Implications of Standardized Uptake Values of Oral Squamous Cell Carcinoma in PET-CT on Prognosis, Tumor Characteristics and Mitochondrial DNA Heteroplasmy.

Under aerobic conditions, some cancers switch to glycolysis to cover their energy requirements. Taking advantage of this process, functional imaging techniques such as PET-CT can be used to detect and assess tumorous tissues. The aim of this study was to investigate standardized uptake values and mitochondrial DNA mutations in oral squamous cell carcinoma. A cohort of 57 patients underwent 18[F]FDG-PET-CT and standardized uptake values were collected. In 15 patients, data on mitochondrial DNA mutations of the tumor were available. Kaplan-Meier curves were calculated, and correlation analyses as well as univariate Cox proportional hazard models were performed. Using ROC analysis to determine a statistical threshold for SUVmax in PET investigations, a cut-off value was determined at 9.765 MB/mL. Survival analysis for SUVmax in these groups showed a Hazard Ratio of 4 (95% CI 1.7-9) in the high SUVmax group with 5-year survival rates of 23.5% (p = 0.00042). For SUVmax and clinicopathological tumor features, significant correlations were found. A tendency towards higher mtDNA heteroplasmy levels in high SUVmax groups could be observed. We were able to confirm the prognostic value of SUVmax in OSCC, showing higher survival rates at lower SUVmax levels. Correlations between SUVmax and distinct tumor characteristics were highly significant, providing evidence that SUVmax may act as a reliable diagnostic parameter. Correlation analysis of mtDNA mutations suggests an influence on metabolic activity in OSCC.

Nutritional Status in Patients with Medication-Related Osteonecrosis of the Jaw (MRONJ).

Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe side effect of mostly antiresorptive drugs. The aim of this prospective clinical study was to evaluate the nutritional status in MRONJ patients scheduled for surgical treatment (intraoral soft tissue closure). The following parameters were evaluated: body weight, body height, BMI, nutritional risk index (NRI), bioelectric impedance analysis (BIA), vitamins A, B12, D3, E, K1, folic acid, iron, total protein, transferrin, ferritin, prealbumin, albumin, and zinc. All subjects were admitted to hospital four to five days before surgery and sip-fed with Nutritia Fortimel Compact Protein in addition to regular oral food intake. During surgery, a nasogastric tube was inserted and only removed on hospital discharge five days postoperatively. A total of 58 patients could be included. Half of the MRONJ patients were identified to be at risk for malnutrition. Deficiencies regarding protein levels were revealed, whereas hardly any relevant deficits of micronutrients were noted. The intraoral wound healing four weeks post-surgery was highly satisfactory with a low dehiscence rate of intraoral mucosal sites. Of all parameters analyzed, the dehiscence rate at the last follow-up four weeks post-surgery was significantly influenced by vitamin K, transferrin, and ferritin levels (p = 0.030, p = 0.004, and p = 0.023, respectively). In conclusion, perioperative dietary counselling and appropriate nutritional therapy are important supportive measures in MRONJ patients scheduled for intraoral soft tissue closure.

New Perspective for Soft Tissue Closure in Medication-Related Osteonecrosis of the Jaw (MRONJ) Using Barbed Sutures.

The aim of this study was to compare the effectiveness of barbed versus smooth sutures for soft tissue closure of exposed jawbone sites in medication-related osteonecrosis of the jaw (MRONJ) patients. Exposed necrotic jawbone sites surgically managed by intraoral soft tissue closure were evaluated. Either barbed sutures (Stratafix™ or V-Loc™) together with Prolene® or Vicryl® sutures were used. We estimated the effect of barbed sutures (BS) with Prolene® compared to smooth sutures (Vicryl®) on the hazard rate of intraoral soft tissue dehiscence using a multivariate Cox regression model within a target trial framework, adjusting for relevant confounders. In total, 306 operations were performed in 188 sites. In the primary analysis 182 sites without prior surgery were included. Of these, 113 sites developed a dehiscence during follow-up. 84 sites were operated using BS and Prolene®. A total of 222 sites were operated with Vicryl® (control group). In the BS group, the median time to event (i.e., dehiscence) was 148 days (interquartile range (IQR), 42-449 days) compared to 15 days (IQR, 12-52 days) in the control group. The hazard rate of developing intraoral dehiscence was 0.03 times (95%-confidence interval (CI): 0.01; 0.14, p < 0.001) lower for BS patients compared to the control group. Within the limits of a retrospective study, BS showed a high success rate and are therefore recommended for soft tissue closure of exposed jawbone sites in MRONJ patients. Additional studies are warranted to further evaluate this novel application of BS.

