Evaluation of peri-implant perfusion in patients who underwent avascular augmentation or microvascular reconstruction using laser Doppler flowmetry and tissue spectrophotometry: a prospective comparative clinical study.

OBJECTIVES: The aim of this study was to evaluate the peri-implant perfusion, such as oxygen saturation, the relative amount of hemoglobin, and blood flow, in implants placed in pristine bone and avascular and microvascular grafts using a non-invasive measurement method. MATERIALS AND METHODS: A total of 58 patients with 241 implants were included. Among them, 106 implants were based in native bone (group I), 75 implants were inserted into avascular bone grafts (group II), and 60 implants were placed in microvascular bone grafts (group III). Gingival perfusion was measured using laser Doppler flowmetry and tissue spectrophotometry (LDF-TS). Implants with signs of gingival inflammation were excluded to analyze healthy implant perfusion in different bony envelopes. RESULTS: The mean values for oxygen saturation, relative hemoglobin levels, and blood flow did not differ significantly between the groups (p = 0.404, p = 0.081, and p = 0.291, respectively). There was no significant difference in perfusion between implants that were surrounded by mucosa and implants based within cutaneous transplants (p = 0.456; p = 0.628, and p = 0.091, respectively). CONCLUSION: No differences in perfusion were found between implants inserted into native bone and implants involving bone or soft tissue augmentation. However, implants based in avascular and microvascular transplants showed higher rates of peri-implant inflammation. CLINICAL RELEVANCE: Peri-implant perfusion seems to be comparable for all implants after they heal, irrespective of their bony surroundings. Although perfusion does not differ significantly, other factors may make implants in avascular and microvascular transplants vulnerable to peri-implant inflammation.

Evaluation of bone contact area and intercondylar distance changes in orthognathic surgery - a comparison between BSSO and HSSO technique depending on mandibular displacement extent.

OBJECTIVES: The present study aims to assess the impact of bilateral and high oblique sagittal split osteotomy (BSSO/HSSO), as well as displacement distances and directions on the expected and achievable bone contact area (BCA) and changes in the intercondylar distance (ICD). The primary question addressed is whether mandibular splitting through BSSO results in a greater BCA and/or ICD when compared to splitting through HSSO. MATERIALS AND METHODS: Totally 80 mandibular displacements were performed on 20 fresh cadavers, for each subject, four splints were produces to facilitate mandibular advancement as well as setbacks of 4 and 8 mm. Pre- and postoperative CBCT scans were performed to plan the surgical procedures and to analyze the expected and achieved BCA and ICD. RESULTS: Regarding the maximum mandibular displacement, the expected BCA for HSSO/BSSO were 352.58 ± 96.55mm2 and 1164.00 ± 295.50mm2, respectively, after advancement and 349.11 ± 98.42mm2 and 1344.70 ± 287.23mm2, respectively, after setback. The achieved BCA for HSSO/BSSO were 229.37 ± 75.90mm2 and 391.38 ± 189.01mm2, respectively, after advancement and 278.03 ± 97.65mm2 and 413.52 ± 169.52 mm2, respectively after setback. The expected ICD for HSSO/BSSO were 4.51 ± 0.73 mm and 3.25 ± 1.17 mm after advancement and - 5.76 ± 1.07 mm and - 4.28 ± 1.58 mm after setback. The achieved ICD for HSSO/BSSO were 2.07 ± 2.9 mm and 1.7 ± 0.60 mm after advancement and - 2.57 ± 2.78 mm and - 1.28 ± 0.84 mm after setback. Significant differences between the BCA after HSSO and BSSO were at each displacement (p < 0.001), except for the achieved BCA after 8-mm setback and advancement (p ≥ 0.266). No significant differences were observed regarding ICD, except for the expected ICD after 8-mm setback and advancement (p ≤ 0.037). CONCLUSIONS: Compared to the virtual planning, the predictability regarding BCA and ICD was limited. ICD showed smaller clinical changes, BCA decreased significantly in the BSSO group. CLINICAL RELEVANCE: BCA and ICD might have been less important in choosing the suitable split technique. in orthognathic surgery.

