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OBJECTIVES: Patient perceived benefit of treatment for cleft lip and/or palate is of great importance since it is central to development of cleft care. CLEFT-Q is a cleft-specific questionnaire on health-related quality of life. Test-retest reliability, aspects of responsiveness and interpretability are yet to be established for CLEFT-Q. This study aims to investigate these psychometric characteristics of CLEFT-Q.

METHODS: To establish the test-retest reliability of CLEFT-Q, data will be collected repeatedly and independently at approximately 1-week intervals. Inclusion of approximately 50 patients is considered adequate for a test-retest study. To improve the interpretability of CLEFT-Q norm data from a control population of volunteers without a cleft will be collected. A total of approximately 210 participants will be included from schools, high-schools and universities. To test the responsiveness of CLEFT-Q, patients will answer selected subscales of CLEFT-Q, longitudinal anchor questions and perform global ratings of change before and after surgery. To ensure robust results, approximately 50 patients for each type of treatment will be recruited. If CLEFT-Q is found to be responsive, the pre- and postoperative difference in scores of CLEFT-Q will be compared with the change in objective measurements based on assessments by professionals in cleft care obtained in this study. To evaluate interpretability, results will be analysed to investigate the minimal important change using anchor-based, distribution-based and qualitative approach.

REGISTRATION DETAILS: This study is registered at ClinicalTrials.gov under the ID 2021-06993-01.

Background: Magnetic resonance imaging (MRI) of the brain is frequently performed on patients with neurofibromatosis type 1 (NF1), to detect and follow-up intracranial findings. In addition, NF1-related pathologies can appear in the jaws. This case study investigates if it is advantageous to assess the depicted parts of the jaws in the imaging of NF1 patients with intracranial findings, thereby detecting jaw pathologies in their initial stages.

Case presentation: We report on the 3-year management with clinical and radiological follow-ups of a central giant cell granuloma and a neurofibroma in the mandible of a patient with NF1 who underwent examinations with brain MRIs. A review of the mandible in the patient’s MRIs disclosed lesions with clear differences in progression rates.

Conclusion: NF1-related jaw pathologies may be detected in the early stages if the depicted parts of the jaws are included in the assessment of the imaging of NF1 patients with intracranial findings. This could impact the treatment of eventual pathologies before lesion progression and further damage to the vicinity.

Materials and Methods: Patients subjected to orthognathic surgery due to dentofacial deformity (DFD) and registered in the National Register of Orthognathic Surgery (NROK) in Sweden between 2017 and 2020 were eligible for inclusion in this study. The Swedish-validated Orthognathic Quality of Life Questionnaire (S-OQLQ) was used to evaluate patient quality of life before and after surgery. The S-OQLQ measured each patient's subjective experience regarding social aspects.

Results: Eighty-four participants were included in this cohort study, including 45 men (mean age 24.7 years), 48 women (mean age 23.4 years), and eight patients who stated no gender. Women generally graded several aspects of the S-OQLQ higher than men, including facial aesthetics p = 0.029), oral function (p < 0.001), and awareness of facial deformity (p = 0.0054). For all domains of the questionnaire (social, facial aesthetics, function, and awareness), a significant improvement was seen 6–24 months after surgery (p < 0.001). Women rated improvement of function and awareness of facial deformity higher than men (p < 0.001 and p = 0.039, respectively).

Conclusion: Quality of life aspects of orthognathic surgery have a strong impact on the treatment outcome. Although functional impairment is often considered a major indication for surgery, the social and aesthetic influence of DFD is highly rated by patients, whereas pain is not an issue before or after treatment.

Purpose: The aim was to assess skeletal stability after maxillary advancement using either distraction osteogenesis (DO) or conventional Le Fort I osteotomy (CO) in patients with cleft lip and palate (CLP) or cleft palate (CP) utilising a new superimposition-based cephalometric method.

Method: This retrospective study included patients who were treated with DO (N = 12) or CO (N = 9). Sagittal and vertical changes after surgery, and skeletal stability at 18 months post-operatively were assessed with superimposition-based cephalometry, comparing lateral cephalograms performed pre-operatively (T0), post-operatively after CO or immediately after completed distraction in DO (T1), and at 18 months of follow-up (T2).