Choosing the Right Partner for Medication Related Osteonecrosis of the Jaw: What Central European Dentists Know.

Medication-related osteonecrosis of the jaw (MRONJ) is a side effect of antiresorptive drugs. In this online survey, the awareness and knowledge of dentists regarding MRONJ was evaluated, and potential implications for oncologists are discussed. Questionnaires were emailed to dentists from Germany, Austria, Switzerland, and South Tyrol to evaluate disease-related knowledge and management. In addition to the overall score, a separate score was calculated for knowledge (maximum score: 15 points) and management (maximum score: 6 points) questions, and 1197 valid replies with completed questionnaires were received. The mean overall score was 10.45 ± 3.97 points, the mean knowledge score was 7.68 ± 3.05 points, and the mean management score was 2.76 ± 1.77 points. Factors influencing the outcome of the overall score were age, specialization, continuous professional education, and the number of dental screening exams in patients before antiresorptive therapy. Due to the considerable lack of knowledge regarding MRONJ among dentists, MRONJ patients and subjects at risk should be guided towards specialists for dental screening, treatment, and follow-up. This is important from an oncologic point of view to avoid any delay for treatment start of antiresorptives, and to reveal a potentially emerging osteonecrosis at an early stage, thus, avoiding the need for interruption or even cancellation of antiresorptive therapy.

Medical Diagnoses, Mode of Residence, and Dental Treatment Demand under General Anesthesia in Special Needs Adults in Innsbruck, Austria. A Retrospective Breakdown of Four and a Half Years.

Regarding oral/dental care and attendance, special needs individuals depend on their caregivers' commitment. The purpose of this retrospective data analysis of adults who received dental general anesthesia (DGA) in Innsbruck, Austria, was a breakdown of demographic parameters (including the mode of accommodation/care), medical diagnoses (comprising intellectual/physical disablement (IPD) or psychiatric (anxiety) disorders (PDs)), and dental therapy performed under DGA. The sample was composed of 233 consecutive adults who underwent DGA from January 2015 to June 2019. Data were analyzed with descriptive and comparative statistics. In total, 133 (57.1%) subjects were male and 100 (42.9%) female; 176 (75.5%) had IPD and 57 (24.5%) PDs; 168 (72.1%) were living at private and 65 (27.9%) at nursing homes. Median age (IQR) was 35.6 (25.7-47.2) years. In the total sample, 5 (2-9) teeth were restored and 2 (0.5-6.5) teeth were extracted. Individuals with PDs had more teeth restored (p = 0.01) and extracted (p < 0.001) than individuals with IPD. Private home residents had more teeth restored (p < 0.001) but less teeth extracted (p = 0.003) than nursing home residents. Special needs individuals' oral health backlog should be tackled in private and institutional care modalities alike.

Dentists' Working Conditions during the First COVID-19 Pandemic Lockdown: An Online Survey.

The aim of this study was to investigate the operating conditions of dentists in Central Europe during the first coronavirus disease 2019 (COVID-19) lockdown. A survey including 24 questions was emailed to dentists in Austria, Germany, Switzerland and South Tyrol (Italy). Questions regarding dentists' field of work, working hours, treatments performed, personal protective equipment and protocols, and economic consequences were asked. 1731 participants were included. 30.4% of participants worked mainly in Austria, 60.8% in Germany, 6% in Switzerland and 2.1% in South Tyrol. A country-specific analysis for the situation of South Tyrol was not possible due to the low participation; 53.7% of German, 45.5% of Austrian, and 11.7% of Swiss respondents reduced their working hours; 42.8% of Austrian, 41.5% of Swiss, and 17.3% of German participants closed their offices temporarily; 52.2% of respondents provided emergency service including pain management, restorations/temporaries, and denture repairs. A lack of access to FFP2/FFP3 (filtering facepiece) respirators was indicated by 59.4% Austrian, 38.0% German, and 11.7% Swiss dentists (p < 0.001). FFP2/FFP3 respirators were, when available, most frequently used in Austria (86.9%), followed by Switzerland (61.2%) and Germany (56.7%) (p < 0.001). Financial consequences could not be conclusively quantified by 58.6% of the participants. Most respondents in all partaking countries made use of governmental support. A lack of blueprints/guidelines resulted in heterogeneous working conditions. In consideration of a potentially high risk of infection in the dental setting, non-emergency dental treatments were largely suspended in all participating countries.

