Soft tissue response and determination of underlying risk drivers for recession and mucositis after AMSJI implantation in the maxilla.

PURPOSE: There are few treatment options for oral rehabilitation in patients with advanced maxillary resorption (Cawood-Howell Class V or more). Patient-specific, 3D-printed titanium subperiosteal implants have been described as a potentially valuable alternative solution. Surgeon and patient mediated functional outcomes have been studied and the results are promising. The surrounding soft tissue health has been much less researched. This study aims to evaluate the soft tissue response to the placement of additively manufactured subperiosteal jaw implants (AMSJI®) in the severely atrophic maxilla and to identify possible risk factors for soft tissue breakdown. MATERIALS AND METHODS: An international multicenter study was conducted and fifteen men (mean age 64.62 years, SD ± 6.75) and twenty-five women (mean age 65.24 years, SD ± 6.77) with advanced maxillary jaw resorption (Cawood-Howell Class V or more) were included in this study. General patient data were collected and all subjects were clinically examined. Inclusion criteria were patients who underwent bilateral AMSJI placement® in the maxilla at least a year before and whose surgeon and themselves agreed to participate in the study before their inclusion. RESULTS: A total of forty patients were enrolled with a mean follow-up period of 917 days (SD ± 306.89 days). Primary stability of the implant was achieved postoperatively in all cases, and all implants were loaded with a final prosthesis. At the time of study, only one patient showed mobility of the bilateral AMSJI (more than 1 mm). Exposure of the framework, due to mucosal recession, was seen in 26 patients (65%) and was mainly in the left (21.43%) and right (18.57%) mid-lateral region. Thin biotype and the presence of mucositis were found to be risk factors (p-value < 0.05). Although not significant, smokers had a nearly seven times (Odds ratio 6.88, p=0.08) more risk of developing a recession compared to nonsmokers. CONCLUSION: Twenty-six (65%) patients presented with a recession in one or (more) of the seven regions after oral rehabilitation with bilateral AMSJI installation. Several risk drivers were evaluated. The collapse of soft tissues around the AMSJI that led to caudal exposure of the arms was correlated with a thin biotype and the presence of mucositis.

Patient Satisfaction and Impact on Oral Health after Maxillary Rehabilitation Using a Personalized Additively Manufactured Subperiosteal Jaw Implant (AMSJI).

Subperiosteal implants (SIs) were first developed by Dahl in 1941 for oral rehabilitation in case of severe jaw atrophy. Over time, this technique was abandoned due to the high success rate of endosseous implants. The emergence of patient-specific implants and modern dentistry allowed a revisitation of this 80-year-old concept resulting in a novel "high-tech" SI implant. This study evaluates the clinical outcomes in forty patients after maxillary rehabilitation with an additively manufactured subperiosteal jaw implant (AMSJI®). The oral health impact profile-14 (OHIP-14) and numerical rating (NRS) scale were used to assess patient satisfaction and evaluate oral health. In total, fifteen men (mean age: 64.62 years, SD ± 6.75 years) and twenty-five women (mean age: 65.24 years, SD ± 6.77 years) were included, with a mean follow-up time of 917 days (SD ± 306.89 days) after AMSJI installation. Patients reported a mean OHIP-14 of 4.20 (SD ± 7.10) and a mean overall satisfaction based on the NRS of 52.25 (SD ± 4.00). Prosthetic rehabilitation was achieved in all patients. AMSJI is a valuable treatment option for patients with extreme jaw atrophy. Patients enjoy treatment benefits resulting in high patient satisfaction rates and impact on oral health.

Prevention and non-surgical treatment of soft tissue polly beak deformity after rhinoplasty: a scoping review.

The aim of this study is to map the available evidence of surgical preventive measures and postoperative methods for addressing supratip fibrosis (polly beak deformity) following rhinoplasty, to describe the postoperative results and to identify the most effective techniques. A scoping review was performed, selecting articles from the following medical electronic databases: PubMed, Cochrane Central, EMBASE, and Web of Science up to October 2022. The following keywords were used: supratip fullness, supratip deformity, polly beak deformity and supratip fibrosis. A total of 19 studies met the eligibility criteria. Of these 18 were included, and were divided into two categories: studies that solely used non-surgical management and studies that used operative techniques to prevent soft tissue polly beak deformity. Cartilaginous causes of polly beak deformity were excluded. Although a number of different methods are described in literature, the effectiveness and potential of each are still open to debate. Randomized controlled trials that use a standardized objective measurement method for soft tissue polly beak deformity are needed to objectively compare different methods.

Exploration of the Influences of Temporary Velum Paralysis on Auditory-Perceptual, Acoustic, and Tomographical Markers.

Purpose To better understand hypernasality (HN), we explored the relations between velopharyngeal orifice, auditory perception of HN, and acoustic-spectral measures in an in vivo within-subject design: (a) with a normally functioning velum as the control condition and (b) with a temporarily paralyzed velum as the experimental condition. Method The velum of eight volunteers was injected with ropivacaine hydrochloride (Naropin) in the area of the levator veli palatini and tensor veli palatini muscles to induce temporary velopharyngeal inadequacy (VPI) and HN. Sustained [a] and [i] and oronasal text readings were recorded, and 3D cone-beam computed tomography images of the vocal tract were built before and during velar anesthesia. Differences between conditions and correlations in normal-to-numb differences between velopharyngeal cross-sectional area (VParea), mean ratings of HN severity, and nine acoustic-spectral measures were determined. Results Three subjects already had some incomplete velopharyngeal closure in the control condition. Temporary motor nerve blockage of the velum (increased VParea) was accomplished in seven subjects, leading to increased HN and changes in three acoustic-spectral measures. Furthermore, significant correlations only emerged between VParea, HN, and ModelKataoka. Conclusions In most of the participants, it was possible to temporarily increase the velopharyngeal orifice to investigate HN while controlling other speech variables and cephalic morphology. Although this study was exploratory and its are findings preliminary, it provided additional evidence for the possible clinical value of ModelKataoka, A 3-P 0, and B F1 for the objective measurement of VPI or HN.