Results: The mean sagittal movements from T0 to T2 in the DO and CO groups were 5.9 mm and 2.2 mm, respectively, with a skeletal relapse rate of 16% in the DO group and 15% in the CO group between T1 and T2. The vertical mean movement from T0 to T2 in the DO and CO groups was 2.8 mm and 2.0 mm, respectively, and the skeletal relapse rate between T1 and T2 was 36% in the DO group and 32% in the CO group.

Conclusion: Sagittal advancement of the maxilla was stable, in contrast to the vertical downward movement, which showed more-extensive relapse in both groups. Despite more-extensive maxillary advancement in the DO group, the rates of skeletal relapse were similar.

Introduction: Dental education blends theoretical and practical training to prepare students for independent patient care. This study examines the confidence levels of dental students at Umeå University, Sweden regarding independent performance of general dentistry tasks, and whether this confidence changes after clinical training.

Material and methodsSurveys were conducted before and after a summer clinical internship, with students rating their comfort levels on a scale from 0 to 10 for various procedures.

Results: Results from 64 initial surveys and 54 follow-up surveys showed no significant difference in confidence before and after the internship except for performing a tooth extraction (p = 0.010). However, confidence levels varied based on whether students had practiced specific tasks during the internship.

Discussion: Students felt least confident in managing acute dental trauma (mean 6.1–6.2) and treating cavities in young children (mean 6.2–6.7), while they were most confident in tasks like obtaining radiographic surveys (mean 8.5–8.6) and debriding periodontally compromised dentition (mean 8.2–8.3). Tooth extraction and dental fillings were the most practiced procedures during the internship.

Conclusions: The study concludes that the internship between the ninth and tenth semesters does not notably boost students’ confidence in specific dental procedures except for dental extractions. This result can possibly be explained due to the short duration of the training. Further exploration, including input from clinical supervisors, is suggested to optimise clinical training in dental education.

Purpose: To retrospectively evaluate long-term outcomes after temporomandibular joint (TMJ) discectomy.

Methods: Included patients (n = 64) had undergone discectomy during 1989-1998 at Umeå University Hospital. A questionnaire was used to evaluate pre- and postoperative symptoms, postoperative complications, general pain, and subjective opinion about the outcome of the surgery.

Results: The results are based on responses from 47 patients (40 women/7 men), including 36 (30 women/6 men) who completed the questionnaire and 11 (10 women/1 man) who were contacted by telephone and answered selected questions. Seventeen patients were excluded because of death, a move abroad, declining to participate, or no available patient information. Among the respondents, 41 (87%) were satisfied with the results, five (11%) were unsatisfied, and one (2%) patient did not answer the question. The results showed a significant long-term improvement in locking, clicking/crepitation, and pain when chewing or opening the jaw (p = 0.001). The prevalence of headaches had decreased significantly at follow-up (p = 0.001). Reported impaired jaw-opening capacity showed no significant improvement (p = 0.08). Of the 47 respondents, 19 (40%) had asked for additional treatment after the discectomy, and six of the 19 patients (13%) had undergone more surgery of the joint.

Conclusion: The results of this retrospective long-term follow-up study indicate that TMJ discectomy has a high success rate, as most patients were satisfied with the postoperative results. Discectomy is thus an effective surgical intervention for patients with disabling TMJ pain and dysfunction when conservative interventions have been unsuccessful.

PURPOSE: In patients who underwent virtual planning and guided flapless implant surgery for teeth missing in the anterior maxilla, we compared buccal bone loss between those treated with and without autogenous bone augmentation.

METHODS: Of 22 patients with teeth missing because of trauma or aplasia, 10 (18 implant sites) were reconstructed with buccally placed bone graft harvested from the mandibular ramus, and 12 were non-reconstructed (16 sites). Baseline cone-beam computed tomography allowed for implant planning using the NobelClinician® software and was performed again at 1 year after functional loading. The marginal bone level was assessed radiographically at post-implant baseline and at follow-up.

RESULTS: At follow-up, buccal bone loss differed significantly between groups at the central level of the implant (p = 0.0005) but not at the coronal level (p = 0.329). The mean marginal bone level change was 0.6 mm, with no significant between-group difference (p = 0.876). The actual implant position often deviated in the vertical or sagittal plane by an average of 0.3-0.6 mm from the planned position.

CONCLUSION: Compared with non-reconstructed patients, reconstructed patients experienced significantly more buccal bone loss at the central level of implants. The groups did not differ at the coronal level or in marginal bone loss, possibly because of the more augmented bone at the central level among reconstructed patients. Differences between planned versus actual implant positions should be considered in situations of limited bone volume at the planned implant site.

