Bis-EMA/Bis-GMA ratio effects on resin-properties and impregnated fiber-bundles.

OBJECTIVES: To evaluate the effect of different ratios of Bis-EMA/Bis-GMA resin mixtures on the inherent viscosity and curing-related properties: including degree of cure (DC%), shrinkage strain, Knoop micro-hardness (KH) and flexural strength of resin-impregnated fiber-bundles. METHODS: Bis-EMA/Bis-GMA monomers were mixed (by weight) in the following ratios: M1 = 30 %/70 %, M2 = 50 %/50 %, M3 = 70 %/30 %, and M4 = 100 %/0 %. Standard measurements were made of refractive index, viscosity, degree of conversion, shrinkage strain and Knoop hardness (KHN). For 60 % glass fiber-bundles impregnated with 40 % resin, three-point bending test for flexural strength and shrinkage strain were measured. Data were analyzed by One-way ANOVA and Bonferroni post-hoc tests (α = 0.05). RESULTS: For resin mixtures, increasing Bis-EMA proportion decreased refractive index (p < 0.05), and viscosity (p < 0.05), and increased monomer conversion (DC%), shrinkage strain and KHN (p < 0.05). DC% increased after 1 h for all resin mixtures. The shrinkage strain and flexural strength of resin-impregnated fiber-bundles reduced with increased Bis-EMA. SIGNIFICANCE: Monomeric mixtures with highest amounts of Bis-EMA showed enhancement in several clinically-relevant properties and polymerization of respective resin-impregnated glass fibers. This makes them potential candidates for impregnating glass fibers in fiber-reinforced restorations.

Is Polyetheretherketone an Effective Alloplastic Material in Comparison to Titanium in Calvarial Reconstruction.

INTRODUCTION AND AIM: Polyetheretherketone (PEEK) and titanium (Ti) cranioplasty implants ideal outcomes are good esthetics, long-term stability, and protection of the fragile brain tissue. However, it is unclear whether PEEK implants can offer an equal alternative to Ti implants. This work aimed to critically review papers and case series published on both Ti and PEEK Cranioplasty regarding complications, clinical outcomes, ease of use, esthetics, manufacture and availability, cost and time-saving factors, postoperative quality of life (QOL), as well as their suitability for the fronto-orbito region reconstruction. METHODS: PubMed database was sourced for published literature in the period 2007 to the end of 2023; a further manual search for articles was carried out on the reference lists of each paper. RESULTS: A total of 48980 papers were found during the initial search, but only 33 articles met the inclusion criteria. A total of 6023 cranial implants, with 3879 being Ti and 1205 PEEK. Titanium was the material of choice in over 64.4% of cases; however, Ti has been in application for many years compared to PEEK. Out of the 33 papers, there was 27 retrospective cohort/analysis/case series and reviews: 1 meta-analysis, 2 systematic reviews and 3 randomized control trials. Four articles commented on the QOL, 15 on esthetics, 7 discussed cost and time-saving without measurable variables, and 7 articles looked explicitly at the complex fronto-orbito region, of which 49% were primary 1-stage surgical reconstructions, 54% were reconstructed with PEEK and 7% Ti (CAD/CAM). CONCLUSION: There is no absolute consensus for the preference of either material, however, in the fronto-orbito region, PEEK is the material of choice for ease of use, esthetics, and time-saving. However, there are no long-term studies on PEEK cranioplasty, and fewer in comparison with Ti implants. Further research is required in this field. No reliable or measurable data was found to determine the QOL, esthetics, cost, or time-saving elements.

Fracture strength of anterior cantilever resin-bonded fixed partial dentures fabricated from high translucency zirconia with different intaglio surface treatments.

