrome (unicoronal 1.15 ± 0.20 mm, bicoronal 0.69 ± 0.16 mm), and TCF12-related craniosynostosis (unicoronal 1.40 ± 0.51 mm, bicoronal 0.66 ± 0.05 mm), compared with controls (0.49 ± 0.12 mm). Longitudinal analysis identified an increasing MFA trend in unicoronal synostosis patients. Our study revealed higher MFA in syndromic patients with uni- and bicoronal synostosis compared with controls, with the most pronounced MFA in Muenke syndrome patients with unilateral synostosis. Bicoronal synostosis patients demonstrated higher facial asymmetry than expected given the condition's symmetrical presentation.

Patient experience and satisfaction of surgically assisted rapid maxillary expansion and mandibular midline distraction.

Little is known regarding patient experience and satisfaction with surgically assisted rapid maxillary expansion (SARME) and mandibular midline distraction (MMD). This study therefore aimed to assess patient experience and satisfaction with these techniques in two different groups. The first group answered the post-surgical patient satisfaction questionnaire on a 7-point Likert scale during a long-term follow-up recall. The second group answered a visual analogue scale questionnaire (range: 0-10) with different questions regarding experience and satisfaction, at different time points during the first year of treatment. In both groups, 17 patients were included. Regarding the post-surgical patient satisfaction questionnaire, a mean satisfaction rate of 6.4 (range: 4-7) was reported, with a mean follow-up of 6.5 years post-operatively. In the visual analogue scale group, the mean satisfaction rate was 8.0 and did not significantly differ from the expectations pre-operative (P = 0.96). Both procedures showed relatively low pain scores, although a significant higher score was observed in MMD post-operatively (P = 0.00051). Regarding hindrance, the scores were moderate; the bone-borne distractor in the mandible gained higher scores than the tooth-borne distractor in the mandible. In conclusion, both SARME and MMD gain high satisfaction rates.

Soft tissue contour and radiographic evaluation of ridge preservation in early implant placement: A randomized controlled clinical trial.

OBJECTIVES: To compare two ridge preservation techniques and spontaneous healing in terms of hard and soft tissue changes 2 months after tooth extraction. MATERIAL AND METHODS: The study was designed as a randomized controlled trial and included 75 patients. After single tooth extraction in the maxillary incisor/premolar area, patients were randomly allocated to one of the following groups: (a) ridge preservation with a xenogeneic bone substitute covered with a collagen matrix (CM-group), (b) ridge preservation with a xenogeneic bone substitute covered with a free palatal graft (PG-group) or (c) spontaneous healing (control). Eight weeks after tooth extraction, implants were placed and clinical, profilometric and radiographic evaluations were performed. In addition, the need for further guided bone regeneration (GBR) at implant placement was assessed. The differences between the treatment groups were compared with the One-way ANOVA or Kruskal-Wallis test with the corresponding post hoc analysis. The proportions of the categorical parameters were compared with the Fisher´s exact test. RESULTS: Seventy-five patients underwent early implant placement 8 weeks after tooth extraction and were evaluated. CM-group (-0.9 SD 0.6 mm) and PG-group (-1.0 SD 0.8 mm) showed less horizontal bone resorption compared to the control group (-3.2 SD 2.1 mm) (p < .001). Moreover, the necessity of GBR at implant placement was significantly less in CM-group (32%) and PG-group (24%) when compared to control group (72%) (p = .001). Patients in CM-group experienced less pain than PG-group, one week after tooth extraction (p = .042). No significant differences were found regarding graft evaluation, post-operative complications, and soft tissue contour. CONCLUSIONS: Ridge preservation using a xenogeneic bone substitute covered with a collagen matrix or a palatal graft, results in less bone resorption and fewer GBR procedures at early implant placement compared to spontaneous healing.

Single versus triple daily activation of the distractor: no significant effects of frequency of distraction on bone regenerate quantity and architecture.

OBJECTIVES: To study the effect of two different frequencies of distraction on the quantity and architecture of bone regenerate using micro-computed tomography, and to determine whether radiographic and ultrasonographic bone-fill scores provide reliable predictive value for the amount of new bone in the distraction area. MATERIAL AND METHODS: Twenty-six skeletally mature rabbits underwent three full days of latency, after which midface distraction was started. Low-frequency group (n=12): a distraction rate of 0.9 mm/d achieved by one daily activation for 11 days to create a 10mm distraction gap. High-frequency group (n=12): idem, but three daily activations were used instead of one. Control group (n=2) underwent no distraction. After 21 days of consolidation, bone-fill in the distraction area was assessed by means of ultrasonography and radiography. Micro-computed tomography was used to quantify new bone formation and bone architecture. RESULTS: Relative bone volume (BV/TV) showed a tendency towards a difference (P=0.09) between the low and high-frequency groups. No significant differences were found for bone architecture. No significant correlation between BV/TV values and bone-fill scores was found. CONCLUSIONS: An increase in rhythm from one to three activations daily does not create significantly more bone. Bone-fill score values provided no reliable predictive value for the amount of new bone formation.