Quality of orthodontic care-A multicenter cohort study in a German convenience sample : Part 2: Cross-sectional patient-reported outcomes after orthodontic treatment.

OBJECTIVES: In light of the growing interest in orthodontic care and its effectiveness in Germany, part 2 of this multicenter cohort study evaluated patient-reported outcomes such as oral health-related quality of life (OHRQoL), oral hygiene habits, oral health beliefs, and potential influencing factors. METHODS: Of 586 patients screened from seven German study centers, data from 343 patients were analyzed for this part of the study. At the end of their orthodontic treatment, study participants filled out a questionnaire of either the German long version of the Oral Health Impact Profile (OHIP-G 49) or the German short version of the Child Oral Health Impact Profile (COHIP-19), depending on their age, as well as questions about their oral hygiene behavior and beliefs. Patient-, treatment- and occlusion-related factors were analyzed to account for potential influencing factors with regard to patients' OHRQoL after orthodontic treatment. RESULTS: In all, 222 study participants filled out the OHIP-based and 121 the COHIP-based questionnaire. The mean OHIP-G 49 score was 12.68 and the mean OHIP-G 14 score was 3.09; the mean COHIP-19 score was 6.52 (inverted score 69.48). For OHIP-G 49 scores, a nonsignificant trend towards a higher score for male patients (14.45 vs 11.54; p = 0.061) was detected, while this trend was inverse for the COHIP-19 scores, i.e., female patients reported more impairment (total score 6.99 vs. 5.84; p = 0.099). Analyses suggested a trend towards better OHRQoL for patients who classified for the Peer Assessment Rating (PAR) Index improvement rate group 'greatly improved' as well as for nonsmokers. Oral hygiene habits and beliefs after orthodontic treatment were estimated to be good. CONCLUSION: In this German cohort, OHRQoL proved to be good and was rather unimpaired after orthodontic treatment. Furthermore, self-reported oral hygiene behavior and oral health beliefs represented good health awareness.

Three-dimensional evaluation of bracket placement accuracy and excess bonding adhesive depending on indirect bonding technique and bracket geometry: an in-vitro study.

BACKGROUND: This study aimed at comparing bracket placement and excess bonding adhesive depending on different indirect bonding (IDB) techniques and bracket geometries. METHODS: Four hundred eighty brackets without hook (WOH) and 360 with hook (WH) were placed on 60 plaster models. Three IDB techniques were tested: polyvinyl-siloxane vacuum-form (PVS-VF), polyvinyl-siloxane putty (PVS-putty), and translucence double-polyvinyl-siloxane (double-PVS). PVS-VF and PVS-putty were combined with chemically, and double-PVS was combined with light cured bonding adhesive. Virtual images of models before and after bracket transfer were generated, and computerized images were compared. Linear, angular deviations, and excess bonding adhesive were measured. RESULTS: Linear differences between the three groups were obtained for PVS-VF (WH: 1.08, SD 0.50 mm; WOH: 0.86, SD 0.25 mm), PVS-putty (WH: 0.73, SD 0.51 mm; WOH: 0.58, SD 0.28 mm), and double-PVS (WH: 0.65, SD 0.45 mm; WOH: 0.59, SD 0.33 mm) (P < 0.001). Hooks affected bracket placement accuracy in PVS-VF (P < 0.001) and PVS-putty (P = 0.029). Angular differences were observed for brackets WOH between the PVS-VF (0.64, SD 0.48°) and double-PVS group (0.92, SD 0.76°) (P < 0.001) and within double-PVS group (WH: 0.66, SD 0.51° vs. WOH: 0.92, SD 0.76°, P < 0.001). Highest amount of excess adhesive was obtained for PVS-putty group (WH: 6.54, SD 5.31 mm 2). CONCLUSIONS: The double-PVS group revealed promising results with respect to transfer accuracy, whereas the PVS-VF group provided least excess bonding adhesive. Basically, hooks lead to lower precision and higher excess bonding adhesive. PVS trays for IDB generate high bracket placement accuracy. PVS-putty is the easiest to handle with and also the cheapest, but leads to large excess bonding adhesive, especially in combination with hooked brackets or tubes.

