Effects of early preventive dental visits and its associations with dental caries experience: a cross-sectional study.

OBJECTIVES: Limited information is known about preventive dental visits (PDVs) before seven years of age among children in China. This study aimed to examine the early PDV rate, identify the impact of PDV on dental caries and untreated dental caries, and explore the factors related to PDV among Chinese sampled children under seven years old. METHODS: A cross-sectional survey was conducted in five selected primary health care facilities in Chengdu, China, from May to August 2021. Parent-child dyads during regular systematic medical management were recruited to participate. Children's dental caries were identified through dental examinations and documented as decayed, missing and filled teeth index (dmft) by trained primary care physicians. Dental-related information was collected through a questionnaire. Zero-inflated negative binomial (ZINB) regression was used to test the effect of early PDV on the dmft value, and logistic regression was used to analyse impact factors on the early PDV. RESULTS: A total of 2028 out of 2377 parent-child dyads were qualified for analysis. Half of the children (50.4%) were male, with a mean age of 4.8 years. Among all the children, 12.1% had their first dental visit for preventive purposes, 34.4% had their first dental visit for symptomatic purposes, and more than half had never visited a dentist. The results showed that a lower dmft value (adjusted OR: 0.69, 95% CI: 0.48-0.84), a higher rate of caries-free (aOR: 6.5, 95% CI: 3.93-10.58), and a lower rate of untreated dental caries (aOR: 0.40, 95% CI: 0.21-0.76) were associated with early PDV utilization. Children who had a higher rate of PDV were positively associated with living in a family with better parental behaviours (aOR: 2.30, 95% CI: 1.71-3.08), better parental oral health perception (aOR: 1.23, 95% CI: 1.06-1.32), fathers who had no untreated caries (aOR: 0.68, 95% CI: 0.47-0.97), families with higher socioeconomic status (aOR: 1.09, 95% CI: 1.04-1.16), and dental health advice received from well-child care physicians (aOR: 1.47, 95% CI: 1.08-2.00). CONCLUSIONS: Early PDV was associated with a lower rate of dental caries prevalence and untreated dental caries among sampled children younger than seven in Western China. Underutilization and social inequities existed in PDV utilization. Public health strategies should be developed to increase preventive dental visits and eliminate social disparities that prevent dental care utilization.

[Routine Epidemic Prevention and Control and Treatment Process Reengineering of Outpatient Dental Care].

The coronavirus disease 2019 (COVID-19) pandemic is the most severe global public health emergency in over a hundred years. We have collected and organized prevention and control information from China and other counties and used it as an important reference for designing routine epidemic prevention and control measures and treatment process reengineering of outpatient dental services. Suggestions are made in the following aspects: standard precaution is adopted for all patients based on situational risk assessment conducted by the medical staffs; transmission-based precautions are adopted in addition while caring for patients who are suspected of or have been confirmed of having infectious diseases, in which scenario, standard precautions may not be enough; regarding clinical services, the triage process should be further improved, clinical service delivery areas should be redesigned to maximize safe distances, minimally invasive dentistry procedures should be prioritized for treatment, and postponement of treatment should be recommended appropriately; infection prevention and control guidelines should be regularly updated and relevant trainings provided to the medical staffs accordingly; COVID-19 incidents associated with delivery of dental care should be documented and evaluated; it is also important to communicate with Chinese and international colleagues and stress research and professional training.

A survey on oral care practices for ventilator-assisted patients in intensive care units in 3A hospitals of mainland China.

Oral hygiene is a critical element of patient care, particularly among patients who need ventilator-assisted equipment. The objective of this study was to explore the current status of oral care practices, attitudes, education and knowledge among intensive care unit (ICU) nurses caring for ventilator-assisted patients in 3A hospitals in mainland China. To achieve this aim, an 18-item self-assessment questionnaire was mailed to head ICU nurses in 189 Grade 3A hospitals. Additional data were collected through in-person interviews at 38 ICUs throughout Sichuan, Shanxi, Jiangsu provinces, as well as Chongqing and Beijing. We found that most ICUs conducted oral examinations at patient admission, and that this care was largely provided by nurses. The most common oral care methods were foam swabs and mouth rinse containing antibiotics or disinfectants. Although the majority of ICUs provided continuing training for oral care, and most training was conducted by head nurses, the content and scope of training were not consistent among the hospitals in the study. The most popular sources of oral care knowledge were academic journals, Internet and professional books. Overall, it is clear that an evidence-based oral care standard manual is urgently needed for oral practice in ICUs in mainland China.

