Peri-implant health after microvascular head and neck reconstruction-A retrospective analysis.

INTRODUCTION: Prosthodontic rehabilitation after reconstruction with microvascular revascularized free flaps following ablative tumor surgery is challenging due to the altered anatomical and functional conditions. The aim of this retrospective study was to determine whether the type of graft and the type of peri-implant tissue have an effect on peri-implant inflammatory parameters and implant survival. MATERIALS AND METHODS: Patients who received a free flap reconstruction with subsequent implant-prosthetic rehabilitation between 2010 and 2022 were retrospectively included. The primary outcome variable was the probing depth (PPD) at a minimum of 1 year after completion of prosthetic restoration. Predictive variables were type of free flap, emergence profile, and history of radiation. RESULTS: Seventy-one patients after free flap reconstruction were included in the analysis. At a minimum of 24 months after implant insertion the primary outcome, PPD showed no clinically relevant differences between the types of free flaps used. The emergence profile through a skin island resulted in an increase in BOP compared to native mucosa in the descriptive analysis (p-value > .05). The analysis showed a 5-year implant survival of 96.2% (95% CI: 0.929-0.996) in cases without irradiation and 87.6% (95% CI: 0.810-0.948) with irradiation of the region evaluated (p-value .034). CONCLUSION: Flap and associated soft tissue type had no significant effect on 5-year implant survival or peri-implant inflammatory parameters. However, the large heterogeneity of the patient population indicates that further prolonged studies are required for a more differentiated assessment of the long-term success.

Do Functional Scores of Flap Donor Sites Recover After Reconstruction of Segmental Jaw Defects?

PURPOSE: The potential for donor-site morbidity in major maxillofacial reconstruction remains a concern. The purpose of this study was to compare the outcome of donor-site morbidity of deep circumflex iliac artery (DCIA) and scapula free flaps after radical treatment of the jaw and flap reconstruction. PATIENTS AND METHODS: We implemented a prospective cohort study design. Patients requiring segmental resection for benign pathology underwent reconstruction with either DCIA or scapula free flaps. The primary predictor variable was the use of DCIA versus scapula free flaps. The primary outcome variables were changes in orthopedic functional scores for both donor sites. The secondary outcome variable was neurosensory recovery at the recipient site. RESULTS: We included 8 patients in this study, comprising 3 women (38%) and 5 men (62%). Orthopedic scores were assigned preoperatively (T0) and at follow-up appointments at 1 to 3 months postoperatively (T1) and 6 to 12 months postoperatively (T2). In patients with DCIA flaps, a significant reduction (P = .0096) in the Larson I score between examination time points T0 and T1 was found. The score then improved on the operated side between T1 and T2 by an average of 29 points and showed no significant difference compared with the T0 level (P = .68). Patients with a scapular graft showed a significant reduction (P = .004) in the Constant-Murley score on the operated side between T0 and T1. The Constant-Murley score again improved significantly (P = .0136) between T1 and T2. Most of the patients (n = 7, 88%) had a neurologically unremarkable local situation of the recipient site at T0. At T1, 1 patient had level A (mild) neurosensory disorder and 1 had level B (moderate). At T2, all patients' initial neurologic scores were restored. CONCLUSIONS: The donor-site morbidity associated with DCIA and scapula flap reconstruction is a short-term condition and returns to baseline by 3 to 6 months postoperatively.

Estimates of wind power and radiative near-inertial internal wave flux: The hybrid slab model and its application to the North Atlantic.