Effect of the pterygomaxillary disjunction on surgically assisted rapid palatal expansion in context of orthodontic treatment.

OBJECTIVE: This retrospective study analyzed the dentoalveolar effects of pterygomaxillary disjunction (PMD) in surgically assisted rapid palatal expansion (SARPE) after orthodontic treatment. STUDY DESIGN: Virtual study casts before and after orthodontic treatment involving SARPE were analyzed in 12 patients without (-) PMD and 15 patients with (+) PMD. Linear and angular measurements and maximum deviations on the alveolar ridge and hard palate were determined. RESULTS: Dental arch widths in the first molars of the (-) and (+) PMD groups increased to 6.07 ± 2.11 mm and 6.61 ± 2.33 mm (P = .96) and the corresponding axial angles increased to 0.34 ± 9.45 degrees and 2.39 ± 9.59 degrees (P = .58), respectively. The palatal angles changed by about 0.10 ± 11.50 degrees and 1.74 ± 14.56 degrees (P = .75) in the (-) and (+) PMD groups and the maximum labial deviations at the alveolar ridge were 3.04 ± 0.76 mm and 3.22 ± 1.16 mm (P = .65) for the (-) and (+) PMD groups, respectively. Statistically significant differences were found before and after surgery (P < .04), but no significant differences were observed in PMD after orthodontic treatment. CONCLUSIONS: SARPE led to a significant transverse expansion, and the dental effects were more than the skeletal effects. We did not find a significant difference between both surgical techniques with regard to the anterior and posterior parts of the maxilla or the corresponding dentition.

[Influence of Sociodemographic Factors on Type of and Stage at Diagnosis in Breast Cancer]. / Zum Einfluss soziodemografischer Faktoren auf die Art der Verdachtsdiagnosestellung und das Tumorstadium bei Erstdiagnose von Brustkrebs.

This study examines the influence of sociodemographic factors on the type of and stage at diagnosis in breast cancer in Germany. METHOD: As part of the certification of the breast cancer centers by the German Cancer Society (DGK), the Institute of Medical Sociology, Health Services and Rehabilitation Science (IMVR) conducted nationwide post-stationary postal patient surveys (n=852). The influence of sociodemographic factors on the type of diagnosis and on the stage at diagnosis were each analyzed using a multinomial logistic regression. RESULTS: 45.5% palpated the tumor by themselves, 33.4% were diagnosed by mammography screening and 16.6% by gynecological check-up. Being diagnosed by screening was associated with an early stage cancer. Furthermore, breast cancer patients without private health insurance or with a low educational level were less likely to be diagnosed by a gynecological check-up. Patients within screening age (50-69) had higher odds for an early stage breast cancer. Patients with a low educational level had lower odds for an early stage breast cancer. CONCLUSION: Fifty percent of the breast cancer patients were not diagnosed by screening. Mammography screening appears to be more sensitive in detecting early stage cancer, since we found an association between diagnosis by screening and an early stage cancer. Age outside of the screening range and a low educational level might be risk factors for an advanced stage breast cancer. High screening rates, especially for these risk groups, seem to be important for early detection of breast cancer.

Influence of physician evaluation portals on orthodontist selection by patients.

