Questionnaire-Based Assessment of the Masticatory Function and Facial Nerve Recovery Post Pterional Approach in Brain Tumors Surgery.

BACKGROUND: The pterional approach for craniotomy, one of the most used surgical intervention in neurosurgery, results in a series of postoperative changes that, if they persist, affect the patient's life, social reintegration, and his/her physical and mental recovery. The aim of the present study was to develop and validate a questionnaire for indicating directly affected masticatory muscles groups and facial nerve branches, in patients undergoing the pterional approach in neurosurgery, so that the recovery therapy can be monitored and personalized. METHODS: A self-reporting questionnaire consisting of 18 items (12 for postoperative masticatory status and 6 for facial nerve branches involvement), validated on fifteen patients, following three steps: items development, scale development, and scale evaluation, was prospectively applied twice, at a one-year interval (T0 and T1), with thirty-two patients suffering from vascular or tumoral pathology and surgically treated through a pterional approach. RESULTS: No statistically significant correlation could be found between postoperative outcomes and age or gender. Facial nerve branch involvement could not be correlated with any of the assessed variables. Pathology and time elapsed from surgery were statistically significantly correlated to preauricular pain on the non-operated side (p = 0.008 and p = 0.034, respectively). Time elapsed from surgery was statistically significantly correlated to the ability to chew hard food, pain while yawning, and preauricular pain during back and forward jaw movements and gradual mouth opening. CONCLUSIONS: We created and validated a valuable patient-centered questionnaire that can be employed as a tool for postoperative assessment of directly affected masticatory muscles and groups of facial nerve branches.

Eighteen Months Follow-Up with Patient-Centered Outcomes Assessment of Complete Dentures Manufactured Using a Hybrid Nanocomposite and Additive CAD/CAM Protocol.

Abstract: The present study aimed to assess the eighteen month follow-up patient-centered outcomes of a simple and predictable protocol for 3D-printed functional complete dentures manufactured using an improved poly(methyl methacrylate) (PMMA)-nanoTiO2. A detailed morphological and structural characterization of the PMMA-TiO2 nanocomposite, using SEM, EDX, XRD, and AFM, after 3D-printing procedure and post-wearing micro-CT, was also performed. METHODS: A total of 35 fully edentulous patients were enrolled in this prospective study. A 0.4% TiO2-nanoparticle-reinforced PMMA composite with improved mechanical strength, morphologically and structurally characterized, was used according to an additive computer-aided design and computer-aided manufacturing (CAD/CAM) protocol for complete denture fabrication. The protocol proposed involved a three-step appointment process. Before denture insertion, 1 week, 12 month, and 18-month follow up patients were evaluated via the Visual Analogue Scale (VAS, 0-10) and Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT), with a higher score meaning poor quality of life. RESULTS: A total of 45 complete denture sets were inserted. OHIP-EDENT scored significantly better after 18 months of denture wearing, 20.43 (±4.42) compared to 52.57 (±8.16) before treatment; mean VAS was improved for all parameters assessed. CONCLUSIONS: Within the limitations of this study, we can state that the proposed workflow with the improved material used is a viable treatment option for patients diagnosed with complete edentulism.

Five-year clinical trial using three attachment systems for implant overdentures.

OBJECTIVE: The objective is to compare, in a prospective randomized clinical trial, three types of attachment systems for mandibular implant overdenture, focusing on costs, maintenance requirements and complications from baseline to the end of 5-year follow-up period. MATERIALS AND METHODS: Sixty-nine fully mandibular and fully/partially maxillary edentulous patients received two screw-type Straumann implants, in the mandibular canine region. New overdentures with three types of attachment systems were inserted according to an early-loading protocol: Group B (balls, divided into Subgroup B.1 - retentive anchor with gold matrix and Subgroup B.2 - retentive anchor with titanium matrix) (n = 23), Group M (magnets) (n = 23) and Group L (locator) (n = 23). RESULTS: The highest maintenance event number (195) was observed in Group B vs. 31 in Group L and 15 in Group M. Significantly more complications were recorded in Subgroup B.1 than in Subgroup B.2, Group M and Group L (P < 0.05). Group M registered the highest prosthetic success (82.6%) in the 5 years, followed by Group L (78.2%). Subgroup B.1 had the lowest success rate (50%). The magnet group recorded statistically significant higher costs, comparing with the other two groups (P < 0.05). CONCLUSIONS: The three attachment systems functioned well after 5 years. The magnets had a low maintenance requirement and high success rate, despite the relatively increased initial costs. Retentive anchor with titanium matrix and locator may be a better choice from a financial point of view, taking into consideration the initial low cost of the components and also the reduced number of complications.