Ultraviolet C as a method of disinfecting medical silicone used in facial prostheses: An in vitro study - Part 2.

STATEMENT OF PROBLEM: Disinfection is an important factor in preserving facial prostheses and maintaining tissue health. However, whether disinfection with ultraviolet C is an effective disinfection method is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effectiveness of irradiation with different exposure durations of an ultraviolet-C light-emitting diode in the disinfection of the silicone (A-588-1; Factor II) used in facial prostheses. MATERIAL AND METHODS: A total of 216 specimens were prepared, contaminated by multispecies biofilm, and divided into 9 groups (n=24) for different treatments: chlorhexidine 0.12% (G CHG), ultraviolet-C light-emitting diode for 5 minutes (G UVC5), ultraviolet-C light-emitting diode for 10 minutes (G UVC10), ultraviolet-C light-emitting diode for 20 minutes (G UVC20), their respective untreated controls (Gcontrol CHG, Gcontrol UVC5, Gcontrol UVC10, Gcontrol UVC20), and dimethyl sulfoxide (G DMSO) as the negative control. Cell viability was measured by using the methyl tetrazolium salt (MTT) method. Two statistical analyses were performed. First, a 2×3 ANOVA was carried out to compare the control groups (Gcontrol UVC5, Gcontrol UVC10, and Gcontrol UVC20) and the experimental groups of UV-C LED light with different exposure durations (G UVC5, G UVC10, and G UVC20). The second analysis was performed using generalized linear models to compare the optical density of the groups (G UVC5, G UVC10, G UVC20, G CHG, and G DMSO). RESULTS: Cell viability results demonstrated a microbial reduction after exposure to the ultraviolet-C light-emitting diode for 20 minutes (G UVC20) compared with untreated controls (P<.05). The 5- and 10-minute exposures were statistically similar to their respective control groups (P>.05). The 20 minutes exposure had the lowest average optical density value, being statistically different from the 5-minute exposure (P<.05). A 20-minute exposure to the ultraviolet-C light-emitting diode (G UVC20) was similarly effective when compared with the standard disinfection treatment (G CHG) and dimethyl sulfoxide (G DMSO) (P>.05). CONCLUSIONS: Irradiation with an ultraviolet-C light-emitting diode for 20 minutes decreased the in vitro microbial cell viability on the medical silicone used in facial prostheses.

De novo TRPV4 Leu619Pro variant causes a new channelopathy characterised by giant cell lesions of the jaws and skull, skeletal abnormalities and polyneuropathy.

BACKGROUND: Pathogenic germline variants in Transient Receptor Potential Vanilloid 4 Cation Channel (TRPV4) lead to channelopathies, which are phenotypically diverse and heterogeneous disorders grossly divided in neuromuscular disorders and skeletal dysplasia. We recently reported in sporadic giant cell lesions of the jaws (GCLJs) novel, somatic, heterozygous, gain-of-function mutations in TRPV4, at Met713. METHODS: Here we report two unrelated women with a de novo germline p.Leu619Pro TRPV4 variant and an overlapping systemic disorder affecting all organs individually described in TRPV4 channelopathies. RESULTS: From an early age, both patients had several lesions of the nervous system including progressive polyneuropathy, and multiple aggressive giant cell-rich lesions of the jaws and craniofacial/skull bones, and other skeletal lesions. One patient had a relatively milder disease phenotype possibly due to postzygotic somatic mosaicism. Indeed, the TRPV4 p.Leu619Pro variant was present at a lower frequency (variant allele frequency (VAF)=21.6%) than expected for a heterozygous variant as seen in the other proband, and showed variable regional frequency in the GCLJ (VAF ranging from 42% to 10%). In silico structural analysis suggests that the gain-of-function p.Leu619Pro alters the ion channel activity leading to constitutive ion leakage. CONCLUSION: Our findings define a novel polysystemic syndrome due to germline TRPV4 p.Leu619Pro and further extend the spectrum of TRPV4 channelopathies. They further highlight the convergence of TRPV4 mutations on different organ systems leading to complex phenotypes which are further mitigated by possible post-zygotic mosaicism. Treatment of this disorder is challenging, and surgical intervention of the GCLJ worsens the lesions, suggesting the future use of MEK inhibitors and TRPV4 antagonists as therapeutic modalities for unmet clinical needs.

