A Multidisciplinary Approach for Full-Mouth Rehabilitation in Oligodontia: A Clinical Report.

The absence of teeth in children due to congenital agenesis, syndromic or not, could lead to oral dysfunctions with general repercussions and sociopsychological problems. This case was a 17-year-old girl with severe nonsyndromic oligodontia who was missing 18 permanent teeth and had a class III skeletal pattern. It was challenging to provide functional and esthetically pleasing results in terms of temporary rehabilitation during growth and long-term rehabilitation in adulthood. This case report described the originality of the realization steps of oligodontia management, in 2 main parts. The osseous time by the LeFort 1 osteotomy advancement with simultaneous parietal and xenogenic bone grafting to improve a large bimaxillary bone volume, allowing future early implant placement by absence of growth of adjacent alveolar processes. The prosthetic rehabilitation with the conservation of natural teeth for proprioception and the use of a screw-retained polymethyl-methacrylate immediate prostheses to evaluate the needed vertical dimensional changes and make functional and esthetic results more predictable. This article could be retained as a technical note to manage this kind of case with the intellectual workflow and the difficulties encountered.

What about using sniffin' sticks 12 items test to screen post-COVID-19 olfactory disorders?

BACKGROUND: Post-COVID-19 Olfactory impairment has a negative impact on quality of life. The Sniffin Sticks test 12 items (SST-12) can be used in quick olfactory disorders screening. Its evaluation in a post-covid-19 situation was the main objective of this work. METHODS: All patient impaired with a post-COVID olfactory loss were included while consulting to the ENT department. The clinical examination included an olfaction recovery self-assessment (VAS), a nasofibroscopy, a quality of life (QoL) assessment, the complete Sniffin' Sticks Test (SST), and the SST-12. RESULTS: Among the 54 patients included, 92% (n = 50) were correctly screened as olfactory impaired by SST-12. We report excellent correlations between SST-12 and SST (rho (52) = 0.98, p < 0.001), QoL(rho(52) = 0.33 p = 0.016), or VAS (rho(52) = 0.49, p < 0.001) assessments. CONCLUSIONS: SST-12 is a quick and reliable tool to screen large-scale population of post-COVID-19 olfactory impaired patients and could be used in a general daily clinical practice.

Condylar repositioning according to digital bite registration method for virtual orthognathic surgery planning: A series of 49 consecutive patients.

INTRODUCTION: The accurate mandibular condylar positioning for orthognathic surgical planning is fundamental in obtaining a planned occlusal result. The differences between the position of condyles seen on computed tomography or cone-beam computed tomography (CBCT) scans and during surgery reduce the accuracy of the result. This study aimed to assess the differences between the condylar position recorded on CBCT and a numerical 3-dimensional (3D) model created after mandibular repositioning for orthognathic surgery planning. METHODS: This study retrospectively evaluated 49 patients who underwent virtual orthognathic surgery planning. The procedure involved recording a computed tomography or CBCT of the skull and dental surface using an intraoral digital scanner. The mandible was repositioned on the numerical 3D model according to the superimposed virtual bite registration in centric relation. Linear and angular measurements of the right and left condyles were recorded before and after mandibular repositioning. RESULTS: The positions of 98 condyles were compared. Linear measurements of the posterior and superior joint spaces revealed a significant difference. Subgroup analyses displayed statistically significant differences for patients with skeletal Class II malocclusion. CONCLUSION: According to the digital bite registration method, the difference between the mandibular position recorded on CBCT and on the numerical 3D model after repositioning may have clinical significance. Further studies are needed to validate this theory and test the accuracy of the clinical results.

Impact of a new combined preoperative cleft assessment on dental implant success in patients with cleft and palate: a retrospective study.