Dental pathologies in tumor patients with bone metastases or multiple myeloma scheduled for antiresorptive therapy.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potentially severe complication of mainly antiresorptive drugs. We evaluated the frequency of dentoalveolar pathologies in patients scheduled for antiresorptive therapy in a 'real-world' setting, also including patients with poor oral health potentially requiring tooth extractions and/or other dentoalveolar surgery. This approach is in contrast to the setting of recent randomized trials with restrictive exclusion criteria. Patients & methods: We prospectively included patients suffering from solid tumors with osseous metastases or multiple myeloma. Screening for dentoalveolar pathologies was done prior to initiation of antiresorptive therapy at the specialized MRONJ clinic of the University Hospital for Cranio-Maxillofacial and Oral Surgery, Innsbruck, Austria. Results: 119 subjects could be included. In 76 patients (63.9%), a dental focus was revealed including deep caries (24.4% of patients), chronic apical periodontitis (26.9%), periodontal disease (45.8%), root remnants (16%), jaw cysts (2.5%), partially impacted teeth (5.0%) and peri-implantitis (5.0%). Conclusion: Considering the high number of dentoalveolar pathologies (63.9%), systematic dental focus screening prior to initiation of antiresorptive therapy is of utmost importance to lower the risk for MRONJ.

Hyperspectral imaging as a diagnostic tool to differentiate between amalgam tattoos and other dark pigmented intraoral lesions.

The goal of this project is to identify any in-depth benefits and drawbacks in the diagnosis of amalgam tattoos and other pigmented intraoral lesions using hyperspectral imagery collected from amalgam tattoos, benign, and malignant melanocytic neoplasms. Software solutions capable of classifying pigmented lesions of the skin already exist, but conventional red, green and blue images may be reaching an upper limit in their performance. Emerging technologies, such as hyperspectral imaging (HSI) utilize more than a hundred, continuous data channels, while also collecting data in the infrared. A total of 18 paraffin-embedded human tissue specimens of dark pigmented intraoral lesions (including the lip) were analyzed using visible and near-infrared (VIS-NIR) hyperspectral imagery obtained from HE-stained histopathological slides. Transmittance data were collected between 450 and 900 nm using a snapshot camera mounted to a microscope with a halogen light source. VIS-NIR spectra collected from different specimens, such as melanocytic cells and other tissues (eg, epithelium), produced distinct and diagnostic spectra that were used to identify these materials in several regions of interest, making it possible to distinguish between intraoral amalgam tattoos (intramucosal metallic foreign bodies) and melanocytic lesions of the intraoral mucosa and the lip (each with P < .01 using the independent t test). HSI is presented as a diagnostic tool for the rapidly growing field of digital pathology. In this preliminary study, amalgam tattoos were reliably differentiated from melanocytic lesions of the oral cavity and the lip.

Cleansing efficacy of an auto-cleaning electronic toothbrushing device: a randomized-controlled crossover pilot study.

OBJECTIVES: To compare the cleansing efficacy of a representative "ten seconds" auto-cleaning device with that of uninstructed manual toothbrushing in a pilot study. MATERIALS AND METHODS: Twenty periodontally healthy probands refrained from oral hygiene for 3 days. Baseline full-mouth plaque scores (Rustogi Modified Navy Plaque Index, RMNPI) were assessed. After randomization, probands cleaned their teeth either with the auto-cleaning test device according to the manufacturer's protocol or with a manual toothbrush. Plaque reduction was assessed by two aligned blinded investigators. After a 2-week recovery, the clinical investigation was repeated in a crossover design. The brushing pattern of the auto-cleaning device was analyzed in probands' casts. RESULTS: Full-mouth plaque reduction was 11.37 ± 3.70% for the auto-cleaning device and 31.39 ± 5.27% for manual toothbrushing (p < 0.0001). The investigation of the auto-cleaning device's brushing pattern in dental casts revealed a positive relationship of bristle rows in contact with tooth surfaces and the cleansing efficacy in the respective areas. A maximum of 2/4 bristle rows were in contact with the tooth surfaces; in some areas, the bristles had no contact to the teeth. CONCLUSIONS: Uninstructed manual toothbrushing is superior to auto-cleaning. The alignment and density of the auto-cleaning device's bristle rows need to be improved, and assorted sizes would be necessary to cover different jaw shapes. CLINICAL RELEVANCE: The auto-cleaning device has been developed to accommodate individuals with poor dexterity or compliance. To date, it is unable to provide sufficient plaque reduction due to an inappropriate bristle alignment and poor fit with diverse dental arches.