Thermal implant removal in a pig jaw: a proof of concept study.

OBJECTIVES: The aim of this study was to evaluate whether thermal implant removal of osseointegrated implants is possible using a diode laser with an specific temperature-time interval. MATERIALS AND METHODS: First, tooth extraction of the first three premolars was performed in the maxilla and mandible on both sides of 10 pig. After 3 months, implants were inserted into the upper and lower jaws of 10 pigs. After 3 more months, osseointegrated implants were heated with a laser device to a temperature of 50 °C for 1 min. After 14 days, the implant stability quotient (ISQ), torque-out values, and bone-to-implant contact (BIC) ratio were assessed using resonance frequency analysis. RESULTS: ISQ values showed no significant differences within each group or between the control and test groups. Furthermore, torque-out and BIC value measurements presented no significant differences between the groups. CONCLUSIONS: At 50°C, changes in the BIC values were noticeably smaller; however, these differences were not significant. Future studies should evaluate the same procedures at either a higher temperature or longer intervals. CLINICAL RELEVANCE: With only 50 °C for 1 min, a dental implant will not de-integrate predictably.

Evaluation of one-piece zirconia dental implants: An 8-year follow-up study.

OBJECTIVES: Long-term studies of modern zirconia implants are still insufficient. This prospective 8-year follow-up study investigated one-piece zirconia implants. MATERIALS AND METHODS: Patients who had received a one-piece zirconia dental implant (PURE ceramic implant, Institut Straumann GmbH, Basel, Switzerland) were included in this study. Next to the implant survival and success rates, the radiographic and clinical implant parameters were assessed. RESULTS: The overall survival rate of 67 zirconia implants in 39 patients was 100%. The overall success rate was 89.6%. Around the immediate zirconia implants, the success rate was 94.7%, and around the delayed implants, 87.5%. The immediate implants showed a significantly higher bone crest compared to the delayed implants (p = 0.0120). According to the pink esthetic score, the immediate implants revealed more favorable esthetic results compared to the delayed implants after an 8-year follow-up (p = 0.0002). CONCLUSIONS: After 8 years, the one-piece zirconia implants presented an 89.6% success rate. Regarding the timing of implantation, in individual cases, immediate implantation can have slight advantages over delayed implantation. CLINICAL RELEVANCE: Immediate implants can also be considered for zirconia implants and should not be excluded on principle.

Evaluation of perfusion parameters of gingival inflammation using laser Doppler flowmetry and tissue spectrophotometry- a prospective comparative clinical study.

BACKGROUND: The aim of this study was to determine the values of different perfusion parameters- such as oxygen saturation, the relative amount of hemoglobin, and blood flow- in healthy subjects compared to patients with gingivitis as a non-invasive measurement method. METHODS: A total of 114 subjects were enrolled in this study and separated into subjects with gingivitis (50) and without gingivitis (64) based on clinical examination. Gingival perfusion was measured at 22 points in the maxilla and mandible using laser Doppler flowmetry and tissue spectrophotometry (LDF-TS) with the "oxygen to see" device. All patients underwent measurement of gingival perfusion, followed by the clinical evaluation (measurement of probing depths, evaluation of bleeding on probing, plaque level, and biotype). Perfusion parameters were compared between the groups, associations between the non-invasive and clinical measurements were analyzed, and theoretical optimal cut-off values for predicting gingivitis were calculated with receiver operating characteristics. RESULTS: The mean oxygen saturation, mean relative amount of hemoglobin, and mean blood flow all significantly differed between the groups with and without gingivitis (p = 0.005, p < 0.001, and p < 0.001, respectively). The cut-off value for predicting gingivitis was > 40 AU (p < 0.001; sensitivity 0.90, specificity 0.67). CONCLUSIONS: As a non-invasive method, LDF-TS can help determine gingival hyperemia. Flow values above 40 AU indicate a higher risk of hyperemia, which can be associated with inflammation. The LDF-TS method can be used for the objective evaluation of perfusion parameters during routine examinations and can signal the progression of hyperperfusion before any change in clinical parameters is observed. TRIAL REGISTRATION: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional Clinical Research Ethics Committee (Ethik-Kommission der Medizinischen Fakultät der RWTH Aachen, Decision Number 286/20) and retrospectively registered by the German Clinical Trials Register (File Number DRKS00024048, registered on the 15th of October 2021).

