Customized Subperiosteal Implants for the Rehabilitation of Atrophic Jaws: A Consensus Report and Literature Review.

(1) Background: The aim was to perform a literature review on customized subperiosteal implants (CSIs) and provide clinical guidelines based on the results of an expert consensus meeting held in 2023. (2) Methods: A literature search was performed in Pubmed (MEDLINE) in July 2023, including case series and cohort studies with a minimum follow-up of 6 months that analyzed totally or partially edentulous patients treated with CSIs. Previously, an expert consensus meeting had been held in May 2023 to establish the most relevant clinical guidelines. (3) Results: Six papers (four case series and two retrospective cohort studies) were finally included in the review. Biological and mechanical complication rates ranged from 5.7% to 43.8% and from 6.3% to 20%, respectively. Thorough digital planning to ensure the passive fit of the CSI is mandatory to avoid implant failure. (4) Conclusions: CSIs are a promising treatment option for rehabilitating edentulous patients with atrophic jaws; they seem to have an excellent short-term survival rate, a low incidence of major complications, and less morbidity in comparison with complex bone grafting procedures. As the available data on the use of CSIs are very scarce, it is not possible to establish clinical recommendations based on scientific evidence.

Modificaciones en el diseño de los implantes subperiósticos personalizados para evitar complicaciones. Presentación de una serie de casos y revisión de la literatura / Design modifications in subperiosteal implants to avoid complications. Presentation of a case series study and literature review

Introducción: La reabsorción severa del maxilar en pacientes totalmente edéntulos en ocasiones imposibilita la colocación de implantes endoóseos estándares para rehabilitar la ausencia de dientes. Para este tipo de atrofias tan severas se patentaron en 1938 en Suecia los implantes subperiósticos. Este tipo de implantes subperiósticos personalizados (ISP) han tenido excelentes resultados a lo largo de estos últimos años pero no están exentos de complicaciones. El objetivo de nuestro estudio es describir las principales complicaciones con este tipo de implantes y cuáles han sido las modificaciones que hemos realizado en el diseño de los mismos para intentar evitarlas.Material y método: Diseñamos un estudio de seguimiento retrospectivo de 15 pacientes con atrofia severa del maxilar superior tratados en 2 centros privados con un ISP en los años 2021 y 2022. Resultados: Los 8 primeros pacientes fueron tratados con un ISP bilateral y los 7 restantes con dos ISP uno a cada lado del maxilar. Todos los pacientes fueron rehabilitados con una prótesis provisional atornillada a las 48 horas de la cirugía y sustituida a los 3 meses por una prótesis fija definitiva. En 5 pacientes (33,33 %) tuvimos complicaciones postoperatorias menores. Conclusiones: A pesar de las limitaciones del estudio consideramos que el uso de ISP en pacientes con atrofia severa del maxilar es un tratamiento predecible y con excelentes resultados. La exposición es la principal complicación en nuestra serie de casos y consideramos que el uso de ISP dobles individuales y de una guía de corte minimizan el riesgo de que aparezca. (AU)

Introduction: Severe resorption of the maxilla in fully edentulous patients sometimes makes it impossible to place standard endoosseous implants to rehabilitate the absence of teeth. For such severe atrophies subperiosteal implants were patented in 1938 in Sweden. This type of subperiosteal implants have had excellent results over the last few years but are not without complications. The aim of our study is to describe the main complications with this type of implants and witch modifications have been made trying to avoid them. Material and method: We designed a retrospective follow-up study of 15 patients with severe upper jaw atrophy treated in 2 private centers with a customized subperiosteal implant in 2021 and 2022, to which we apply a few modifications in the design of the same. Results: First eight patients were treated with a single bilateral subperiosteal implant and the remaining seven with two subperiosteal implants, one on each side of the maxilla. All patients were treated with a temporary prosthesis bolted 48 hours after surgery and replaced at three months with a definitive prosthesis. In five patients (33.33%), we had minor postoperative complications. Conclusions: Despite the limitations of the study, we think that the use of customized subperiosteal implants in patients with severe maxillary atrophy is a predictable treatment with excellent results. Exposure is the main complication in our case series and we consider that the use of individual double subperiosteal implant and a bone cutting guide help to minimize the risk of this complication. (AU)

Neurotrophic Keratitis in a Pediatric Patient With Goldenhar Syndrome and Trigeminal Aplasia Successfully Treated by Corneal Neurotization.