PURPOSE: To compare the fracture resistance and failure modes of anterior cantilever resin-bonded fixed partial dentures (RBFPDs) fabricated from high translucency zirconia with different intaglio surface treatments. MATERIALS AND METHODS: Sound-extracted canines (N = 50) were randomly divided into five groups (n = 10) to be restored with high translucency zirconia RBFBDs of different intaglio surface treatments. The RBFPD was designed using exocad software and fabricated using a CAM milling machine. The RBFPDs were treated differently: abrasion with 50 µm alumina particles (Group 1); abrasion with 30 µm silica-coated alumina particles (Group 2); abrasion with silica-coated alumina particles (30 µm) and silane application (Group 3); abrasion with silica-coated alumina particles (30 µm) and 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) primer application (Group 4); abrasion with silica-coated alumina particles (30 µm) and silane, and 10-MDP primer application. All RBFPDs were cemented using dual-cured resin cement. The RBFPDs underwent 6000 thermal cycles with distilled water at 5/55°C for 2 min per cycle and then mechanical cyclic loading with 1200,000 cycles of 50 N at a 1.7 Hz frequency at an angle of 135° to the abutment's long axis. Then, RBFPDs were loaded to fracture using a universal testing machine at 1 mm/min. Maximum fracture forces and failure modes were recorded. Fractured specimens and uncemented specimens were examined using a scanning electron microscope. Data was analyzed using ANOVA and Games-Howell post hoc tests at p < 0.05. RESULTS: Mean fracture load results showed a statistically significant difference between the research groups (p < 0.0001) and it ranged from 69.78 to 584 N. Group 4 exhibited the highest fracture load mean (p < 0.0001) which was significantly different from all other groups. Group 2 recorded a significantly higher fracture load mean than Group 3 (p = 0.029). Three modes of failure were observed: prosthesis debonding, prosthesis fracture, and abutment fracture. CONCLUSIONS: Abrasion of zirconia surface with 30 µm silica-coated alumina particles and application of 10-MDP primer yielded the highest mean fracture loads of monolithic high translucency zirconia RBFPD. The mode of fracture of the RBFPDs was influenced by the type of surface treatments.

Cohesive Zone Modeling of Pull-Out Test for Dental Fiber-Silicone Polymer.

BACKGROUND: Several analytical methods for the fiber pull-out test have been developed to evaluate the bond strength of fiber-matrix systems. We aimed to investigate the debonding mechanism of a fiber-silicone pull-out specimen and validate the experimental data using 3D-FEM and a cohesive element approach. METHODS: A 3D model of a fiber-silicone pull-out testing specimen was established by pre-processing CT images of the typical specimen. The materials on the scans were posted in three different cross-sectional views using ScanIP and imported to ScanFE in which 3D generation was implemented for all of the image slices. This file was exported in FEA format and was imported in the FEA software (PATRAN/ABAQUS, version r2) for generating solid mesh, boundary conditions, and material properties attribution, as well as load case creation and data processing. RESULTS: The FEM cohesive zone pull-out force versus displacement curve showed an initial linear response. The Von Mises stress concentration was distributed along the fiber-silicone interface. The damage in the principal stresses' directions S11, S22, and S33, which represented the maximum possible magnitude of tensile and compressive stress at the fiber-silicone interface, showed that the stress is higher in the direction S33 (stress acting in the Z-direction) in which the lower damage criterion was higher as well when compared to S11 (stress acting in the XY plane) and S23 (stress acting in the YZ plane). CONCLUSIONS: The comparison between the experimental values and the results from the finite element simulations show that the proposed cohesive zone model accurately reproduces the experimental results. These results are considered almost identical to the experimental observations about the interface. The cohesive element approach is a potential function that takes into account the shear effects with many advantages related to its ability to predict the initiation and progress of the fiber-silicone debonding during pull-out tests. A disadvantage of this approach is the computational effort required for the simulation and analysis process. A good understanding of the parameters related to the cohesive laws is responsible for a successful simulation.

Mechanical properties and bonding of maxillofacial silicone elastomer mixed with nano-sized anti-microbials.