Energy transfer mechanisms between the atmosphere and the deep ocean have been studied for many years. Their importance to the ocean's energy balance and possible implications on mixing are widely accepted. The slab model by Pollard (Deep-Sea Res Oceanogr Abstr 17(4):795-812, 1970) is a well-established simulation of near-inertial motion and energy inferred through wind-ocean interaction. Such a model is set up with hourly wind forcing from the NCEP-CFSR reanalysis that allows computations up to high latitudes without loss of resonance. Augmenting the one-dimensional model with the horizontal divergence of the near-inertial current field leads to direct estimates of energy transfer spectra of internal wave radiation from the mixed layer base into the ocean interior. Calculations using this hybrid model are carried out for the North Atlantic during the years 1989 and 1996, which are associated with positive and negative North Atlantic Oscillation index, respectively. Results indicate a range of meridional regimes with distinct energy transfer ratios. These are interpreted in terms of the mixed layer depth, the buoyancy frequency at the mixed layer base, and the wind field structure. The average ratio of radiated energy fluxes from the mixed layer to near-inertial wind power for both years is approximately 12%. The dependence on the wind structure is supported by simulations of idealized wind stress fronts with variable width and translation speeds.

Oral health-related quality of life and standard of treatment in aggressive periodontitis patients more than 5 years after therapy.

OBJECTIVES: To assess OHRQoL in patients with aggressive periodontitis (AgP) after periodontal treatment using the Oral Health Impact Profile-49 (OHIP-49) and compare to patients' dental status. MATERIAL AND METHODS: More than 5 years after therapy, 71 patients were examined and answered the OHIP-questionnaire. The dental and periodontal status were assessed according to the SSO (Swiss Dental Society) criteria. Descriptive statistics were performed with SPSS, correlation analysis and tests for differences using R 3.2.2. RESULTS: More than 90% of all patients showed no probing depths (PD) >5 mm, a bleeding on probing (BOP) index below 35%, and a sufficient function. Four patients showed no visible plaque, PDs ≤ 3 mm, a BOP below 10%, and an optimum function. Non-smoking and compliant patients exhibited a more favourable status. The OHIP-49 added up to 24.9 points, representing a comparatively high satisfaction of AgP-patients with their oral status. The subscale which most patients reported impairment in was "functional limitation." A correlation between quality standard and the OHIP-49G could only be shown in the psychological disability subscale. CONCLUSION: After treatment, a moderate to high quality level can be retained over more than 5 years. Most patients are satisfied with their oral health. Correlations between the objective and subjective view could not be found, apart from the subscale "psychological disability."

Reconstruction of the severely atrophic edentulous maxillae with calvarial bone grafts.

OBJECTIVES: Treatment of the severely atrophic maxilla with dental implants is challenging due to the insufficient horizontal and vertical bone volume and centripetal resorption pattern of the maxilla. Bone-augmentation procedures are often necessary prior to implant placement. The objective of this study was to assess the suitability of using calvarial bone grafts to enable implant placement in severely atrophic maxillae. MATERIAL AND METHODS: Seventeen patients with severe atrophic edentulous maxillae were reconstructed with autogenous calvarial bone grafts. After a 4-month healing period, the patients received a total of 134 dental implants, which were left to heal in submerged positions for 3 months before prosthetic rehabilitation was performed. Patients were followed clinically and radiographically for an average observation period of 53.94 months. RESULTS: At the intraoral recipient sites, two infections developed, causing partial loss of the respective bone grafts. Implant placement, however, was possible at all sites. No donor-site complications occurred. Two of 134 implants were lost in two patients prior to prosthetic loading. The implant survival rate was 98.51%. The implant success rate was 87.6%, and a mean marginal bone loss of 0.62 mm (SD 0.77 mm) was documented. CONCLUSIONS: Patients with severe bone atrophy of the edentulous maxilla can be successfully reconstructed with calvarial bone grafts and dental implants and show a stable clinical and radiographic situation after a mean observation period of 53 months.

Periodontal pathogens and associated factors in aggressive periodontitis: results 5-17 years after active periodontal therapy.