BACKGROUND: Bone height assessment alone is frequently used to guide rehabilitation choice, without consideration for soft tissues or adjacent teeth. This study aimed to evaluate the impact of different preoperative cleft assessments on implant success and patient satisfaction. METHODS: The study involved a retrospective assessment of records from 40 patients with cleft lip and palate (CLP). The alveolar cleft score (ACS; clinical criteria), interdental alveolar bone height (IABH) score (radiological criteria), patient compliance score (dental hygiene, medical visit observance, and smoking), and a novel combined score (IABH-ACS-Compliance) were assessed from patient records. Patients who required prosthetic tooth rehabilitation in the cleft dental arch space were included. Twenty-six patients (Group 1) were treated with dental implants, and 14 patients (Group 2) selected another prosthetic option (fixed prosthodontics, removal prosthesis), orthodontic space closure, or no rehabilitation. The main outcomes measured were relative implant success (no implant loss involving marginal bone loss ≤ 1.9 mm) for patients treated with dental implant therapy (Group 1) and patient satisfaction for all patients (Groups 1 and 2). RESULTS: Forty dental implants were placed in the patients in Group 1. Four implants in four patients (Group 1 relative failure, RF) were lost (implant survival rate of 90%) after 36 (± 12.4) months of follow-up. Twenty-two patients who received implants belonged to the relative implant success group (Group 1 RS). The average "IABH-ACS-Compliance" scores were significantly different (p < 0.05): 16.90 ± 2.35 and 12.75 ± 0.43 for the Group 1 RS and RF groups, respectively. CONCLUSIONS: Preoperative cleft parameters have an impact on relative implant success and patient satisfaction. The new cleft assessment combined-score ("IABH-ACS-Compliance") allows an accurate selection of cleft cases eligible for dental implants, thereby improving postoperative outcomes.

Intra-Individual Aging of the Facial Skeleton.

BACKGROUND: Midface skeletal changes through aging have been conceptualized as a clockwise rotation relative to the cranial base. This finding is mainly supported by cross-sectional population studies based on comparisons between groups of individuals in different age ranges. Few papers have evaluated the intra-individual evolution of the facial skeleton, and those that have included only a limited number of patients. OBJECTIVES: The authors sought to analyze the intra-individual evolution of the facial skeleton. METHODS: We conducted a retrospective study including patients who underwent 2 separate facial computed tomography scans (T1 and T2) with a minimum gap of 7 years. Employing 3-dimensional reconstructions, we measured and compared 7 facial angles (glabellar, orbital, piriform, maxillary, subdental, chin, gonial) and 6 facial distances (lacrimal crest, orbital floor, piriform, zygoma, labiomental, gnathion) on both computed tomography scans. RESULTS: A total of 56 patients (29 males and 27 females) were included. Mean ages at T1 and T2 were 50 and 59 y, respectively. We found a significant decrease between T1 and T2 in facial angles at the midface (glabella, orbital, piriform, and maxillary angles, all P < 0.0001). We found a significant increase in all facial distances between T1 and T2 for the overall population and for men (all P < 0.05). For women, all distances increased, but only piriform and zygoma distances showed significant changes (P < 0.001 and P < 0.04, respectively). Bone remodeling appeared earlier in women. CONCLUSIONS: Our study confirms the clockwise rotation of the midface during aging. This finding could lead to a better understanding of aesthetic medicine practices.

An original procedure for orbitonasal cutaneous infiltrative tumor repair, using combined forehead and melolabial propeller flaps.

INTRODUCTION: Resections of cutaneous tumors in the medial orbitonasal region can be transfixing. Repairs using a single local flap run the risk of failure and that of secondary sinonasal fistula, especially in cases of surgery on a radiated field. We propose an original and reliable repair procedure using two pedicled regional flaps vascularized by two distinct arterial systems clinched together to reconstruct the mucosal and cutaneous planes. MATERIALS AND METHODS: A first melolabial propeller flap (MPF) with a superior perforating pedicle was elevated and the cutaneous side was sutured to the deep plane of the loss of substance (mucosal lining). A second homolateral or contralateral paramedian forehead flap (PFF) was then lifted and sutured over the first flap (superficial plane). The forehead pedicle flap was divided at 1 month. RESULTS: No trophic complication or failure was recorded on two patients. The 7-year carcinologic, aesthetic, and functional results were satisfying. CONCLUSION: This technique involving the superimposition of two local flaps, vascularized by two different arterial systems, appears to offer a simple and reliable repair technique for transfixing cutaneous losses of substance in the medial orbitonasal region. It could be used in the first-line treatment, particularly if an additional radiotherapy is to be performed.

Otologic Outcomes With Two Different Surgical Protocols in Patients With a Cleft Palate: A Retrospective Study.