Evaluation of the 3D error of 2 face-scanning systems: An in vitro analysis.

STATEMENT OF PROBLEM: Facial scanning systems have been developed as auxiliary tools for diagnosis and planning in dentistry. However, little is known about the trueness of these free software programs and apps for facial scanning. PURPOSE: The purpose of this in vitro study was to evaluate the trueness of 3D facial scanning by using Bellus3D and +ID ReCap Photo. MATERIAL AND METHODS: A mannequin head was used as the master model. The control group was created by scanning the mannequin head with a noncontact structured blue light 3D scanner (ATOS Core). Two facial scanning methods were used for the experimental groups: a facial scanning app (FaceApp) and the Plus identity photogrammetry methodology (ReCap Photo). In both methods, image capturing was performed under the same natural lighting conditions with a smartphone (iPhone X) calibrated with an app. Trueness was assessed from the 3D measurement error, which was calculated with a 3D mesh analysis software program (GOM Inspect). Two comparison groups were created: ATOS versus Bellus3D (B3D) and ATOS versus +ID with ReCap Photo (+IDRP). The results were statistically evaluated by using the Shapiro-Wilk and paired t tests (α=.05). RESULTS: B3D had a greater error than +IDRP in measuring the regions of the upper and lower lips, nose, and mentum (P<.01). This error was statistically higher for +IDRP (P<.01) in the right face area, but the left face area showed no statistically significant difference between the evaluated scanning methods (P=.93). The 3D global trueness of B3D was 0.34 ±0.14 mm, and that of +IDRP was 0.28 ±0.06 mm. CONCLUSIONS: Both methods evaluated in this study provided a 3D model of the face with clinically acceptable trueness and should be reliable tools for planning esthetic restorations.

Influence of Restorative Material on the Distribution of Loads to the Bone in Hybrid Abutment Crowns-In Vitro Study.

Background: The objective of this study was to evaluate the load transmitted to the peri-implant bone by seven different restorative materials in single-unit rehabilitations with morse taper implants using a strain gauge. Materials: In a polyurethane block that simulated type III bone, a morse taper platform implant was installed (3.5 × 11 mm) in the center and 1 mm below the test base surface, and four strain gauges were installed around the implant, simulating the mesial, distal, buccal and lingual positions. Seven similar hybrid abutment crowns were crafted to simulate a lower premolar using different materials: 1-PMMA; 2-glass ceramic over resin matrix; 3-PEEK + lithium disilicate; 4-metal-ceramic; 5-lithium disilicate; 6-zirconia + feldspathic; 7-monolithic zirconia. All groups underwent axial and oblique loads (45 degrees) of 150 N from a universal testing machine. Five measurements (n = 5) were performed with each material and for each load type; the microdeformation data underwent statistical analysis. The data were obtained in microdeformation (µÎµ), and the significance level was set at p ≤ 0.05. Results: There was no statistically significant difference in the evaluation among the materials under either the axial load or the oblique load at 45 degrees. In turn, in the comparison between axial load and oblique load, there was a difference in load for all materials. Conclusion: The restorative material did not influence the load transmitted to the bone. Furthermore, the load transmitted to the bone was greater when it occurred obliquely at 45° regardless of the material used. In conclusion, it appeared that the different elastic modulus of each material did not influence the load transmission to the peri-implant bone.

Oculofacial Prosthetic Rehabilitation Complemented With Temporary Fillers and Neurotoxin.