OBJECTIVES: The antibacterial efficacy of silicone is improved by impregnating it with antimicrobials such as chlorohexidine and zinc oxide. The purpose of this study was to examine mechanical properties and bonding of maxillofacial silicone elastomer mixed with Zinc Oxide nanoparticles (ZnO-NP), and Chlorohexidine Diacetate Salt (CHX) at three different concentrations (1 %, 3 %, and 5 %). METHODS: Specimens of a silicone elastomer (M511) were prepared and divided into 7 groups. Group 1 was control of no additive. Groups 2-4 included silicone elastomer mixed with ZnO-NP (surface area = 67 m2/g) at 3 different concentrations (by weight %); 1 %, 3 % and 5 %. Groups 5-7 included silicone elastomer mixed with CHX at the same concentrations. Tear and tensile strengths, elongation percentage, modulus of elasticity, and shear bond strength to primed acrylic resin surfaces were evaluated. Data was analyzed with 1-way ANOVA, Bonferroni, and Dunnett's T3 post-hoc tests (P < 0.05). RESULTS: There was significant effect of the additives on the tensile strength, elongation percentage, tear strength, and shear bond strength (P < 0.05). Shear bond strengths ranged from 0.55 to 0.96 MPa. Silicone elastomer mixed with CHX (5 %) resulted in the highest shear bond strength (P < 0.05). Non-linear regressions between tensile strength and ZnO and CHX additives were 0.95 and 0.96 respectively. SIGNIFICANCE: All additives reduced the tensile strength of the silicone. However, CHX at 5 % optimized shear bond strength and thus is proposed in order to fabricate maxillofacial prostheses of sufficient mechanical properties, bonding and antimicrobial activity.

Use of 3-dimensional imaging and manufacturing for bilateral auricular prostheses: A case series of six patients with congenital auricular defects.

The prosthetic reconstruction of unilateral ear deformity is a straightforward procedure which relies on copying the details, position, and symmetry of the existing contralateral ear. However, reconstructing bilaterally missing ears is challenging. The use of 3-dimensional (3D) technology in the prosthetic reconstruction of the bilaterally missing ears of 6 patients is described. The deformity site was created directly by segmenting the patient's digital scan or indirectly via a desktop scanner. Adequate bone quantity and quality for implant retention and optimal implant locations were also identified virtually. The use of 3D technologies has made it more straightforward to accomplish ear symmetry, as well as to validate the orientation and location of the ears reliably with the minimum subjectivity. The printed ears were matched in shape, surface texture, and anatomy. The skin color was straightforward to record and store so that it could be reproduced at a future time. Overall, the digital manufacture of the ears was controlled, consistent, and reproducible.

Contemporary Review on Craniectomy and Cranioplasty; Part 1: Decompressive Craniectomy.

ABSTRACT: This paper aims to review clinical benefits of decompressive craniectomy (DC) in both adult and paediatric populations; its indications and factors contributing to its postoperative success. The Glasgow Outcome Scale and the Modified Rankin Scale are the most commonly used scales to assess the long-term outcome in patients post DC. In adult traumatic brain injury patients, 2 randomized clinical trials were carried out; DECRA (Decompressive Craniectomy in Diffuse Traumatic Brain Injury) and RESCUEicp (Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of inter cranial pressure) employing collectively 555 patients. Despite the differences in these trials, their initial results affirm DC can lead to reduced mortality and more favorable outcomes. In ischemic stroke adult patients, different clinical trials of HAMLET (Dutch trial of Hemicraniectomy after middle cerebral artery infarction with life-threatening Edema), DESTINY (German trial of Decompressive Surgery for the treatment of Malignant Infarct of the Middle Cerebral Artery), and DECIMAL (French trial of Decompressive Craniectomy in Malignant Middle Cerebral Artery Infarcts) suggested that DC improves survival compared with best medical management, but with an increased proportion of treated individuals surviving with moderate or severe disability. With regard to the size of bone to be removed, the larger the defect the better the results with a minimum diameter of 11 to 12 cm of bone flap. Cranioplasty timing varies and ranges from 6 weeks to more than 12 months post DC, depending on completion of medical treatment, clinical recovery, resolution of any infection, and an evaluation of soft tissues at the defect site.

