Approaching 3D printing in oral and maxillofacial surgery - suggestions for structured clinical standards.

PURPOSE: With respect to the European Union 2017 amendment of the Medical Device Regulations (MDR), this overview article presents recommendations concerning medical 3D printing in oral and maxillofacial surgery (OMFS). METHODS: The MDR were screened for applicability of the rules to medical in-house 3D printing. Applicable regulations were summarized and compared to the status of medical use of 3D printing in OMFS in Germany. Recommendations were made for MDR concerning medical 3D printing. RESULTS: In-house printed models, surgical guides, and implants fall under the category of Class I-III, depending on their invasive and active properties. In-house medical 3D printing for custom-made medical devices is possible under certain prerogatives: (1) the product is not being used in another facility, (2) appropriate quality systems are applied, (3) the reason for omitting commercial products is documented, (4) information about its use is supplied to the responsible authority, (5) there is a publicly accessible declaration of origin, identification, and conformity to the MDR, (6) there are records of manufacturing site, process and performance data, (7) all products are produced according to the requirements proclaimed before, and (8) there is an evaluation of clinical use and correction of possible issues. CONCLUSION: Several aspects must be addressed for in house medical 3D printing, according to the MDR. Devising MDR related to medical 3D printing is a growing challenge. The implementation of recommendations in OMFS could help practitioners to overcome the challenges and become aware of the in-house production and application of 3D printed devices.

Rating of French maxillofacial surgeons on their Google® business account: Current status and reflections for equitable communication.

INTRODUCTION: Online reputation is misattributed in France in academic publications. However, this phenomenon is growing. The objective of this study was to establish an inventory of the e-reputation of French maxillofacial surgeons through the opinions posted on their professional Google® account. MATERIAL AND METHODS: A descriptive study included all the surgeons registered on the list of the French National Medical Council in "maxillofacial surgery and stomatology". Data collection was carried out from February to April 2022. RESULTS: Among the 483 surgeons included, 61.1% had received at least one opinion, the number of per surgeon was 22.2. The average was 4.3/5. Among the 4433 written comments completing the review, 85% were positive. The average response rate of surgeons was 10% and was all the more important as the rating of the opinion was lower. Stomatology (65.3%), aesthetic surgery of the face (15.1%) and orthognathic surgery (14.5%) were the most commented maxillofacial procedures. DISCUSSION: The online image of French maxillofacial surgeons was very positive. However, faced with a defamatory or insulting comment, the surgeon found in an unbalanced situation where he could not respond without risking betraying medical. We recall some common-sense recommendations for managing one's e-reputation and some legislative adjustments for better regulation of these platforms, also considering legal and ethical aspects.

Maxillofacial Surgery in Ukraine During a War: Challenges and Perspectives-A National Survey.