ABSTRACT: Surgical treatment of head and neck cancer causes severe tissue loss, therefore, deformities and psychosocial consequences. In cases involving orbit exenteration, satisfactory reconstruction can only be achieved with prosthetic replacement, despite successful reconstructive plastic surgery. Extraoral implants, 3D scanning, and prototyping technologies have contributed to increase satisfactory aesthetic results of oculofacial prosthesis. However, to achieve prosthetic rehabilitation refinement, patients' biological tissues have been treated with injectable cosmetic adjuncts methods as complements to results. This study aimed to describe the use of botulinum toxin type A, hyaluronic acid, and calcium hydroxyapatite previously to oculofacial prostheses manufacturing, in 5 oncologic patients of a rehabilitation unit. Outcomes produced by additional cosmetic methods on tissues, prostheses planning, and overall facial rehabilitation were observed and registered by photographs. Botulinum toxin type A, hyaluronic acid, and calcium hydroxyapatite has shown to be useful in improving asymmetries, volumizing surgical depressions and dissembling atrophic scars. Presenting an additional resource to improve overall results, enabling the manufacturing of smaller, thinner, and better-fitting oculofacial prostheses. Limitations as chronic infection and necrosis episodes, related to filler injection into previously irradiated sites, were described. The temporary effect of the materials used generates a need for reapplications but increases the safety of such procedures and enables patients' cancer treatment follow-up.

Ultraviolet C as a method of disinfecting medical silicone used in facial prostheses: An in vitro study.

STATEMENT OF PROBLEM: Hygiene and disinfection are important factors for preserving facial prostheses and supporting tissue health. However, a method that does not accelerate degradation or color change is necessary. PURPOSE: The purpose of this in vitro study was to evaluate the effectiveness of irradiation with ultraviolet C light-emitting diode (UV-C LED) light in the disinfection and initial color stability of the silicone (A-588-1; Factor II) used in facial prostheses. MATERIAL AND METHODS: One hundred and twenty specimens were made, contaminated by multispecies biofilm, and divided into 5 groups (n=24) with different treatments: control, distilled water, 0.12% chlorhexidine, UV-C LED light, and dimethyl sulfoxide (DMSO) as the negative control. Cell viability was measured by the methyl tetrazolium salt method. Statistical analysis was performed by generalized linear models. Additional descriptive analysis was performed for color analysis by using 16 silicone specimens made with light and dark intrinsic coloring in 4 groups (controls and treatments n=4) submitted to UV-C LED light. The ΔE of the specimens was obtained by CIEDE200. RESULTS: The results of cell viability demonstrated a statistically significant difference among the groups (P<.001), with a microbial reduction after UVC-LED exposure compared with the control group. Regarding the color, the groups presented an average ΔE (light 0.205 and dark 0.308) compatible with visually imperceptible changes (light <0.7 and dark <1.2). CONCLUSIONS: Irradiation with UV-C LED light decreased the in vitro microbial cell viability of the medical silicone used in facial prostheses, demonstrating initial color stability.

A Digital Method to Fabricate the Ocular Portion of An Orbital Prosthesis with A Smartphone Camera, Color Calibration and Digital Printing.

Conventional techniques described in the literature for the manufacture of ocular prostheses are time-consuming since they involve manual work. The use of technologies could improve this laborious process, providing better esthetic outcomes. This technique describes how to manufacture the ocular portion of an orbital prosthesis using a smartphone camera, color calibration with a tooth shade guide, and digital printing. This method allows clinicians to fabricate customized ocular prosthesis by using a photograph of the patient's eye, thus eliminating the need for hand-painting and manual work, and reducing fabrication time.

Photoelastic stress analysis surrounding different implant designs under simulated static loading.

OBJECTIVE: The proposal of this study was to use a photoelasticity method to analyze the stress dissipation in the bone surrounding an implant under simulated loading. MATERIALS AND METHODS: Four implant systems with different internal connection designs were studied: conical connection (group 1), triangular connection (group 2), Morse taper (group 3), and internal hexagon (group 4). After the models' inclusion in a photoelastic resin, they were subjected to static loads of 100, 150, and 200 N. The lengths of fringes that were generated were measured at the bone crest parallel to the neck of the implant and along the implant body, as well as the dissipation of force across the entire area of extension. RESULTS: Lower stress was observed at the crestal bone in groups 1 and 3 with no significant increase (P < 0.05) in different levels of load, whereas the stress levels in groups 2 and 4 were observed to be higher with loads of all intensities with significant differences from the other groups (P < 0.05). CONCLUSIONS: The type of connection and the implant neck design influenced the dissipation of force. The conical-type connection exhibited better load dissipation in the neck area, regardless of the load applied on the implant.