OBJECTIVE: This survey aimed to determine the influence of physician evaluation portals (PEP) on a patient's choice of physicians, particularly orthodontists. MATERIALS AND METHODS: Questionnaires were used to collect sociodemographic data, reasons for orthodontist selection, type of Internet use, as well as information on the knowledge, use and evaluation of 14 popular PEPs. A total of 506 questionnaires were evaluated, and a descriptive statistical evaluation was conducted using the χ2 test. RESULTS: The majority of the respondents selected orthodontists on the basis of personal recommendations by other physicians (35%), family/friends (33%) or patient referral (14%). Currently, the most popular portals in Germany, which are mostly found through Internet searches, are jameda.de (36%) and arztauskunft.de (19%). A total of 5% of the respondents have already used a PEP to evaluate a physician. Moreover, 70% of the respondents described PEPs as helpful, 28% as recommendable and 2% use PEPs regularly. Knowledge of PEPs is correlated with the level of educational attainment (p = 0.024) and the frequency of Internet use (p < 0.001). CONCLUSION: On the selection of healthcare providers, particularly orthodontists, PEPs have little influence. Patients select physicians on the basis of personal recommendations. Physicians' concerns about negative evaluations on PEPs are unfounded given the low level of awareness of PEPs by the general populace.

Biomechanical properties of CAD/CAM-individualized nickel-titanium lingual retainers: an in vitro study.

PURPOSE: This study aimed to determine and compare the mechanical properties of novel CAD/CAM(computer-aided design/manufacturing)-individualized nickel-titanium (NiTi) and conventional twisted wires. METHODS: Seven NiTi wires (angular, 0.20â€¯× 0.20 mm up to 0.50â€¯× 0.50 mm) and two twisted steel wires (round, 0.40 mm and 0.44 mm) were investigated in three-point (3PBT) and four-point bending tests (4PBT) using the Orthodontic Measurement and Simulation System. All wires were loaded up to a distance of 3.3 mm, and resulting forces were measured. Additionally, in the biomechanical test (BMT), CAD/CAM-individualized NiTi retainers (0.35â€¯× 0.35 mm) were subjected to intrusive and extrusive deformation of 0.1, 0.2, and 0.4 mm. RESULTS: For twisted wires, typical plastic deformations were found in 3PBT (0.40 mm: 0.3 mm; 0.44 mm: 0.4 mm), and maximum resulting forces for these reached 1.3 N and 3.2 N for the 0.40 mm and 0.44 mm wires, respectively. Corresponding values in the 4PBT totaled 0.8 N for the 0.40 mm and 1.9 N for the 0.44 mm twisted wire. The NiTi samples showed plastic deformations in the 3PBT for the 0.25â€¯× 0.25 mm dimension and in 4PBT for the 0.35 mmâ€¯× 0.35 mm version. At a deflection of 1.5 mm, both tests revealed significantly different forces for the NiTi wires of different dimensions (p ≤ 0.001). In the BMT, no remarkable loading plateau or plastic deformation was observed. The resulting forces were significantly higher for extrusive than for intrusive deformation (p ≤ 0.001). CONCLUSIONS: Individualized NiTi retainers feature specific elasticity and dimensional stability, and more deflection is necessary to achieve permanent deformations. The CAD/CAM production process did not significantly influence the biomechanical properties of the NiTi wires.

Spatial agreement of demineralized areas in quantitative light-induced fluorescence images and digital photographs.

OBJECTIVES: Previous work has shown qualitatively that detection of demineralized tooth areas (white spot lesions, WSLs) is more reliable in digital photographs (DP) as in quantitative light-induced fluorescence (QLF) images. Based on non-rigid, multimodal image registration, we now quantitatively compare manual and automatic markings in both modalities. METHODS: After braces removal, pairs of DP and QLF were acquired from 124 teeth of 31 patients. Three experienced raters marked the WSL on both DP and QLF images, each of which was presented twice in randomized order. For each tooth and each modality, a ground truth (GT) was established using the simultaneous truth and performance level estimation algorithm on the total of six manual markings per image. DP and QLF image pairs were spatially registered, by aligning the outline of the tooth area in DPs to that of the corresponding tooth area in QLF. Between all pairs of markings for all teeth, position and size were compared quantitatively by the Dice coefficient and the novel coefficient of inclusion. RESULTS: Our hypotheses: (i) the clinical inspection supported by DP is more sensitive to WSL as that by QLF, disregarding whether the automatic analysis or the experts' manual assessment of QLF is applied, and (ii) detected lesions in QLF are included in those of DP, were confirmed and not confirmed, respectively. CONCLUSION: DP and QLF are valuable methods to detect WSL in demineralized teeth. Combining both modalities can provide additional information on early lesion assessment.