INTRODUCTION: The invasion of Ukraine by Russian troops on February 24, 2022, and the beginning of the full-scale war had huge humanitarian consequences. The major challenges facing the Ukrainian health care system included the disruption of medical infrastructure and logistics, the termination of the supply of expendable materials, significant migration, and a dramatic increase in high-velocity blast and gunshot injuries among combatants and civilians.The aim of the present study was to analyze the challenges and solutions in patient care faced by the Ukrainian system of maxillofacial surgery during the war in different regions of the country. MATERIALS AND METHODS: A cross-sectional study was designed and implemented as an online survey to collect national data concerning maxillofacial surgeons' experiences and professional activities. The study was initiated and supported by Bogomolets National Medical University (Kyiv, Ukraine), the Ukrainian representative of AO CMF (Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial Surgery) and the University of Helsinki (Finland).The questionnaire was developed by specialists in maxillofacial surgery and sociologists and contained 65 close-ended questions. Surgeons who had not worked in this specialty in inpatient departments of hospitals since at least the beginning of the full-scale war were excluded from the study. We received and analyzed 97 responses that met the abovementioned criteria. The geography of respondents covered all the regions and the main cities of Ukraine, expect for the occupied territories. RESULTS: After a year of warfare, the percentage of surgeons who treated patients with blast and gunshot injuries increased from 43.4% to 86.6%. This percentage was higher in military hospitals and in regions located in the vicinity of the front line. We found that, during the war, 78.6% of respondents performed osteosynthesis in cases of high-velocity multifragmented facial bone fractures (in such cases, 58.3% of them strictly followed AO CMF recommendations, while 41.7% performed the fixation based on available hardware, existing technical possibilities and their own preferences). We found that 70.2% of respondents had the opportunity to apply Computer-Aided Design/Computer-Aided Manufacture technology and patient-specific implants for the treatment of gunshot injuries, 38.1% reported that their hospitals were able to perform microsurgical reconstructions for facial defects, 79.4% of respondents reported that their departments received humanitarian aid and support from volunteer organizations (either Ukrainian or international), which significantly facilitated the treatment process. CONCLUSIONS: According to this nationwide survey of Ukrainian maxillofacial surgeons during a year of the full-scale war, 86.6% of respondents were involved in the treatment of gunshot and ballistic injuries in civilians and combatants. The main problems reported by the respondents were (1) a lack of experience and knowledge related to the treatment of severe wounds, especially by secondary reconstruction, and (2) a deficit of resources (equipment, materials, and medications) under conditions of disrupted logistics and changes in the numbers and nosological distribution of patients. There were the opportunity to transfer the patients to European clinics (29.9%), online consultations (45.4%), collaboration with foreign surgeons who come to Ukraine asvolunteers (32%).

Surgical Treatment of a Borderline Skeletal Class III Patient: an Interdisciplinary Approach.

INTRODUCTION: Class III malocclusion is considered the most challenging discrepancies in orthodontic diagnosis and treatment planning. It is often difficult to classify borderline cases as surgical or non-surgical. The following case report is of a borderline Class III case with several missing maxillary premolars treated via an interdisciplinary approach. AIM: This clinical case highlights the importance of meticulous diagnosis to obtain optimal results in borderline Class III cases. The significance of an interdisciplinary approach in complex adult orthodontic cases was also discussed. CASE REPORT: Given the complexity of the case, the treatment required a comprehensive interdisciplinary approach with the intervention of multiple specialties including periodontics, prosthodontics, orthodontics, oral surgery and maxillofacial surgery. The presurgical orthodontic stage was achieved in preparation for LeFort I maxillary advancement. Third molars extractions along with implant placement were implemented. Finally, crown placement and connective tissue graft were completed to achieve an optimal result. Total treatment time was 1.7 years (20 months). Patient's profile and facial appearance were dramatically enhanced, and a stable functional Class II occlusion was attained despite the preexisting skeletal Class III. CONCLUSION: Borderline adult Class III cases require a delicate diagnostic approach to be able to distinguish a surgical from a non-surgical approach. Complex adult orthodontic cases require a diplomatic interdisciplinary approach from all required specialties in order to attain the most favorable results.

Precaution of 2019 novel coronavirus infection in department of oral and maxillofacial surgery.

The epidemic of the 2019 novel coronavirus (2019-nCoV) infection has presented as a critical period. Until February 23th 2020, more than 77 000 cases of 2019-nCoV infection have been confirmed in China, which has a great impact on economy and society. It has also interferred with ordinary medical practice of oral and maxillofacial surgery seriously. In order to protect oral and maxillofacial surgery medical staff from 2019-nCoV infection during the outbreak period, this paper suggests the necessary medical protective measures for oral and maxillofacial surgery outpatient and ward.

The lingual foramina, a potential risk in oral surgery. A retrospective analysis of location and anatomic variability.