OBJECTIVES: To assess the association between presence of periodontal pathogens and recurrence of disease in patients with aggressive periodontitis (AgP) after active periodontal therapy (APT) and further influencing factors. MATERIAL & METHODS: Microbiological samples were taken from 73 patients with AgP 5-17 years after APT at 292 sites (deepest site per quadrant). Real-time polymerase chain reactions were used to detect the periodontal pathogens Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola. Uni- and multivariate analyses evaluated the associations between pathogens and recurrence of disease, smoking and adjunctive antibiotic therapy. RESULTS: At re-examination A. actinomycetemcomitans could be detected in six patients (8.2%), P. gingivalis in 24 (32.9%), T. forsythia in 31 (42.5%) and T. denticola in 35 (48.0%). Increased levels of T. forsythia and T. denticola at re-examination were significantly associated with recurrence of disease in multivariate analyses (OR: 12.72, p < 0.001; OR 5.55, p = 0.002 respectively). Furthermore, high counts of T. denticola were found in patients with increased percentage of sites with clinical attachment levels (CAL) ≥ 6 mm compared to those with low counts (13.8% versus 3.2%, p = 0.005). CONCLUSION: In patients with recurrence of disease T. forsythia and T. denticola were detected more frequently and in higher counts. Furthermore, T. denticola was found more frequently in patients with increased CAL.

Early bone resorption after vertical bone augmentation--a comparison of calvarial and iliac grafts.

OBJECTIVE AND AIM: Severe cases of bone atrophy in the maxilla or mandible are often reconstructed using bone from extraoral donor sides. Most commonly, grafts from the iliac crest are used for augmentation, however, frequently associated with bone resorption as possible late complication. Calvarial bone grafts, often reported to show less resorption, are an alternative. The aim of this study was to compare the bone stability of vertical bone grafts from the iliac crest and the calvarium. PATIENTS AND METHODS: Twenty-three patients receiving vertical onlay bone grafts were included in this retrospective cohort study. In nine patients alveolar ridge defects were treated with bone from the iliac crest. Fourteen patients were reconstructed using calvarial bone grafts. To quantify bone resorption, the data of digital panographs were evaluated. Radiographs were taken prior to bone grafting, after augmentation surgery, 6 months after bone healing, prior to implant surgery, after implant surgery and at yearly intervals thereafter. RESULTS: Postoperative complications at the recipient site occurred equally in both groups. The complication rate was 35.7% for the calvarial group and 33.3% in the iliac crest group. No donor-site complications were reported in either group. After bone augmentation procedure, a mean vertical bone gain of 8.55 mm (SD 5.96) was measured. Bone grafts from the iliac crest showed a significantly higher bone loss of 24.16% (SD 8.47) than grafts from the calvarium (8.44%, SD 3.64) at the time of implant placement (P = 0.0003). Implant survival was similar in both groups. DISCUSSION: Both bone-grafting approaches are successful and reliable techniques, enabling implant placement in even highly atrophied alveolar ridges and with identical implant survival rates, although bone resorption differs. Within the limitations of this study bone from the calvarium shows higher bone stability in the early healing phase.

Full block or split block?-Comparison of two different autogenous block grafting techniques for alveolar ridge reconstruction.

OBJECTIVE: To evaluate radiographic bone gain after alveolar ridge augmentation with two different designs of autogenous block graft harvested from the mandible. MATERIALS AND METHODS: Alveolar ridge defects were evaluated by preoperative cone beam computed tomography (CBCT) and grafted in a staged approach using intraoral block grafts. The ridge augmentation was either performed using the full-block technique (group 1) or the split-block technique (cortical plate with autogenous bone chips) (group 2). After 4 months of bone healing, a further CBCT scan was performed before implant placement. Horizontal and vertical bone gain were measured. RESULTS: In this retrospective study, 91 patients were grafted with block grafts (36 patients with full-block grafts; 55 patients with split-block grafts) resulting in 171 block grafts in total. The mean horizontal bone gain was 3.37 ± 0.71 mm in group 1 and 5.79 ± 2.20 mm in group 2. A linear mixed-effect model also showed a statistically significant group difference (p < 0.001, estimate: 3.455, 95% CI: [2.082-4.829]). The mean vertical bone gain was 2.85 ± 0.73 mm in group 1 and 7.60 ± 1.87 mm in group 2. A linear mixed-effect model also showed a statistically significant group difference (p: 0.029, estimate: 3.126, 95% CI: [0.718-5.557]). Mean marginal bone level was 0.33 ± 0.37 mm (group 1) and 0.17 ± 0.29 mm (group 2). CONCLUSION: The split-block technique resulted in a greater bone gain than the full-block technique. This effect was observed in both the vertical and the horizontal dimensions.