OBJECTIVE: To compare otologic outcomes in patients with cleft palate who underwent 2 different surgical protocols. DESIGN: Monocentric retrospective analysis of medical reports. PATIENTS, PARTICIPANTS: All consecutively treated patients affected by a cleft palate, born between January 1998 and December 2002 (group 1) and between January 2007 and December 2010 (group 2). INTERVENTIONS: Patients in group 1 underwent Veau-Wardill-Kilner palatoplasty at 10 months and had ventilation tubes inserted in case of otitis media with effusion (OME) during surgery. Patients in group 2 underwent Sommerlad intravelar veloplasty at 5 months. Ventilation tubes were inserted only in case of persistent OME. MAIN OUTCOME MEASURE(S): The need for a second set of ventilation tubes to be inserted in case of persistent OME, the presence of OME at the age of 2 years, and tympanic abnormalities at the age of 5 years were analyzed. RESULTS: There was no statistically significant difference either for the presence of OME at the age of 2 years (27 [45%] vs 32 [57.14%], respectively, in groups 1 and 2; P = .191) or for tympanic abnormalities at the age of 5 years (20 [33.33%] vs 15 [26.79%]; P = .433). Statistically significant difference was found for the need to insert a second set of ventilation tubes in case of persistent OME (29 [48.33%] vs 12 [21.42%], respectively; P = .02). CONCLUSION: Early Sommerlad intravelar veloplasty may reduce persistent OME and consequently the need for ventilation tubes insertion, compared to later Veau-Wardill-Kilner palatoplasty.

Facial Painting and 3D Stereophotogrammetric Analysis of Facial Dynamics: A Reliable Anatomical Educational Method.

(1) Background: Accurate knowledge of the dynamic anatomy of facial muscles is crucial for the use of functional and aesthetic botulinum toxin injections. We studied the reliability and relevance of facial painting as a pedagogic tool for the dynamic anatomy of facial muscles. (2) Methods: Different facial expressions were performed by a female model after a professional makeup artist applied makeup to the various facial muscles on her left hemiface. A 3D photograph was taken at the beginning and end of each movement using the VECTRA H2 Imaging System device. Cutaneous movements were visualized using displacement vectors. The correlation between the theoretical and dynamic positions of the makeup-muscle was assessed by two facial anatomy experts, thanks to a correlation scale. (3) Results: The overall average score for the 11 analyzed muscles or muscle groups was 3.36 out of 4, indicating a "strong" to "very strong" estimated correlation. There was a moderate agreement between Evaluator 1 and Evaluator 2 (ICC: 0.64; 95%CI: [0.244; 0.852]; p-value: 0.005). (4) Conclusions: The educational model with facial makeup provides an indirect but nonetheless precise and reliable representation of all facial muscles on the skin's surface. It is presented as a reliable and reproducible method, which exhibits great potential as a teaching tool.

Treatment of benign maxillomandibular osteolytic lesions larger than 4 cm: A systematic review.

OBJECTIVE: This systematic review aimed to assess the different treatments of benign maxillo-mandibular radiolucent bone lesions over 4 cm to propose a management algorithm. STUDY DESIGN: A literature search was conducted using MEDLINE/PubMed, Scopus, Google Scholar, Virtual Health Library databases, and gray literature. Randomized or non-randomized clinical trials and case series with 10 or more patients with a minimum follow up of 1 year, published in French or English until August 2023, were included. The risk of bias was assessed for all papers included. RESULTS: Of 1433 records identified, 22 were included in this review, reporting data from 1364 lesions. Ameloblastoma was the most common lesion (51.22%) and mandible was the most common site (81.21%). Initial conservative treatment was prevalent (71.04%). Recurrence was higher after conservative (13.8%) than after radical treatments (6.5%). Multilocularity, cortical perforation, dental element preservation were linked to a higher recurrence risk. CONCLUSION: This study has shown importance of understanding specific characteristics and recurrence risk in benign maxillomandibular osteolytic lesions. Multidisciplinary team approval, personalized approach based on lesion type and patient are crucial. The presence of at least one risk factor could lead to therapeutic decision. Despite limitations, the study informed lesion management and provided precise recommendations.

Impact of Orthodontic-Surgical Treatments on the Signs and Symptoms of Temporomandibular Disorders: A Systematic Review.

