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Orthognathic surgery, a standard procedure used to improve intermaxillary relationship, surgically moves either one or both jaws. However, statistics for frequency and indications for orthognathic surgery in Sweden are non-existent. This study examines indications, frequency, and surgical techniques for orthognathic surgery performed in Oral and Maxillofacial Surgery (OMFS) clinics in Sweden. In 2011, a questionnaire survey was sent to all OMFS clinics in Sweden to collect data on gender and age of patients, surgical techniques, indications, frequency of operations, and whether patients underwent one- or two-jaw surgery. Of the 50 OMFS clinics, 47 responded, revealing that 891 patients in 23 clinics were treated with orthognathic surgery, slightly more women than men were treated, and 91% of the patients were 26 years or younger. The results from our survey indicate that functional indication is the most common surgical indication. This is not in line with the literature, which describes the aesthetic component as the most common indication. One explanation could be that the treatment in Sweden is heavily subsidized by federal financial support if certain inclusions criteria are fulfilled. These criteria are mainly based on cephalometric analysis together with dental arch relationship and not on aesthetic components, which are harder to measure. It was also revealed that there was a great discrepancy among the Swedish counties concerning one- vs. two-jaw surgery. A possible reason for this can be differences in surgical experience and custom at each OMFS clinic.

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.

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.

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: Lichen planus (LP) is a chronic inflammatory, immunological, mucocutaneous disease can affect skin, genital and oral mucosa. Oral lichen planus (OLP) is the most common noninfectious, chronic inflammatory oral disease affecting 1-2% of the general adult population. World Health Organization (WHO) classifies OLP as a potentially malignant disorder. Epstein Barr virus or human herpesvirus-4, is a member of the herpes virus family and one of the most ubiquitous viruses known to human, infecting approximately 90% of the world's adult population. The virus often infects B lymphocytes resulting in a wide spectrum of mucocutaneous and systemic diseases, ranging from mild lesions to aggressive malignancies. The aim of this study was to investigate expression of the EBV encoded RNAs EBER1 and EBER2 in oral and genital lichen planus and compare results with normal tissues in situ hybridization which is considered the golden standard for detection of EBER.

MATERIAL AND METHODS: A total of 68 biopsies, 25 oral LP, 26 genital LP, 10 oral controls and finally 7 genital controls were analysed using situ hybridization.

RESULT: All samples had RNA as shown by the control slide, whereas no case contained neither EBER1 nor EBER2.

CONCLUSIONS: Based on results from our study EBV is not involved in aetiology of lichen planus.

This is a case report of a benign osteoblastoma in the temporomandibular joint of a 17-year-old female. The patient had a two-and-a-half-year history of reduced mouth opening accompanied by tenderness and swelling in the left temporomandibular joint (TMJ). Initial treatment included stabilization of occlusion with a splint, jaw exercise and analgesics. At first symptoms decreased, but then increased 18 months later, prompting evaluation by a cone beam computed tomography (CBCT) scan of the joint. The radiographic findings showed a somewhat ill-defined, radiolucent, expansile lesion containing small scattered calcifications. The lesion was removed under general anesthesia and sent for histopathological examination. At 12-month follow-up the patient had normal function in the TMJ without clinical symptoms. CBCT examination showed a small recurrence of 3 millimeter. Another 12 months later CBCT showed a 1 mm increase of the recurrence. Function was normal with a subtle tenderness lateral to the left TMJ. The decision from a multidisciplinary meeting was further annually follow-up. The present case illustrates the importance of radiographic examination of patients with temporomandibular dysfunction when conservative treatment of symptoms does not relieve pain or swelling.

Anatomical factors that narrow the upper airway predisposes for obstructive sleep apnea (OSA). Orthognathic surgery causes changes in the pharyngeal airway anda successful long-term treatment requires an understanding of all variables. This paper aims to describe the pharyngeal anatomy, factors that affects its dimension andconfiguration, discuss imaging of the pharynx with focus on computed tomography as well as normative volumetric data for healthy adults by 3-dimensional (3D)analysis.

The literature search was performed in PubMed with following MeSH terms: "pharynx", “diagnostic imaging", “tomography, x-ray computed”, "imaging, threedimensional"and "adult” together with “upper airway” and “pharyngeal airway”. Articles evaluating the upper airway in relation to a surgical procedure or to specificdisease were excluded. A total of 46 articles were included and analyzed.

As a fibromuscular tube, the size and shape of the pharynx is related to its mechanical intrinsic properties, surrounding anatomical structures and dynamic patientdependent factors, including breathing, gravity and postural changes, as well as technical aspects regarding imaging acquisition, processing and analysis by software.Even though 3D imaging allows cross-sectional and volumetric measurements, the current literature cannot present a consistent normative dimensional referencefor the pharyngeal airway.

Airway size should be considered when planning orthognathic surgery in order to minimize negative side-effects. 3D imaging might provide a range of informationconcerning pharyngeal size and shapes that can be used to analyze what type and extension of surgical movement is necessary to optimize the treatment. A standardprotocol for 3D assessment of the pharyngeal airway is still missing and clinical research with good quality and standardized criteria are needed.

Purpose: The aim of this retrospective study was to evaluate long-term results regarding skeletal stability and Neurosensory Disturbance (NSD) in the Inferior Alveolar Nerve (IAN) after mandibular advancement by distraction osteogenesis using an intraoral device in an adult cohort.