Comparison of Different Antibiotic Regimes for Preventive Tooth Extractions in Patients with Antiresorptive Intake-A Retrospective Cohort Study.

In the present study, the impacts on success rates between three different antibiotic regimes in patients receiving preventive tooth extraction during/after antiresorptive treatment were compared. For the retrospective analysis, we enrolled patients who had undergone tooth extraction from 2009 to 2019 according to the specified preventive conditions under antiresorptive therapy. Three antibiotic regimens were distinguished: (Group 1) intravenous for 7 days, (Group 2) oral for 14 days, and (Group 3) oral for 7 days of application. The primary endpoint was the occurrence of medication-related osteonecrosis of the jaw at 12 weeks after surgery. A total of 760 patients and 1143 extraction regions were evaluated (Group 1 n = 719; Group 2 n = 126; Group 3 n = 298). The primary endpoint showed no significant difference in the development of medication-related osteonecrosis of the jaw between the groups studied (Group 1 n = 50/669 (7%); Group 2 n = 9/117 (7%); Group 3 n = 17/281 (6%); p = 0.746). Overall, the success rate was 93% after intervention when preventive measures were followed. With the same success rate, a reduced, oral administration of antibiotics seems to be sufficient regarding the possible spectrum of side effects, the development of resistance and the health economic point of view.

Colitis ameliorates cholestatic liver disease via suppression of bile acid synthesis.

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by chronic inflammation and progressive fibrosis of the biliary tree. The majority of PSC patients suffer from concomitant inflammatory bowel disease (IBD), which has been suggested to promote disease development and progression. However, the molecular mechanisms by which intestinal inflammation may aggravate cholestatic liver disease remain incompletely understood. Here, we employ an IBD-PSC mouse model to investigate the impact of colitis on bile acid metabolism and cholestatic liver injury. Unexpectedly, intestinal inflammation and barrier impairment improve acute cholestatic liver injury and result in reduced liver fibrosis in a chronic colitis model. This phenotype is independent of colitis-induced alterations of microbial bile acid metabolism but mediated via hepatocellular NF-κB activation by lipopolysaccharide (LPS), which suppresses bile acid metabolism in-vitro and in-vivo. This study identifies a colitis-triggered protective circuit suppressing cholestatic liver disease and encourages multi-organ treatment strategies for PSC.

Quantification of Remimazolam Besylate (CNS7056B) and Its Metabolite (CNS7054X) by LC-MS/MS in Human Plasma Using Midazolam-d4 Maleate as Internal Standard.

A new assay was developed to measure the concentration of remimazolam besylate (CNS7056B) and its major carboxylic acid metabolite (CNS7054X) in human plasma. For this new assay method, midazolam-d4 maleate was used as an internal standard. After setting up a previously described assay method, using CNS7056-d4 and CNS7054-d4 as internal standards, analytical results of both methods were compared. For the new analytical method, ultra-high-performance liquid chromatography (UHPLC) with tandem mass spectrometry was applied. A purification method, using solid phase extraction, was developed and validated. The chromatographic separation of the analytes was achieved with a mobile phase gradient using a Water Acquity™ UHPLC-System. The Kinetex™ biphenyl 50 × 2.1 mm UHPLC column was used with a particle diameter of 1.7 µm (Phenomenex, Germany). A measuring range of 0.6-2,000 ng/mL for CNS7056B and of 6-20,000 ng/mL for CNS7054X could be achieved with this new assay. The lower limit of quantification was 0.6 ng/mL for CNS7056B and 6 ng/mL for CNS7054X. The assay was validated according to US Food and Drug Administration guidelines. The new method showed an accuracy of 96.9-110.4% and a precision of 2.1-6.7% for both analytes.