INTRODUCTION: Some patients exhibit temporomandibular joint or muscular disorders of the masticatory system before, during, or after orthognathic surgery (OS). These are collectively referred to as temporomandibular disorders (TMDs). This systematic literature review aimed to determine the relationship between orthodontic-surgical treatment and TMDs. METHODS: An electronic search of the PubMed database, supplemented by a manual search, was performed; the search included any studies published between 2021 (date of the last search in a systematic review of the literature on the subject) and June 2023 that evaluate the prevalence of TMDs during orthodontic-surgical treatment. The diagnosis of TMDs had to be established using the diagnostic algorithm "diagnostic criteria for temporomandibular disorders (DC/TMDs)", and the diagnosis of disc displacement had to be confirmed using magnetic resonance imaging (MRI). The data were extracted and statistically analyzed. RESULTS: Of the 100 results, seven eligible articles were included, representing a total of 529 cases undergoing orthodontic-surgical treatment. A reduction in joint noises (64.8%), arthralgia (57 to 77%), and myalgia (73 to 100%) was found after orthodontic-surgical treatment despite the fact that a minority of patients exhibited these signs and symptoms even though they were asymptomatic before treatment. The effects of OS on disc position were objectively unpredictable. After surgery, the presence of headaches decreased without significance and the risk of their occurrence was very low (1%). The studies converged toward a reduction in the amplitudes of mouth opening and lateral/protrusion movements. Finally, after the treatment, mandibular function was improved. CONCLUSION: Under the conditions of this study, OS seems to have a positive impact on the signs and symptoms of TMDs; however, it is not possible to predict the consequential effects on the position of the TMJ disc, whether it is initially in a normal position or displaced.

DentalSegmentator: Robust open source deep learning-based CT and CBCT image segmentation.

OBJECTIVES: Segmentation of anatomical structures on dento-maxillo-facial (DMF) computed tomography (CT) or cone beam computed tomography (CBCT) scans is increasingly needed in digital dentistry. The main aim of this research was to propose and evaluate a novel open source tool called DentalSegmentator for fully automatic segmentation of five anatomical structures on DMF CT and CBCT scans: maxilla/upper skull, mandible, upper teeth, lower teeth, and the mandibular canal. METHODS: A retrospective sample of 470 CT and CBCT scans was used as a training/validation set. The performance and generalizability of the tool was evaluated by comparing segmentations provided by experts and automatic segmentations in two hold-out test datasets: an internal dataset of 133 CT and CBCT scans acquired before orthognathic surgery and an external dataset of 123 CBCT scans randomly sampled from routine examinations in 5 institutions. RESULTS: The mean overall results in the internal test dataset (n = 133) were a Dice similarity coefficient (DSC) of 92.2 ± 6.3 % and a normalised surface distance (NSD) of 98.2 ± 2.2 %. The mean overall results on the external test dataset (n = 123) were a DSC of 94.2 ± 7.4 % and a NSD of 98.4 ± 3.6 %. CONCLUSIONS: The results obtained from this highly diverse dataset demonstrate that this tool can provide fully automatic and robust multiclass segmentation for DMF CT and CBCT scans. To encourage the clinical deployment of DentalSegmentator, the pre-trained nnU-Net model has been made publicly available along with an extension for the 3D Slicer software. CLINICAL SIGNIFICANCE: DentalSegmentator open source 3D Slicer extension provides a free, robust, and easy-to-use approach to obtaining patient-specific three-dimensional models from CT and CBCT scans. These models serve various purposes in a digital dentistry workflow, such as visualization, treatment planning, intervention, and follow-up.

Bone Formation and Maintenance in Oral Surgery: The Decisive Role of the Immune System-A Narrative Review of Mechanisms and Solutions.

Based on the evidence of a significant communication and connection pathway between the bone and immune systems, a new science has emerged: osteoimmunology. Indeed, the immune system has a considerable impact on bone health and diseases, as well as on bone formation during grafts and its stability over time. Chronic inflammation induces the excessive production of oxidants. An imbalance between the levels of oxidants and antioxidants is called oxidative stress. This physio-pathological state causes both molecular and cellular damage, which leads to DNA alterations, genetic mutations and cell apoptosis, and thus, impaired immunity followed by delayed or compromised wound healing. Oxidative stress levels experienced by the body affect bone regeneration and maintenance around teeth and dental implants. As the immune system and bone remodeling are interconnected, bone loss is a consequence of immune dysregulation. Therefore, oral tissue deficiencies such as periodontitis and peri-implantitis should be regarded as immune diseases. Bone management strategies should include both biological and surgical solutions. These protocols tend to improve immunity through antioxidant production to enhance bone formation and prevent bone loss. This narrative review aims to highlight the relationship between inflammation, oxidation, immunity and bone health in the oral cavity. It intends to help clinicians to detect high-risk situations in oral surgery and to propose biological and clinical solutions that will enhance patients' immune responses and surgical treatment outcomes.