Effect of the COVID-19 Mitigation Measure on Dental Care Needs in 17 Countries: A Regression Discontinuity Analysis.

Objectives: The effect of COVID-19 mitigation measures on different oral health care needs is unclear. This study aimed to estimate the effect of COVID-19 mitigation measures on different types of oral health care utilization needs and explore the heterogeneity of such effects in different countries by using real-time Internet search data. Methods: Data were obtained from Google Trends and other public databases. The monthly relative search volume (RSV) of the search topics "toothache," "gingivitis," "dentures," "orthodontics," and "mouth ulcer" from January 2004 to June 2021 was collected for analysis. The RSV value of each topics before and after COVID-19 was the primary outcome, which was estimated by regression discontinuity analysis (RD). The effect bandwidth time after the COVID-19 outbreak was estimated by the data-driven optimal mean square error bandwidth method. Effect heterogeneity of COVID-19 on dental care was also evaluated in different dental care categories and in countries with different human development index (HDI) rankings, dentist densities, and population age structures. Results: A total of 17,850 monthly RSV from 17 countries were used for analysis. The RD results indicated that advanced dental care was significantly decreased (OR: 0.63, 95% CI: 0.47-0.85) after the COVID-19 outbreak, while emergency dental care toothache was significantly increased (OR: 1.54, 95% CI: 0.99-2.37) 4 months after the COVID-19 outbreak. Compared to the countries with low HDI and low dentist density, the effect was much more evident in countries with high HDI and high dentist density. Conclusions: COVID-19 mitigation measures have different effects on people with various dental care needs worldwide. Dental care services should be defined into essential care and advanced care according to specific socioeconomic status in different countries. Targeted health strategies should be conducted to satisfy different dental care needs in countries.

Prediction model for early childhood caries risk based on behavioral determinants using a machine learning algorithm.

BACKGROUND: An easily accessible caries risk prediction model (CRPM) based on nonbiological predictors is lacking. Developing a CRPM for community screening is essential for children's dental health promotion by a public health approach. OBJECTIVE: This study aimed to develop and validate a caries risk prediction model (CRPM) for children using a machine learning algorithm based on dental care behavioral factors and other nonbiological factors using a 3-month multicenter cohort. METHODS: Children aged 12 months to 60 months were recruited at three primary care settings and three kindergartens in Chengdu, China. Dental examination was conducted for all enrolled children by calibrated pediatric dentists at baseline and three months later. All parents of the enrolled children were asked to complete a questionnaire with dental-related information. Machine learning algorithms, including random forest, logistic regression, and adaptive boosting, were used to develop a prediction model. Sensitivity, specificity, accuracy, precision, negative predictive value and F-score were reported to estimate the internal validation of the models. RESULTS: A total of 481 out of 745 children without a history of caries experience at baseline remained for analysis. In the total sample population, 236 (49.1%) children were female, and the mean age was 31.2 months. During the follow-up exams, 66 (13.6%) children had new-onset caries. The child's age, height, weight, family caries status, brush teeth two minutes per time, fluoride toothpaste usage, brushing twice per day, parental monitoring brushing teeth, mother delivery method, brushing child's teeth every day, child number counts, and night feeding frequency in the last month were measured and included in a prediction model. Of the prediction models, the highest area under the curve of RF was 0.91 (95% CI: 0.87- 0.94), followed by 0.86 (95% CI: 0.81-0.91) of LR and 0.81 (95% CI: 0.76-0.86) of AdaBoost. CONCLUSION: In this CRPM, new onset of dental caries in three months among children aged < 60 months could be predicted by answering twelve nonbiological questions. A good model performance was shown within the internal validation. Dental home care could be improved by referring the CRPM result before new caries onset.

Caries Risk Assessment and Dental Referral by Paediatric Primary Care Physicians in Sichuan Province, China: A Cross-Sectional Study.

