Clinical and radiographic assessment of patient-specific transantral reconstruction of orbital floor fractures: A case series.

To clinically and radiographically evaluate patient-specific titanium meshes via a trans-antral approach for correction of enophthalmos and orbital volume in patients with recent unilateral orbital floor fracture. Seven patients with unilateral orbital floor fractures received patient-specific titanium meshes that were designed based on a mirror-image of the contralateral intact orbit. The patient-specific implants (PSIs) were inserted via a trans-antral approach without endoscopic assistance. The patients were evaluated clinically for signs of diplopia and restricted gaze as well as radiographically for enophthalmos and orbital volume correction. Diplopia was totally resolved in two of the three patients who reported diplopia in the upward gaze. Whereas enophthalmos significantly improved in all but two patients, with a mean value of 0.2229 mm postoperatively compared to 0.9914 mm preoperatively. CT scans showed excellent adaptation of the PSIs to the orbital floor with a mean reduction of the orbital volume from 29.59 cc to 27.21 cc, a mean of 0.6% smaller than the intact orbit. It can be concluded that the proposed PSI can offer good reconstruction of the orbital floor through an isolated intraoral transantral approach with minimal complications. It could of special benefit in extensive orbital floor fractures.

Clinical, volumetric and densitometric evaluation of tissue engineered constructs for secondary alveolar cleft reconstruction: A randomized clinical trial.

The objective of this study was to assess the efficacy of tissue engineered (TE) constructs compared to the standard autogenous anterior iliac crest (AIC) bone graft in secondary maxillary alveolar cleft reconstruction. This clinical trial was registered on (clinical trials.gov); the trial registry number is: NCT03563495. Patients with unilateral alveolar clefts were allocated on the basis of simple randomization. Selected patients were randomly divided into two equal groups: the AIC group (control) received autogenous particulate bone graft from anterior iliac crest, whereas the TE group received tissue engineered construct. Assessment included the newly formed bone volume and density at the grafted cleft sites, which were measured immediately, 6 and 12 months postoperatively on axial computed tomograms. The study population included 10 patients; each group comprised 5 patients. There was no statistically significant difference between the 2 groups regarding the mean volume of the newly formed bone (p = 0.91 at 6 months, p = 0.994 at 1 year) and the mean density of the newly formed bone (p = 0.364 at 6 months, p = 0.073 at 1 year). However, there was a significant increase of TE graft density from 6 months to 1 year (p = 0.048). Within the limitations of the study it seems that the tissue engineered construct (collagen/osteogenically differentiated bone marrow-derived mesenchymal stem cells) might be an alternative to autogenous bone for unilateral secondary alveolar cleftgrafting.

Assessment of three dimensional bone augmentation of severely atrophied maxillary alveolar ridges using prebent titanium mesh vs customized poly-ether-ether-ketone (PEEK) mesh: A randomized clinical trial.

BACKGROUND: Alveolar bone grafting techniques and dental rehabilitation of patients with maxillary alveolar defects is a very challenging and costly procedure. Various methods have been described to reconstruct these defects in order to facilitate the placement of dental implants. The aim of this study was to assess three dimensional (3D) maxillary ridge augmentation using two innovative, accurate, and time saving protocols. MATERIALS AND METHODS: Sixteen patients (32 implants) with vertically and horizontally deficient maxillary alveolar ridges, were equally allocated into 2 groups; a mix of particulate autogenous and xenogenic bone grafts loaded in a prebent titanium mesh (Control group) vs patient specific poly-ether-ether ketone meshes (Study group). Radiographic assessment was performed preoperatively, 1 week and 6 months postoperatively. Assessment included measurements of linear changes in the vertical and horizontal dimensions on cross sectional cuts of cone beam computed tomography using special software. Finally; the percentage of 3D bone gain in each group was compared to that of the other. RESULTS: Wound healing was uneventful for all cases except one patient in each group were the meshes were exposed 2 weeks' postsurgery. There was no statistical significance between both groups (P value = 0.2). CONCLUSION: Within the limitations of the sample size of this study, both techniques could be used as a successful method of ridge augmentation with no statistical significance between them.