Contemporary Review on Craniectomy and Cranioplasty; Part 2: Material Selection and Plate Manufacture.

ABSTRACT: Cranioplasty materials include metals (ie, titanium); ceramics (ie, hydroxyapatite); polymers (ie, poly-methyl-metha-acrylate [PMMA]); and plastics (ie, polyether ether ketone). This paper aims to review their advantages and drawbacks. No ideal material currently exist, however, titanium implants are universally agreed to have lower infection rates than those reported for hydroxyapatite and PMMA implants; thus justifying their current wide use. These implants can be manufactured conventionally from medical grade titanium alloy Ti64 (titanium-aluminum-vanadium) in the form of plates ranging in thickness from 0.5 to 0.7 mm thick, or following the computer-aided design/manufacture principle. Surface finish of these implants is best achieved by electroplating.

Successful prosthetic salvage of a suboptimal autogenous auricular reconstruction with digital technologies: A report of 3 challenging treatments.

The surgical reconstruction of congenitally missing or malformed ears is challenging and involves complicated surgeries. Ear shape, position, and skin color will likely be compromised in patients with relative anatomic symmetry, and it is easier to reproduce these features with a prosthesis. This article describes the prosthetic reconstruction of 3 patients who had received failed or suboptimal surgical reconstruction of their missing or deformed ears. Challenging characteristics included limited soft-tissue availability, skeletal hypoplasia with prominent concavity defect, and bilaterally missing ears with abnormally low hairline. Three-dimensional planning using a software program was used to determine the ideal implant locations and mirror the contralateral ear. The mirrored ear was 3-dimensionally printed with a stereolithography printer. The skin color was reproduced digitally by using the Spectromatch Pro system.

Preparation and In Vitro Analysis of Craniofacial Titanium Implants Surfaces Produced by Additive 3D Printing and Conventional Manufacturing.

STUDY DESIGN: Surface finish of titanium patient-specific craniofacial implants is known to affect their acceptability and durability and relevant literature still inconclusive on the best surface finishing protocol. OBJECTIVES: This study investigated surface topography of three-dimensionally (3D) printed and conventionally manufactured craniofacial titanium implants following non-contact 3D laser profile-meter analysis. METHODS: Seven groups of titanium specimens (n = 10) were prepared and their surfaces were treated differently and included sole or combined treatment of mechanical polishing, gritting with 50 micron AL2O3, cold acid treatment using nitric acid for 20 hours (70% w/w), etching using acidic solution (69% nitric and 48% hydrofluoric acids) for 10 minutes and then electro-chemically anodized in another acidic solution (85% orthophosphoric and 98%sulphuric acid). Eighth group included specimens that were 3D printed. 3D micro-roughness parameters Sa, Sp, Sv, and Sz were determined (µm) for each specimen. Data was analyzed using one way ANOVA and Dunett T3 post-hoc tests (p < 0.05). RESULTS: There were statistically significant effects of surface finishing protocols (p < 0.05). Sa values were 2.72-13.75 and specimens which were electroplated or mechanically polished and acid treated were the smoothest (p < 0.05). Sp was in the range 9.07-43.56 as sandblasting significantly roughened surfaces (p < 0.05). The same inferior effect was evident for the Sv (p < 0.05). The Sz values were 19.46-107.05 and was the highest for sandblasted surfaces (p < 0.05) and the lowest for surfaces of electro-chemical treatment (p < 0.05). CONCLUSION: Titanium surfaces are affected by the finishing procedure and electro-chemical treatment or mechanical polishing combined with acid treatment produced clinically-favorable smooth surfaces.

Effect of freshly placed core buildup composites on setting of silicon impression materials.