Effect of systemic antiresorptive medication on the histopathological parameters of implant osseointegration in an in vivo rodent study.

BACKGROUND: The purpose of this study was to evaluate the osseointegration of zirconia and titanium implants in the rat maxilla in specimens under systemic antiresorptive therapy. MATERIALS AND METHODS: After 4 weeks of systematic medication administration (either zoledronic acid or alendronic acid), 54 rats received one zirconia and one titanium implants that were immediately inserted in the rat maxilla after tooth extraction. Twelve weeks after implant placement, histopathological samples were evaluated for implant osteointegration parameters. RESULTS: The bone-implant-contact (BIC) ratio revealed no significant inter-group or inter-material differences. The distance between the implant shoulder to the bone level was significantly greater around the titanium implants of the zoledronic acid group compared to the zirconia implants of the control group (p = 0.0005). On average, signs of new bone formation could be detected in all groups, although often without statistical differences. Signs of bone necrosis were only detected around the zirconia implants of the control group (p < 0.05). CONCLUSIONS: At the 3-month follow-up, no implant material was demonstrably better than the others in terms of osseointegration metrics under systemic antiresorptive therapy. Further studies are necessary to determine whether there are differences in the osseointegration behavior of the different materials.

Guided discovery learning: A follow-up study of try-it-yourself surgery and subsequent video-assisted teaching for oral surgical skills training.

INTRODUCTION: The purpose of this follow-up study was to assess the effects of discovery learning and subsequent standardised teaching on students' advanced dental surgical skills. MATERIALS AND METHODS: A total of 29 dental students who had no theoretical education on the Rehrmann flap were included in the skills training programme. Without prior teaching, the students were initially asked to perform a discovery surgery with a subsequent multiple-choice test (MCT) on the first day. This was followed by a video-assisted teaching lecture. On the same day and after 122 days, the surgery and MCT were repeated. Aside from the practical and theoretical assessment forms, the training was evaluated by the students themselves. RESULTS: Regarding the evaluation of surgery (EOS), significant improvements were measured between the first surgery and the second and third surgeries (p > .001). In addition, the theoretical test scores showed significant improvements after the first test when compared with the second (p = .004) and third tests (p < .001). For both assessments, no significant difference was found between the second and third attempts. The MCT and EOS in the second and third attempts strongly correlated (r = .77 and r = .71 respectively). CONCLUSION: The dental students in this study successfully learned a complex oral surgical procedure, the Rehrmann flap technique, for closing oro-antral communications. The participants indicated their high satisfaction with the teaching approach. After 122 days of follow-up, their practical and theoretical test scores remained high and presented no significant difference, which suggests that the newly learnt individual skills were retained.

Development of root resorption during orthodontic tooth movement after cleft repair using different grafting materials in rats.