Volcanically hosted venting with indications of ultramafic influence at Aurora hydrothermal field on Gakkel Ridge.

The Aurora hydrothermal system, Arctic Ocean, hosts active submarine venting within an extensive field of relict mineral deposits. Here we show the site is associated with a neovolcanic mound located within the Gakkel Ridge rift-valley floor, but deep-tow camera and sidescan surveys reveal the site to be ≥100 m across-unusually large for a volcanically hosted vent on a slow-spreading ridge and more comparable to tectonically hosted systems that require large time-integrated heat-fluxes to form. The hydrothermal plume emanating from Aurora exhibits much higher dissolved CH4/Mn values than typical basalt-hosted hydrothermal systems and, instead, closely resembles those of high-temperature ultramafic-influenced vents at slow-spreading ridges. We hypothesize that deep-penetrating fluid circulation may have sustained the prolonged venting evident at the Aurora hydrothermal field with a hydrothermal convection cell that can access ultramafic lithologies underlying anomalously thin ocean crust at this ultraslow spreading ridge setting. Our findings have implications for ultra-slow ridge cooling, global marine mineral distributions, and the diversity of geologic settings that can host abiotic organic synthesis - pertinent to the search for life beyond Earth.

Implant-supported fixed prostheses in the edentulous maxilla: 8-year prospective results.

OBJECTIVE: The purpose of this prospective study was to evaluate the long-term survival and success rates of implants and screw-retained, full-arch prostheses placed in edentulous maxillae over 8 years of function. MATERIALS AND METHODS: A total of 106 Astra Tech implants were placed in the maxillae of 17 edentulous patients in a one-stage surgical approach. After a healing period of 6 months, the patients received fixed screw-retained bridges. Follow-up visits, including clinical and radiographic examinations, were performed after 6 months and at yearly intervals. Implant survival, implant success, and marginal bone-level changes were defined as the primary outcome variables. The secondary aims were to report periodontal pathogens at 5 years' follow-up and patients' satisfaction at the 8-year follow-up. RESULTS: The overall observation time was 8 years. One patient died during the study and one implant failed during the healing period, yielding an 8-year cumulative implant survival rate of 99%. The prosthetic survival rate was 100%. The mean crestal bone loss amounted to 0.3 ± 0.72 mm. Patients' subjective evaluations demonstrated an overall high level of satisfaction. In all cases, except for one, microbiologic probing of the peri-implant sulcus after 5 years showed no higher incidence of periodontal pathogens. CONCLUSIONS: Screw-retained, full-arch restorations on six implants in an edentulous maxilla are a predictable and highly successful treatment concept as observed throughout this study with an observation period of 8 years of function, in particular with respect to low crestal bone loss and high patient satisfaction.

Early and immediate loading of titanium implants with fluoride-modified surfaces: results of 5-year prospective study.

OBJECTIVE: Multiple experimental and animal studies have shown that topographic, mechanical and chemical properties of implant surfaces lead to in vivo responses such as increased bone formation, increased bone anchorage and reduced healing time. A fluoride modification of the titanium implant surface also seems to positively influence bone anchorage as compared with unmodified titanium implants. Using implant survival and marginal bone loss as primary outcome parameters, the purpose of the present prospective study was to investigate whether a fluoride modification of the titanium implant surface has positive clinical effects. MATERIALS AND METHODS: The 17 patients included in this study received 49 Astra Tech OsseoSpeed implants for various indications in the maxilla and mandible. Implants were either loaded immediately or after a mean healing period of 9.56 weeks. Fifteen patients were followed up clinically including radiographic examination for 5 years. Forty-two implants were assessed for implant survival, marginal bone loss, surgical and/or prosthetic complications, presence or absence of plaque, signs of inflammation and size of the papilla. RESULTS: Of the original 17 patients, 15 patients were available for the full 60-month follow-up. One early implant failure occurred, leading to an implant survival rate of 97%. Radiographic analyses demonstrated stable bone conditions with a mean marginal bone loss of 0.1 mm (SD 0.4 mm, min -0.7 mm, max 1.7 mm) after 5 years of function. Immediately loaded implants did not show a different mean marginal bone loss as compared with implants that were not loaded immediately. Repeated soft-tissue examinations revealed healthy conditions in terms of 6.1% plaque and 4.2% of the implants with signs of inflammation at the 5-year control. DISCUSSION: Implants used in this study had high survival and success rates after 5 years. Marginal bone was well maintained, irrespective of the loading regime.