Fracture patterns after bilateral sagittal split osteotomy of the mandibular ramus according to the Obwegeser/Dal Pont and Hunsuck/Epker modifications.

The aim of this study was to compare the fracture patterns after sagittal split osteotomy according to Obwegeser/Dal Pont (ODP) and Hunsuck/Epker (HE), as well as to investigate the relationship between lateral bone cut ending or angle and the incidence of unfavorable/bad splits. Postoperative cone-beam computed tomograms of 124 splits according to ODP and 60 according to HE were analyzed. ODP led to 75.8% and HE led to 60% lingual fractures with mandibular foramen contact. Horizontal fractures were found in 9.7% and 6.7%, respectively, and unfavorable/bad splits were found in 11.3% and 10%, respectively. The lateral osteotomy angle was 106.22° (SD 12.03)° for bad splits and 106.6° (SD 13.12)° for favorable splits. Correlations were found between favorable fracture patterns and split modifications and between buccal ending of the lateral bone cut and bad splits (p < 0.001). No relationship was observed between split modifications (p = 0.792) or the osteotomy angle (p = 0.937) and the incidence of unfavorable/bad splits. Split modifications had no influence on the incidence of unfavorable/bad splits, but the buccal ending of the lateral bone cut did have an influence. More lingual fractures with mandibular foramen contact are expected with the ODP modification. The osteotomy angle did not differ between favorable and bad splits.

Quantitative light-induced fluorescence images and digital photographs - Reproducibility of manually marked demineralisations.

OBJECTIVE: Hard tooth tissue demineralisation is an undesirable side effect of orthodontic treatment with fixed appliances. Whereas both clinically and in digital photographs (DP), demineralisations appear as white spot lesions, WSLs appear as dark areas when quantitative light-induced fluorescence (QLF) imaging is used. This study aims at comparing the reproducibility of the detection of decalcified tooth areas in DP and QLF. MATERIALS AND METHODS: DP and QLF pairs were acquired from 139 teeth of 32 patients after braces removal. Three raters manually marked the decalcified area on both DP and QLF images. The markings were repeated after 2 weeks. A ground truth was estimated for each tooth and modality using the simultaneous truth and performance level estimation (STAPLE) algorithm. The Dice coefficients (DC) of each rater marking to the ground truth were calculated for all teeth and modalities to quantify the spatial agreement. A three-way repeated measures analysis of variance (ANOVA) was used to compare the means of the DCs for both modalities ([Formula: see text]). Intra-observer and intercycle variabilities were assessed comparing the means across the raters and the cycles for both modalities. RESULTS: ANOVA revealed a statistical significant difference between the modalities [[Formula: see text], [Formula: see text]]. The standard deviation of the DC for the photographs are lower than those for the QLF images. Intra-observer and intercycle differences are rather small as compared to the intermodality differences. CONCLUSIONS: The results indicate a higher spatial reproducibility in identifying a decalcified area on a tooth surface using visual inspection of DP rather than QLF images.

Evaluation of ultrasonic and conventional surgical techniques for genioplasty combined with two different osteosynthesis plates: a cadaveric study.