Aim: The aim is to study the effect of freshly placed composite build-ups on setting of additional silicone impression materials. Settings and Design: In vitro - experimental study. Materials and Methods: Three composite materials; Build-It™ F. R™, Filtek™ Bulk Fill flow and Filtek™ Z350 and three light-bodied additional silicone impression materials; Elite HD+, Aquasil LV Ultra and Express™ were used. Cylindrical-shaped specimens were made of each material (diameter 15 mm and height 10 mm). The silicone specimens were brought into contact with the composite specimens, which were either freshly cured (9 groups, n = 90) or cured and then stored in normal saline for 1 week (9 groups, n = 90). Shore A hardness (SAH) scores of silicone surfaces were recorded following the ASTM D2240-5 standards for shore A Durometer testing. Six measurements were made per each silicone surface and medians were calculated. Kruskal-Wallis and Mann-Whitney tests (SPSS v20) were used to check statistical significant differences between all groups and paired comparisons, respectively (P < 0.05). Statistical Analysis Used: Kruskal-Wallis and Mann-Whitney tests. Results: The SAH scores of additional silicones in direct contact with freshly placed composites were significantly less than SAH scores of additional silicones in direct contact with composites specimens aged for 1 week in 7 out of 9 combinations (P < 0.05). Only when Express™ and Elite HD+ were applied over freshly placed Filtek™ Bulk Fill flow, the SAH scores difference was not statistically significant to SAH scores of matching combinations applied after 1 week of composite storage. Conclusions: Freshly placed composite might affect setting of additional silicone impression materials. Dentists should carefully assess final impression on areas of prepared teeth that have received composite fillings recently.

Effect of universal adhesives on microtensile bond strength to hybrid ceramic.

BACKGROUND: The aim of this study was to evaluate the effect of universal adhesives (UA) and silane on the microtensile bond strength (µTBS) of resin cement to a hybrid ceramic Vita Enamic (VE). METHODS: VE specimens were acid etched using hydrofluoric acid (HF) and were assigned to three groups (n = 10) based on the applied bonding technique. In group 1 (S), a silane-based primer was used as a surface treatment prior to the application of a resin cement (Variolink Esthetic DC). In group 2, a silane-containing UA, Clearfil Universal Bond (CUB) was used for the surface treatment, and in group 3, A silane-free UA, Tetric N-Bond Universal (TNU) was used for surface treatment. Resin cement build-ups were prepared. The bonded specimens were sectioned into resin-ceramic beams. Half of the beams of each group were stored for 24 h at 37 °C and the other half were subjected to a thermo-cycling aging. The microtensile bond strength (µTBS) was measured at a crosshead speed of 0.5 mm/min. Failure modes were assessed accordingly. Data were analyzed using a) two-way analysis of variance ANOVA followed by one-way ANOVA and Tukey tests between groups and b) independent t-test to detect differences (α = 0.05) for each group. The surface topographies of the ceramic surface were evaluated using scanning electron microscopy. RESULTS: The results showed that silane-based primer (S) application resulted in significantly higher (p < 0.05) µTBS values after 24 h and after thermocycling compared to both silane-containing UA (CUB) and silane-free UA (TNU). The µTBS values of all groups were significantly reduced after thermocycling. No statistically significant difference was observed between the µTBS of CUB and TNU after 24 h. However, TNU showed significantly higher µTBS after thermocycling. Different failure modes were observed, and adhesive failure was the most common in all groups. Marked surface topographic changes were observed following HF etching. CONCLUSION: It is concluded that, the UAs tested cannot be recommended as substitutes to the silanization of Hybrid ceramic.

Developing an In-house Interdisciplinary Three-Dimensional Service: Challenges, Benefits, and Innovative Health Care Solutions.

Three-dimensional printing (3DP) technologies have been employed in regular medical specialties. They span wide scope of uses, from creating 3D medical models to design and manufacture of Patient-specific implants and guidance devices which help to optimize medical treatments, patient education, and medical training. This article aims to provide an in-depth analysis of factors and aspects to consider when planning to setup a 3D service within a hospital serving various medical specialties. It will also describe challenges that might affect 3D service development and sustainability and describe representative cases that highlight some of the innovative approaches that are possible with 3D technology. Several companies can offer such 3DP service. They are often web based, time consuming, and requiring special call conference arrangements. Conversely, the establishment of in-house specialized hospital-based 3D services reduces the risks to personal information, while facilitating the development of local expertise in this technology. The establishment of a 3D facility requires careful consideration of multiple factors to enable the successful integration with existing services. These can be categorized under: planning, developing and sustaining 3D service; 3D service resources and networking workflow; resources and location; and 3D services quality and regulation management.