Assessment of the correlation between insertion torque and resonance frequency analysis of implants placed in bone tissue of different densities.

The primary stability of dental implants is fundamental for osseointegration. Therefore, this study aimed to assess the correlation between insertion torque (IT) and resonance frequency analysis (RFA) of implants placed in mandibles and maxillas of different bone densities. Eighty dental implants were placed in maxillas and mandibles, and IT and the implant stability quotient (ISQ) were measured at the time of implant insertion. Bone density was assessed subjectively by the Lekholm and Zarb index. The type I and II densities were grouped together (group A)as were the type III and IV densities (group B). The IT in group A was higher (Student t test, P = .0013) than in group B (46.27 ± 18.51 Ncm, 33.62 ± 14.74 Ncm, respectively). The implants placed in group A showed higher ISQ (Student t test, P = .0004) than those placed in group B (70.09 ± 7.50, 63.66 ± 8.00, respectively). A significant correlation between IT and the ISQ value was observed for group A (Pearson correlation test; r = 0.35; P = .0213) and for group B (r = 0.37; P = .0224). Within the limitations of this study, it was possible to conclude that there is a correlation between IT and RFA of implants placed in mandibles and maxillas of different bone densities.

Evaluation of additive manufacturing processes in the production of oculo-palpebral prosthesis.

Background: Prosthetic restorations are made to adapt or attach missing human parts in order to restore function and appearance. Maxillofacial defects connote a greater impact on patients, since the face cannot be concealed, and all the senses of the human body are expressed in it. Therefore, in order to restore the patient's quality of life, they are the ones that require the best possible adaptation to the characteristics of the patients. Methods: For the maxillofacial prostheses to fit patients, they must be personalized for each patient. The NGO "Mais Identidade" is a multidisciplinary team that specializes in the rehabilitation of patients with maxillofacial trauma. They use digital manufacturing as a tool to manufacture personalized maxillofacial prostheses for patients. With the help of the NGO, the following research is conducted with the purpose of evaluating different methods of additive manufacturing, 3D printing, in order to select the equipment that suits the needs of the method used in the manufacture of maxillofacial prostheses. To this end, eyelid models will be manufactured in different additive manufacturing equipment, and these will be evaluated according to their economic, physical, and aesthetic characteristics.

Color translation from monoscopic photogrammetry +ID Methodology into a Polyjet final 3D printed facial prosthesis.

Background: The artistic techniques necessary to fabricate facial prostheses mainly depend on individual skill and are not a resource easily reproduced. Digital technology has contributed to improved outcomes, often combining analog and new digital techniques in the same workflow. Methods: This article aims to present an innovative workflow to produce a final colored 3D printed and facial prosthesis by UV-map color translation into colored resin 3D printing. A modified +ID Methodology was used to obtain 3D models with the calibrated 3D printable patient's skin color. No hands-on physical molding, manual sculpture, or intrinsic silicone coloration was used. Results: The outcome resulted in acceptable aesthetics, adaptation, and an approximate color match after extrinsic coloration. The patient reported good comfort and acceptance. Conclusions: A direct resin 3D printed prosthesis may be a viable alternative, especially for rapid delivery as an immediate prosthesis or an option when there is no experienced anaplastogist to manufacture a conventional prosthesis.

Bleeding evaluation during single tooth extraction in patients with coronary artery disease and acetylsalicylic acid therapy suspension: a prospective, double-blinded, and randomized study.