Profiling of Mitochondrial DNA Heteroplasmy in a Prospective Oral Squamous Cell Carcinoma Study.

While a shift in energy metabolism is essential to cancers, the knowledge about the involvement of the mitochondrial genome in tumorigenesis and progression in oral squamous cell carcinoma (OSCC) is still very limited. In this study, we evaluated 37 OSCC tumors and the corresponding benign mucosa tissue pairs by deep sequencing of the complete mitochondrial DNA (mtDNA). After extensive quality control, we identified 287 variants, 137 in tumor and 150 in benign samples exceeding the 1% threshold. Variant heteroplasmy levels were significantly increased in cancer compared to benign tissues (p = 0.0002). Furthermore, pairwise high heteroplasmy frequency difference variants (∆HF% > 20) with potential functional impact were increased in the cancer tissues (p = 0.024). Fourteen mutations were identified in the protein-coding region, out of which thirteen were detected in cancer and only one in benign tissue. After eight years of follow-up, the risk of mortality was higher for patients who harbored at least one ∆HF% > 20 variant in mtDNA protein-coding regions relative to those with no mutations (HR = 4.6, (95%CI = 1.3-17); p = 0.019 in primary tumor carriers). Haplogroup affiliation showed an impact on survival time, which however needs confirmation in a larger study. In conclusion, we observed a significantly higher accumulation of somatic mutations in the cancer tissues associated with a worse prognosis.

The Role of HPV and Non-HPV Sexually Transmitted Infections in Patients with Oropharyngeal Carcinoma: A Case Control Study.

Background: Certain high-risk (hr) types of human papillomavirus (HPV) can cause cervical cancer in women and penile cancer in men. Hr-HPV can also cause cancers of the oropharynx and anus in both sexes. In the anal and cervical region, a contribution of co-infections with Ureaplasma spp. on the persistence of the hr-HPV infection by a profound inflammatory state is suggested. Here, we investigated if non-HPV sexually transmitted infections are associated with oropharyngeal carcinoma (OPC). Materials and Methods: In this case-control study, a brush test directly from the tumor surface of OPC patients (study group) and from the oropharynx of healthy volunteers (control group), both groups matching in age and sex, was performed. HPV subtypes were detected using a commercially available test kit. For non-HPV sexually transmitted infections (Ureaplasma spp., Chlamydia trachomatis, Mycoplasma hominis, and Mycoplasma genitalium), a multiplex nucleic acid amplification approach was performed. Results: In the study group, 96 patients (23 female/73 male), with histologically confirmed OPC and in the control group 112 patients (19 female/93 male), were included. Oropharyngeal hr-HPV-positivity was detected in 68% (65/96 patients) of the study group and 1.8% (2/112 patients) of the control group (p < 0.001). In three patients in the study group, Ureaplasma spp. was detected, whereas no patient was Ureaplasma spp. positive in the control group (p = 0.097). Chlamydia trachomatis, Mycoplasma hominis, and Mycoplasma genitalium were negative in both groups. Conclusion: Based on the current study, the prevalence of oropharyngeal Ureaplasma spp. among patients with OPC is low and does not support a role in oropharyngeal cancer. However, the detection of the pathogen only among OPC patients but not in the healthy individuals might indicate a potential role and needs further elucidation.

Cervical Lymph Node Metastases in Oral Squamous Cell Carcinoma-How Much Imaging Do We Need?