Patients and Methods: Twenty adult patients (13 women and 7 men; mean age 41 years) were included. Mean mandibular advancement was 11.1 mm (range 6 mm to 15 mm); 19 of the 20 patients had a mandibular advancement >7 mm. The skeletal stability was analyzed with cephalometric analysis using lateral cephalograms at predistraction (T0), start of consolidation (T1), and postdistraction after device removal (T2). The basal sagittal relation of the mandible in relation to the cranial base (SNB), the relation between the maxilla and mandible (ANB), and the mandibular jaw angle (GN-tgo-Ar) were analyzed.

Results: Cephalometric analysis indicated significant differences in ANB, SNB, and mandibular jaw angle between T0 and T1. There was also a significant difference in the mandibular jaw angle between T1 and T2. Sensory function in the mental nerve was subjected to evaluation. Forty percent of the operated sides had a partially affected sensory function at the 18-month postdistraction follow-up. Six patients (30%) had complications registered between the osteotomy and removal of the distraction device; two had device-related problems, two had operator-related problems, and two patients had minor problems with infection and local irritation.

Conclusion: Mandibular distraction osteogenesis is a sagittal skeletally stable method for adult patients in situations with larger advancements, with no risk for total loss of sensory function.

Background: Osteopetrosis is a rare hereditary bone disease caused by mutated osteoclasts that are either in scarce abundance or have reduced efficiency. This condition leads to less bone resorption, and thus, denser, more fragile bones. Osteopetrosis leads to complications that can be severe and even fatal.

Aim: To summarize the current knowledge of (a) how Osteopetrosis affects the oral health, dentition, and facial skeleton of patients with different disease subtypes, and (b) which treatmentoptions are used worldwide to treat the different orofacial complications and provide symptomrelief in the oral cavity.

Methods: This review was based on published studies on oral health among patients witho steopetrosis that focused on diagnosis and treatment. Two searches were performed in PubMed, based on seven search terms: Osteopetrosis, oral, jaw, dental, craniofacial, mandible, and maxilla. After screening based on predefined inclusion and exclusion criteria; 30 articles were selected

.Results: All 30 articles were case studies, which have a low grade of evidence. Thus, the data studied were at high risk of bias. The 30 articles included 40 patients. The most common observed complication was osteomyelitis.

Conclusion: The data highlighted the importance of good oral hygiene and tissue-conservative treatment in preventing complications from infection. Osteomyelitis should be treated with acombination of surgery, antibiotics, and hyperbaric oxygen therapy. Follow up should continue throughout life to ensure successful treatment of this chronic disease.

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.

The aims of this study were; i) to determine the accuracy by which two intra-oral radiographic examinations performed on patients with edentulous mandibles treated with dental implants can be matched. ii) to determine whether prosthodontic supra-construction is important for matching. iii) to investigate whether there is a difference between oral and maxilla-facial radiologists (OMR) and dental practitioners, not specialized in oral and maxillofacial radiology (NOMR), regarding their ability to match. The specific features of the radiographs used by the operators to acquire a match were also investigated. Intra-oral radiographic examinations from 59 patients were utilized. Radiographic examinations from 47 patients carried out at placement of the supra-construction and at subsequent follow-up examinations were used as "ante-mortem" and "post-mortem" records respectively. Examinations from 12 patients were added to the "post-mortem" records without "ante-mortem" records being available. The study was divided into two parts. In Part One all "ante"- and "post-mortem" records had the supra-construction masked and in Part Two it was visible. Seven dentists (4 OMR, 3 NOMR) were instructed to specify on what basis each matching was made on the confidence of a three-graded scale OMR had 93.2 % and 98.5 % accuracy in Parts One and Two respectively. NOMR had 63.8 % and 87.9 %. Bone anatomy was the most commonly used feature by OMR to obtain a match. For NOMR it was the appearance of the fixtures. OMR reported higher confidence in their ability to match the examinations. This study indicates that OMR could be a valuable resource in cases of identification where dental implants are a feature of the post-mortem dental records.

Background: Osteopetrosis comprises a group of inherited disorders that are rare and result in abnormal bone structure. Bone remodeling is extremely inhibited because osteoclasts are nonfunctional or lacking. This condition causes overgrowth of bone with disappearance of the bone marrow, leading to aplastic anemia; obstruction of nerve passages in the skull leads to blindness and often hearing impairment. In most cases, osteopetrosis results in oral complications such as tooth deformation, hypomineralization, and delayed or absent tooth eruption. The only curative treatment is hematopoietic stem cell transplantation (HSCT). The main treatment of the oral complications during childhood and adolescence consists in protecting the erupted teeth against caries disease through prophylactic treatment aimed at optimal oral hygiene through frequent regular dental visits throughout life. Many patients with osteopetrosis require major oral rehabilitation to treat complications of the disease. Improved results of HSCT increase the likelihood that dental professionals will encounter patients with osteopetrosis.

Case presentation: In this case report, we show that individuals with osteopetrosis who have severe oral complications can be treated successfully if they are treated for osteopetrosis at an early age. The boy had his dental care in pedodontics, and regular multidisciplinary meetings were held for future treatment planning. At the age of 15, he was then referred for rehabilitation. The initial evaluations revealed no further growth in the alveolar bone. The rehabilitation was done stepwise, with extraction of malformed and malpositioned teeth. Initially, the patient received a removable partial denture followed by reconstruction of the width of the alveolar process, titanium implants, temporary fixed bridges, and finally screw-retained titanium-ceramic bridges with titanium frames for the upper and lower jaws.