OBJECTIVE: The aim of the present study was to investigate the influence of three grafting materials for cleft repair on orthodontic tooth movement in rats. MATERIALS AND METHODS: Artificial alveolar clefts were created in 21 Wistar rats and were repaired 4 weeks later using autografts, human xenografts and synthetic bone substitute (beta-tricalcium phosphate/hydroxyapatite [ß-TCP/HA]). A further 4 weeks later, the first molar was moved into the reconstructed maxilla. Microfocus computed tomography (µCT) was performed six times (T0-T5) to assess the tooth movement and root resorption. After 8 weeks, the affected reconstructed jaw was resected for histopathological investigation. RESULTS: Total distances reached ranged from 0.82 ± 0.72 mm (ß-TCP/HA) to 0.67 ± 0.27 mm (autograft). The resorption was particularly determined at the mesiobuccal root. Descriptive tooth movement slowed and root resorption increased slightly. However, neither the radiological changes during tooth movement (µCT T1 vs. µCT T5: autograft 1.85 ± 0.39 mm3 vs. 2.38 ± 0.35 mm3, p = 0.30; human xenograft 1.75 ± 0.45 mm3 vs. 2.17 ± 0.26 mm3, p = 0.54; ß-TCP/HA: 1.52 ± 0.42 mm3 vs. 1.88 ± 0.41 mm3, p = 0.60) nor the histological differences after tooth movement (human xenograft: 0.078 ± 0.05 mm2; ß-TCP/HA: 0.067 ± 0.049 mm2; autograft: 0.048 ± 0.015 mm2) were statistically significant. CONCLUSION: The autografts, human xenografts or synthetic bone substitute used for cleft repair seem to have a similar effect on the subsequent orthodontic tooth movement and the associated root resorptions. CLINICAL RELEVANCE: Development of root resorptions seems to have a secondary role in choosing a suitable grafting material for cleft repair.

Impact of quality certification of multidisciplinary head and neck tumor centers.

BACKGROUND: Certification of multidisciplinary tumor centers is nowadays seen as the gold standard in modern oncological therapy for optimization and realization of guideline-based therapy and better outcomes. Single cases are reimbursed based on diagnosis-related groups (DRG). We aimed to review efficiency, cost analysis, and profitability following a certification. METHODS: Tumor board certification at the university hospital Aachen was implemented in 2013. We compared 1251 cases of oropharyngeal cancer treated from 2008 to 2017 before and after certification. For this purpose, several patient characteristics, surgery, and stay-related constants, as well as expenses and reimbursement heights were analyzed statistically. RESULTS: Following certification, the total case and patient number, surgery duration, hours of mechanical ventilation, case mix index points, DRG reimbursements as well as the costs increased significantly, whereas days of intensive care unit, amount of blood transfusions, patient clinical complexity level (PCCL) and the overall stay were significantly lowered. No changes were observed for the patient's age and gender distribution. Also, the predetermined stay duration stayed constant. CONCLUSIONS: Certification of head-neck tumor centers causes a concentration of more complex cases requiring higher surgical efforts, which can be processed more efficiently due to a higher level of professionalism. Despite their benefits in cancer care, without compensation, centers may be struggling to cover their expenses in a system, which continuously underestimates them.

Anatomical assessment by cone beam computed tomography with the use of lateral cephalograms to analyse the vertical bone height of the anterior palate for orthodontic mini-implants.

OBJECTIVE: Lateral cephalograms (LC) should be usable to evaluate the vertical bone height of the anterior maxilla for planning the placement of orthodontic mini-implants (OMI). The purpose of this study is to determine the usability of LC for examining the real vertical dimension of the anterior palate. SETTING AND SAMPLE POPULATION: Lateral cephalograms and corresponding cone beam computed tomography (CBCT) scans were employed for examining 30 fresh cadaver heads. MATERIALS & METHODS: The minimum (distance A) and maximum (distance B) vertical palatal bone heights on LCs at the level of first premolars were measured, whereas the corresponding measurements were taken via CBCTs on the median, and 2-, 4- and 6-mm paramedian planes. Additionally, the overall minimum vertical palatal height on CBCT was recorded. RESULTS: Distance A and B on LC were about 8.3 ± 2.5 mm and 9.9 ± 2.5 mm, respectively. The median palatal height on CBCT was significantly higher than both measurements on LC (P < .01). Furthermore, the bone supply on the paramedian planes was similar or higher on CBCT compared to Distance A and similar or less compared to Distance B. The strongest correlation at the level of the premolars was found in the comparison of the maximum vertical palatal height via LC with the vertical palatal height on the median plane via CBCT (r = .84, 95% CI: 0.69-0.92, P < .001). CONCLUSIONS: In order to make the best possible use of the vertical bone supply of the anterior palate and to avoid injuries to the nasal floor, Distance A should be taken into account for planning paramedian OMI placements and distance B for median OMI insertion.