OBJECTIVE: This study evaluates the mandibular lingual foramina (LF) using computed tomographic imaging data from a large Central European cohort, focusing on the most relevant anatomical parameters. We aimed to examine whether there are differences in key parameters between ethnic groups, or based on age and gender. Additionally, we analyze the potential effect of tooth loss on the LF and discuss risk management options before and during surgery. METHODS: 460 CT scans of adults (273 females and 186 males) were examined. The number, the location and the diameter of the median and lateral LF were assessed for each patient. The data was analyzed statistically, whereby a p-value lower than 0.05 was considered as significant. RESULTS: Median and lateral LF were present in 95,9%, and 38,9% of patients, respectively. Male patients had a greater number of LF than females. While the majority of median LF (62%) was located above the mental spine, the majority of lateral LF was located below (84%). The diameter of lateral LF (1,15 mm ± 0,33) was smaller than for median LF (1,22 mm ± 0,35), as well the lateral canals (4,8 mm ± 1,28) were shorter than the median canals (5,32 mm ± 1,74). Lateral LF were equidistant to the symphysis (13,89 ± 3,63 mm) on either side. Critical diameter size >1 mm was found in about 2/3 of our cases. The distance from the foramen to the residual ridge was ∼7 mm less in edentulous patients compared to dentulous patients. CONCLUSION: The median LF is a near-obligatory structure of the mandible, while the lateral LF is a frequently encountered structure. Age does not seem to affect the frequency of LF. Edentulous patients did not show differences regarding the presence of the LF, but their vertical osseous dimension was diminished by 7 mm and they may, therefore, be at an increased risk of adverse surgical incidents. The main findings of this study relate to the substantial variability in the anatomy and location of the LF and confirm with previous studies. As the LF can be reliably detected using CT/CBCT, the use of three-dimensional-imaging is recommended prior to conducting oral surgery. Careful pre-operative planning and accurate anatomical information may help to avoid surgical complications. To ascertain the potential significance of ethnicity on LF, more data need to be collected using standardized methodologies. A definitive conclusion on the impact of ethnicity on LF thus cannot currently be drawn based on the results of our study and those available from the published medical literature.

Developing an Assessment-of-Clinical-Exodontia-Skills (ACES) Rating Scale for Undergraduate Dental Students.

OBJECTIVE: To develop assessment-of-clinical-exodontia-skills (ACES) rating scale for formative and summative assessment of undergraduate dental students performing exodontia. PLACE AND DURATION OF STUDY: Faisalabad Medical University, Faisalabad, from May 2017 to February 2018. METHODOLOGY: A preliminary scale was developed using literature search and informal discussion with experts. In the first round of Delphi, this scale was emailed to oral surgery faculty across Pakistan. Their opinions were sought and the form was modified accordingly. In the second round, the modified form was emailed again to the respondents of first round and thus the form was finalized by obtaining their comments on the modified form. RESULTS: A preliminary 27-point round-1 questionnaire was sent to 42 experts. Out of these, 30 responded (overall response rate 71.4%) and the form was modified according to their response. Frequency, percentage, and mean of Likertbased responses was calculated along with thematic analysis of individual responses. In round 2, the modified form was sent to the 30 respondents of round 1. Out of these, 21 replied (response rate 70%) and form was further modified accordingly. In round 2, primary focus was on marking/scoring strategy. CONCLUSION: ACES form was developed, which can be important tool in assessing exodontia skills of undergraduate dental students. This needs practical application and testing for validity.

Advantages and disadvantages of implant navigation surgery. A systematic review.

This review elucidates the advantages and disadvantages of the different implant navigation methods to assist the precise surgical placement of dental implants. Implant navigation surgery can be classified into: dynamic and static navigation, and static navigation can further be divided into full (FG)- and half-guided (HG) implant surgery. The HG implant placement includes the drilling-guided, pilot-drill guided, and the non-computed guided approaches. In dynamic navigation, the bone drilling and the implant placement are completely tracked with a specific software; while the static navigation refers to the use of static surgical templates. The FG associated with flapless surgery and teeth/crown supported guides has demonstrated the highest accuracy, followed by the drilling and pilot HG surgery that may provide comparable results, while the non-computer HG and FH implant placement provide the least accuracy in transmitting the implant positioning from the pre-surgical planning to the patient. Additionally, flapless implant surgery is related to reduced pain, less analgesic consumption, less swelling, shorter chair-time, and reduced risk of hemorrhage while achieving greater patient satisfaction. Nevertheless, other methods such as non-computer HG and FH implant surgery procedures require more surgical experience to overcome their limitations. There is still limited evidence to support dynamic surgery, and further investigations are needed.