The « patient casting ¼: a key decision in orthognathic surgery / Le « casting du patient ¼: clé de décision en chirurgie orthognathique

Introduction: The surgical orthodontic patient is a patient whose management is specific. The success of this protocol goes beyond of the right indication and the control of the pre-surgical orthodontic preparation of the treatment. The coordination revolves around a multidisciplinary team, namely an orthodontist, a maxillofacial surgeon, a physiotherapist, a speech therapist, a general practitioner, etc. but also with the collaboration of a specialized psychotherapist. Material and Method: Does the ideal « patient ¼ exist in orthognathic surgery? The decision criteria are morphological (occlusal, aesthetic and cephalometric) but also psychosocial. Results: A new classification called « psychological ¼ is proposed in this article. Conclusion: This new classification can be considered as a key decision in the « casting ¼ of the surgical orthodontic patient and represents a first basis for further investigations in this field.

Introduction: Le patient orthodontique chirurgical est un patient dont la prise en charge est spécifique. La réussite de ce protocole va au-delà de la pose de la bonne indication et de la maîtrise de la préparation orthodontique pré-chirurgicale du traitement. La coordination s'articule autour d'une équipe pluridisciplinaire, à savoir un orthodontiste, un chirurgien maxillofacial, un kinésithérapeute, un orthophoniste, un omnipraticien, entre autres, mais également avec la collaboration d'un psychothérapeute spécialisé. Matériel et méthode: Le « patient idéal ¼ existe-t-il en chirurgie orthognathique ? Les critères de décisions sont morphologiques (occlusaux, esthétiques et céphalométriques), mais aussi psycho-sociaux. Résultats: Une nouvelle classification dite « psychologique ¼ est proposée dans cet article. Conclusion: Cette nouvelle classification peut être considérée comme une clé de décision dans le « casting ¼ du patient orthodontique chirurgical et représente une première base pour de plus amples investigations dans ce domaine.

Management of postoperative outcomes of polytetrafluoroethylene membranes in alveolar ridge reconstruction: a systematic review.

Guided bone regeneration (GBR) is a validated technique with satisfactory outcomes during 30 years of follow-up. The use of polytetrafluoroethylene (PTFE) membrane for vertical augmentation has been studied extensively. However, studies have reported exposure rates of up to 31%, there is no consensus on the management of postoperative exposure. The objective of this study was to propose a management approach for postoperative exposure of polytetrafluoroethylene (PTFE) membranes in alveolar ridge reconstruction. MATERIAL AND METHOD: An electronic search in PubMed Central's and additional electronic databases was performed. The search strategy was limited to human studies, full-text English or French articles published from 1990 until april 2023. The extracted data included defect location, membrane type, biomaterials, time to postoperative exposure, and Fontana classification stage. Protocol bias assessment was performed using an adaptation of the QUADAS-2 tool. This review has been registered on PROSPERO (ID: CRD42023445497). RESULTS: A total of 43 articles were found to be eligible, and 11 of these met the predefined inclusion and exclusion criteria. Based on the results of this systematic review, an algorithm for the management of PTFE membrane exposure is proposed. CONCLUSION: Postoperative membrane exposure is not a determining factor for the success of bone grafting. In cases with postoperative complications, the majority of cases still achieved adequate implant-prosthetic rehabilitation. Lastly, this series of 11 articles was insufficient to draw conclusions regarding good practice recommendations. A larger series is required to validate the specific management approaches.

Accuracy of mandibular anterior subapical osteotomy by virtual planning in orthognathic surgery using patient-specific implants.

