Patients' Preference for Receiving Informed Consent Information Regarding Third Molar Surgery.

PURPOSE: It is important that patients have adequate information about a surgical procedure and its risks and benefits before giving consent to proceed. The purpose of this study was to determine patients' satisfaction with various methods of presenting such information and their preferred method. MATERIALS AND METHODS: Patients presenting for removal of impacted third molars were shown an informational video discussing the diagnosis of impacted teeth, the potential risks of not having them removed, their treatment, the surgical complications, and the anesthetic options and risks. They subsequently met with the treating doctor, who again reviewed the material shown in the video and answered any questions before patients signed the informed consent document. Patients then completed a brief questionnaire asking them to rate their satisfaction with the 2 presentation methods and to indicate their preferred method. RESULTS: A total of 50 patients (18 male and 32 female patients; average age, 26 years) completed the questionnaire. Of these patients, 58% had a high school education whereas 42% had some college or a college degree. Sixty-six percent of patients found the video very helpful, and 78% found the oral presentation very helpful. However, when asked which format provided the best information, 62% indicated the video whereas 38% indicated the oral presentation. CONCLUSIONS: Because there was no clear consensus among patients regarding the best format, providing both a video and an oral presentation is the ideal situation.

The Opinion of Different Observer Groups About the Esthetic Impact and Need for Surgical Correction of Varying Submental Lengths.

PURPOSE: This study evaluated the opinion of different observer groups about the influence of the submental length on perceived attractiveness and when surgical correction was deemed necessary. MATERIALS AND METHODS: The submental length of an idealized silhouette of a white male profile was altered incrementally between 5 and 95 mm. Images were rated for attractiveness on a Likert scale by pretreatment orthognathic surgery patients (n = 75), laypersons (n = 75), and clinicians (maxillofacial surgeons and orthodontists) (n = 35). RESULTS: For perceived attractiveness, the ideal submental length was approximately 50 mm (range, 40 to 75 mm). A submental length shorter than or equal to 30 mm was deemed unattractive by all 3 groups. Overall, a submental length less than 40 mm generally was judged less attractive than a comparable increase in length. Clinicians were generally least likely to suggest surgery for varying submental lengths. For this group, the cutoff at which the majority suggested surgery was a submental length of 25 mm or less. For the patient and layperson groups, the corresponding cutoff values were a length shorter than or equal to 30 mm or equal to 95 mm. CONCLUSIONS: A submental length of approximately 50 mm (range, 40 to 75 mm) was viewed by most observers as attractive. At 30 mm or less, it was generally deemed progressively less attractive. Clinicians were less likely to suggest corrective surgery than were the patient and layperson groups. For comparative proportional relationships, the submental length should be between the lower lip-chin height and lower facial height, assuming an otherwise proportional facial profile.

Recognition of the Asymmetrical Smile: A Comparison of Orthodontists, Oral and Maxillofacial Surgeons, and Laypersons.

PURPOSE: Studies have shown that an asymmetrical smile is a relatively common problem. Yet, many patients are unaware of having this condition. Because having an asymmetrical smile can affect the final esthetic result of orthodontic therapy or orthognathic surgery, such patients need to be aware of the problem. The purpose of this study was to determine what amount of smile asymmetry is clinically evident to orthodontists, oral and maxillofacial surgeons (OMSs), and the lay public. MATERIALS AND METHODS: A total of 56 OMSs, 117 orthodontists, and 123 laypersons participated in the study. They were asked to view a randomly arranged series of computer-generated male and female facial photographs with the smile symmetrical or altered in 0.5-mm increments from 1 to 4 mm and to indicate whether the person had an asymmetrical smile. RESULTS: The OMSs and orthodontists were able to recognize relatively smaller amounts of asymmetry than the laypersons (2 mm vs 3 to 3.5 mm). CONCLUSIONS: Although the clinicians performed better than the laypersons, both groups were able to recognize relatively small amounts of asymmetry. Because such a condition is generally not correctable and can affect the esthetic result, patients undergoing orthodontic therapy or orthognathic surgery need to be made aware of the situation before treatment.

How Important Are Letters of Recommendation? A Survey of Oral and Maxillofacial Surgery Residency Program Directors.