PURPOSE: Acetylsalicylic acid (ASA) has been used for the primary and secondary prevention of cardiovascular events. To reduce bleeding, the administration of ASA has traditionally been suspended before dental procedures; however, this suspension potentially increases the risk of thromboembolic events. The effect of ASA on the amount of bleeding that occurs during tooth extraction procedures is controversial, and perioperative guidelines recommend that ASA administration should not be altered for such procedures. The aim of this study was to evaluate the amount of bleeding that occurs during the intraoperative period of tooth extraction procedures in patients with coronary artery disease who are either undergoing acetylsalicylic acid (ASA) therapy or who have been instructed to suspend their ASA use. PATIENTS AND METHODS: Sixty-three patients with coronary artery disease who required tooth extraction were enrolled in this study. All patients were receiving 100 mg/d of ASA at the time of enrollment and were randomly placed into 2 groups: group S, which was comprised of patients whose ASA therapy was suspended 7 days before tooth extraction, and group NS, comprised of patients whose ASA therapy was unaltered. A platelet aggregation test was carried out on the day of the operation, and the amount of bleeding was measured during the intraoperative period by means of aspirated blood collection. All the extractions were performed by the same surgeon, who was unaware of whether the patient's ASA therapy had been suspended. RESULTS: The mean (± SD) volume of bleeding was 12.10 ± 9.37 mL for patients who underwent ASA therapy suspension and 16.38 ± 13.54 mL for those patients whose treatments were unaltered (P = .151). Local hemostatic methods were sufficient to control bleeding, and there were no reported episodes of hemorrhaging during the intra- and postoperative periods. The platelet reactivity index values exhibited statistically significant differences between the 2 investigated groups (P = .004). The platelet reactivity index values for group S and group NS were 242.58 ± 71.26 and 192.09 ± 60.54, respectively. CONCLUSION: There was no difference in the amount of bleeding that occurred during tooth extraction between patients who continued ASA therapy versus patients who suspended their ASA therapy. The platelet reactivity test demonstrated a reduction in platelet aggregation in the ASA therapy group (group NS), but this reduction was without clinical consequence.

In Vitro Analysis of the Implant-Abutment Interface Connection and Bacterial Infiltration in Two Extraoral Implant Models.

PURPOSE: To compare the connection microgaps and the bacterial infiltration of implant-abutment interfaces of two extraoral implant models. MATERIALS AND METHODS: Two implant models were used: the inner connection and the flush connection types. The implant-abutment microgaps of five sets of each extraoral implant were evaluated with scanning electron microscopy. Eleven additional sets of each model design were immersed in Staphylococcus aureus cultures for 24 hours, and samples were obtained from the external surface and from the implant's internal chamber to quantify the colony-forming units. RESULTS: Scanning electron microscopy analysis showed that microgaps of the flush connection were smaller compared with the inner connection (P < .0001), and that bacterial counts were higher at the inner connection compared with the flush connection (P < .0001). CONCLUSION: Within the limitations of this experimental study, it can be concluded that the flush connection model presented a smaller microgap and fewer bacterial colonies compared with the inner connection model.

Quality of life assessment of patients utilizing orbital implant-supported prostheses.

STATEMENT OF PROBLEM: Evaluate the effect of orbital prosthesis retained by implants through a specific quality of life (QOL) questionnaire provides important information on patients QOL, great incentive for the multidisciplinary team and public health support to continue work in this area. PURPOSE: The objective of the study was to evaluate patient satisfaction with orbital implant-supported prostheses using an adapted quality of life questionnaire. MATERIALS AND METHODS: Forty five patients using orbital implant-supported prostheses for a period ranging from six to 120 months. The subjects answered a questionnaire that consisted of 10 questions covering appearance, retention, conspicuousness, self-confidence, difficulty of placement, difficulty of removal, cleaning, limitation of activities, discomfort of tissues, and recommendation of the method to other patients. Answers were expressed using a visual 100-mm scale. The arithmetic mean of the responses was converted into a percentage to represent the satisfaction index. RESULTS: Patients demonstrated a high level of satisfaction on all items, with the lowest rate being for aesthetics and the highest being for recommending the method to other patients. High satisfaction rates regarding the placement and removal of the prosthesis, discomfort to the tissues, and cleaning suggest the ease of handling of the prosthesis. High satisfaction with retention, self-confidence, conspicuousness of the prosthesis, and limitation of activities indicated an association with a better social life. CONCLUSIONS: The results showed that use of bone anchorage technique of extraoral prostheses provided a high level of satisfaction among patients, confirming that osseointegrated implants are a very important resource for the rehabilitation of orbital deformities.