Conclusions: The three-year follow-up after loading indicated a stable marginal bone level and optimal oral hygiene as a result of frequent professional oral hygiene care. The patient showed no signs of symptoms from the temporomandibular joint and has adapted to the new jaw relation without any functional or phonetical issues.

BACKGROUND: Innate lymphoid cells (ILCs) are the most recently identified leukocytes of the immune system and these cells are increasingly acknowledged to play important roles in host defence and tissue repair. ILCs are also contributors of inflammatory diseases such as asthma and colitis. We analyzed the presence and relative proportions of the different ILC subsets (ILC1, ILC2 and ILC3) in gingivitis and periodontitis. Further, we investigated if ILCs express receptor activator of nuclear factor kappa-B ligand (RANKL), a cytokine crucial for osteoclast differentiation and bone resorption.

METHODS: We collected gingivitis and periodontitis soft tissue and characterized ILC subsets including RANKL expression in single-cell suspensions using flow cytometry.

RESULTS: ILCs were detected both in gingivitis and periodontitis. The majority of ILCs, in both conditions, were ILC1s. Furthermore, RANKL expression was detected on a fraction of the ILC1s.

CONCLUSIONS: Our discovery of the presence of ILCs both in gingivitis and periodontitis and concomitant expression of RANKL on a fraction of the ILC1 population suggest that these cells may be of importance in periodontal disease. In addition, our findings provide a new insight into the field of oral immunology.

AIM: Innate lymphoid cells (ILCs) are the most recently identified leukocytes of the immune system and these cells are increasingly acknowledged to play important roles in host defence and tissue repair. ILCs can also contribute to inflammatory diseases such as asthma and colitis. We analysed the presence and proportions of the different ILC subsets (ILC1, ILC2 and ILC3) in gingivitis and periodontitis. Furthermore, we investigated if ILCs express nuclear factor kappa-B ligand (RANKL), a cytokine crucial for osteoclast differentiation and bone resorption.

MATERIALS AND METHODS: We collected gingivitis and periodontitis soft tissue and characterised ILC subsets including RANKL expression in single cell suspensions using flow cytometry.

RESULTS: Although not statistically significant, the total number of ILCs detected was twice as many in periodontitis compared to gingivitis. The majority of ILCs, in both conditions, were ILC1s with a 2.5-fold increase of ILC1s in periodontitis compared to gingivitis. Furthermore, we found RANKL expression exclusively expressed on ILC1s.

CONCLUSIONS: Our discovery of the presence of ILCs in gingivitis and periodontitis and concomitant expression of RANKL in ILC1 suggest that these cells may be of importance in periodontal disease. In addition, our findings provide new insights into the field of oral immunology. 

Background. Complications of orthognathic surgery are quite rare, but they cause suffering in affected individuals.The range of complications is broad and includes both hard and soft tissue.

Case presentation: We here present a case of a fully healthy woman without signs of impaired healing capacity. Thepatient underwent bimaxillary orthognathic surgery and experienced multiple complications both peri- and postoperatively.During the post operative period, the patient also suffered from soft tissue complications after an orthopaedicinjury. Therefore, we referred the patient to her general practitioner for further medical investigation. Wealso present the result after restorative surgery and endodontic and prosthodontic treatment resulting in a successfulrehabilitation.

Conclusion: This case report clearly shows the need for a good collaboration between different odontologicaland medical fields to achieve a good and predictable result. In situations where normal healing processesdo not occur, in-depth analysis must be carried out.

Highlights: Orthognathic surgery affects soft and hard tissue which can result in adverse healing and complications.It is of great importance to follow up performed surgery to see late complications. Be restrictive with earlyre-operations when there are signs of necrosis. Always use a multidisciplinary approach when handling complicationsafter surgery.

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)

BACKGROUND: Evidence concerning the most appropriate retention strategy after orthodontic treatment is still inconclusive.

OBJECTIVE: This trial compares the retentive capacity of vacuum-formed Essix C-retainers (VFR) and bonded cuspid-to-cuspid retainers (CTC) in the mandible 6 and 18 months after orthodontic treatment.

TRIAL DESIGN: A single-centre two-arm parallel-group randomized controlled trial.

METHODS: This study included 104 adolescent patients, computer-generated randomized with sequentially numbered, opaque, and sealed envelopes into two groups and stratified by gender (52 females and 52 males). The patients were treated with fixed appliances with and without tooth extractions in both jaws and were ready for debond. In the intervention arm, patients received a VFR (n = 52); in the active comparator arm, patients received a CTC (n = 52). Dental casts were obtained at debond (T1), after 6 months (T2), and after 18 months (T3). The casts were digitized. The retentive capacity was evaluated on digital three-dimensional models using Little's Irregularity Index (LII), overbite, overjet, arch length, and intermolar and intercanine width.

RESULTS: Baseline values were similar for both groups. Statistically significant increases were noted in LII and overbite, mainly between T1 and T2, but also between T1 and T3 in the VFR group (LII = 0.52 mm, P < 0.001, overbite = 0.51 mm, P < 0.001) and in the CTC group (LII = 0.45 mm P < 0.001, overbite = 0.36 mm, P < 0.001). There were no significant differences between groups. Overjet showed small variations during the observation periods but was overall stable within and between groups after 18 months. Arch length decreased slightly in both groups after 6 and 18 months. Intermolar and intercanine widths remained stable after debond.