PURPOSE: Letters of recommendation are currently part of the application process for residencies in oral and maxillofacial surgery. However, the value placed on the information contained in such letters by program directors is unclear. The purpose of this study was to determine what role letters of recommendation play in the decision-making process. MATERIALS AND METHODS: In this cross-sectional study, a questionnaire was sent to 122 current and former program directors asking them to rate the importance they gave to letters of recommendation compared with other application attributes through a visual analog scale that ranged from 0 ("not important") to 100 ("very important"). Respondents also specified the format in which they would prefer recommendations be sent and, if they preferred letters, to state why. Responses were summarized with descriptive statistics (counts and percentages). The average perceived importance of applicant attributes and components of recommendations was compared using random-effects models to adjust for multiple responses from the same respondent. Post hoc pairwise comparisons were performed using Tukey adjustment. RESULTS: Of the 122 questionnaires sent, 14 were not deliverable. Forty-one of the 108 remaining program directors answered, for a response rate of 38%. Only 10% of respondents indicated that they do not consider letters of recommendation. However, they rated class rank, comprehensive basic science score, and leadership qualities more important than letters of recommendation. They preferred letters of recommendation from a faculty member rather than from a dean or non-oral surgeon and favored letters over a standard recommendation form, which they believed provided information not found in supporting documents. CONCLUSIONS: Despite some deficiencies found with letters of recommendation, and the varying importance given to the information they contain, program directors still find that they provide some useful information.

A needle in a haystack: Report of a retained archwire fragment in the pterygomandibular space.

This clinical report describes a retained archwire fragment, discovered during a new-patient examination of a young woman seeking orthodontic retreatment. The diagnostic process, care coordination, and patient management decisions are discussed, along with a brief exploration of clinical considerations associated with this incident. A suggested emergency prevention and response protocol is also presented.

Does Viewing a Third Molar Informed Consent Video Decrease Patients' Anxiety?

PURPOSE: Before having impacted third molars removed, patients are frequently asked to view a brief video describing the operation and its benefits and risks. The purpose of this study was to determine whether such information reduces or increases patients' anxiety level. PATIENTS AND METHODS: In this prospective cohort study, 100 patients presenting for consultation regarding removal of their impacted third molars completed a form asking them to grade their anxiety level before and after viewing the informational video as calm, slightly anxious, moderately anxious, or very anxious. RESULTS: Thirty-one percent reported increased anxiety after viewing the video. Only 12% showed a decrease, and in 57%, there was no change (28% were still slightly, moderately, or very anxious). Scoring of the pre- and post-viewing anxiety levels showed a statistically significant increase in anxiety after viewing. CONCLUSIONS: Viewing the video increased or did not reduce the anxiety level in a significant number of patients. Therefore, it is important to complement this video with positive verbal and written reinforcement of such aspects as patient comfort, procedural safety, and adequate pain control.

In Vivo Tooth-Supported Implant Surgical Guides Fabricated With Desktop Stereolithographic Printers: Fully Guided Surgery Is More Accurate Than Partially Guided Surgery.

PURPOSE: Desktop stereolithographic printers combined with intraoral scanning and implant planning software promise precise and cost-effective guided implant surgery. The purpose of the present study was to determine the overall range of accuracy of tooth-supported guided implant surgery using desktop printed stereolithographic guides. MATERIALS AND METHODS: A cross-sectional study comparing fully and partially guided implant surgery was conducted. Preoperative cone beam computed tomography (CBCT) and intraoral scans were used to plan the implant sites. Surgical guides were then fabricated using a desktop stereolithographic 3-dimensional printer. Postoperative CBCT was used to evaluate the accuracy of placement. Deviations from the planned positions were used as the primary outcome variables. The planning software used, implant systems, and anterior/posterior positions were the secondary outcome variables. The differences between the planned and actual implant positions in the mesial, distal, buccal, and lingual dimensions and buccolingual angulations were determined, and the accuracy was compared statistically using the 1-tail F-test (P = .01), box plots, and 95% confidence intervals for the mean. RESULTS: Sixteen partially edentulous patients requiring placement of 31 implants were included in the present study. The implant deviations from the planned positions for mesial, distal, buccal, and lingual dimensions and buccolingual angulations with the fully guided protocol (n = 20) were 0.17 ± 0.78 mm, 0.44 ± 0.78 mm, 0.23 ± 1.08 mm, -0.22 ± 1.44 mm, and -0.32° ± 2.36°, respectively. The corresponding implant deviations for the partially guided protocol (n = 11) were 0.33 ± 1.38 mm, -0.03 ± 1.59 mm, 0.62 ± 1.15 mm, -0.27 ± 1.61 mm, and 0.59° ± 6.83°. The difference between the variances for fully and partially guided surgery for the distal and angulation dimensions was statistically significant (P = .006 and P < .001, respectively). No statistically significant difference was found between the software programs. Anterior implants had less variation in deviation than posterior implants. CONCLUSIONS: Fully guided implant surgery is more accurate than partially guided implant surgery. Implant positional deviation is influenced by implant location but not implant systems or software. If possible, clinicians should use guided surgery protocols that allow placement of implants through a surgical guide.