Effects of mobile learning on writing panoramic radiograph reports: a quasi-experimental trial in dental education.

BACKGROUND: In dentistry, the reporting of panoramic radiographs is particularly challenging, as many structures are depicted in one image and pathologies need to be identified completely. To enhance the learning process for these interpretations, the advantages of the increasingly popular education method of mobile learning could be used. Therefore, this study aimed to determine the effectiveness of learning to report panoramic radiographs using an application (app) on a mobile device. METHODS: The existing e-learning programme 'PantoDict' was further developed into a mobile app with a new training section. Participants of a dental radiology course were divided into two groups, one of which additionally had the chance to practise reporting panoramic radiographs using the app. A test to assess the knowledge gained was conducted at the end of the semester; the course and the app were also evaluated. RESULTS: The group that used the app showed significantly better results in the test than the control group (p < 0.05). Although the app group approved a high satisfaction using the app as an additional supplement to the course, this did not result in a higher overall satisfaction with the course. Further, these students observed that the traditional face-to-face seminar could not be replaced by the app. CONCLUSION: By using the PantoDict app, students were offered better training options for writing reports on panoramic radiographs, which resulted in significantly better test results than the results of the control group. Therefore, the mobile app is a useful supplement to classical education formats within the context of a blended learning approach.

Implant removal using thermal necrosis-an in vitro pilot study.

OBJECTIVES: The purpose of this pilot porcine cadaver study was to evaluate the feasible temperature thresholds, which affect osteocyte viability and bone matrix in a preclinical setup, assessing the potential of thermal necrosis for implant removal for further in vivo investigations. MATERIALS AND METHODS: After implant bed preparation in the upper and lower jaw, temperature effects on the bone were determined, using two tempering pistons with integrated thermocouples. To evaluate threshold temperature and time intervals leading to bone necrosis, one piston generated warm temperatures at 49 to 56 °C for 10 s and the other generated cold temperatures at 5 to 1 °C for 30 s. Effects were assessed by a semi-quantitative, histomorphometrical scoring system, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), and transmission electron microscopy (TEM). RESULTS: The bone matrix was significantly degenerated starting at 51 °C for 10 s and 5 °C for 30 s. The osteocyte condition indicated significant bone damage beginning at cold temperatures of 2 °C. Temperature inputs starting at 53 °C led to decalcification and swollen mitochondria, which lost the structure of their inner cristae. CONCLUSIONS: This study identified temperatures and durations, in both heat and cold, so that the number of samples may be kept low in further studies regarding temperature-induced bone necrosis. Levels of 51 °C for 10 s and 5 °C for 30 s have presented significant matrix degeneration. CLINICAL RELEVANCE: Temperature thresholds, potentially leading to thermo-explantation of dental implants and other osseointegrated devices, were identified.

Effectiveness of face-to-face, blended and e-learning in teaching the application of local anaesthesia: a randomised study.

BACKGROUND: Local anaesthesia plays a key role in many aspects of a dentist's work. The required skills to perform anaesthesia successfully are acquired at university. To take advantage of the possibilities for new teaching formats, a blended learning concept for the local anaesthesia course was developed. The aim of the study was to compare the effectiveness of face-to-face, blended and e-learning in teaching in local anaesthesia by assessing students' knowledge gain, performance of practical skills and satisfaction with the course. METHODS: All participants (n = 37) were randomly allocated into three groups. After acquiring the theoretical background in the blended learning, e-learning or lecture groups, a test to assess knowledge gain was performed. The performance of the practical skills was assessed in a small-group seminar. Student attitudes were evaluated with a questionnaire. RESULTS: The blended group showed significantly better results (mean = 17, SD =1.5) in theoretical knowledge gain than the other two groups (e-learning group: mean = 14.7, SD = 2.2; lecture group: mean = 14.8, SD =2.3). When comparing the results of the clinical skills assessment, there was no significant difference among all three groups (p > 0.017). The participants confirmed a high overall satisfaction with the course, in particular with the blended learning approach. CONCLUSION: This study indicates that blended learning improves the learning outcome for theoretical knowledge in teaching local anaesthesia more than either face-to-face learning or e-learning alone. Furthermore, the blended learning approach is highly appreciated by the students. For acquiring practical skills, this study shows that blended learning is as effective as other teaching methods.

