Patients' narratives of orthognathic treatment for facial asymmetry: a qualitative study.

To explore patients' experiences of orthognathic treatment for facial asymmetry and their adaptation to facial changes after surgery, we did a qualitative, cross-sectional study of patients after treatment for non-cleft asymmetry at two UK sites. A total of 15 patients aged 19-40 years were approached after being identified using patient databases and clinical notes. Individual and photo-elicitation interviews were conducted covering experiences prior to treatment, during treatment, and after surgery. Interviews were transcribed and thematic narrative analysis undertaken. Participants were largely positive about their orthognathic treatment. The following themes were identified: preoperative (becoming aware, negative impacts of asymmetry, committing to treatment, establishing expectations), pre-surgery orthodontics and inpatient experiences (challenges and coping strategies, preparedness, support, and shared experiences); and postoperative (surgery as 'worth it', positive impacts of treatment, adapting to facial change). Undergoing orthognathic surgery was portrayed as a journey involving recognisable narratives (treatment unfinished, threat of liminality, treatment as resolution, and treatment as transformation). Patients' experiences of facial asymmetry are associated with feeling 'abnormal', and negative impacts, and orthognathic treatment for facial asymmetry is worthwhile. Having the feeling that something is 'wrong' legitimised by clinicians allows patients access to a recognisable treatment narrative (resolution). Orthognathic treatment is also described as transformation from 'normal abnormality' to being 'normal'. Nevertheless, the associated challenges can be frustrating, particularly if resolution is hard to envisage. Further psychological input could help patients cope with these challenges and the complex process of adapting to facial change.

Influence of window size in small-window colour measurement, particularly of teeth.

Tooth colour is often measured with a small window for illumination and measurement. This causes edge loss of the light, resulting in systematic errors in colour coordinates. This paper gives a quantification of the edge losses, and explains their cause. We measured reflectance spectra for 27 Formalin fixated extracted incisors using a small-window reflectance spectrophotometer equipped with external diaphragms of 3, 4, and 5 mm diameter, and using a spectroradiometer. We calculated the colour coordinates L*a*b* from these spectra. Finally, 16 randomly chosen teeth were illuminated with a pencil beam (lambda = 543 nm, and lambda = 633 nm) while the emerging light was measured as a function of distance from the illuminated spot using a CCD detector. These data were used to calculate small-window edge losses, and thus to predict the small-window reflectance factors relative to spectroradiometrically determined reflectance, at both 543 nm and 633 nm. In all instruments the same spot on the tooth was illuminated and measured, and the teeth were always wet. Colour coordinates for the small-window colour measurements deviate significantly from those determined using the spectroradiometer. These deviations can be explained from the wavelength-dependant edge loss that arises in small-window colour measurement.

[Observing the tooth. The paths of light in visual and instrumental observation]. / Kijken naar de tand. De gang van het licht bij visuele en instrumentele waarneming.

The light we observe when we look at a tooth has travelled a long way through the tooth. A large fraction has passed through the dentine. There is also a sideways displacement: the point of entrance into the tooth is about 2 mm away from the point of exit. This implies that tooth color cannot correctly be measured with an instrument employing a single circular window for both illumination and measurement. Visual caries diagnosis of smooth surfaces and with Fiber Optic Trans Illumination (FOTI) is discussed in terms of light paths through the tooth.

Treatment of the edentulous atrophic maxilla using zygomatic implants: evaluation of survival rates over 5-10 years.

The aim of this retrospective observational cohort study was to analyse and report the 5-10-year survival rates of endosseous zygomatic implants used in the rehabilitation of the atrophic maxilla. Forty-three consecutive zygomatic implant placements in 25 patients were evaluated over a 5-10-year period. All zygomatic implant surgery was carried out under general anaesthesia. Nobel Biocare zygomatic machined-surface implants were used, and placement was undertaken using the modified sinus slot method. The main outcome measures and determinants for success were survival of the restored implants and the proportion of originally planned prostheses delivered to patients. Of the 25 patients treated, 12 were male and 13 were female; 19 were non-smokers, and the mean age at time of surgery was 64 years. Patients were treatment-planned for implant-retained bridgework, a removable prosthesis retained by fixed cast gold or milled titanium beams, or magnet-retained removable prostheses. A combination of zygomatic and conventional implants was used in all but one patient. In this study it was shown that the overall success rate for zygomatic implants was 86%, with six of the implants either failing to integrate or requiring removal due to persistent infection associated with the maxillary sinus. All patients received their planned prosthesis, although in six cases the method of retention required modification. This study illustrates that zygomatic implants are a successful and important treatment option when trying to restore the atrophic maxilla, with the potential to avoid additional augmentation/grafting procedures and resulting in a high long-term success rate.