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The clinical outcomes of maxillary rehabilitation with the additively manufactured sub-periosteal jaw implant (AMSJI; CADskills BV) were evaluated in edentulous patients with a Cawood-Howell atrophy classification ≥5 in all regions of the maxilla. Fifteen consecutive patients were included in the study and followed up for 1 year. They were interviewed using a survey protocol and were examined clinically and radiographically preoperatively (T0) and at 1 (T1), 6 (T2), and 12 (T3) months after permanent upper prosthesis placement. The patients reported an increased oral health-related quality of life. The overall mean Oral Health Impact Profile-14 score at T0 was 17.20 (standard deviation (SD) 6.42). When results at T0 were compared to those at T1 (mean 8.93, SD 5.30), a statistically significant difference was seen (P = 0.001). At T3, the mean value was 5.80 (SD 4.18). Compared to T0, there was also a statistically significant difference at T3 (P = 0.001). General satisfaction based on the numerical rating scale was a mean 49.93 at T1, which was less than patient expectation prior to treatment at T0 (52.13). A higher overall value was seen at T3 (53.20) when compared to T0. Within the constraints of the short follow-up, the AMSJI appears to be a promising tool for patients with extreme jaw atrophy. The high patient expectations were met without complications.

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. ispartof: JOURNAL OF CLINICAL MEDICINE vol:10 issue:16 ispartof: location:Switzerland status: published

Strong mandibular angles and a heavy chin are perceived as masculine features, so surgical feminization of female or transgender faces may warrant mandibular base narrowing (borders and angles) and a reduction in chin width and height. With this in mind, we have devised an interdental midline osteotomy (triangular in shape and with a caudal base) to accompany a box-shaped impaction osteotomy of the chin symphysis and horizontal triangular resection of the lateral mandibular border. The reduction of the intergonial width and of the mandibular border and chin widths takes place upon closure of the midline defect. Between November 2016 and August 2017, five patients agreed to the mandibular feminization osteotomy and were followed up thereafter for 6-13 months. All expressed satisfaction with the results; no dental, periodontal, or temporomandibular joint-related complications were encountered. This technique is a viable alternative to buccal decortication, chin reduction osteotomy, and masseter reduction surgery.

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.

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.

Residual bilateral cleft lip deformities are commonly attributed to neglect of oral sphincter reconstruction during primary repair. This report describes a straightforward technique for reoperation that is applicable for most patients. It also describes the results of a retrospective observational cohort study of 21 patients that underwent reoperation performed by the senior author (MYM) from 1991 to 2018. The patients had undergone primary lip repair at other institutions. Their mean age at reoperation was 17 years. Pre‑ and post‑operative photographs (at 3.5 years’ postoperation) were assessed for 15 parameters. Overall configuration, scar appearance, philtrum anatomy, Cupid’s bow shape, and esthetic aspects of lip dynamics improved considerably. This procedure is the same as that used by the authors in 4‑month‑old children who have undergone a nasolabial adhesion procedure at 4 weeks of age. We discuss the rationale of using this procedure for primary lip repair, thus eliminating the need for reoperation.