Cervical lymph node metastases in oral squamous cell carcinoma (OSCC) are key predictors of disease specific survival. It was therefore the aim of this study to evaluate how much imaging is minimally needed for reliable and efficient identification of cervical lymph node metastases. In this retrospective cross-sectional study, results (metastasis yes/no) of ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) were compared to the final histopathological results of the corresponding neck dissection (ND) specimens (metastasis yes/no). A score was calculated to account for cervical lymph node size, shape, clustering, peripheral enhancement, hilus sign, architecture, blood flow, and central necrosis. Sensitivity and specificity were analyzed for each imaging technique separately. In 164 patients diagnosed with OSCC, 96 underwent uni- or bilateral ND (122 ND in total). One hundred percent sensitivity was achieved by CT+MRI, MRI+PET, US+CT+MRI, US+MRI+PET, CT+MRI+PET, and US+CT+MRI+PET. The highest specificity was realized by US with 79% (95% CI [0.698-0.890]). Specificity for CT+MRI and PET+MRI was 51% (95% CI [0.359-0.665]) and 70% (95% CI [0.416-0.984]), respectively. Regarding 100% sensitivity with acceptable specificity, the combination of CT+MRI or PET+MRI appeared to be suitable for staging cervical lymph nodes in primary OSCC.

Clinical Outcome Following Surgical Repair of Small Versus Large Orbital Floor Fractures Using Polyglactin 910/Polydioxanone (Ethisorb®).

The aim of this retrospective study was to evaluate the clinical outcome of surgical management of small versus large, isolated orbital floor fractures (OFFs) using polyglactin 910/polydioxanone (Ethisorb®). Covering a four-year period (2010-2013), all records concerning midfacial fractures with involvement of the orbit were screened. Isolated fractures of the orbital floor as well as combined injuries of the orbital floor and medial wall that had been treated surgically using polyglactin 910/polydioxanone (Ethisorb®) were included. Patients underwent a preoperative, a postoperative, and a late ophthalmologic assessment. The clinical outcomes of surgically managed small OFFs up to 2 cm2 were statistically analyzed and compared to clinical results in larger defects. The final sample included 61 patients (25 women, 36 men). Fractures up to 2 cm2 were found in 33 patients (54.1%), whereas 28 patients (45.9%) suffered from OFFs larger than 2 cm2. The clinical outcomes did not significantly differ between both sample categories, and statistical analysis showed a power of 0.91 to detect a potentially existing difference. On final examination, 52 patients were free of any clinical symptoms, whereas minor issues were found in seven subjects, and two patients suffered from severe impairment. In conclusion, polyglactin 910/polydioxanone (Ethisorb®) seems to be a suitable material for surgical repair of both small and large OFFs.

Is it safe to drive after oral surgery?

OBJECTIVES: Driving ability largely depends on the total brake response time (TBRT) corresponding to the time a subject needs to react to a stimulus and apply a well-defined force on the brake pedal. As yet, the English literature completely lacks clinical studies evaluating the TBRT following oral surgery. MATERIALS AND METHODS: In this case-control study, a driving simulator was used to evaluate the TBRT in patients scheduled for oral surgery in local anesthesia. Measurements were taken shortly before (t1) and after (t2) surgery as well as 7-10 days later (t3) when sutures were removed. Results were compared to data of a group of healthy volunteers. RESULTS: Seventy-three patients (37 women, 36 men) underwent evaluation at t1, t2, and t3. In 13 patients who did not return for removal of sutures, only measurements at t1 and t2 could be performed. The median TBRT was 583 milliseconds (ms), 634 ms, and 520 ms at t1, t2, and t3, respectively. Statistical analysis revealed significant differences between readings at t1 versus t2 (t = - 4.944, p < 0.001), t1 versus t3 (t = 7.454, p < 0.001), and t2 versus t3 (t = 11.971, p < 0.001). There was no significant difference between TBRT at t3 in study subjects compared to normal reference values of 67 healthy volunteers. TBRT was significantly increased immediately after oral surgery (t2) compared to measurements 7-10 days postoperatively (t3). Since readings at t3 did not differ from TBRT values in the comparison group, they were considered normal. CONCLUSIONS: Due to significantly elevated total brake response time, driving ability is assumed to be considerably affected following oral surgery, and patients should be advised to abstain from driving immediately after such operations. CLINICAL RELEVANCE: Our study results put into question patients' driving ability following dentoalveolar procedures which should be considered regarding informed consent and could potentially have consequences on health issues (road traffic accidents) as well as legal and financial matters (court charges, insurance claims).

Amalgam tattoo versus melanocytic neoplasm - Differential diagnosis of dark pigmented oral mucosa lesions using infrared spectroscopy.