Background: Limited information is known about dental implementation by pediatric primary care physicians (PCPs) at the primary care level in China. This study aimed to explore the current status of primary oral care implementation and related influencing factors. Methods: A cross-sectional survey was conducted among PCPs in Sichuan Province, China. Multivariable logistic regression was used to analyse factors associated with CRA and dental referral for high caries-risk children. Results: A total of 504 out of 524 questionnaires remained for analysis. In all, 93.8% of PCPs reported that they usually or sometimes performed dental screening for children, 31.3% performed CRA, and 49.0% referred high caries-risk children to dentists. More CRA activities were associated with PCPs who encountered a greater number of children with caries during systematic care (adjusted OR: 2.37, 95% CI:[1.08,5.18], had dental knowledge training by pediatric dentists (aOR: 2.26, 95% CI:[1.36, 3.75], and learned pediatric dental knowledge on their own (aOR: 2.87, 95% CI: [1.51, 5.45]). In addition to the above associators, a higher rate of dental referrals for high caries-risk children was associated with having a dental department in the same work institute (aOR: 1.72, 95% CI: [1.09, 2.70] and having more confidence in their dental knowledge (aOR: 1.29, 95% CI: [1.04, 1.61]). Conclusion: Paediatric PCPs commonly implement dental screening but perform fewer CRAs and dental referrals for high caries-risk children during systematic health management in western China. To increase CRA activities and dental referral by paediatric PCPs, health policymakers could encourage interdisciplinary cooperation between dental professionals and paediatric PCPs.

Evaluation of therapeutic effect and health economics of general anesthesia and routine outpatient dental treatment in children with severe early child caries.

OBJECTIVES: To evaluate the efficacy and health economics of the comprehensive therapy for the children with severe early child caries (S-ECC) under dental general anesthesia (DGA) and conventional outpatient treatment to provide references for dentists and parents in the choice of clinical treatment. METHODS: A retrospective cohort study was conducted on S-ECC children aged 36-71 months and who received dental treatment under general anesthesia or routine outpatient situation. The filled tooth survival rate, treatment cost, and cost-filled tooth survival time of the two groups were compared, and the curative effect and health economics was evaluated. RESULTS: The filled tooth survival rate of the DGA group was higher than that of the routine outpatient group (P<0.05). The average direct medical cost per filled tooth was significantly higher in the DGA group than in the routine outpatient group (P<0.05). The direct medical cost-filled tooth survival time ratio in the DGA group was higher than that in the routine outpatient group (P<0.05), but no significant difference was observed in the total medical cost-filled tooth survival time ratio (P>0.05). CONCLUSIONS: Compared with the conventional outpatient treatment group, the treatment outcomes of S-ECC under general anesthesia were better, and the costs were higher. However, no significant difference was observed in the total medical cost-filled tooth survival time between these two groups, and the conventional outpatient treatment did not have evident economic advantages.

Improved accuracy of hemimandibular reconstructions involving the condyle by utilizing hydroformed reconstruction plates rather than hand-bent stock plates.

BACKGROUND: Computer-aided design/computer-aided manufacturing (CAD/CAM) surgical templates allow precise mandibular reconstructive surgery. However, their clinical accuracy is limited by manual plate bending. Digitally hydroformed plates maintain a digital workstream in virtual planning. METHODS: Twelve patients with Brown's class IIc mandibular defects were randomized into two groups: group I (experimental), the reconstruction plate was digitally hydroformed, and group II (control), surgeries were performed CAD/CAM guided with the reconstruction plate manually prebent. The linear and angular deviations of reconstruction outcomes were compared to surgical simulation in both groups. RESULTS: The mean linear and angular deviations of middle and posterior segments were 2.14 ± 0.79 mm, 3.71 ± 0.95 mm, 8.73° ± 1.91°, and 9.06° ± 0.96° in group I and 4.31 ± 0.78 mm, 6.74 ± 1.40 mm, 16.35° ± 0.72°, and 31.48° ± 3.38° in group II, respectively. Measurements in group I were significantly lower than group II (P < .005). CONCLUSION: Digital hydroforming for plate prebent is a reliable method that helps improving the clinical accuracy of CAD/CAM-guided mandibular reconstruction surgery.

Randomized control trial comparing the titanium osteosynthesis and the biodegradable osteosynthesis in mandibulotomy access.