LIMITATIONS: Patients, operator, and outcome assessor could not be blinded due to the study design.

CONCLUSIONS: VFR and CTC have the same retention capacity in the mandible after 6 and 18 months. Relapse mainly occurs during the first 6 months of retention, but the post-treatment changes are generally small. Shorter VFRs in the mandible do not cause negative vertical effects. Part-time wear regimen is not associated with increased relapse.

TRIAL REGISTRATION: NCT03070444.

OBJECTIVE: To compare removable vacuum-formed Essix C retainers with bonded cuspid-to-cuspid retainers (CTCs) regarding patients' perceptions after debonding and 6 and 18 months of retention.

TRIAL DESIGN: A single-centre two-arm parallel-group randomized controlled trial.

METHODS: This trial included 104 adolescent patients, computer-generated randomized, with sequentially numbered, opaque and sealed envelopes, into two groups and stratified by gender. They were treated with fixed appliances with and without tooth extractions in both jaws and were ready for debond. Patients in the intervention arm received a vacuum-formed retainer (VFR) in the mandible (n = 52), and patients in the active comparator arm received a CTC (n = 52). Both groups had a VFR in the maxilla. Treatment outcome satisfaction, quality of care and attention, side-effects during the retention phase, and retainer acceptance and compliance were assessed with questionnaires at baseline (T1, 2 weeks after debond) and after 6 (T2) and 18 months (T3) of retention. Operator was blinded to group assignment during measurements.

RESULTS: Ninety-five patients completed the questionnaires at all three time points. Patients were overall satisfied with treatment outcome, quality of care and attention, and how their retainers worked at all three time points, with no differences between groups. At T1 and T3, the VFR group reported significantly more pain and discomfort (T1: P = 0.005, T3: P < 0.0001) and soreness (T1: P = 0.001, T3: P = 0.011) in the mandible compared to the CTC group. The CTC group found it easier to get used to their retainers. After 18 months, 70.5 per cent in the VFR group and 73.9 per cent in the CTC group reported the recommended wear-time of the VFRs. Decreased wear-time was correlated to perceived pain and discomfort (rs = -0.421, P < 0.0001).

LIMITATIONS: The results were limited by our retainer design and recommended wear regimen.

CONCLUSIONS: Both groups reported high treatment outcome satisfaction and low levels of side-effects during the retention phase. Nevertheless, the VFR group reported more pain and discomfort at T1 and at T3. Self-reported compliance was the same in both groups. The VFR group was more concerned about relapse.

TRIAL REGISTRATION: NCT03070444 (https://clinicaltrials.gov).

The aim of this study was to determine if edentulous persons could be identified using panoramic images by: I) investigating the possibility of matching two panoramic radiographs of the same person obtained on two different occasions, II) determining what anatomical features are used as the base for matching, III) investigating if oral and maxillofacial radiologists (OMR) and dentists who were not oral and maxillofacial radiologists (NOMR) differed in their ability to match the images, and IV) determining if the time elapsed between the images affected the results or the confidence of the match. Panoramic image pairs from 19 patients obtained on two different occasions were included, plus 10 images from other edentulous patients. The time elapsed between the image pairs varied between 4 months and 6 years. Four OMR and four NOMR were asked to match the image pairs depicting the same patient. The participants marked each match as “certain”, “likely”, or “possible” and what anatomical structure they used for matching. The OMR group correctly matched 100% of the images and the NOMR group correctly matched 96%. The anatomy of the mandible was most often used for matching. The OMR group was more certain in their decisions than the NOMR group. The time elapsed between the examinations did not affect the result. In conclusion, panoramic images can be used to identify edentulous patients. Both OMR and NOMR could identify edentulous individuals when only panoramic radiographic images were available and the OMR were especially confident in the identification process.

The aim of this study was to determine if edentulous persons could be identified using panoramic images by: I) investigating the possibility of matching two panoramic radiographs of the same person obtained on two different occasions, II) determining what anatomical features are used as the base for matching, III) investigating if oral and maxillofacial radiologists (OMR) and dentists who were not oral and maxillofacial radiologists (NOMR) differed in their ability to match the images, and IV) determining if the time elapsed between the images affected the results or the confidence of the match. Panoramic image pairs from 19 patients obtained on two different occasions were included, plus 10 images from other edentulous patients. The time elapsed between the image pairs varied between 4 months and 6 years. Four OMR and four NOMR were asked to match the image pairs depicting the same patient. The participants marked each match as "certain", "likely", or "possible" and what anatomical structure they used for matching. The OMR group correctly matched 100% of the images and the NOMR group correctly matched 96%. The anatomy of the mandible was most often used for matching. The OMR group was more certain in their decisions than the NOMR group. The time elapsed between the examinations did not affect the result. In conclusion, panoramic images can be used to identify edentulous patients. Both OMR and NOMR could identify edentulous individuals when only panoramic radiographic images were available and the OMR were especially confident in the identification process.

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.

Objective: To evaluate the outcome of secondary alveolar bone grafting (SABG) in patients with cleft lip and palate at 16 years of age and to identify predictors associated with surgical failure.