Surface characteristics and biocompatibility of cranioplasty titanium implants following different surface treatments.

OBJECTIVE: Surface and mechanical properties of titanium alloys are integral for their use in restoring bone defects of skull and face regions. These properties are affected by the method of constructing and surface treatment of the titanium implant. This study aimed to investigate the effects of titanium finishing protocols on the surface morphology, hardness and biocompatibility of TiAl6V4. METHODS: Square shaped TiAl6V4 specimens (ASTM F68) (10×10×0.5mm) were divided into seven groups of different surface treatments (n=10). The treatments included mechanical polishing, sandblasting with AL2O3 (50µm), immersion in different acids, and/or electro-chemical anodization. Weight loss %; 3D micro-roughness; Knoop micro-hardness, and osteoblast cell attachment and proliferation (after 3 days) were determined for each specimen. Data was analysed using one way ANOVA and Dunett T3 post-hoc tests, and t-test (p<0.05). RESULTS: Weight loss % was in the range of 1.70-5.60 as mechanical polishing produced the highest weight loss, followed by sandblasting, and combined protocol of mechanical polishing and acid treatment (p<0.05). Micro-roughness values (µm) were in the range of 2.81-16.68. It was the highest for control specimens (p<0.05), and smoothest surfaces after combined mechanical polishing and acid treatment; or after electro-chemical treatment (p<0.05). Micro-hardness values (MPa) ranged 170.90-442.15 as sandblasting with/without acid treatment caused statically significantly the highest values (p<0.05) while control and mechanically polished specimens had the lowest values (p<0.05). All treatments produced equally biocompatible surfaces (p>0.05) after 1h or 3 days. Furthermore, osteoblast cell proliferation statistically significantly increased after 3days among each surface treatment (p<0.05). SIGNIFICANCE: Different finishing treatments have variable effect on cranioplasty titanium surface loss, micro-roughness and micro-hardness but constant improved biocompatibility effect. Electro-chemical treatment caused less material loss and produced biocompatible smoothest surface of comparable hardness; hence it can be suitable for cranioplasty titanium surface finishing.

Fracture load and survival of anatomically representative monolithic lithium disilicate crowns with reduced tooth preparation and ceramic thickness.

PURPOSE: To investigate the effect of reducing tooth preparation and ceramic thickness on fracture resistance of lithium disilicate crowns. MATERIALS AND METHODS: Specimen preparation included a standard complete crown preparation of a typodont mandibular left first molar with an occlusal reduction of 2 mm, proximal/axial wall reduction of 1.5 mm, and 1.0 mm deep chamfer (Group A). Another typodont mandibular first molar was prepared with less tooth reduction: 1 mm occlusal and proximal/axial wall reduction and 0.8 mm chamfer (Group B). Twenty crowns were milled from each preparation corresponding to control group (n=5) and conditioned group of simultaneous thermal and mechanical loading in aqueous environment (n=15). All crowns were then loaded until fracture to determine the fracture load. RESULTS: The mean (SD) fracture load values (in Newton) for Group A were 2340 (83) and 2149 (649), and for Group B, 1752 (134) and 1054 (249) without and with fatigue, respectively. Reducing tooth preparation thickness significantly decreased fracture load of the crowns at baseline and after fatigue application. After fatigue, the mean fracture load statistically significantly decreased (P<.001) in Group B; however, it was not affected (P>.05) in Group A. CONCLUSION: Reducing the amount of tooth preparation by 0.5 mm on the occlusal and proximal/axial wall with a 0.8 mm chamfer significantly reduced fracture load of the restoration. Tooth reduction required for lithium disilicate crowns is a crucial factor for a long-term successful application of this all-ceramic system.