OBJECTIVES: The aim of this study was to compare genioplasties performed using traditional saw or piezosurgery combined with different osteosynthesis plates. MATERIALS AND METHODS: Thirty-two genioplasties were first performed on fresh human cadavers using a saw or piezosurgery, followed by chin osteosynthesis with bending or pre-shaped plates. The time required for osteotomy and plate fixation was measured, and the suprahyoid pedicle was inspected. RESULTS: The mean time required was 204 s (SD 43) with the saw and 52 s (SD 67) with piezosurgery. Osteosynthesis fixation time was 100 s (SD 31) for pre-shaped plates and 124 s (SD 24) for individual plates. Statistical differences were found between both osteotomy techniques (p < 0.001) and osteosynthesis plates (p = 0.025). Injuries of the suprahyoid muscle pedicle were found in 10/16 saw cases and 3/16 piezosurgery cases (p = 0.012). CONCLUSIONS: Although piezosurgery is more time consuming compared with saw osteotomy, it is still adequate in time and allows a reduction of the suprahyoid pedicle injuries. Therefore, piezosurgery seems to be a viable alternative technique for genioplasty. From a clinical point of view, the time difference for osteosynthesis fixation has no significance. CLINICAL RELEVANCE: The time taken for ultrasonic surgery is suitable for clinical use and leads additional to less damage to the suprahyoid pedicle.

Three-dimensional effects of pterygomaxillary disconnection during surgically assisted rapid palatal expansion: a cadaveric study.

OBJECTIVE: The aim of this study was to investigate the influence of pterygomaxillary disconnection on the transversal expansion of the maxilla. STUDY DESIGN: Fifteen cadaver heads were used for surgically assisted rapid palatal expansion (SARPE), which was carried out twice on the same heads-with and without pterygoid disconnection. The maxillae were expanded by 10 mm by using a rapid palatal expander. Study models before and after both SARPE techniques were made and scanned by an oral scanner for virtual analysis by software. RESULTS: Performing pterygomaxillary disconnection during SARPE led to a decrease in the deviation between the incisor regions from 5.42 ± 1.13 mm to 4.05 ± 1.12 mm (P = .002) and an increase in the distance between second premolar regions from 2.63 ± 1.64 mm to 4.07 ± 2.01 mm (P = .040). CONCLUSIONS: SARPE without pterygomaxillary disconnection led to a V-shaped transverse expansion of the maxilla, whereas osteotomy of the pterygoid plates led to a parallel transverse expansion.

Bony contact area and displacement of the temporomandibular joint after high-oblique and bilateral sagittal split osteotomy: a computer-simulated comparison.

The most common way to move the mandible during orthognathic surgery is by bilateral sagittal split osteotomy (BSSO). The high-oblique sagittal split osteotomy (HSSO) is an alternative, although its use is limited by potential complications, mainly to do with the position of the condyle and reduced contact with bone. The aim of this study was to find out the optimal intercondylar distance and area of contact with the surface of the bone for mandibular advancement and setback in BSSO and HSSO. Data from computed tomographic (CT) images from 40 patients were loaded into special planning software, and virtual operations done for mandibular advancement and setback at 3, 5, 8, and 10mm using BSSO and HSSO, which resulted in 640 individual mandibular displacements. The resultant area of bony contact and intercondylar distance were calculated by the software. The mean (SD) areas of contact with the bony surface after 10mm advancement for HSSO and BSSO were 193.94 (63.76) mm(2) and 967.92 (229.21) mm(2), respectively, and after 10mm setback 202.64 (62.30) mm(2) and 1108.86 (247.38) mm(2). The mean corresponding intercondylar distance after maximum advancement were 86.76 (6.40) mm and 86.59 (6.24) mm, and after maximum setback 74.90 (5.73) mm and 73.06 (6.06) mm. There were significant differences between the two for the area of contact with the surface at each displacement distance (p<0.001), but not for intercondylar distance. A larger area of bony contact can be expected at any displacement distance for BSSO, so the changes in intercondylar distance should not be considered when deciding which osteotomy to select.

Influence of setback and advancement osseous genioplasty on facial outcome: A computer-simulated study.