Oral Cancer Knowledge Assessment: Newly Graduated versus Senior Dental Clinicians.

The present study assessed the level of dentists' knowledge regarding oral cancer in the city of São Paulo, Brazil. A questionnaire was used to compare the level of knowledge among newly graduated and senior clinicians. A total of 20,154 e-mails were correctly delivered to the dentists registered in the database of the Regional Dentistry Council of São Paulo, and 477 (2.36%) responses were received. This sample consisted of 84 newly graduated clinicians and 105 senior clinicians. For the statistical analysis, the chi-square test and the logistic regression analysis were performed with α = 0.05, and the results were described herein. According to their knowledge level, the results were statistically different between the groups, since 19% of the newly graduated clinicians were evaluated with knowledge grade A (excellent) in comparison to 6.7% of the senior clinicians. In spite of the results indicated that newly graduated clinicians' knowledge regarding oral cancer was 2.1 times higher, 34.5% of the professionals in this group had regular or poor knowledge on the subject, and several questions relating to clinical characteristics and risk factors indicated that there still exist some knowledge gaps, demonstrating that there is a need for further studies and information activities addressing oral cancer.

3D Bitemark Analysis in Forensic Odontology Utilizing a Smartphone Camera and Open-Source Monoscopic Photogrammetry Surface Scanning

Abstract Bitemark analysis is a challenging procedure in the field of criminal case investigation. The unique characteristics of dentition are used to find the best match between the existing patterned injury and the suspected perpetrator in bitemark identification. Bitemark analysis accuracy can be influenced by various factors, including biting pressure, tooth morphology, skin elasticity, dental cast duplication, timing, and image quality. This review article discusses the potential of a smartphone camera as an alternative method for 3D bitemark analysis. Bitemark evidence on human skin and food should be immediately recorded or duplicated to retrieve long-lasting proof, allowing for a sufficient examination period. Various studies utilizing two-dimensional (2D) and three-dimensional (3D) technologies have been developed to obtain an adequate bitemark analysis. 3D imaging technology provides accurate and precise analysis. However, the currently available method using an intraoral scanner (IOS) requires high-cost specialized equipment and a well-trained operator. The numerous advantages of monoscopic photogrammetry may lead to a novel method of 3D bitemark analysis in forensic odontology. Smartphone cameras and monoscopic photogrammetry methodology could lead to a novel method of 3D bitemark analysis with an efficient cost and readily available equipment.

Breast metastasis around dental implants: a case report.

BACKGROUND: Metastases to the oral cavity and to the jaws are rare; hence, the clinical manifestations of the oral metastasis lesion could frequently be simulating general pathologic entities, making the diagnosis a challenging process to the dental team. Local factors, such as trauma, have been observed to facilitate the growth of blood-borne tumors. To this end, surgical procedures such as fixture placement might cause cancer cells to spread. PURPOSE: Careful clinical examination is a valuable help in diagnosing oral lesions, which can improve the quality of life of patients and reduce the risks of oral complications. MATERIALS AND METHODS: A female patient was referred to the clinic with symptoms of irritation, swelling, and pain associated with implants in the mandible and the maxilla. RESULTS: Clinical examination, x-ray, and histopathology revealed that the patients suffered from a metastatic lesion, primary tumor being an adenocarcinoma of the breast diagnosed at the same time. CONCLUSION: Optimal clinical examination in conjunction with radiography and histopathology is a necessity in order to discover malignant lesions in time. Routine dental check-ups must comprise more thorough soft-tissue examination.

Auricular rehabilitation by means of bone grafting from the iliac crest in combination with porous extraoral implants: a case report.