Herein, the authors report an unusual case of a 6-year-old boy with right-sided Goldenhar syndrome and trigeminal nerve aplasia who developed neurotrophic keratopathy (NK). Despite the use of therapeutic contact lenses and multiple temporary tarsorrhaphy, NK worsened showing a central corneal scar, neovascularization, and significant stromal thinning, with risk of corneal perforation. Cochet-Bonnet esthesiometry revealed complete corneal anesthesia. To minimize additional corneal complications, the patient underwent indirect corneal neurotization by a sural nerve autograft anastomosed to the contralateral supratrochlear nerve. At 24-month follow up, no epithelial defects, complications, or recurrence were observed. Significant improvements in corneal sensitivity with esthesiometry score of 20 mm and reflex blinking were achieved. This case highlights corneal anesthesia should be suspected among Goldenhar syndrome ophthalmologic abnormalities and monitored before corneal changes become irreversible. Since corneal neurotization can successfully improve corneal sensation, it could be considered as an early therapeutic option to avoid refractory NK.

Oral health-related quality of life after dental treatment in patients with intellectual disability

BACKGROUND: The influence of dental treatment on oral health-related quality of life (OHRQOL) has rarely been evaluated in patients with intellectual disability (ID) through validated questionnaires. The aim of this study was to estimate the changes on OHRQOL in patients with ID after the implementation of an institutional dental treatment program under general anesthesia using the Franciscan Hospital for Children Oral Health-Related Quality of Life questionnaire (FHCOHRQOL-Q). MATERIAL AND METHODS: A prospective longitudinal study was conducted on 85 patients (mean age=24.85 years) classified according to DSM-V whose parents/caregivers completed the FHC-OHRQOL-Q. We analyzed the changes in the questionnaire's overall score and its dimensions from pre-treatment to 12-months of follow-up, considering effect sizes and minimal important differences estimated by the standard measurement error. The impact of clinical and therapeutic factors was evaluated using univariate and multiple linear regression analysis (p < 0.05). RESULTS: Significant improvement of OHRQOL was found after dental treatment in oral symptoms (p ≤ 0.001), daily life problems (p = 0.018), parent's perceptions (p = 0.013) and FHCOHRQOL-Q's overall score (p = 0.001). OHRQOL changes exhibited an intermediate magnitude (0.38-0.21) as estimated by effect sizes. Changes in oral symptoms showed positive correlation with DMFT index (r = 0.375, p = 0.002), decayed teeth (r = 0.244, p = 0.036), dental extractions (r = 0.424, p < 0.001) and number of treatments (r = 0.255, p = 0.019). The improvement was greater in patients with ≥ 4 decayed teeth (p = 0.049) and undergoing ≥ 2 dental extractions (p = 0.002). Multiple regression analysis demonstrated that dental extractions (p < 0.001) and DMFT index ( p= 0.028) were significantly related to oral symptom improvement. CONCLUSIONS: Dental treatment under general anesthesia showed a positive effect on the overall FHC-OHRQOL-Q score and most of its dimensions. At 12-months of follow-up, the improvement of oral symptoms was significantly associated with DMFT index, decayed teeth, dental extractions and number of treatments. In our clinical setting, the implementation of a dental treatment program enhanced the OHRQOL of patients with ID

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Sentinel Lymph Node Biopsy in Oral and Oropharyngeal Squamous Cell Carcinoma: Statistical Validation and Impact of Micrometastasis Involvement on the Neck Dissection Decision.