The aim of this virtual study was to investigate the influence of angular deviation and displacement distance on the overlying soft tissue during chin genioplasty. Computed tomography data from 21 patients were read using ProPlan CMF software. Twelve simulated genioplasties were performed per patient with variable osteotomy angles and displacement distances. Soft-tissue deformations and cephalometric analysis were compared. Changes in anterior and inferior soft-tissue of the chin along with resultant lower facial third area were determined. Maximum average changes in soft-tissue were obtained anterior after 10-mm advancement about 4.19 SD 0.84 mm and inferior about -1.55 SD 0.96 mm. After 10-mm setback anterior -4.63 SD 0.56 mm and inferior 0.75 SD 1.16 mm were deviations found. The anterior soft tissue showed a statistically significant change with bony displacement in both directions independent of osteotomy angle (p < 0.001) and only after a 10-mm advancement with an angle of -5° significant differences at inferior soft-tissue were noted (p = 0.0055). The average area of the total lower third of the face was 24,807.80 SD 4,091.72 mm(2) and up to 62.75% was influenced. Advanced genioplasty leads to greater changes in the overlying soft tissue, whereas the affected area is larger after setback displacement. The ratio between soft and hard tissue movements largely depends on the displacement distance.

Limitations of osseous genioplasty in relation to the displacement distance: a computer-based comparative study.

OBJECTIVE: The aim of this study was to compare the contact surface area (CSA) between bony segments after performing 4 different osteotomy techniques for genioplasty. STUDY DESIGN: Virtual genioplasties were done in terms of sliding or chin-shield genioplasty and 1- or 2-tiered genioplasty on computed tomography (CT) data from 42 patients. Advancement or setback genioplasty was simulated at 3, 5, 8, and 10 mm. The resulting bony contact areas were calculated by using software. RESULTS: No statistically differences were found between both 2-tiered techniques at any displacement distance. Significant statistical differences were noticed between 1-tiered genioplasty and corresponding upper and lower osteotomy at 2-tiered genioplasty and between lower osteotomies of both 2-tiered techniques (P < .001). However, at a displacement distance of 8 mm, the CSA of the lower 2-tiered genioplasty was found to be larger than that of the corresponding after 1-tiered genioplasty (P < .001). CONCLUSIONS: From a displacement distance of 8 mm, a relatively larger CSA could be achieved after performing 2-tiered genioplasty technique.

Effect of maxillary advancement on the change in the soft tissues after treatment of patients with class III malocclusion.

The aesthetic outcome of treatment has become increasingly important to patients having orthognathic surgery. The aim of this observational cohort study based on clinical records was to evaluate the effect of maxillary advancement on changes to the soft tissues. We studied 53 patients with class III malocclusion (29 women and 24 men, mean (SD) age 28 (11) years). We identified all patients treated between 1 January 2002 and 30 December 2013 who could be monitored postoperatively for 6 months. To study the effect of maxillary advancement on changes to the soft tissue we distinguished between patients who had had less than 6mm, and those with 6mm advancement or more. In those who had had less than 6mm, we found no significant changes in the soft tissue in the region of the nasolabial angle. However, the lip-chin- throat angle (p=0.016), cervical length (p=0.002), lower lip (p=0.007) and upper lip distance (p=0.0001) from the aesthetic line changed significantly. On the other hand, the changes to the soft tissue in the submental and nasolabial regions were significant in patients with 6mm advancement or more, and indicated a clear improvement in the aesthetic outcome of this region. This aesthetic change for the good in the submental and nasolabial regions after maxillary advancement of 6mm or more should be considered when planning treatment, and reduction in the mandibular setback will reduce the risk of development of a double chin.

Soft-tissue changes associated with different surgical procedures for treating class III patients.