Study Design: This retrospective follow-up included 91 patients with 100 cleft palates treated with SABG at a mean age of 9.2 years. The possible predictors for surgical failure analyzed were sex, dental development stadium, type of cleft, side, tooth erupting into the graft, cortical boundary, presence of a lateral incisor, extraction, preoperative expansion, oral hygiene, retention device, and age. The outcome variable for surgical success was Bergland score I and II. Surgical outcome was analyzed at 16 years of age based on intraoral radiographs, according to the Bergland index. Statistical analyses included estimation of odds ratios for predictor variables.

Results: The post-SABG success rate was 91% (Bergland score I and II) with a mean follow-up of 7.2 years. Surgical failure was significantly associated with poor oral hygiene.

Conclusions: This study revealed a high success rate (91%) at a mean of 7.2 years post-SABG. Poor oral hygiene significantly increased the risk of surgical failure. This suggests that increased perioperative measures to maintain good oral health could reduce surgical failure.

The aim of the present study was to histologically analyse the bone graft-titanium implant interface after six and twelve months of healing for a simultaneous approach and after six months for a delayed approach. For this purpose, screw-shaped c.p. titanium microimplants, 2 mm in diameter and 5 mm long, were placed and retrieved at different time intervals in ten consecutive patients with severely resorbed maxillae and treated with iliac cortico-cancellous bone grafts and titanium implants in a two-stage procedure. The histomorphometrical analyses of ground sections of the specimens showed a higher degree of bone-implant contact and more bone filling the implant threads in the delayed approach microimplants. This was probably due to the partly revascularized grafted bone in the delayed approach being able to respond to the surgical trauma, resulting in interfacial bone formation. It is concluded that the results from the present study favour the use of a delayed approach when using free autogenous bone grafts and titanium implants for reconstruction of the severely atrophied maxilla.

Objective: To retrospectively analyze the outcome of patients operated with discectomy and to compare the short-term results to results in the available literature.

Materials and method: Patients who underwent discectomy at the Department of Oral and Maxillofacial Surgery, Umeå University hospital in Sweden, between 1988 and 1998 were included (n=64). Mean age: 37 years. 55 were women and 9 were men. 48 patients underwent unilateral surgery and 16 patients underwent bilateralsurgery (14 women/2 men), totally 80 individual discectomies.

Results: Six months after the surgery, 70 % of the patients reported no pain from the Temporomandibular Joint (TMJ) area, compared to 10 % pre-surgery (P-value <0.001). Mean opening increased from 36,7 mm before surgery to 41,8 mm aftersurgery (P-value = 0.001). TMJ crepitation was found in 36 % of the joints beforesurgery respectively 34 % of the joints six months after surgery (P-value = 0.125). TMJ clicking was found in 43 % joints before surgery and in 6 % after surgery (Pvalue< 0.001). Locking occurred in 59 % of the TMJ prior to surgery and in 11 %after surgery (P-value < 0.001).

Conclusion: Surgical removal of the disc in the temporomandibular joint reduces painand increases mouth opening. The result from our study is consistent with other studies and recognizes discectomy as an effective treatment of persistent pain and/or limitation of mouth opening.

Giant cell lesions of the maxillofacial region constitute a diverse group of lesions, which frequently affect the lower jaw, and are commonly detected at younger ages, in the second and third decades of life. They can be categorized as aggressive or non-aggressive lesions, mainly based on clinical behavior. Management is most commonly through surgical intervention. However, many patients consider surgery to be unfavorable due to the sacrifice of surrounding anatomic structures, potentially necessitating reconstruction procedures. Therefore, alternative modalities of conservative therapy have emerged. One method of alternative management is intralesional corticosteroid injections, which have been described with promising results. Here we report our experience with the treatment of a 56-year-old female patient, in whom a non-aggressive giant cell lesion was managed using intralesional steroid injections. This treatment resulted in total regression according to radiographic examinations.

CEOT is a rare benign, but locally aggressive odontogenic tumor, and some authors have claimed that the biologic behavior of the clear cell variant is even more aggressive, with greater propensity to recur. We report a rare case of clear cell calcifying epithelial odontogenic tumor (CEOT) and discuss its possibly aggressive behavior. A 40-year-old woman experienced an asymptomatic expansion of the left posterior mandible. After radiographic examination and biopsy, a block resection was performed. Histologic examination included analysis of Ki-67 reactivity as a marker of tumor growth activity. Ki-67 labeling was pronounced in the non-clear cell population in the tumor periphery but low in the central and clear cell portions. Clinical and radiographic follow-up 6 years after resection has not revealed any signs of recurrence. On the basis of a review of the literature and our own findings, there is no clear data to suggest that clear cell CEOT exhibits more aggressive behavior compared with conventional CEOT.

Local anaesthesia is taught early in the practical part of dental programs. However, dental students express uncertainty and concern before their practical training in local anaesthesia. The aim of this study was to evaluate how extra educational elements in the teaching of local anaesthesia affect students’ confidence using local anaesthesia. The students were divided into three groups (A, B and C). Group A received the same education that was used the previous year (i.e., four hours of theoretical lectures followed by four hours of practical exercises performed on a fellow student). Group B did their practical training on fellow students in groups of three, with each student taking turns performing, receiving and observing the procedure. Group C received training using an anatomically correct model before their practical training on a fellow student. After each training step, the students completed a questionnaire about their confidence administering local anaesthesia. The students experienced a significant increase in confidence after each educational step. Combining theory and practical instruction, including the use of anatomically correct models and peer instruction, improved students’ confidence in administering local anaesthesia. The greatest increase in confidence was in the students placed in groups of three where each student performed, received and observed the procedure.