The effect of different soft-tissue management techniques for alveolar ridge preservation: a randomized controlled clinical trial.

PURPOSE: For alveolar ridge preservation, various treatment protocols have been described. While most studies focus on the effect of the bone graft material, the aim of this study was to analyze the influence of different soft-tissue management techniques on the soft and hard tissue. METHODS: A total of 20 maxillary extraction sockets were grafted with an anorganic xenogenic bone graft and then randomly treated with either a combined epithelialized-subepithelial connective tissue graft (CECG) or a porcine collagen matrix (CM) placed in labial and palatal tunnels. Measurements of soft-tissue thickness were performed at tooth extraction (T0), implant insertion (T1) and second stage surgery (T2). RESULTS: In the CECG group, gingival thickness was 1.18 ± 0.56 mm (T0), 1.29 ± 0.26 mm (T1) and 1.2 ± 0.32 mm (T3). In the CM group, the measurements were 1.24 ± 0.50 mm (T0), 1.6 ± 0.6 mm (T1) and 1.7 ± 1.06 mm. Thus, there was an overall increase in gingival thickness from T0 to T2 of 0.02 ± 0.66 mm (CECG) compared to 0.46 ± 0.89 mm (CM). The thickness of keratinized soft-tissue was 3.91 ± 1.11 mm (CECG) and 4.76 ± 1.48 mm (CM) before extraction and 3.93 ± 1.17 mm (CECG) and 4.22 mm ± 1.26 mm (CM) at implant follow-up. Mean peri-implant probing depths were 3.15 ± 1.39 mm (CECG) and 3.41 ± 0.99 mm (CM). CONCLUSIONS: After ridge preservation, comparable soft-tissue parameters were observed in both groups, whether treated with a collagen matrix or a combined autologous connective tissue graft.

Mandibular Brown Tumor as a Result of Secondary Hyperparathyroidism: A Case Report with 5 Years Follow-Up and Review of the Literature.

BACKGROUND: Brown tumor is a rare skeletal manifestation of secondary hyperparathyroidism. Although diagnosis of the disease is increasingly seen in early stages due to improved screening techniques, some patients still present in a progressed disease stage. The treatment depends on tumor mass and varies from a conservative approach with supportive parathyroidectomy to extensive surgical resection with subsequent reconstruction. CASE PRESENTATION: We report a case of extensive mandibular brown tumor in a patient with a history of systemic lupus erythematosus, chronic kidney disease, and secondary hyperparathyroidism. Following radical resection of the affected bone, reconstruction could be successfully performed using a free flap. CONCLUSIONS: There were no signs of recurrence during five years of close follow-up. Increased awareness and multidisciplinary follow-ups could allow early diagnosis and prevent the need for radical therapeutical approaches.

The Influence of Different Graft Designs of Intraoral Bone Blocks on Volume Gain in Bone Augmentation Procedures: An In Vitro Study.