Survey of Ocular Prosthetics Rehabilitation in the United Kingdom, Part 2: Anophthalmic Patients' Satisfaction and Acceptance.

AIM: Ocular prostheses are integral for anophthalmic patients. Part 1 of this study reported that patients' aetiology, opinions, and attitudes significantly affected their prosthetic eyes experience. Part 2 investigates the patient satisfaction and acceptance in light of some of the aetiological demographics reported in Part 1. METHODOLOGY: One hundred sixty questionnaires were delivered to anophthalmic patients attending oculoplastic clinic. Etiological aspects presented in the questionnaire were disseminated in part 1. Patient satisfaction was assessed through 8 closed-end statements reflecting aspects concerning patient's views on prosthesis comfort and appearance; patient's expectations, self-esteem, and perception; and cooperation with ocularist. Each statement had 3 categories as agree, moderately agree, and disagree. A total of 126 questionnaires were returned (response rate was 78.8%). Data was analyzed using SPSS software. Association coefficients and correlations between variables were also analyzed. RESULTS: Total number of responses for the 8 statements was 888, averaging of 111 (expected 126) respondent per statement. Overall, 95.4% of our patients agreed with all satisfaction statements presented echoing very high satisfaction rate with their ocular prosthetics. Having an eye replacement that covers the defect is associated with high satisfaction among patients regardless of ocular prosthetic type. Patient acceptance of prosthesis in relation to employment status was high but not the same among the different categories (P > 0.05). High satisfaction with ocular prosthetics was prevalent among both genders, but there were no statistically significant differences in percentages of agreement in all statements (P > 0.05). Satisfaction and acceptance with ocular prosthetics was the same among all age groups of 12 to 85 years old (P > 0.05). CONCLUSIONS: The patient satisfaction is associated with the interplay of different variables that is related to ocular prosthesis design and its ability to disguise disfigurement (ie, prosthesis shape, resemblance to existing contra-lateral eye, etc.); patients themselves (ie, gender, age, occupation, marital status, etc); and psychological well-being and social support provided. Anophthalmic patients of the north west of England are significantly happy with their ocular prosthetic rehabilitation and support they receive from their regional hospital. Ocular prosthetics enhances their psychological well-being and social interaction and factors like patients' sex, age, employment status, and type of ocular prosthesis have no effect on their acceptance and satisfaction.

Novel Treatment Planning of Hemimandibular Hyperplasia by the Use of Three-Dimensional Computer-Aided-Design and Computer-Aided-Manufacturing Technologies.

RATIONALE AND AIM: Hemimandibular hyperplasia is characterized by an obvious overgrowth in the size of the mandible on one side, which can extend up to the midline causing facial asymmetry. Surgical resection of the overgrowth depends heavily on the skill and experience of the surgeon. This report describes a novel methodology of applying three-dimensional computer-aided-design and computer-aided-manufacturing principles in improving the outcome of surgery in 2 mandibular hyperplasia patients. METHODOLOGY: Both patients had their cone beam computer tomography (CBCT) scan performed. CMF Pro Plan software (v. 2.1) was used to process the scan data into virtual 3-dimensional models of the maxilla and mandible. Head tilt was adjusted manually by following horizontal reference. Facial asymmetry secondary to mandibular hypertrophy was obvious on frontal and lateral views. Simulation functions were followed including mirror imaging of the unaffected mandibular side into the hyperplastic side and position was optimized by translation and orientation functions. Reconstruction of virtual symmetry was assessed and checked by running 3-dimensional measurements. Then, subtraction functions were used to create a 3-dimensional template defining the outline of the lower mandibular osteotomy needed. Precision of mandibular teeth was enhanced by amalgamating the CBCT scan with e-cast scan of the patient lower teeth. 3-Matic software (v. 10.0) was used in designing cutting guide(s) that define the amount of overgrowth to be resected. The top section of the guide was resting on the teeth hence ensuring stability and accuracy while positioning it. The guide design was exported as an .stl file and printed using in-house 3-dimensional printer in biocompatible resin. CONCLUSION: Three-dimensional technologies of both softwares (CMF Pro Plan and 3-Matic) are accurate and reliable methods in the diagnosis, treatment planning, and designing of cutting guides that optimize surgical correction of hemimandibular hyperplasia at timely and cost-effect manner.