BACKGROUND: The clinical degradation rate and strength of biodegradable implant exposed to postoperative radiotherapy (PORT) are unknown. METHODS: A prospective randomized control trial of 40 consecutive mandibulotomy patients randomly divided into titanium and biodegradable cohorts. All patients received PORT. The following parameters were compared: maximal mouth opening, occlusal force, center of force trajectory, occlusal status, radiographic evidence of bony union, mandibular function impairment questionnaire (MFIQ), overall satisfaction score, and complication rates. RESULTS: Both the mandibular function and occlusal status parameter of the biodegradable and the titanium groups were not significantly difference. Biodegradable cohort showed better MFIQ scores (P = .08) and overall satisfaction scores (P = .64) but was not statistically significant. Of note, 40% of patients in the titanium cohort complained of plate palpability/cold intolerance and required plate removal (P = .02); 10% of patients in the titanium cohort developed osteoradionecrosis. CONCLUSION: Biodegradable osteosynthesis is as reliable as titanium osteosynthesis for mandibulotomy fixation. PORT did not increase the complication rate in the biodegradable group.

[Dental care utilization of immigrants in Chengdu, China].

OBJECTIVE: This study considered Chengdu, Sichuan, China as an example to investigate the dental service utilization by foreigners and its influencing factors. Results of the study can be referred by dental practitioners to explore international development of dental services and can be provided for health policy makers to formulate oral health policies for immigrants. METHODS: A simple random sampling method with a questionnaire was designed based on Anderson's health utilization model and "Oral Health Questionnaire for Adults" by the World Health Organization. Oral health condition, consciousness, and demographic data were collected. Binary Logistic regression and stratified analysis with SPSS 20.0 were performed. RESULTS: A total of 654 immigrants repre-senting 75 countries participated in the study. Among all participants, 102 (15.6%) experienced dental problems while in residence in China but paid no visit to dentists. Female immigrants, who spent considerable time living in Chengdu, experienced oral problems in a year, used dental floss, and reported family members in Chengdu, were more likely to visit Chinese dentists. Participants who lived in Chengdu for at least 10.5 months were the threshold distinguishing differences in dental visits in the country. CONCLUSIONS: The policymakers in Chengdu should consider creating a convenient and conducive dental care environment for immigrants. Additional information related to urgent oral and routine care should be provided to short- and long-term living immigrants in China. Dental practitioners in China should also contemplate on collaborating with foreign dental insurance companies to ensure better dental care access for immigrant patients.

Post-operative hemimaxillectomy rehabilitation using prostheses supported by zygoma implants and remaining natural teeth.

OBJECTIVES:: This study aimed to evaluate the stability of prostheses supported by zygoma implants and remaining teeth for subjects who had undergone hemi-maxillectomy. METHODS:: Ten patients were included in the study. Oral rehabilitation was performed using a temporary prosthesis that was supported by remaining teeth for the first three months. Then, a zygoma implant was placed to provide support for a final prosthesis in addition to the remaining teeth. Each prosthesis was tailor-made according to biomechanical three-dimensional finite element analysis results. The patients were assessed using the prosthesis functioning scale of the Memorial Sloan-Kettering Cancer Center. In addition, retention and bite force were recorded for both the temporary prosthesis and the final prosthesis. RESULTS:: The mean bite force of the prosthetic first molar was increased to 69.2 N. The mean retentive force increased to 13.5 N after zygoma implant insertion. The bite force on the prosthetic first molar was improved to 229.3 N. CONCLUSION:: Bite force increased significantly with the support of a zygoma implant. The use of zygoma implants in the restoration of maxillary defects improved functional outcome and patient satisfaction.

[Comparative dosimetry of dental cone-beam computed tomography and multi-slice computed tomography for oral and maxillofacial radiology].

OBJECTIVE: To compare the effective radiation dose levels of cone beam computed tomography (CBCT) with those of multi-slice computed tomography (MSCT) when scanning the same maxillofacial regions. METHODS: The effective doses of 2 CBCT (NewTom 9000 and DCT Pro) and 1 MSCT (bright speed edge select 8 slice) scanners were calculated using thermoluminescent dosimeters (TLD) that were placed in a head and neck phantom, and expressed according to the International Commission on Radiation Protection (ICRP) 2007 guidelines. RESULTS: Effective dose values ranged from 41.8 to 249.1 µSv for CBCT. The doses of MSCT scanning for maxilla, mandible and maxilla + mandible were 506.7, 829.9 and 1066.1 µSv, respectively. Dose levels of scanning only for maxilla or mandible were significantly lower than those for maxilla + mandible. CONCLUSIONS: When scanning the same maxillofacial regions, the dose levels for NewTom 9000 and DCT Pro CBCT images were lower than those for Bright speed edge select 8 slice MSCT images. Dose levels reduction could be obtained when smaller regions were scanned.

[Analysis of the development of dental insurance in China].