Accuracy of fully guided orthodontic mini-implant placement evaluated by cone-beam computed tomography: a study involving human cadaver heads.

OBJECTIVES: The aim of this study was to evaluate the accuracy of fully guided orthodontic mini-implant (OMI) placements supported by tooth- (TBGs) or gingiva-borne silicone guides (GBGs) based on virtually superimposed lateral cephalograms on virtual plaster models. MATERIALS AND METHODS: Lateral cephalograms and corresponding plaster models were virtually superimposed for the planning of OMI positions; fully guided TBGs and GBGs were fabricated (each, n = 10). A total of 40 OMIs were inserted in a paramedian position into the palate of 20 human cadavers. Postoperative cone-beam computer tomographies (CBCTs) were carried out, and an accuracy evaluation was performed by comparing preoperative planning models and postoperative CBCTs. Deviations of the axis, tip, centre of the shoulder and vertical position of each of the implants were evaluated. Furthermore, the transfer accuracy measured by postoperative CBCT scans were compared with the accuracy determined using an intraoral scanner. RESULTS: A significant deviation between TBGs (2.81° SD 2.69) and GBGs (6.22° SD 4.26) regarding implant angulation was evaluated (p = 0.005). Implant tip and implant shoulder deviations revealed no statistical differences between the guides. Accuracy values of oral scans regarding vertical deviations were significantly more inaccurate when compared with CBCTs (p < 0.001). CONCLUSIONS: The accuracy of an OMI position can be significantly increased by using a guide extension over the teeth. Vertical implant positions presented the lowest deviations. Postoperative oral scans and CBCTs represent diverging accuracy measurements when compared with virtual planning. CLINICAL RELEVANCE: Users must keep in mind that despite virtual planning deviations, inaccuracies of a few millimetres may occur.

Effect of drain application on postoperative complaints after surgical removal of impacted wisdom teeth-a randomized observer-blinded split-mouth clinical trial.

OBJECTIVES: The aim of this randomized observer-blinded split-mouth-study is to objectively assess the influence of a rubber drain on postoperative swelling using 3D face scans as measurement method and additionally evaluate pain, trismus and complications after the osteotomy of lower third molars. MATERIAL AND METHODS: Seventy-two patients with symmetrically impacted lower wisdom teeth were recruited. Before the operation, patients rated pain using the visual analogue scale, the interincisal distance was measured, and 3D face scans were taken with an optical scanner. Each patient underwent two procedures which were at least 30 days apart. On one side, a rubber drain was inserted randomly before closure, the contralateral control side was closed without drainage. On the third and tenth postoperative day, face scans to quantify the swelling, pain evaluation and trismus measurements were performed. Due to loss of follow-up, 32 patients were excluded which resulted in 40 out of 72 patients remaining in the study. RESULTS: There was no statistical difference in using a drain on swelling and trismus on the third and tenth day (p > 0.05). Pain was slightly worse on the third day on the treatment side, but the difference was not significant (p > 0.05). We observed no differences in the number of wound infections. CONCLUSIONS: The insertion of a rubber drain does not have any influence on swelling, pain or trismus and has no impact on the number of wound infections. CLINICAL RELEVANCE: The use of a rubber drain cannot be recommended as no reduction of postoperative discomfort was detected.

Surgical Management of Facial Fractures in Geriatric Patients.