Background: Base of tongue cancer incidence and patient survival is increasing why treatment sequelaebecomes exceedingly important. Osteoradionecrosis (ORN) is a late adverse effect of radiotherapyand brachytherapy (BT) could be a risk factor. Brachytherapy is used in three out of six health careregions in Sweden.

Aims: Investigate if patients treated in regions using BT show an increased risk for ORN and whetherbrachytherapy has any impact on overall survival.

Material and Methods: We used data from the Swedish Head and Neck Cancer Register between2008–2014. Due to the nonrandomized nature of the study and possible selection bias we comparedthe risk for ORN in brachy vs non-brachy regions.

Results: Fifty out of 505 patients (9.9%) developed ORN; eight of these were treated in nonbrachyregions (16%), while 42 (84%) were treated in brachy regions. Neither age, sex, TNM-classification/stage, p16, smoking, neck dissection, or chemotherapy differed between ORN and no-ORN patients.The risk for ORN was significantly higher for patients treated in brachy regions compared to nonbrachyregions (HR ¼ 2,63, p¼.012), whereas overall survival did not differ (HR ¼ 0.95, p¼.782).

Conclusions and Significance: Brachytherapy ought to be used cautiously for selected patients orwithin prospective randomized studies.

Background: Retention after orthodontic treatment is still a challenge and more evidence about post-treatment stability and patients’ perceptions of different retention strategies is needed.

Objectives: This trial compares removable vacuum-formed retainers (VFR) with bonded cuspid-to-cuspid retainers (CTC) after 5 years of retention.

Trial design: A single centre two-arm parallel-group randomized controlled trial.

Methods: This trial included 104 adolescent patients, randomized into two groups (computer-generated), using sequentially numbered, opaque, and sealed envelopes. All patients were treated with fixed appliances in both jaws with and without tooth extractions. Patients in the intervention group received a VFR in the mandible (n = 52), and patients in the active comparator group received a CTC (n = 52). Both groups had a VFR in the maxilla. Dental casts at debond (T1), after 6 months (T2), after 18 months (T3), and after 5 years (T4) were digitized and analysed regarding Little’s Irregularity Index (LII), overbite, overjet, arch length, and intercanine and intermolar width. The patients completed questionnaires at T1, T2, T3, and T4.

Results: Post-treatment changes between T1 and T4 in both jaws were overall small. In the maxilla, LII increased significantly (median difference: 0.3 mm), equally in both groups. In the mandible, LII increased significantly in the group VFR/VFR (median difference: 0.6 mm) compared to group VFR/CTC (median difference: 0.1 mm). In both groups, overjet was stable, overbite increased, and arch lengths decreased continuously. Intercanine widths and intermolar width in the mandible remained stable, but intermolar width in the maxilla decreased significantly. No differences were found between groups. Regardless of retention strategy, patients were very satisfied with the treatment outcome and their retention appliances after 5 years.

Limitations: It was not possible to perform blinded assessments of digital models at follow-up.

Conclusions: Post-treatment changes in both jaws were small. Anterior alignment in the mandible was more stable with a bonded CTC retainer compared to a removable VFR after 5 years of retention. Patients were equally satisfied with fixed and removable retention appliances.

Trial registration: ClinicalTrials.gov (NCT03070444).Issue

Section:Randomized Controlled Trial (RCT)

This review describes the role of modern preprosthetic surgery. The atrophic edentulousjaw can cause severe functional impairment for patients, leading to inadequate denture retention,reduced quality of life, and significant health problems. The aim of preprosthetic surgery is to restorefunction and form due to tooth loss arising from congenital deformity, trauma, or ablative surgery.Alveolar bone loss is due to disuse atrophy following tooth loss. The advent of dental implants andtheir ability to preserve bone heralded the modern version of preprosthetic surgery. Their ability tomimic natural teeth has overcome the age-old problem of edentulism and consequent jaw atrophy.Controversies with preprosthetic surgery are discussed: soft tissue versus hard tissue augmentationin the aesthetic zone, bone regeneration versus prosthetic tissue replacement in the anterior maxilla,sinus floor augmentation versus short implants in the posterior maxilla—interpositional bone graftingversus onlay grafts for vertical bone augmentation. Best results for rehabilitation are achieved bythe team approach of surgeons, maxillofacial prosthodontists/general dentists, and importantly,informing patients about the available preprosthetic surgical options.