Radiographic Evaluation of Bone Remodeling after Additively Manufactured Subperiosteal Jaw Implantation (AMSJI) in the Maxilla: A One-Year Follow-Up Study.

Additively manufactured subperiosteal jaw implants (AMSJI) are patient-specific, 3D-printed, titanium implants that provide an alternative solution for patients with severe maxillary bone atrophy. The aim of this study was to evaluate the bony remodeling of the maxillary crest and supporting bone using AMSJI. Fifteen patients with a Cawood-Howell Class V or greater degree of maxillary atrophy were evaluated using (cone beam) computed tomography scans at set intervals: one month (T1) and twelve months (T2) after definitive masticatory loading of bilateral AMSJI implants in the maxilla. The postoperative images were segmented and superimposed on the preoperative images. Fixed evaluation points were determined in advance, and surface comparison was carried out to calculate and visualize the effects of AMSJITM on the surrounding bone. A total mean negative bone remodeling of 0.26 mm (SD 0.65 mm) was seen over six reference points on the crest. Minor bone loss (mean 0.088 mm resorption, SD 0.29 mm) was seen at the supporting bone at the wings and basal frame. We conclude that reconstruction of the severely atrophic maxilla with the AMSJI results in minimal effect on supporting bone. Reduced stress shielding with a biomechanically tuned subperiosteal implant does not induce radiographically significant crestal bone atrophy.

Guidelines for the Use of Resection Guides for Subperiosteal Maxillary Implants in Cases of Terminal Dentition - A Novel Approach.

INTRODUCTION: We described our rationale and experiences with the use of cutting jigs for vertical ostectomy in cases of terminal maxillary dentition when edentulation and an additively manufactured subperiosteal jaw implant (AMSJI®) are planned. MATERIAL AND METHODS: Our experience covers 15 patients treated by four clinicians. We tabulated our criteria for planning and manufacturing vertical and horizontal ostectomy guides. RESULTS: In order to guarantee accurate osteotomy, titanium guides are preferable to guides made of polymer. The most important consideration is to avoid acute angles in the buccal arms of the AMSJI®. It is up to the surgeon whether to screw-fix the ostectomy guides or to use handles to maintain their position. DISCUSSION: Guided ostectomy has the potential to extend the use of AMSJI® to cases where teeth have yet to be removed or where the contours of the residual bone are not favorable. The use of guided ostectomy in such cases lessens the time between edentulation and implantation and improves the design of the implants.

Transverse Maxillary Development in Complete Cleft Patients: Comparison of 2 Treatment Strategies by Longitudinal and Cross-Sectional Model Analysis.

OBJECTIVE: This study aimed to compare differences in the maxillary transverse dimension following cleft repair using 2 protocols involving a 2-staged palatal closure with similar timing but different techniques. DESIGN: Retrospective study. Two matched study samples, each containing 10 patients. SETTING: Cleft center A is a university hospital. Cleft Center B is a general teaching hospital. PATIENTS: Patients with cleft lip alveolus and palate (CLAP) were matched by cleft type, gender, age, and palatal morphology at the age of 1 month. Differences in the transverse dimension were measured at 4 ages in 2 matched groups (A and B from center A and B), each including 5 patients with unilateral CLAP (UCLAP) and 5 patients with bilateral CLAP (BCLAP). INTERVENTIONS: Orthodontic/orthopedic expansion treatment began at 8 and 5 years of age at centers A and B, respectively. RESULTS: The mean intercanine distance decreased by 8 mm (standard deviation [SD] = 1.6; P = .030) in group A patients with UCLAP between 1 and 5 years (SD = 1.6; P = .030) and by 6.3 mm (SD = 3.2; P = .016) in group B patients with BCLAP. The mean intermolar distance increased by 4 mm (SD = 3.4; P = .076) in patients with BCLAP. A trend toward improved canine positioning was observed in patients with BCLAP by 12 years of age, with improvement occurring between 4 and 12 years. CONCLUSION: The type of palatal closure (inducing scar tissue at the bony level) and the late installment of orthodontic/orthopedic expansion probably reduced the intercanine width in bilateral complete clefts.

Perforator free flaps in head and neck reconstruction: a single-center low-volume experience.

OBJECTIVE: The aim of this article is to investigate the results of free-flap reconstructions in the head and neck area in a secondary low-volume institution and compare these with the literature. STUDY DESIGN: A retrospective study was performed of all patients who underwent free-flap reconstructive surgery in our institution from January 9, 2011, to July 12, 2015, by one young surgeon in a one-team approach. The types of flaps applied, defect sites, pathology, anastomotic details, success and complication rates, lengths of stay, and patients' ages and comorbidities were analyzed. RESULTS: A total of 97 patients received 100 free flaps. Perforator flaps comprised 85% of the total (63% anterolateral thigh, 22% fibular). Thirty-six percent of free flaps were performed in patients who received previous chemotherapy radiation to the head and neck. Free-flap survival was 96%. CONCLUSION: From our data, it seems that free-flap surgery not only is a safe and successful technique in tertiary academic hospitals, but also can be performed in smaller institutions, even in salvage situations and in patients with comorbidities. Therefore, we believe that free tissue transfer is predictable in all centers when performed by skilled microsurgeons and well-trained nursing teams.