ABSTRACT: Facial fractures comprise a substantial part of traumatology. Due to aging of the population, over the last 20 years, there has been a pattern of redistribution of these fractures with a higher incidence at an older age. The aim of this study was to retrospectively analyze the epidemiology, pattern, and surgical management of facial fractures in geriatric patients presenting at a single tertiary trauma center.This study included patients aged ≥70 years who presented with facial bone fractures between 2008 and 2017 and were treated with surgical interventions. Parameters such as age, sex, American Society of Anesthesiologists classification, Glasgow Coma Scale score, fracture type, fracture mechanism, concomitant injuries, duration of hospitalization, and postoperative complications were evaluated.A total of 300 patients were included: 118 men (39.3%) and 182 women (60.7%). The mean age was 78.8 years. An orbital floor fracture was the most common injury (35.1%). The most common cause of fracture was a fall at home (67%). A total of 113 patients (37.7%) had 162 concomitant injuries, 35 patients (11.7%) suffered from polytrauma, and 7 patients developed postoperative complications. The average length of stay was 1.67 days in the intensive care unit and 5.50 days in the standard ward. Polytrauma, pre-existing medical conditions, and oral anticoagulation had a significant impact on the duration of hospitalization.Facial fractures are common in combination with other injuries. Women are more often affected than men, and falling at home is the most common cause of facial injuries. Postoperative complications are rare.

Objective and Subjective Comparisons of Split Thickness Skin Graft and Full Thickness Skin Graft for Radial Forearm Flap Donor Sites Using a New Measuring Method.

ABSTRACT: A split thickness skin graft (STSG) or a full thickness skin graft (FTSG) are commonly used for donor site closure after raising a radial forearm flap. The aesthetic outcome of the donor site is frequently not satisfying for the patient. This study evaluated the aesthetic outcome of the donor site of a radial forearm flap covered with an STSG or FTSG using an objective measurement method. The forearms of 30 patients (15 FTSG, 15 STSG) were scanned with an optical three-dimensional scanner. The surface of the forearm at the skin transplant was cut out and filled by an automatic hole-filling algorithm. The mean surface deviation between the original and the filled forearm was acquired. This method was validated with a control group of 15 volunteers. A questionnaire investigating aesthetical and healing satisfaction, postoperative pain and scarring was filled in by the patients. The mean surface difference in the STSG group was 0.9907 ±â€Š0.3120 and 0.6177 ±â€Š0.2245 mm in the FTSG group. The difference in the surface deviation between STSG and FTSG groups was significant (P = 0.0009). Correlations between the surface deviation and the subjective aesthetical satisfaction of the patient were not significant. In the questionnaires no significant differences between STSG and FTSG group were measured. Both FTSGs and STSGs resulted in good aesthetical outcomes after closure of a radial forearm flap donor site. Scanning the radial forearm flap donor site with an optical three-dimensional scanner supplied an objective, fast, and reliable measuring method of aesthetical outcomes.

Heat Analysis of Different Devices for Thermo-explantation of Dental Implants: A Numeric Analysis and Preclinical In Vitro Model.

Thermal treatment may reverse the osseointegration of implants and could become an atraumatic controlled method for implant removal in the future. The aim of this nonrandom in vitro study was to empirically identify suitable sources for a controlled heating process, to generate a homogenous temperature distribution at a threshold level of 47°C for future in vivo research. Two different setups evaluating 4 different sources (water, laser, monopolar, and an electrical joule heater device) were used to carry out infrared measurements and numerical calculations at 47°C along the implant axis and along the peri-implant area at the axial plane. Furthermore, required time intervals to heat up the implant tip from 33°C to 47°C were determined. The monopolar electric device led to the most uneven and unpredictable implant heating and was therefore excluded. The thermal analysis suggested identical thermal distributions without any significant differences for water and electrical joule sources with a heat maximum at the implant shoulder (P > .05). On the other hand, the laser device may produce the temperature maximum in the middle of the implant without any afterglow effect (P < .01). When the implant was heated from 33°C to 47°C, the water device indicated the fastest approach. Thermal distributions of water and laser sources may be suitable for clinical applications. For future research, numerical analysis suggests an ideal time interval of 120 seconds to 180 seconds for a homogenous implant temperature of 47°C.

In vivo and in vitro analysis in a rat model using zoledronate and alendronate medication: microbiological and scanning electron microscopy findings on peri-implant rat tissue.