Survey of Ocular Prosthetics Rehabilitation in the United Kingdom, Part 1: Anophthalmic Patients' Aetiology, Opinions, and Attitudes.

PURPOSE: Ocular prostheses are constructed to aid cosmetic, functional, and psychological rehabilitation of anophthalmic patients. Part-1 of this study aimed to evaluate anophthalmic patients' opinions, attitudes, and experience about aspects related to their postfit ocular prostheses. METHODS: One hundred sixty questionnaires were delivered to anophthalmic patients inquiring about different information such as age, gender, occupation, eye-loss cause, prosthesis type, prosthesis-wearing frequency, prosthesis-cleaning frequency, and problems encountered. A total of 126 questionnaires were returned (response rate was 78.8%). Data was analyzed using SPSS software (P <0.05). RESULTS: The patients were 74 males and 52 females (57.55 years ±â€Š17.57). Almost 50% of the patients lost their eye due to trauma that was the highest among other causes (P <0.05). High proportion clean their prosthesis daily (37.4%) which was the highest among other cleaning regimes (P <0.05). Almost 30.3% experienced having problems with their prosthetic eye. Patients who clean their prosthetic eye every 6 months have experienced more problems (P <0.05). Majority of patients wear their prosthetic eyes 24 hours (92%) (P <0.05). Half of patients who received a prosthetic eye for the first time experienced problems with it (P <0.05) such as excess discharge (45%), infection (25%), and soreness (20%). However, the problems were independent of prosthesis-type (P >0.05). CONCLUSIONS: Trauma is the most common cause of anophthalmic patients in the North-West of England. Anophthalmic patients are likely to experience problems with their prosthetic eye if they have lost their natural eye due to disease; it is their first prosthesis; or if they clean it once every 6 months.

Simultaneous Computer-Aided Design/Computer-Aided Manufacture Bimaxillary Orthognathic Surgery and Mandibular Reconstruction Using Selective-Laser Sintered Titanium Implant.

This patient report describes simultaneous bimaxillary orthognathic surgery and mandibular reconstruction by means of three-dimensional (3D) planning, 3D printed biocompatible surgical wafers, and 3D selective-laser sintered titanium implant. A 26-year-old male patient presented with a left mandibular defect secondary to trauma. The whole body of the mandible on the left hand side was deficient with a narrow connection with the remaining left condyle. He had undergone orthodontic treatment for 18 months and was ready to undergo bimaxillary orthognathic surgery. Advanced cranio-maxillofacial software was used in processing his cone beam computer tomography scan data, and e-casts of his upper and lower dental arches. Bimaxillary surgery was planned with Le Fort 1 maxillary impaction and mandibular advancement to achieve a class 1 incisor relationship. Intermediate and final surgical wafers were designed following the planned movements and printed using biocompatible resin. The deficient left side of the mandible was reconstructed by means of mirror imaging the contra-lateral right side into the deficient left side with the aim of restoring normal facial symmetry. Biomedical software was then used in designing a reconstruction plate that connected the condylar head and the mandible following the planned bimaxillary surgery and mandibular continuity symmetry reconstruction. The plate was printed in titanium following state-of the-art selective laser sintering technology. The bimaxillary surgery and mandibular reconstruction were done simultaneously as planned along with an iliac-crest bone graft. This patient confirms the advantages of 3D computer-aided design/computer-aided manufacture technologies in optimizing clinical outcomes for cranio-maxillofacial reconstruction, especially when conducting two simultaneous clinical procedures.