Management of the Maxillary Diastema by Various Dental Specialties.

PURPOSE: There is considerable controversy in the literature concerning the indications for frenectomy for treating a maxillary diastema and for timing of the procedure. The purpose of this study was to survey pediatric dentists, orthodontists, and oral and maxillofacial surgeons on their opinion of this matter to develop a consensus. MATERIALS AND METHODS: An anonymous 7-item electronic questionnaire was sent to members of the American Academy of Pediatric Dentists, the American Association of Orthodontists, and the American Association of Oral and Maxillofacial Surgeons asking about the etiology of the maxillary diastema, its diagnosis, and treatment. RESULTS: Although there was no agreement among the oral and maxillofacial surgeons for the timing of frenectomy and when the diastema should be closed, the pediatric dentists and orthodontists generally agreed that frenectomy should not be performed before the permanent canines are erupted and that the operation should follow orthodontic closure of the space. CONCLUSION: Although there was no complete consensus among the 3 groups, a logical treatment approach for the maxillary diastema is proposed.

Do Implant Surgical Guides Allow an Adequate Zone of Keratinized Tissue for Flapless Surgery?

PURPOSE: A major advantage of guided implant surgery using 3-dimensionally printed guides is the ability to perform accurate flapless surgery. A drawback of a flapless technique is the inability to manipulate soft tissue to ensure sufficient gingiva around the implant. The purpose of this study was to determine how often flapless surgery using surgical guides results in less than 2 mm of keratinized tissue surrounding the implant. MATERIALS AND METHODS: This retrospective analysis included 27 maxillary and 27 mandibular implant sites that underwent treatment planning for implant-guided surgery using 3Shape Implant Studio (3Shape, Copenhagen, Denmark). Intraoral scan images were used to measure the width of the keratinized tissue on the buccal aspect of each implant site in both arches and the lingual aspect in the mandibular arch. Three examiners measured the amount of buccal and lingual keratinized tissue in millimeters at each implant site. Analysis of variance (P < .05) and correlation coefficients were used to determine statistically significant differences in keratinized tissue among sites. RESULTS: No statistically significant difference was found either between the widths of buccal keratinized tissue in the maxillary anterior (4.06 ± 1.42 mm) and posterior (4.93 ± 2.54 mm) areas (P = .293) or between the amounts of buccal and lingual keratinized tissue in the mandible (P = .995). The keratinized tissue width in the maxillary buccal area was significantly different (4.48 ± 2.04 mm) from that in the mandibular posterior buccal (1.98 ± 1.41 mm) and lingual (1.98 ± 1.23 mm) areas (P < .001). Over 77% of maxillary implant sites had greater than 3 mm of gingiva, and just over 20% had sufficient gingiva in the mandible. CONCLUSIONS: Adequate keratinized tissue was found in most of the planned maxillary implant sites, whereas most of the mandibular posterior implant sites had inadequate keratinized tissue. Therefore, elevation of a flap to preserve and reposition existing keratinized tissue around implants should be considered when planning to use tooth-borne surgical guides in the posterior mandible.

Burnout, depression and suicidal ideation in dental and dental hygiene students.