Local anaesthesia is taught early in the practical part of dental programs. However, dentalstudents express uncertainty and concern before their practical training in local anaesthesia. The aimof this study was to evaluate how extra educational elements in the teaching of local anaesthesiaaffect students’ confidence using local anaesthesia. The students were divided into three groups (A,B and C). Group A received the same education that was used the previous year (i.e., four hoursof theoretical lectures followed by four hours of practical exercises performed on a fellow student).Group B did their practical training on fellow students in groups of three, with each student takingturns performing, receiving and observing the procedure. Group C received training using ananatomically correct model before their practical training on a fellow student. After each trainingstep, the students completed a questionnaire about their confidence administering local anaesthesia.The students experienced a significant increase in confidence after each educational step. Combiningtheory and practical instruction, including the use of anatomically correct models and peer instruction,improved students’ confidence in administering local anaesthesia. The greatest increase in confidencewas in the students placed in groups of three where each student performed, received and observedthe procedure.

Background: The treatment of head and neck cancer is an intensive multimodal treatment that has a great impact on the individual patient.

Aims/Objectives: This study aimed to evaluate acute and long-term complications associated with mandibular resections and reconstructions.

Material and Methods: We retrospectively retrieved data on complications and recurrences among patients that underwent mandibular resections and reconstructions for treating oral cavity cancer (n = 190 patients) and osteoradionecrosis (ORN, n = 72). Reconstructions included composite grafts (n = 177), soft tissue flaps (n = 61), or primary closure without any graft (n = 24).

Results: Forty-two patients that underwent reconstructions with composite grafts displayed serious complications (Clavien–Dindo ≥ IIIa). The complication rates were similar between patients treated for oral cavity cancer and patients treated for ORN. Patients that underwent a primary closure without any graft, had a significantly lower risk of complications compared to patients that underwent the other treatments. After hospitalization, 181 patients (69%) had at least one complication.

Conclusions: A majority of patients undergoing resection and reconstruction due to oral cancer/ORN suffered from postoperative complications regardless of indication, comorbidity status or reconstruction technique. The risk of Clavien–Dindo grade IIIa–V events was significantly lower for patients treated with primary closure without grafts. 

Significance: The results from this study clarifies the importance of in-depth analyse prior to decision of treatment for patients with head and neck cancer.

Purpose: Cleft lip and palate (CLP) patients often require orthognathic surgical correction due to maxillary hypoplasia secondary to primary surgeries, through either distraction osteogenesis (DO) or conventional orthognathic surgery (CO). The objective was to evaluate both surgical techniques regarding functional, aesthetics and quality-of-life and stability outcomes for the patient.

Materials and Method: The PubMed database was searched with the inclusion criteria: studies in English detailing maxillary orthognathic surgery on non-syndromic patients with CLP. Clinical trials, systematic reviews, meta-analysis, reviews, randomized control trials were included. Studies with less than five patients and studies reporting bimaxillary surgery were excluded. References lists of these studies were consulted for more studies to be included. Studies were then evaluated for relevance, quality checked for risk of bias and divided based on the results studied. In total, 22 studies published between 1997 and 2017 were included.

Results: Most studies had low levels of bias. The evidence to support one surgical technique before the other was low. DO offered better stability. No clear evidence exists on which technique had the best aesthetic results and functional improvement. DO may cause higher levels of anxiety and distress in patients compared to CO.

Conclusion: Regarding all outcomes studied, the scrutinized literature did not allow for the recommendation of one specific technique. Future multicentre collaboration may enable greater sample size and better statistical comparison of results of both techniques.

BACKGROUND: National quality registries (NQRs) provide open data for user-directed acquisition. National Quality Registry (NQR) data are often used to analyze the rates of treatment success and adverse events for studies that aim to improve treatment quality and patient satisfaction. Thus, NQRs promote the goal of achieving evidence-based therapies. However, the scientific literature seldom focuses on the complex process of initiating, designing, and implementing an NQR. Starting an NQR may be particularly challenging in a setting where specialized care is decentralized, such as orthognathic surgery in Sweden. The present study describes the initiation and early phases of a new NQR for orthognathic surgery in Sweden.

METHODS: The initial inventory phase included gaining knowledge on regulations, creating economic plans, and identifying pitfalls in existing NQRs. Next, a crude framework for the registry was achieved. Outcome measures were selected with a nation-wide questionnaire, followed by a Delphi-like process for selecting parameters to include in the NQR. Our inclusive process comprised a stepwise introduction, feedback-based modifications, and preparatory educational efforts. Descriptive data were collected, based on the first 2 years (2018-2019) of registry operation.

RESULTS: Two years after implementation, 862 patients that underwent 1320 procedures were registered. This number corresponded to a 91% coverage rate. Bimaxillary treatments predominated, and the most common were a Le Fort I osteotomy combined with a bilateral sagittal split osteotomy (n = 275). Reoperations were conducted in 32 patients (3.6%), and the rate of patient satisfaction was 95%.

CONCLUSIONS: A National Quality Registry should preferentially be started and maintained by an appointed task force of active clinicians. A collaborative, transparent, inclusive process may be an important factor for achieving credibility and high coverage, particularly in a decentralized setting.