PURPOSE: To evaluate the effectiveness of sentinel lymph node biopsy (SLNB) as an optimal staging method in oral and oropharyngeal squamous cell carcinoma (OOSCC) and the impact of the extent of SLN involvement on the decision for neck dissection (ND). MATERIALS AND METHODS: A prospective cohort study was performed in 96 consecutive patients with stage T1 to T4N0M0 OOSCC (mean follow-up, 62.9 months). SLN localization was determined using cervical lymphoscintigraphy and single-photon emission computed tomography. Patients underwent SLNB examination and ND. The ND specimen was investigated by hematoxylin and eosin (H&E) staining and the SLNs were investigated using H&E staining and step-serial sectioning and cytokeratin antibodies AE1 and AE3. The statistical study calculated the sensitivity and negative predictive value (NPV). The sample size of 96 patients was calculated for a 95% confidence interval with an accuracy of ±2% and an estimated a priori sensitivity of 99% compared with the benchmark. The impact of extent of SLN involvement on the decision for ND was analyzed by χ(2) test. A logistic regression model was used to assess the association of predictor variables with SLN involvement and neck disease. RESULTS: The diagnostic accuracy, sensitivity, NPV, and negative likelihood ratio were 95%, 88%, 94%, and 0.06. The statistical comparison between the extent of metastatic involvement of the SLN and neck disease was important for SLN macrometastasis (odds ratio = 11.9), but not for SLN micrometastasis (odds ratio = 0.93). CONCLUSIONS: SLNB examination is an excellent staging method in OOSCC. The present data indicate a very small risk of additional lymph node metastasis with SLN micrometastasis.

Quality of life in long-term oral cancer survivors: a comparison with Spanish general population norms.

PURPOSE: Health-related quality-of-life (HRQOL) data are becoming an important supplement to information pertaining to treatment outcomes for cancer patients. The purpose of this study was to evaluate the HRQOL of patients undergoing primary surgery for oral squamous cell carcinoma > or =5 years after treatment compared with the Spanish general population norms. MATERIALS AND METHODS: A total of 50 oral cancer patients (mean age 55.78 years, 80% male) with cancer-free survival of > or =5 years after surgery were enrolled. HRQOL was assessed with a standardized questionnaire: the Medical Outcomes Study Short Form 36-Item Health Survey. RESULTS: The Medical Outcomes Study Short Form 36-Item Health Survey scores of the oral cancer patients did not differ significantly from those of an age- and gender-matched sample from the Spanish normative population, except for the pain and social functioning domains. The patients had significantly better results compared with the population norms (Wilcoxon test, P < .05) in the physical function, general health, and vitality domains. CONCLUSIONS: These results provide patient-reported evidence that oral cancer survivors have a similar HRQOL compared with the general Spanish population. We also believe that it would be necessary to analyze the quality of life > or =5 years after treatment or from the moment the patient was discharged.

Synchronous unilateral parotid neoplasms. A case report

The parotid gland is the most usual location of benign neoplasms affecting major salivary glands and quite oftenthe recurrence of these tumours is noticed, specially in the case of pleomorphic adenoma. The occurrence of multipletumours in the parotid glands is rare and the majority of these are multifocal Warthin`s tumors (papillary cystadenomalymphomatosum). The simultaneous development of tumours with different histological types is unusualand when it occurs, the most common combination is a pleomorphic adenoma and a Warthin`s tumor. There aremany articles about Multiple Parotid Tumors (MPT) but only a few of them are focused on unilateral synchronousbenings tumors, being pleomorphic adenoma and Warthin´s these tumors.The report describes a 55 year old female with a pleomorphic adenoma occurring synchronously with a Warthin`stumor within the superficial lobe of her left parotid gland (AU)

Synchronous unilateral parotid neoplasms. A case report.

The parotid gland is the most usual location of benign neoplasms affecting major salivary glands and quite often the recurrence of these tumours is noticed, specially in the case of pleomorphic adenoma. The occurrence of multiple tumours in the parotid glands is rare and the majority of these are multifocal Warthin's tumors (papillary cystadenoma lymphomatosum). The simultaneous development of tumours with different histological types is unusual and when it occurs, the most common combination is a pleomorphic adenoma and a Warthin's tumor. There are many articles about Multiple Parotid Tumors (MPT) but only a few of them are focused on unilateral synchronous benings tumors, being pleomorphic adenoma and Warthin's these tumors. The report describes a 55 year old female with a pleomorphic adenoma occurring synchronously with a Warthin's tumor within the superficial lobe of her left parotid gland.