BACKGROUND: Maxillofacial defects caused by cancer treatment are a huge problem affecting the quality of life of patients. Some of these deformities are minimized using facial epitheses, which need some additional retention devices like glasses or skin adhesives. The use of extraoral fixtures as bone anchorage was introduced many years ago and since then many patients were rehabilitated with better results. PURPOSE: Because of poor bone conditions, for example, irradiated bone, the success rate of extraoral implants is less than in the oral cavity, causing difficulties to rehabilitation. One possible cause of fixture failure could be the poor primary stability achieved in some cases, hence, with an increased bone contact implant stability and survival could be improved. The present report discusses possibilities to use extraoral fixtures with a modified surface structure. MATERIALS AND METHODS: A new porous surfaced Brazilian extraoral implant (MasterExtra, Conexão, Sistema de Próteses, São Paulo, Brazil) was used. A bone transplant from the iliac crest was taken to make it possible to insert at least three extraoral implants for an auricle epithesis. Clinical evaluation and resonance frequency analysis (RFA) measurements were performed during the course of the treatment. RESULTS: Eight months after grafting, four fixtures were inserted. Three fixtures were used for connection of an auricular epithesis. RFA measurements did show high initial values and the values remained stable during the course of the treatment and at later checkups. CONCLUSION: Porous fixture is a good option in areas where the bone is compromised. RFA is a good tool also in the clinical setting to evaluate immediate and long-term stability of extraoral fixtures.

Extraoral Implants for Anchoring Facial Prostheses: Evaluation of Success and Survival Rates in Three Anatomical Regions.

PURPOSE: The aim of this study was to evaluate the success and survival rates of extraoral implants for the fixation of facial prostheses in three anatomical regions. MATERIALS AND METHODS: Subjects were consecutive patients with facial defects who underwent implant placement by the same surgeon in the orbital, nasal, and auricular regions between 2003 and 2012. After a minimum of 4 months of osseointegration, prostheses were anchored to the implants, and the patients were monitored for 11 to 111 months. Success rate, implant survival time, and occurrence of previous radiotherapy were evaluated. Rate of implant survival was estimated as a function of the anatomical region of the three groups (orbital, nasal, or auricular), and confidence intervals were calculated using Kaplan-Meier analysis with α = .05. RESULTS: In the 68 patients' 138 fixed implants, 48 showed defects in the orbital, 9 in the nasal, and 11 in the auricular region. The success rates and survival times were 95.9% and 8.6 years for the orbital, 92.9% and 2.8 years for the nasal, and 92% and 9.0 years for the auricular region, respectively. The success rate of implants in previously irradiated regions was 90.3% for the orbital and 100% for the auricular region. None of the patients was irradiated in the nasal region. CONCLUSION: No significant differences in implant success or survival were observed with regard to anatomical region or previous irradiation.

Immunohistochemical localization of the NM23 protein in salivary gland neoplasms with distinct biological behavior.

The NM23 protein was shown to be associated with metastasis suppression in human malignancies with various tissue origins. However, its association with the metastatic phenotype of salivary gland neoplasms (SGN) remains unknown. To evaluate the role of NM23 in SGN, the expression patterns of NM23 in the following were compared: benign (pleomorphic adenoma) vs malignant (adenoid cystic carcinoma and mucoepidermoid carcinoma) SGN, and primary malignancies with/without evidence of metastasis vs their metastatic implants (MI). The lesions were studied immunohistochemically. NM23 protein was found in the cytoplasm of 75% of benign SGN, 73.3% of primary SGN malignancies with no evidence of metastasis, 86.6% of primary SGN malignancies with evidence of metastasis, and 60% of MI. There was no statistically significant difference in the frequency of NM23-positive cells between benign and primary malignant tumors (p = 0.79), nor between primary malignancies with/without evidence of metastasis and MI (p = 0.51). However, nuclear NM23 protein was restricted to primary SGN malignancies with evidence of metastasis and MI. The presence of nuclear NM23 protein may be a good marker for predicting the metastatic potential of SGN malignancies.