INTRODUCTION: The aim of this study was to assess the relationship between burnout, depressive symptoms and suicidal ideation in dental and dental hygiene students and to evaluate the influence of gender, programme type and year of study. SUBJECTS AND METHODS: Third- and fourth-year dental (DS) and first- and second-year hygiene students (DHS) completed the Patient Health Questionnaire (PHQ-9) and an abbreviated Maslach Burnout Inventory online as measures of depressive symptoms/suicidality and burnout, respectively. The statistical analyses included summary statistics and tests for intergroup comparisons (chi-square) to evaluate the influence of gender, programme type (DHS or DS) and year of study. Correlations between depression, suicidality and burnout were also conducted. RESULTS: A total of 32 dental hygiene and 119 dental students participated. 40% of the dental and 38% of the hygiene students met criteria for burnout. No differences were found between years or between programmes. Nine per cent of both dental and hygiene students were above the cut-off for moderate depressive symptoms, but there were no statistical differences between the third- and fourth-year dental and the first- and second-year hygiene students. Six per cent of the dental and 9% of the dental hygiene students were above the cut-off for clinically significant suicidal ideation, but there were no statistical differences between dental and hygiene students. There were no differences noted in the dental students based on gender for any of the measures. Depression was significantly associated with all three subscales of burnout. Suicidal ideation was only significantly related to the lack of personal accomplishment subscale of burnout. DISCUSSION: These findings suggest the need for introducing preventive measures for such affective states in dental and dental hygiene training programmes.

Societal Preference for Gender of Surgeons Performing Patients' Surgery.

PURPOSE: Previous studies have shown that there may be a bias among some male oral and maxillofacial surgeons regarding women practicing in the specialty. The purpose of this study was to determine if there is a similar bias in the general public. PATIENTS AND METHODS: We performed a survey of 65 patients of various genders, educational levels, and ages asking them their surgeon gender preference for extraction of a tooth, removal of impacted third molars, and cosmetic surgery, as well as the reasons for their preference. RESULTS: Of respondents, 91% had no preference regarding surgeon gender for tooth extraction, 88% for removal of impacted teeth, and 83% for cosmetic surgery. There was no difference in gender preference based on the respondents' gender, educational level, or age. CONCLUSIONS: There does not appear to be a gender bias against female oral and maxillofacial surgeons in the general population.

Simultaneous Impacted Third Molar Extraction and Lateral Ramus Block Graft Harvest for Horizontal Ridge Augmentation: A Case Series.

PURPOSE: The purpose of this study was to confirm the efficiency of using a lateral ramus block graft taken at the time of impacted mandibular third molar removal for horizontal ridge augmentation and implant placement. PATIENTS AND METHODS: Ten patients had grafts obtained from the lateral aspect of the mandible during impacted third molar removal and placed in areas of horizontal ridge deficiency. RESULTS: Measurements made on cone-beam computerized tomograms after 4 months showed gains of 2.7 to 3.5 mm and 16 implants were placed successfully. CONCLUSIONS: In patients with impacted third molars requiring dental implants, simultaneous harvest of a lateral block bone graft is an efficient way of obtaining bone for horizontal ridge augmentation.

Is Cone-Beam Computed Tomography Always Necessary for Dental Implant Placement?

PURPOSE: The use of cone-beam computed tomography (CBCT) for evaluation of patients for dental implants has gained considerable popularity. This retrospective cohort study was designed to determine whether using a clinical examination and a panoramic radiograph (Panorex) for implant selection and determining the need for bone grafting would be comparable to using CBCT in routine implant cases. PATIENTS AND METHODS: Implant size and need for bone grafting were initially determined in 82 patients using a panoramic radiograph and clinical examination. These patients subsequently underwent CBCT and their treatment was re-planned by the same surgeon using Simplant treatment planning software (DENTSPLY Implants, Mölndal, Sweden) in addition to clinical examination. The length and width of implants selected by each method and the need for bone grafting were recorded and the results were compared statistically with each other and with the actual treatment subsequently rendered. RESULTS: The Panorex method and the CBCT method accurately predicted implant width to within 1.5 mm of the implant actually placed in 100% of cases and length to within 1.5 mm in more than 95% of cases. For bone graft prediction, the results indicated that neither the Panorex method nor CBCT method differed substantially from the actual treatment rendered. CONCLUSIONS: The results of this study indicate that the CBCT is more accurate in predicting implant length and width and the need for bone grafting procedures. However, for routine unguided implant placement in sites where anatomic structures and bone grafting are not a concern, the use of a panoramic radiograph could be adequate for determining the length and width of the implant.

Is Treating Oral and Maxillofacial Trauma Profitable? An Analysis of Hospital and Surgeon Reimbursement at an Academic Medical Center.