The aim of this prospective study was to compare implants placed in grafted and normal non-grafted maxilla by means of resonance frequency analysis (RFA), clinical stability and implant failure. Twenty-nine patients with severe atrophy of the edentulous maxilla were treated with autogenous bone grafts as onlay (24 patients) or as interpositional grafts in conjunction with a Le Fort I osteotomy (five patients) 6 months prior to placement of 222 implants. Ten non-grafted patients treated with 75 Brånemark implants in the edentulous maxillae served as a control group. RFA was performed at implant placement, abutment connection and after 6 months of bridge loading. Seventeen (8%) implants were lost in the grafted bone and one (1%) in normal bone. RFA revealed a similar pattern in both grafted and normal maxillae, i.e. increasing resonance frequency (RF) with time (Wilcoxon Signed Rank test for paired data). Twenty implants that were rotation mobile (low primary stability) at the time of insertion showed a significantly lower value at implant placement according to RFA (Mann-Whitney U-test, P = 0.020). The RF for the failed implants revealed a tendency towards lower values (Mann-Whitney U-test, P = 0.072), compared to the successful implants. It is concluded that implants placed in grafted bone when using a two-stage technique achieve a stability similar to that of implants placed in normal non-grafted bone.

PURPOSE: To analyze the bone graft-implant interface of titanium microimplants (MIs) placed at the time of bone grafting or after a healing period of 6 months and retrieved after another 6 to 14 months of healing. Integration of MIs placed in interpositional bone grafts (IBGs) in conjunction with a Le Fort I osteotomy was compared with the integration of those placed in onlay/inlay bone grafts (OBGs). MATERIALS AND METHODS: The severely atrophied edentulous maxillae of 23 patients (14 women, 9 men) were restored with autogenous bone grafts (either IBG [n=8] or OBG [n=15]) and titanium implants. Six-month periods were allowed between grafting, implant placement, and abutment connection. The bone-implant interface was studied histologically with the use of unloaded titanium MIs. RESULTS: Sixty-eight MIs were either (1) placed simultaneously with grafting and retrieved after 6, 12, or 14 months or (2) placed after 6 months of healing and retrieved after another 6 to 8 months. Histomorphometry indicated equal degrees of osseointegration for the 2 intraoral reconstruction techniques when looking at bone-implant contact, bone area in threads, and newly formed bone (NFB) (Student t test for unpaired observations). There was a significant difference between simultaneous and delayed implant placement with respect to BIC and NFB (Student t test for paired observations). Three additional MIs placed in the nongrafted residual alveolar ridge and retrieved after 6 months showed significantly more bone in threads and NFB (Student t test for paired observations; P = .003 and P = .009, respectively) compared to MIs placed at graft placement (6 months' healing). DISCUSSION: Timing of implant placement appeared more important than healing time or surgical technique. The delayed approach resulted in better implant integration, probably because of the initial revascularization of the graft. CONCLUSIONS: Implant integration was similar in the IBG and OBG groups. Placement of MIs after an initial healing period of 6 months resulted in better integration than placement simultaneously with grafting.

Purpose: Evaluate correlations between volume change for iliac crest bone grafts in maxillary reconstruction (graft volume change [GVC]) and bone mineral density (BMD), bone volume fraction (BVF), hematologic bone metabolic factors (I), and identify indicators of implant failure (II).

Material and Methods: Forty-six consecutive patients had their edentulous atrophic maxilla reconstructed with free autogenous bone grafts from anterior iliac crest. Endosteal implants were placed 6 months after graft healing. Computer tomography was performed after 3 weeks and 6 months after grafting. Bone biopsies were taken from the internal table of donor site for calculation (BVF), and blood samples were collected. Implant stability was measured at placement with resonance frequency analysis and expressed as implant stability quotient (ISQ). Implant failure was registered.

Results: GVC in onlay bone graft was 37%. The BVF in iliac crest biopsies was 32%. Serum-IGFBP3 differed with 79% of the samples over normal range. Fifteen patients had one or more implant failures prior to loading (early failures). Forty-two patients were followed for a minimum of 3 years after implant loading and, in addition, 6/42 patients had one or more implants removed during the follow-up (late failures). GVC correlated to decreased BMD of lumbar vertebrae L2-L4 (Kruskal-Wallis test, p=.017). No correlation was found between GVC and hematologic factors (Pearson correlation test) or between GVC and BVF (Kruskal-Wallis test). No correlation was found between ISQ and GVC (Pearson correlation test, p=.865). The association between implant failures and the described factors were evaluated, and no significant correlations were found (unconditional logistic regression).

Conclusion: Onlay bone grafts decrease 37% during initial healing period, which correlate to BMD of lumbar vertebrae L2-L4. No other evaluated parameters could explain GVC. The evaluated factors could not explain implant failure.