BACKGROUND: Dark pigmented lesions of the oral mucosa can represent a major diagnostic challenge. A biopsy is usually required to determine the nature of such intraoral discolorations. This study investigates the potential use of infrared spectroscopy for differential diagnosis of amalgam tattoos versus benign or malignant melanocytic neoplasms. MATERIALS AND METHODS: For this retrospective study, formalin-fixed paraffin-embedded tissue (FFPE) specimens of dark pigmented lesions concerning the oral mucosa or the lip were investigated using mid infrared spectroscopy. The samples were chosen from patients who had undergone a mucosal biopsy at the University Hospital Innsbruck (Austria) between the years 2000 and 2017. Principal component analysis was used for data exploration. Evaluation was based on the superimposition of the recorded spectra and the corresponding histologic slides. RESULTS: In total, 22 FFPE specimens were analyzed. Clear differences were found between amalgam and non-amalgam samples. A general weakening of the penetrating infrared radiation allowed for unspecific discrimination between these two classes. An overall accuracy in predicting the correct class of 95.24% was achieved. CONCLUSION: Infrared spectroscopy appears to be a suitable technique to differentiate between amalgam tattoos and melanocytic lesions in FFPE samples. It could potentially be applied in vivo, too, serving as a non-invasive diagnostic tool for intraoral dark pigmented lesions.

Crestal Sinus Floor Augmentation Using Hydraulic Pressure and Vibrations: A Retrospective Single Cohort Study.

PURPOSE: To evaluate the sinus membrane perforation and implant survival rate after crestal minimally invasive sinus floor augmentation using hydraulic pressure and vibrations. MATERIALS AND METHODS: In this retrospective single cohort study, all patients who underwent minimally invasive sinus floor augmentation between 2007 and 2015 using hydraulic pressure and vibrations were included. The sinus membrane is elevated by physiologic saline at 1.5 bar. The fluid is then set into vibration to further separate the sinus membrane from the bony floor. The endpoints were sinus membrane perforation and the survival rate of implants. RESULTS: The hydraulic pressure and vibration technique was applied in 156 patients. Seven patients with perforations of the sinus membrane were treated with the lateral window approach and excluded from the follow-up analysis. In the remaining 149 patients, 184 crestal sinus floor augmentations were performed and 184 implants were placed. In 10 of these 184 cases, a perforation was suspected in the postoperative computed tomography (CT) scan. In total, the perforation rate was 8.9% (17/191). Nineteen implants were lost during the follow-up period ranging from 0.2 to 8.4 years with a median of 2.3 years. The cumulative implant survival rates after 1, 3, and 5 years were 94.4%, 87.7%, and 87.7%, respectively. No severe perioperative complications were noted. CONCLUSION: The hydraulic pressure and vibration technique allows a minimally invasive crestal sinus augmentation with a perforation rate less than 10% and implant survival rates of approximately 90%.

An up to 17-year follow-up retrospective analysis of a minimally invasive, flapless approach: 18 945 implants in 7783 patients.

BACKGROUND: This study investigates gender, age, jaw, implant position, loading protocol (immediate vs delayed), smoking, and type of surgery (punch vs flap) as influential factors of implant survival in a large patient collective. PURPOSE: To evaluate the survival rates of implants in patients using a mucoperiosteal punch for flapless implantation in the majority of cases in order to evaluate its medical efficacy and safety. MATERIALS AND METHODS: Between 1994 and 2015 all patients with complete data treated at the Wienerberg Dental Clinic, Vienna, Austria, were included and statistically analyzed in Cox proportional hazard (PH) models. As patients with multiple implants were included, a clustering term was added to the Cox PH model to respect pooled failures in patients. RESULTS: Of the initial 24 282 ANKYLOS/Dentsply implants placed in 8137 patients a total of 7783 patients with 18 945 implants were finally included. The mean follow-up was 2.8 ± 3.2 up to 17.9 years. Cumulative survival rates (CSRs) after 1, 3, 5, and 10 years were 98.5%, 97.7%, 96.7%, and 93.0%, respectively. Of these, 17 517 (92.5%) implants were placed minimally invasive via a flapless approach by use of the ATP-Punch with comparable survival rates as observed for flap surgery. The Cox PH models proved smoking (hazard ratio [HR] = 2.2) and implant position as significant factors of implant survival. In the maxilla, canines and third molars were identified as low risk sites in comparison to the most frequently implanted first premolar site. In the mandible, the central incisor and second premolar were identified as high-risk sites, the canine as low risk site in comparison to the most frequently placed first molar site. CONCLUSION: The analyzed data concludes the safety and medical efficacy of the ATP-Punch. The CSRs using this flapless technique are comparable to the classic surgical flap approach.