This article explained the character of dental disease and effective facts for dental health utilization, and current situation of basic medical insurance for oral diseases through checking up relative articles. Dental insurance had a positive effect on utilization of dental medical service and public oral health. The PEST tool was used to analyze the environment of dental insurance developing direction and feasibility in this article, and then raise some suggestions and core strategies for developing dental insurance. We believe that the dental insurance can increase the oral health service utilizations and enhance the oral health for Chinese people. Only oral insurance will be developed, Chinese oral health could be geared to international practice.

Post-operative hemimaxillectomy rehabilitation using prostheses supported by zygoma implants and remaining natural teeth

OBJECTIVES: This study aimed to evaluate the stability of prostheses supported by zygoma implants and remaining teeth for subjects who had undergone hemi-maxillectomy. METHODS: Ten patients were included in the study. Oral rehabilitation was performed using a temporary prosthesis that was supported by remaining teeth for the first three months. Then, a zygoma implant was placed to provide support for a final prosthesis in addition to the remaining teeth. Each prosthesis was tailor-made according to biomechanical three-dimensional finite element analysis results. The patients were assessed using the prosthesis functioning scale of the Memorial Sloan-Kettering Cancer Center. In addition, retention and bite force were recorded for both the temporary prosthesis and the final prosthesis. RESULTS: The mean bite force of the prosthetic first molar was increased to 69.2 N. The mean retentive force increased to 13.5 N after zygoma implant insertion. The bite force on the prosthetic first molar was improved to 229.3 N. CONCLUSION: Bite force increased significantly with the support of a zygoma implant. The use of zygoma implants in the restoration of maxillary defects improved functional outcome and patient satisfaction.

The detection accuracies for proximal caries by cone-beam computerized tomography, film, and phosphor plates.

OBJECTIVES: To evaluate the accuracy of cone-beam computerized tomography (CBCT) for the detection of noncavitated proximal caries and to compare the detection accuracies of 2 CBCT imaging systems with those based on plain-film radiographs and phosphor-plate images. STUDY DESIGN: Test radiographs of 39 noncavitated unrestored human permanent teeth were obtained with film, phosphor-plate, ProMax 3D, and Kodak 9000 3D imaging systems. Seven observers used a 5-level scale to evaluate test images for the presence of proximal caries. With histologic examination serving as the reference standard, observer performances were assessed with receiver operating characteristic (ROC) curves, and the areas under the ROC curves (A(z) values) for the observers, and modalities were analyzed with a repeated-measures analysis of variance. RESULTS: The mean A(z) values for film, phosphor plates, ProMax 3D, and Kodak 9000 3D imaging systems were 0.541, 0.523, 0.528, and 0.525, respectively (P = .763). CONCLUSION: For detecting subtle noncavitated proximal caries, the detection accuracy with the CBCT images was little better than chance performance and was similar to that with phosphor plate- and film-based intraoral images.

Effects of low-intensity swimming on radiation-induced leg contracture in mice.

OBJECTIVE: To evaluate the effects of low-intensity swimming on radiation-induced leg contracture. METHODS: Forty mice were randomly and equally divided into four groups: 1) irradiation; 2) swimming before irradiation; 3) swimming after irradiation; 4) swimming after contracture, and their left hind legs were exposed to gamma irradiation of 60 Gy. The mice were allowed to swim freely for 10 minutes, three times per day. For group 2, the mice were allowed to swim for only 1 week before irradiation. For group 3, the mice were allowed to swim immediately after irradiation until day 130, post-irradiation. For group 4, the mice were allowed to swim after leg contracture happened (on day 30 post-irradiation) until day 130, post-irradiation. The leg lengths and knee joint angles were measured. Leg contracture was defined as the decrease in the hind leg lengths and the knee joint angles of each animal. The ultrastructural changes of gastrocnemius muscles were observed using transmission electron microscopy. RESULTS: The radiation could result in leg contracture and mitochondrial injury of the muscles. However, the group of swimming immediately after irradiation had less leg contracture and no vacuolar degeneration in the mitochondria, compared with the other groups. CONCLUSION: Low-intensity swimming that began immediately after the mice were irradiated could effectively prevent the irradiated legs from contracture. Patients with irradiated mastication muscles were recommended to begin mouth-opening exercises immediately after radiotherapy.

[Application of maxillary wings guiding plate in rehabilitation of combined defects of maxilla and mandible].