BACKGROUND: The aim of the present study was to assess the development of bacterial deposits and morphological parameters around dental zirconia and titanium implants compared with natural teeth during systemic bisphosphonate medication. MATERIALS AND METHODS: Fifty-four rats were randomly allocated into one control group and two experimental groups (drug application of zoledronic and alendronic acid), with 18 animals in each group. After 4 weeks of drug delivery, either a zirconia or a titanium implant was immediately inserted. Microbiological analysis conducted 1 week, 8 weeks, and 12 weeks after surgery included total bacterial count and composition measurements. Samples were analyzed in a scanning electron microscope (SEM) equipped with energy-dispersive X-ray spectroscopy (EDX). Bone cell morphology was analyzed by transmission electron microscopy (TEM). RESULTS: One week after surgery, titanium and zirconia implants of the alendronic acid and control group showed a significantly higher bacterial count when compared to natural teeth in rats with zoledronic acid administration (p < 0.01). Less significant differences were recorded after 3 months, at which time no inter-material differences were evaluated (p > 0.05). I n the control group, TEM analysis showed that the osteoblasts had a strongly developed endoplasmic reticulum. In contrast, the endoplasmic reticulum of the osteoblasts in drug-treated animals was significantly less developed, indicating less activity. CONCLUSIONS: Within the limits of this study, neither implant material was superior to the other at 3-month follow-up. With regard to the treatment and complications of patients with bisphosphonates, the implant material should not be an influencing factor. Bisphosphonates can be used in the rat model to reduce not only the activity of osteoclasts but also osteoblasts of the peri-implant bone.

Postoperative Morbidity and Complications in Elderly Patients after Harvesting of Iliac Crest Bone Grafts.

Background and objectives: In oral and maxillofacial operations, the iliac crest is a commonly used donor site from which to harvest bone for augmentation prior to dental implantation or for reconstruction of jaw defects caused by trauma or pathological lesions. In an aging society, the proportion of elderly patients undergoing iliac crest bone grafting for oral augmentation is growing. Although postoperative morbidity is usually moderate to low, the age and health of the patient should be considered as risk factors for complications and delayed mobilization after the operation. The aim of this retrospective study was to evaluate the postoperative morbidity and complications in elderly patients after the harvesting of iliac crest bone grafts for oral surgery. Material and Methods: Data were collected from a total of 486 patients (aged 7-85) who had a surgical procedure that included the harvesting of iliac crest bone grafts for intraoral transplantation. All patients were operated on between 2005 and 2021 in the Department for Oral and Maxillofacial Surgery of the University Hospital in Aachen, Germany. As parameters for postoperative morbidity and complications, gait disturbances, hypesthesia of cutaneous nerves, incision hernias, iliac crest fractures, delayed wound healing, and unfavorable scar formation at the donor site were all evaluated. Results: The study was performed with 485 patients due to the exclusion of one patient as the only one from whom grafts were taken from both sides. When younger and older patients were compared, neither gait disturbances (p = 0.420), nor hernias (p = 0.239), nor fractures (p = 0.239), nor hypesthesia (p = 0.297), nor wound healing delay (p = 0.294), nor scar problems (p = 0.586) were significantly different. However, the volume of the graft was significantly correlated with the duration of the hospital stay (ρ = 0.30; p < 0.01) but not with gait disturbances (ρ = 0.60; p = 0.597). Additionally, when controlling for age (p = 0.841), sex (p = 0.031), ASA class (p = 0.699), preexisting orthopedic handicaps (p = 0.9828), and the volume of the bone graft (p = 0.770), only male sex was associated with the likelihood of suffering gait disturbances (p = 0.031). Conclusions: In conclusion, harvesting bone grafts from the anterior iliac crest for intraoral augmentation is a safe procedure for both young and elderly patients. Although there is some postoperative morbidity, such as gait disturbances, hypesthesia, scar formation, or delayed wound healing at the donor site, rates for these minor complications are low and mostly of short duration. Major complications, such as fractures or incision hernias, are very rare. However, in our study, the volume of the bone graft was associated with a longer stay in hospital, and this should be considered in the planning of iliac crest bone graft procedures.