INTRODUCTION: Mandibular anterior subapical osteotomy (MASO) is a complementary procedure during orthognathic surgery to correct proclination or extrusion of the anterior incisors when orthodontic movements fail. The increasing use of patient-specific implants (PSI, titanium plates) in orthognathic surgery has extended to this procedure. Digital orthognathic surgery planning involves manufacturing cutting/drilling guides and specific implants to provide better accuracy and allow complex movement with reduced surgical times compared to conventional planning. This study aimed to assess the accuracy of computer-aided surgery with patient-specific implants in mobilising the MASO segment according to planning. METHODS: Eleven consecutive patients with mean age 26.82 years (15-41, SD = 10.65) were treated with MASO in addition to other conventional orthognathic procedures incorporating digital planning and patient-specific implants. A three-dimensional "stl" format file of the mandibular dental arch was obtained using an intraoral scanner at the end of the surgical procedure. The accuracy of the MASO segment displacement imposed by PSI was assessed by comparing preoperative 3D-planned mandibular dental arch with the immediate postoperative 3D-measured arch, using surface superimposition and 7 standard dental landmarks. Deviations between the preoperative and postoperative landmarks were calculated and compared to determine whether MASO segment repositioning is sufficiently accurate to be safely used to reposition the incisor/canine axis. RESULTS: Quantitative analysis revealed an absolute linear difference of 0.66 mm (SD = 0.51) between preoperative 3D digital dental arch impression and postoperative planned 3D dental arch. Overall, the median absolute discrepancies in the x-axis (right-left direction), y-axis (antero-posterior direction), and z-axis (supero-inferior direction) were respectively 0.56 mm (SD = 0.42), 0.77 mm (SD = 0.45) and 0.65 mm (SD = 0.61). CONCLUSION: A high degree of accuracy between the virtual plan and the immediate postoperative result was observed. According to our results, PSI can be used safely with accuracy in MASO as an adjunct to other conventional orthognathic procedures.

Stress distribution in the temporo-mandibular joint discs during jaw closing: a high-resolution three-dimensional finite-element model analysis.

PURPOSE: This study aims at analysing the stresses distribution in the temporomandibular joint (TMJ) using a complete high-resolution finite element model (FE Model). This model is used here to analyse the stresses distribution in the discs during a closing jaw cycle. In the end, this model enables the prediction of the stress evolution in the TMJ disc submitted to various loadings induced by mandibular trauma, surgery or parafunction. MATERIALS AND METHODS: The geometric data for the model were obtained from MRI and CT scans images of a healthy male patient. Surface and volume meshes were successively obtained using a 3D image segmentation software (AMIRA(®)). Bone components of skull and mandible, both of joint discs, temporomandibular capsules and ligaments and dental arches were meshed as separate bodies. The volume meshes were transferred to the FE analysis software (FORGE(®)). Material properties were assigned for each region. Boundary conditions for closing jaw simulations were represented by different load directions of jaws muscles. The von Mises stresses distribution in both joint discs during closing conditions was analyzed. RESULTS: The pattern of von Mises stresses in the TMJ discs is non-symmetric and changed continuously during jaw movement. Maximal stress is reached on the surface disc in areas in contact with others bodies. CONCLUSIONS: The three-dimension finite element model of masticatory system will make it possible to simulate different conditions that appear to be important in the cascade of events leading to joint damage.

Accuracy of Segmented Le Fort I Osteotomy with Virtual Planning in Orthognathic Surgery Using Patient-Specific Implants: A Case Series.