Modified GoPro Hero 6 and 7 for Intraoperative Surgical Recording-Transformation Into a Surgeon-Perspective Professional Quality Recording System.

Recent innovations in wearable action cameras with high-definition video recording enable surgeons to use cameras for their surgical procedures. In this study, the GoPro HERO 6 (and 7) Black edition camera was modified step by step to allow for a completely wireless surgeon-perspective recording with a battery life and memory capacity never previously obtained with such a high level of digital video quality. With this system, a surgeon can record for more than 14 hours 26 minutes in 1,080 pixels at 60 frames per second without breaking scrub and capture the operating surgeon's direct view of the field. By modifying the newest generation of devices, the authors successfully eliminated all shortcomings of the prior generation of GoPro cameras for surgical recording. The modified GoPro HERO6 camera produced professional recording quality for a total cost lower than US$850. This is critically important, because video-based surgical training will continue to be a primary area of development in the future and represents a novel and effective way for young generations of surgeons to attain technical excellence and knowledge in surgery.

"Run-through" training at specialist training year 1 and uncoupled core surgical training for oral and maxillofacial surgery in the United Kingdom: a snapshot survey.

Training in oral and maxillofacial surgery (OMFS) in the UK has undergone considerable changes during the last 10years, and "core" surgical training has replaced "basic" surgical training. In 2014 a pilot "run-through" training programme from specialist training year one (ST1)-ST7 was introduced to facilitate early entry into the speciality. Run-through training guarantees that a trainee, after a single competitive selection process and satisfactory progress, will be given training that covers the entire curriculum of the speciality, whereas uncoupled training requires a second stage of competitive recruitment after the first one (for OMFS only) or two years of "core" training to progress to higher specialty training. The first two years of run-through training (ST1-ST2) are the same as for core surgical training. Dual-qualified maxillofacial aspirants and those in their second degree course are curious to know whether they should go for the uncoupled core surgical training or the run-through programme in OMFS. The General Medical Council (GMC) has now agreed that run-through training can be rolled out nationally in OMFS. To assess the two pathways we used an online questionnaire to gain feedback about the experience from all OMFS ST3 and run-through trainees (ST3/ST4) in 2016-2017. We identified and contacted 21 trainees, and 17 responded, including seven run-through trainees. Eleven, including five of the run-through trainees, recommended the run-through training programme in OMFS. Six of the seven run-through trainees had studied dentistry first. The overall mean quality of training was rated as 5.5 on a scale 0-10 by the 17 respondents. This survey gives valuable feedback from the current higher surgical trainees in OMFS, which will be useful to the GMC, Health Education England, OMFS Specialist Advisory Committee, and those seeking to enter higher surgical training in OMFS.

Evaluation of Oral and Maxillofacial Surgery Residents' Operative Skills: Feasibility and Engagement Study Using SIMPL Software for a Mobile Phone.

PURPOSE: There are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study was to determine the feasibility of using a smartphone application, SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. The authors hypothesized that these goals would be achieved because the process is convenient and efficient. MATERIALS AND METHODS: This was a prospective feasibility and engagement study using SIMPL to evaluate residents' operative skills. SIMPL requires the attending surgeon to answer 3 multiple-choice questions: 1) What level of help (Zwisch Scale) was required by the trainee? 2) What was the level of performance? 3) How complex was the case? The evaluator also can dictate a narrative. The sample was composed of 3 faculty members and 3 volunteer senior residents. Predictor variables were the surgeons, trainees, and procedures performed. Outcome variables included number and percentage of procedures performed by faculty-and-resident pairs assessed, time required to complete assessments, time lapsed to submission, percentage of assessments with narratives, and residents' response rates. RESULTS: From March through June 2016, 151 procedures were performed in the operating room by the faculty-and-resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n = 75 of 107) was shorter than 2 minutes. The time lapsed to submission was shorter than 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident. CONCLUSIONS: SIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural data. Additional prospective trials to assess this tool further are planned.