PURPOSE: To evaluate the role of maxillary wings guiding plate in rehabilitation of combined defects of maxilla and mandible in convalescent stage. METHODS: Combined resection of maxilla and mandible without reconstruction were performed in 10 patients with oral cancers. The impressions were got in 2 patients preoperatively and 8 patients postoperatively because of preoperative limited mouth opening. The clasps were designed to provide the retentive force according to the remained teeth. The plastic palate baseboard with wings guiding plate was made. The patients wore the plate 1 week after surgery. RESULTS: All the patients get good velopharyngeal competence and occlusion without leakage from nose after using this prosthesis for 1 to 3 months. CONCLUSIONS: Palate baseboard combined with wings guiding plate can not only obstruct the nasal-oral fistula but also correct malocclusion. It's convenient for taking dental prosthesis in late stage and improving patient's quality of life. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality(Grant No.08DZ2271100).

Effective radiation dose of ProMax 3D cone-beam computerized tomography scanner with different dental protocols.

OBJECTIVES: The aim of this study was to compare effective doses resulting from different scan protocols for cone-beam computerized tomography (CBCT) using International Commission on Radiological Protection (ICRP) 1990 and 2007 calculations of dose. STUDY DESIGN: Average tissue-absorbed dose, equivalent dose, and effective dose for a ProMax 3D CBCT with different dental protocols were calculated using thermoluminescent dosimeter chips in a human equivalent phantom. Effective doses were derived using ICRP 1990 and the superseding 2007 recommendations. RESULTS: Effective doses (ICRP 2007) for default patient sizes from small to large ranged from 102 to 298 µSv. The coefficient of determination (R(2)) between tube current and effective dose (ICRP 2007) was 0.90. When scanning with lower resolution settings, the effective doses were reduced significantly (P < .05). CONCLUSIONS: ProMax 3D can provide a wide range of radiation dose levels. Reduction in radiation dose can be achieved when using lower settings of exposure parameters.

[Application of individualized free anterolateral thigh combined flap for tongue and mouth floor defects resulted from tongue carcinoma].

OBJECTIVE: To investigate the application of individualized free anterolateral thigh combined flap (ALTCF) for tongue and mouth floor defect resulted from tongue carcinoma. METHODS: From 2006 to 2008, individualized ALTCFs were used in 31 cases of tongue and mouth floor defects resulted from tongue carcinoma. The nutritional perforator vessel was musculocutaneous pattern in 22 cases and septocutaneous pattern in 9 cases. The size of the flaps and the included muscle was (4-8) cm x (5-10) cm and (2-5) cm x (3-6) cm, respectively. The length of blood vessel pedicle was (6.81 +/- 3.23) cm. RESULTS: All the 31 free flaps survived with primary healing and no complication. The appearance and function were both satisfactory. During the follow-up period of 1-3 years, 28 cases survived, 2 cases were reoperated due to the neck lymphatic metastasis on the contralateral side. 1 case died of distant metastasis. CONCLUSIONS: Individualized ALTCF is a reliable flap for the tongue and month floor defects resulted from tongue carcinoma. Both the cosmetic and functional results are satisfactory with less morbidity in donor site and less complication.

[Vascularized iliac crest graft with internal oblique muscle for immediate reconstruction of composite mandibular defect].

OBJECTIVE: To evaluate the vascularized (deep circumflex iliac vessels) iliac crest graft with internal oblique muscle as a method for reconstruction of composite mandibular defect. METHODS: Vascularized iliac crest graft with internal oblique muscle was used to reconstruct the composite mandibular defects in 10 patients. All clinical data were analyzed retrospectively. A detailed inspection of the case-notes was undertaken to ascertain the presenting diagnosis, the surgery, the complications and the outcome. The type of mandibular defect was recorded. RESULTS: Of the 10 patients with composite mandibular defects including mandibular body, mandibular angle, mandibular ramus and the soft tissue around them, 7 patients were recorded with the defects of mandibular condyles. During the follow-up period from 3 months to 24 months, primary wound healing was observed in all patients, except one patient with minor muscular necrosis. All patients were satisfied with their facial contour and mandibular shape, without tumor recurrence. Donor site problems important enough to be recorded in the notes were minimal. CONCLUSIONS: The vascularized iliac crest graft with internal oblique muscle offers a useful solution for reconstruction of composite mandibular defect. There is sufficient height and depth of bone to maintain a facial contour and mandibular shape. It can be used as a routine surgical technique to reconstruct composite mandibular defect.