Posterior Airway Changes Following Orthognathic Surgery in Obstructive Sleep Apnea.

PURPOSE: The purpose of this systematic review was to describe and compare the different approaches of radiologic posterior airway space (PAS) assessment in obstructive sleep apnea (OSA) and analyze the correlations of PAS changes with polysomnographically evaluated parameters after orthognathic surgery. MATERIALS AND METHODS: For this systematic review, a PubMed query was designed to search for original studies radiographically evaluating the PAS in patients before and after orthognathic surgery for treatment of their OSA. To account for the clinical relevance of PAS changes after surgery, only studies providing pre- and postoperative polysomnographic (PSG) data were included. The authors investigated whether the predictor variables (PAS changes) would be correlated with the primary outcome variables (PSG parameters). RESULTS: The final sample included 15 publications in which the PAS was evaluated by lateral cephalography in 8 studies, cone-beam computed tomography in 3, conventional computed tomography in 5, and magnetic resonance imaging in 1. Most linear, areal, and volumetric PAS changes after surgery (predictor variables) were found to be statistically significant. Maxillomandibular advancement (MMA) was the only orthognathic procedure performed in all studies included and was combined with additional surgical procedures in 9 studies. Improvement (ie, decrease) of the apnea-hypopnea index (AHI) as the primary outcome variable was reported in all publications. CONCLUSION: After MMA (with or without additional surgical procedures), most linear, areal, and volumetric PAS parameters showed significant changes. The PAS changes correlated with clinical improvement in PSG parameters. In particular, decreased AHI was reported in all studies. For better inter-study comparability, internationally accepted standards regarding the methods used for PAS evaluation are needed. Moreover, statistical analysis should account for multiple testing when various PAS parameters are evaluated.

Intraoral Vacuum-Assisted Closure Therapy-A Pilot Study in Medication-Related Osteonecrosis of the Jaw.

PURPOSE: For approximately 2 decades, vacuum-assisted closure (VAC) therapy has been widely used for the management of complex wounds and soft tissue defects on the external surface of the body. As yet, this technique has not been studied for intraoral wound management. Therefore, this study evaluated the feasibility, safety, and effectiveness of intraoral VAC therapy in patients with medication-related osteonecrosis of the jaw (MRONJ). PATIENTS AND METHODS: After successful construction of an intraoral device providing sufficient airtight sealing, individually manufactured appliances were used in a prospective clinical trial of 3 patients using the VAC therapy system. RESULTS: Intraoral VAC therapy showed some success and did not produce serious side effects. Different positive effects, such as formation of new granulation tissue, cessation of pain, and pus suppuration, were found. CONCLUSION: This prospective proof-of-principle study showed that intraoral VAC therapy is feasible and safe. It could play a role in the management of MRONJ and other types of intraoral wounds (eg, osteoradionecrosis, postoperative wound dehiscence, etc).

A pilot-study of a minimally invasive technique to elevate the sinus floor membrane and place graft for augmentation using high hydraulic pressure: 18-month follow-up of 20 cases.

OBJECTIVE: To evaluate medical efficacy and safety of crestal, minimally invasive sinus floor augmentation (MISFA) using an innovative method based on high hydraulic pressure. STUDY DESIGN: Twenty MISFA using the novel Jeder-System were performed in 18 patients at 2 study sites in Vienna, Austria. The Jeder-System consists of the Jeder-drill, the Jeder-pump, and a connecting tube-set. The pump generates high hydraulic pressure (1.5 bar) pushing back the sinus membrane from the drill at the first perforation. The pump also monitors the whole procedure by constantly measuring pressure and volume. RESULTS: Five percent membrane perforation rate (1/20) only detected in the postoperative computed tomography scan and without implication for implant placement. Height gain of 9.2 ± 1.7 mm achieved (from 4.6 ± 1.4 mm to 13.8 ± 2.3 mm). Average patient satisfaction was 9.82 on scale from 1 to 10 (10 = very satisfied). Mean duration of sick leave was 0.19 days. 18-month survival rate was 95% (1/20 implant lost). CONCLUSIONS: Within the limits of a prospective open cohort study with 20 cases, our data demonstrate the safety and medical efficacy of the novel method.