PURPOSE: Intraoral bone blocks from the external oblique are the gold standard for alveolar ridge bone grafting, but the limited amount of available bone limits their use for larger defects. The objective of this study was to compare whether different graft designs of intraoral bone blocks could affect the amount of bone gain. MATERIALS AND METHODS: In this in vitro study, 20 pig jaws were used to harvest bone blocks and subsequently augment single-wall bone defects. Each bone graft was first used as a full block, and then the same block was divided lengthwise into two blocks, with one block fixed at a distance as a cortical shell and the second block particulated to fill the gap between graft and bone. Three stereolithographic (STL) files (pre-OP, full block, split block) were generated using an intraoral scanner. All STL files were evaluated for volume gain and horizontal bone dimensions. RESULTS: A mean volume gain of 0.36 cm2 (SD: 0.09) was achieved for the full block and 0.78 cm2 (SD: 0.14) for the split block using the same block. The difference was statistically significant (P < .0001). A mean horizontal bone gain of 4.37 mm (SD: 0.93) was achieved with a full block and 5.77 mm (SD: 0.85) with the shell technique (P < .0001). CONCLUSION: With the same amount of bone removed, first as a full block and then as a split block, the split-block technique achieved a significantly higher bone gain compared with the full-block design.

[Compulsive buying and psychiatric comorbidity]. / Pathologisches Kaufen und psychische Komorbidität.

Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

The influence of wound closure on graft stability: An in vitro comparison of different bone grafting techniques for the treatment of one-wall horizontal bone defects.

OBJECTIVES: The aim of this preclinical study was to analyze and compare different grafting techniques with respect to volume stability after wound closure. MATERIALS AND METHODS: Four different grafting techniques were evaluated in vitro for volume stability in a one-wall horizontal defect configuration. Group 1: guided bone regeneration (GBR) with collagen membrane, particulated xenograft; group 2: GBR with collagen membrane, particulated xenograft, pins; group 3: GBR with titanium-reinforced membrane, particulated xenograft, pins; group 4: autogenous block graft, particulated xenograft, collagen membrane. Cone beam computed tomography scans were performed before and after wound closure, and the horizontal bone dimensions were analyzed for stability at 0-5 mm apical to the implant shoulder (H0-H5). RESULTS: At H0-H2, wound closure induced a statistically significant change in bone dimensions in groups 1 and 2. In group 3, only the change in H0 was significant, and for group 4, only H2 was significant. CONCLUSION: Wound closure has a significant impact on graft stability in a one-wall horizontal defect configuration. GBR with additional membrane fixation showed better results than without. Titanium-reinforced membranes and autogenous blocks showed significantly greater volume stability than GBR with collagen membrane, especially in the coronal portion.

Subjective and objective appearance of head and neck cancer patients following microsurgical reconstruction and associated quality of life─A cross-sectional study.

PURPOSE: Depending on the site and size of head and neck cancer, the disease affects patients' appearance and subsequently their quality of life. The aim of this study was to correlate subjective and objective evaluation of facial appearance and associated quality of life following ablative tumor surgery and microsurgical reconstruction. MATERIAL AND METHODS: A total of 99 patients with combined ablative and reconstructive microsurgical procedure for head and neck malignancy and seven patients with non-malignant disease were examined by three-dimensional (3D) (photogrammetry at least 6 months post-surgery and were evaluated by two-dimensional (2D) and 3D means for symmetry and facial proportions. Measurements were correlated with subjective reporting from the University of Washington Quality of Life Questionnaire and observer ratings. RESULTS: Of the 106 patients, three patients scored themselves as significantly disfigured (2.8%), 19 were bothered by their appearance (17.9%), 27 (25.5%) reported no change, and 57 (53.8%) reported minor changes in their appearance. On 2D evaluation, 10 patients (9.4%) showed severely abnormal facial proportions. On 3D analysis, 17 patients showed major asymmetry. There was a high correlation (0.67) between patient and observer subjective rating (p < 0.05). While 2D evaluation alone showed no significant correlation with subjective rating, 3D evaluation showed a moderate correlation (0.37; p < 0.05). The best results were achieved by combining 2D and 3D measurements (0.5; p < 0.05). Young female patients were most critical about their appearance. CONCLUSION: Following combined ablative and microsurgical reconstructive procedures, patients have a realistic perception of their appearance compared with observer ratings and a combination of 2D and 3D objective evaluation.