PURPOSE: During the past 2 decades, there has been a marked decrease in the willingness of community-based oral and maxillofacial surgeons to participate in trauma call. Although many factors can influence the decision not to take trauma call, 1 primary disincentive is the perception that managing facial trauma might be profitable for the hospital, but not profitable for the surgeon. The purpose of this study was to compare the profitability of facial trauma management for the hospital and the surgeon at the Virginia Commonwealth University (VCU) Medical Center (Richmond, VA). MATERIALS AND METHODS: In this retrospective cohort study, records were collected for patients who were seen for primary trauma management by the Department of Oral and Maxillofacial Surgery at VCU (VCUOMS) from June 2011 through July 2014. Cost and reimbursement data were analyzed for these patients from the VCU Health System (VCUHS) and the VCUOMS. For the hospital, actual cost data were provided; for the surgeon, cost was calculated based on an average overhead of 50%. For uniformity, patients were excluded if they remained in the hospital for longer than a 23-hour observation period. Patients younger than 18 years also were excluded. RESULTS: In total, 169 patients met the inclusion criteria. There was a statistically relevant difference in the percentage of costs recouped and the actual profit. The average percentage of costs recouped was 230% for the VCUHS versus 47% for the VCUOMS. This amounts to an average profit per case of $3,461 for the hospital versus a loss of $1,162 for the surgeon. CONCLUSIONS: The results of this study indicate that in the VCU Medical Center, maxillofacial trauma yields a net profit for the hospital and a net loss for the operating surgeon. Although the results are limited to outpatient management at 1 academic institution, they suggest that hospitals in some settings might be in a position to incentivize surgeons for trauma management.

Public and Patient Knowledge About Dental Implants.

PURPOSE: The more informed a patient is about a given procedure, the better the ultimate outcome. This study was designed to compare general public awareness and knowledge regarding oral implant treatment with those of patients presenting for such treatment and to determine the sources from which they may have obtained such information, as well as the accuracy of the information. PATIENTS AND METHODS: In this cross-sectional study, 2 groups of patients were asked to complete a questionnaire containing implant knowledge questions and questions regarding any sources they may have used to obtain information about dental implants. Group I consisted of patients presenting for treatment of a dental emergency (general population group), and group II consisted of patients presenting for an implant consultation. The χ2 test was used to determine whether there were differences in knowledge and information sources between the 2 groups. RESULTS: A total of 126 adult patients (76 dental emergency patients and 50 implant consultation patients) participated in the study. The general population group was less informed about dental implants, especially information relating to implant material and longevity, and received information from less reliable sources than patients presenting for implant screening (friends or relatives vs primary dentist). Both groups reported cost of the procedure as a primary barrier to receiving implants (89% and 90%). CONCLUSIONS: There is still a need for continued education of the general public regarding dental implants.

Does Orthognathic Surgery Cause or Cure Temporomandibular Disorders? A Systematic Review and Meta-Analysis.

PURPOSE: There is still controversy about whether orthognathic surgery negatively or positively affects temporomandibular disorders (TMDs). The purpose of this study was to determine whether orthognathic surgery has a beneficial or deleterious effect on pre-existing TMDs. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched 3 major databases to locate all pertinent articles published from 1980 to March 2016. All subjects in the various studies were stratified a priori into 9 categories based on subdiagnoses of TMDs. The predictor variables were those patients with pre-existing TMDs who underwent orthognathic surgery in various subgroups. The outcome variables were maximal mouth opening and signs and symptoms of a TMD before and after orthognathic surgery based on the type of osteotomy. The meta-analysis was performed using Comprehensive Meta-Analysis software (Biostat, Englewood, NJ). RESULTS: A total of 5,029 patients enrolled in 29 studies were included in this meta-analysis. There was a significant reduction in TMDs in patients with a retrognathic mandible after bilateral sagittal split osteotomy (BSSO) (P = .014), but no significant difference after bimaxillary surgery (BSSO and Le Fort I osteotomy) (P = .336). There was a significant difference in patients with prognathism after isolated BSSO or intraoral vertical ramus osteotomy and after combined BSSO and Le Fort I osteotomy (P = .001), but no significant difference after BSSO (P = .424) or bimaxillary surgery (intraoral vertical ramus osteotomy and Le Fort I osteotomy) (P = .728). CONCLUSIONS: Orthognathic surgery caused a decrease in TMD symptoms for many patients who had symptoms before surgery, but it created symptoms in a smaller group of patients who were asymptomatic before surgery. The presence of presurgical TMD symptoms or the type of jaw deformity did not identify which patients' TMDs would improve, remain the same, or worsen after surgery.