OBJECTIVE: The aim of this study was to evaluate the effects of different surgical procedures on soft tissue and skeletal changes. PATIENTS AND METHODS: Pre- and postoperative lateral cephalograms of 191 class III patients aged 16-58 years were retrospectively analyzed and divided into three groups according to the surgical therapy they had undergone. Group I had undergone maxillary advancement (n=51), group II a bimaxillary (n=102) procedure, and group III mandibular setback (n=38). Cephalometric assessments were made at the beginning of orthodontic treatment (T1) and at least 8 weeks after surgical correction of the class III malocclusion (T2). Nasolabial angle and the distance between the lower lip and the esthetic line were evaluated as soft-tissue parameters, while the skeletal parameters included the SNA and SNB angles, Wits value, gonial angle, and relative position of the maxilla to mandible. Mean values and standard deviations were calculated and any significant difference between soft and hard tissue in association with surgery methods was determined applying the Wilcoxon test using SAS statistical software. RESULTS: Compared to mandible setback, the number of bimaxillary procedures and maxilla advancements has increased significantly in recent years (0.04). SNA values measured at T2 were an average of 84° in group I, 83° in group II, and 82° in group III, thus, revealing a tendency to return to the normal range. SNB values measured at T2 averaged 81° in group I, 80° in group II, and 81° in group III. We observed significant changes in the nasolabial angle according to the surgical approach taken (p=0.018). Changes in the distance between the lower lip and the esthetic line were only slightly significant (p=0.050). No significant differences were noted among the surgical approaches in terms of SNA and SNB angles. CONCLUSION: The two groups that underwent advancement of the maxilla (groups I and II) revealed marked improvements in soft-tissue esthetics.

Consideration of effect of the amount of mandibular setback on the submental region in the planning of orthodontic-orthognathic treatment.

Aesthetic outcome has gained in importance in the treatment of patients with orthognathic problems. Historically, Class III malocclusions have historically been treated by isolated mandibular setback and maxillary advancement, whereas bimaxillary procedures have recently become the more common option. Functional outcome and stability have been discussed previously. The aim of this observational study was to evaluate the effect of mandibular setback (BSSO) on the cervical region. We studied 38 Class III patients (20 women and 18 men, mean (SD) age 25 (0.8) years) who we identified from our clinical records and who were treated between 1 January 2002 and 30 December 2012 with mandibular setback procedures and followed up for 6 months. To study the effect of the amount of mandibular setback on the aesthetic outcome we have distinguished between patients with less than 5mm setback and those with 5mm or more. In patients whose mandibular setback was less than 5mm there was no significant change in cervical length. However, it decreased significantly in patients in whom the movement was 5mm or more. Postoperatively the lip-chin-throat angle (p=0.02), the length of the lower lip (p=0.002), and the length of the upper lip (p=0.003) from the aesthetic line also differed significantly between the 2 groups. Our observations strongly suggest that all these relations should be considered when treatment is being planned to avoid an unpleasant aesthetic impact on the chin region.

Functional long-term results after the harvest of vascularised iliac bone grafts bicortically with the anterior superior iliac spine included.

The aim of this study was to evaluate the postoperative morbidity at the donor site and the long-term outcome after the harvest of bicortical iliac bone grafts, including the iliac crest and the anterior superior iliac spine (ASIS), by using a confirmed score. We retrospectively examined 54 consecutive patients who had had vascularised iliac bone grafts harvested to reconstruct different parts of the mandible. We used the Harris Hip Score to evaluate objectively the long-term postoperative morbidity at the donor site. Of 54 patients, 20 were female (37%) and 34 male (63%), with a mean age of 49 years (range 12-81). The causes of the bony defects were malignancy (n=37, 69%), benign tumours (n=7, 13%), osteomyelitis (n=9, 17%), and atrophy of the alveolar ridge (n=1, 2%). All transplants healed adequately. A total of 38/52 patients (73%) had a score of more than 80 points, which defines clinical success. Vascularised iliac bone grafts offer excellent bony dimensions with optimal shape to be used for reconstruction of different parts of the mandible. They can be harvested bicortically, including the iliac crest and the ASIS, with acceptable morbidity at the donor site. The Harris Hip Score is an appropriate tool for the evaluation of long-term impairment at the donor site after the harvest of vascularised iliac bone grafts, and it could be used to compare the results of different studies.