PURPOSE: The purpose of this study was to perform a longitudinal follow-up study of implant stability in grafted maxillae with the aid of clinical, radiological, and resonance frequency analysis (RFA) parameters. MATERIALS AND METHODS: The atrophic edentulous maxillae in 29 patients were reconstructed with free iliac crest grafts using onlay/inlay or interpositional grafting techniques. The endpoint of the resorption pattern in the maxilla determined the grafting technique used. Endosteal implants were placed after 6 months of bone-graft healing. Implant stability was measured four times using RFA: when the implants were placed, after 6 to 8 months of healing, after 6 months and 3 years of bridge loading. Individual checkups were performed at the two later RFA registrations after removal of the supraconstructions (Procera Implant Bridge, Nobel Biocare AB, Goteborg, Sweden). Radiological follow up of marginal bone level was performed annually. RESULTS: Twenty-five patients remained for the follow-up period. A total of 192 implants were placed and with a survival rate of 90% at the 3-year follow up. Women and an implant position with a class 6 resorption prior to reconstruction were factors with significant increased risk for implant failure (multivariate logistic regression). Twelve of the 20 failed implants were lost before loading (early failures). The change in the marginal bone level was 0.3 +/- 0.3 mm between baseline (bridge delivery) and the 3-year follow up. The implant stability quotient (ISQ) value for all implants differed significantly between abutment connection (60.2 +/- 7.3) and after 6 months of bridge loading (62.5 +/- 5.5) (Wilcoxon signed ranks test for paired data, p=.05) but were nonsignificant between 6 months of bridge loading and 3 years of bridge loading (61.8 +/- 5.5). There was a significant difference between successful and failed implants when the ISQ values were compared for individual implants at placement (Mann-Whitney U test, p=.004). All 25 patients were provided with fixed implant bridges at the time of the 3-year follow up. CONCLUSION: This clinical follow up using radiological examinations and RFA measurements indicates a predictable and stable long-term result for patients with atrophic edentulous maxillae reconstructed with autogenous bone and with delayed placement of endosteal implants. The ISQ value at the time of placement can probably serve as an indicator of level of risk for implant failure.

Objective: To identify current knowledge of changes in quality of life including Oral Health-Related Quality of Life (OHRQoL) for patients undergoing orthognathic surgery based on validated questionnaires.

Material and Methods: Two databases (PubMed, Cochrane Library), were searched and full-textarticles concerning patients with dentofacial deformities undergoing orthodontics and orthognathic surgery were included. Inclusion criteria: articles published in English in referee reviewed journals between January 2003 and December 2017, self-assessed quality of life using validated questionnaires. Exclusion criteria: Articles reporting quality of life of patients with syndromes such as cleft lip palateor severe illness, review articles.

Results: Sixteen longitudinal or cross-sectional articles were included, all considered of moderate quality. Oral Health Impact Profile and Orthognathic Quality of Life were the most commonly used questionnaires. Included studies reported a lower OHRQoL for patients with dentofacial deformities compared to patients with normal dentofacial features. There was a tendency towardsmore positive OHRQoL for patients with dentofacial deformities after orthognathic surgery. This positive effect seems to be evident 6 months after surgery, with further improvements at completionof treatment. Changes in general health related quality of life, predominately measured by the 36-item Short-Form Health Survey, were not coherently evident nor was sex differences.

Conclusion: Patients with dentofacial deformities improved moderately after orthognathic surgery, while generic health related quality of life was unchanged.

Objective: To describe the etiology of hypoglossia, the consequences for oral function and our experience from treating a young boy with severe mandibular transversal discrepancy.

Materials and Methods: We present a 15 year old boy with hypoglossia and severe mandibular transversal discrepancy, treated with mandibular midline distraction and orthodontic treatment.

Results: Total treatment time is six years and the result shows improvement of dental occlusion relationship as well as enlargement of the tongue resulting in an improved occlusal function.

Conclusion: From this case report it is suggested that a multidisciplinary approach of several different specialists as pediatric, orthodontists, speech therapists, maxillofacial surgeons and radiologists are should be involved in examination and treatment planning for this rare diagnosis in order to improve the patient's quality of life. Early surgical interventions is positive for occlusal function.

Osteopathia striata combined with cranial sclerosis (OSCS) is a skeletal dysplasia, characterized by linear striation in the long bones and cranial osteosclerosis. OSCS leads to various abnormalities in the cranial and facial bones and disfigurements, including dental arch discrepancies. Here, we present a case of OSCS where dental arch discrepancies were corrected with bimaxillary orthognathic surgery. Boney sclerosis leads to an increase in bone density that can cause complications during and after surgery. Therefore, it is important to evaluate these patients thoroughly with cone beam computed tomography before performing surgery. Analyze of previous surgical procedures as well as adaptation of the surgical technique to the hard brittle bone must take place.

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.

Purpose: It is important to predict and prevent the impaction of canines. The aim of this study was to estimate the prevalence of impacted canines in patients with unilateral cleft lip and palate (UCLP) and to identify factors associated with impaction. Materials and Methods: This retrospective cohort study included patients with nonsyndromic UCLP. The predictors were pre-eruptive inclination angle, deviation in tooth number (agenesis or supernumerary lateral incisors), and reoperation of bone transplant. The outcome variable was impacted and surgically exposed canines. Results: The prevalence of impacted and surgically exposed canines in the 68 consecutive patients with UCLP was 20.6%. The pre-eruptive inclination angle was significantly larger (34.4 degrees) for the impacted canines on the cleft side compared with the spontaneously erupted canines on the cleft and non-cleft sides (25.5 degrees vs 15.4; P < .05). Reoperation of the bone transplant significantly increased canine impaction (50%; P < .05). Conclusion: The eruption of maxillary canines needs to be supervised carefully in patients with UCLP, because the prevalence of impaction is 10 times higher compared with the general population. Factors associated with canine impaction are a pre-eruptive inclination larger than 30 degrees and reoperation of the bone transplant.

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.