How Accurate Are Implant Surgical Guides Produced With Desktop Stereolithographic 3-Dimentional Printers?

PURPOSE: The use of tooth-supported static stereolithographic guides has greatly improved the ability to ideally place implants. This study was designed to determine the accuracy of in office-printed implant surgical guides. MATERIALS AND METHODS: Using 3shape Implant Studio, a treatment plan for implant placement for tooth 8 was developed using a digital intraoral scan from a Trios scanner and cone-beam computed tomography. Ten stereolithographic guides were printed using a Form2 3-dimensional printer. Pre- and post-implant insertion digital scans were used to determine distance and angulation differences in the mesiodistal and faciolingual positions of the implants compared with the planned position. RESULTS: The mean difference in mesiodistal direction at the alveolar crest between planned implants and placed implants was 0.28 mm (range, 0.05 to 0.62 mm) and the difference in the faciolingual direction was 0.49 mm (range, 0.08 to 0.72 mm). The mean mesiodistal angulation deviation was 0.84° (range, 0.08° to 4.48°) and the mean faciolingual angulation deviation was 3.37° (range, 1.12° to 6.43°). CONCLUSIONS: In-office fabricated stereolithographic implant surgical guides show similar accuracy to laboratory- or manufacturer-prepared guides. This technique provides a convenient and cost-effective means of assuring proper implant placement.

Patient Recall of Information on a Third Molar Informed Consent Video.

PURPOSE: Experience has shown that in malpractice cases patients often claim certain information was not provided during the informed consent process. The purposes of this study were to determine how much of an informed consent video patients initially remember and how much is recalled when there is a hiatus from viewing the video to the surgery. PATIENTS AND METHODS: In this prospective cohort study, patients presenting for impacted third molar removal in an academic setting (n = 50) or a private office (n = 50) viewed an informed consent video and then met with the treating doctor for further discussion and signing of an informed consent form. Then, they were given a 10-item test containing questions relating to the information provided on the video. At the subsequent time of surgery, they were again given the same test. The number of correct answers at the 2 points was compared. RESULTS: There was a significant difference in the number of correct responses between the 2 time points (P = .0212) and between patients from the 2 practice settings (P = .0076). However, these differences were less than 0.5 of a possible 10. The number of correct responses was not associated with age (P = .1203), gender (P = .6647), or number of days between testing (P = .7272). CONCLUSION: Patients have good recall of the information provided by the informed consent video. However, because some information was forgotten, a presurgical review of the information is advisable.

How Effective Is the Tent Screw Pole Technique Compared to Other Forms of Horizontal Ridge Augmentation?

PURPOSE: The tent screw pole technique is one of the methods available for practitioners to perform horizontal ridge augmentation to facilitate dental implant placement. The purpose of this study was to evaluate the efficacy of the tent screw pole technique for horizontal ridge augmentation and to compare the results with those of the tunnel technique and open ridge augmentation. PATIENTS AND METHODS: In this retrospective cohort study, 35 patients underwent horizontal ridge augmentation with the tent screw pole technique, a 1:1 ratio of mineralized freeze-dried bone allograft and particulate bovine hydroxyapatite, and a resorbable collagen membrane. The incidence of early wound dehiscence and membrane exposure, the number of courses of antibiotics and postoperative visits required for their management, and the number of sites that subsequently had successful implant placement were recorded. These parameters were compared with those in 21 patients who had undergone horizontal ridge augmentation by the tunnel technique and 31 patients who had been treated using an open procedure and a resorbable polytetrafluoroethylene (PTFE) membrane in the authors' previous study (J Oral Maxillofac Surg 74:1752, 2016). RESULTS: Implant placement rate was similar for all 3 methods (71 to 97%). However, there were significant differences among the 3 surgical techniques for membrane exposure and wound dehiscence (P = .0033), graft loss (P = .0256), courses of antibiotics (P = .0017), and postoperative visits (P = .0043). The PTFE method consistently had the highest rate of complications, whereas the tent screw and tunnel techniques were comparable. CONCLUSIONS: All 3 techniques allowed a high rate of implant placement; however, the PTFE technique was consistently associated with increased postoperative complications compared with the other 2 methods. The tent screw technique might be more favorable than the tunnel technique in cases in which the bony deficiency is flat.