Background: When maxillary transversal expansion is needed, two protocols of treatment can be used: a maxillary orthodontic expansion followed by a classical bimaxillary osteotomy or a bimaxillary osteotomy with maxillary segmentation. The aim of this study was to assess the accuracy of segmented Le Fort I osteotomy using computer-aided orthognathic surgery and patient-specific titanium plates in patients who underwent a bimaxillary osteotomy for occlusal trouble with maxillary transversal insufficiencies. Methods: A virtual simulation of a Le Fort I osteotomy with maxillary segmentation, a sagittal split ramus osteotomy, and genioplasty (if needed) was conducted on a preoperative three-dimensional (3D) model of each patient's skull using ProPlan CMF 3.0 software (Materialise, Leuven, Belgium). Computer-assisted osteotomy saw-and-drill guides and patient-specific implants (PSIs, titanium plates) were produced and used during the surgery. We chose to focus on the maxillary repositioning accuracy by comparing the preoperative virtual surgical planning and the postoperative 3D outcome skulls using surface superimpositions and 13 standard dental and bone landmarks. Errors between these preoperative and postoperative landmarks were calculated and compared to discover if segmental maxillary repositioning using PSIs was accurate enough to be safely used to treat transversal insufficiencies. Results: A total of 22 consecutive patients­15 females and 7 males, with a mean age of 27.4 years­who underwent bimaxillary computer-assisted orthognathic surgery with maxillary segmentation were enrolled in the study. All patients presented with occlusion trouble, 13 with Class III malocclusions (59%) and 9 (41%) with Class II malocclusions. A quantitative analysis revealed that, overall, the mean absolute discrepancies for the x-axis (transversal dimension), y-axis (anterior−posterior dimensions), and z-axis (vertical dimension) were 0.59 mm, 0.74 mm, and 0.56 mm, respectively. The total error rate of maxillary repositioning was 0.62 mm between the postoperative cone-beam computed tomography (CBCT) and the preoperatively planned 3D skull. According to the literature, precision in maxilla repositioning is defined by an error rate (clinically relevant) at each landmark of <2 mm and a total error of <2 mm for each patient. Conclusions: A high degree of accuracy between the virtual plan and the postoperative result was observed.

Review of bone graft and implant survival rate : A comparison between autogenous bone block versus guided bone regeneration.

In oral surgery, there is a multitude of bone augmentation techniques and biomaterials choices. Autogenous bone is considered the gold standard in bone graft due to its biocompatibility, osteoinduction, osteoconduction and osteogenic properties. An alternative to autogenous bone grafting is the guided bone regeneration technique. The objective of this review is to compare the results of implant survival in an autogenous bone block compared to those in a graft by guided bone regeneration. An electronic search in PubMed Central's database was performed. The search strategy was limited to human studies, full-text English or French articles published from 1996 until may 2020. All types of autogenous bone block and guided bone regeneration techniques were evaluated. In total 16 articles were included. The overall survival rate of implants was 97,9% in autogenous block (range: 95.6-100%) and 98,5% (range: 94.4-100%) in GBR. The implant survival rate does not differ between the two types of bone graft in a guided bone regeneration or in an autogenous bone block. They are comparable to the current literature data. The choice of an appropriate treatment is based on several factors related to the patient and the anatomy of the defects.

Artificial intelligence for oral and maxillo-facial surgery: A narrative review.

Artificial Intelligence (AI) is a set of technologies that simulate human cognition in order to address a specific problem. The improvement in computing speed, the exponential production and the routine collection of data have led to the rapid development of AI in the health sector. In this review, we propose to provide surgeons with the essential technical elements to help them understand the possibilities offered by AI and to review the current applications of AI for oral and maxillofacial surgery (OMFS). The review of the literature reveals a real research boom of AI in all fields in OMFS. The algorithms used are related to machine learning, with a strong representation of the convolutional neural networks specific to deep learning. The complex architecture of these networks gives them the capacity to extract and process the elementary characteristics of an image, and they are therefore particularly used for diagnostic purposes on medical imagery or facial photography. We identified representative articles dealing with AI algorithms providing assistance in diagnosis, therapeutic decision, preoperative planning, or prediction and evaluation of the outcomes. Thanks to their learning, classification, prediction and detection capabilities, AI algorithms complement human skills while limiting their imperfections. However, these algorithms should be subject to rigorous clinical evaluation, and ethical reflection on data protection should be systematically conducted.

Management of vascular complications following facial hyaluronic acid injection: High-dose hyaluronidase protocol: A technical note.

Aesthetic medicine has experienced major developments in recent years, which is illustrated by the increasing number of hyaluronic acid injected in the area of facial rejuvenation. Although considered low risk, it can rarely result in arterial embolization with potentially major aesthetic and functional consequences. These vascular complications range from livedo to skin necrosis to permanent blindness. In such cases the management is urgent. Early care leads to a successful recovery but most of the time the diagnosis is delayed. Several treatments have been suggested and the use of hyaluronidase is decisive. There is no official guideline on the use of hyaluronidase. The aim of this article is to propose a protocol to clarify the management of vascular complications of HA with high doses of hyaluronidase based on the literature and our clinical experience of 35 patients treated.