Head & Face Medicine最新文献

Background: The aim of this study was to compare the accuracy of 3D-printed intermediate wafers (3DW) with conventionally made intermediate wafers (CW) fabricated through manual model surgery (MMS). This study was designed as an in vitro experiment focused on the Le Fort I osteotomy and maxillary repositioning process. It aims to achieve maxillary repositioning outcomes mediated by intermediate wafers while eliminating intraoperative errors.

Materials and methods: Both MMS and virtual model surgery (VMS) were performed for each patient to fabricate CW and 3DW. Subsequently, the maxillomandibular dental casts were remounted on the articulator using the fabricated CW and 3DW, followed by digital scanning and superimposition. The midpoint of the right maxillary central incisor edge, the uppermost points of the right and left maxillary canines, and the mesiobuccal cusps of the right and left maxillary molars were used as measurement points. The points in VMS were set as references for comparison. Paired t-tests were conducted to compare the outcomes between CW and 3DW. Independent t-tests were used to analyze differences between groups with and without rotational movements. Additionally, Spearman's correlation analysis was performed to examine the relationship between the rotational movement of the maxilla and the corresponding coordinate differences.

Results: Significant differences were observed in the transverse (p = 0.005), anteroposterior (p = 0.016), and vertical (p = 0.003) coordinates between the maxillary positions derived from CW and VMS. In MMS, the presence of roll movement significantly influenced transverse position (p = 0.002), pitch affected vertical position (p < 0.001), and yaw impacted transverse (p = 0.005) and vertical (p = 0.019) positions.

Conclusion: 3DW demonstrated greater accuracy than MMS with CW. Especially in cases involving rotational maxillary movements such as roll, yaw, and pitch, it resulted in fewer errors compared to MMS with CW. Consequently, 3DW offers more precise recording of maxillary repositioning plan and contributes to the successful transfer of this plan into the surgical outcome in orthognathic surgery.

Objectives: To compare the effects of mandibular setback surgery on the upper airway and sleep quality using two approaches: the surgery-first approach (SFA) and the conventional orthognathic approach (COA).

Materials and methods: A prospective, comparative clinical study was conducted in 20 patients, with 10 in each group undergoing isolated mandibular setback surgery. Three-dimensional upper airway analysis using cone-beam computed tomography and sleep quality assessments through questionnaires and sleep studies were performed preoperatively (T0), within 1 month postoperatively (T1), and six months postoperatively (T2).

Results: The SFA group demonstrated greater mandibular setback and rotational changes compared to the COA group. Both groups exhibited postoperative reductions in airway volume and minimum cross-sectional area, with no significant intergroup differences. Significant differences in the change in airway length in the upper airway segment (0.9 ± 1.0 mm for SFA vs. -1.2 ± 3.4 mm for COA, P = 0.002) and total airway length (3.3 ± 1.8 mm for SFA vs. -0.1 ± 2.3 mm for COA, P < 0.001) were observed at T2 compared to the preoperative period. Subjective and objective sleep parameters were comparable between the groups. Objective sleep quality initially worsened but improved over time.

Conclusions: Isolated mandibular setback surgery, whether performed using SFA or COA, resulted in comparable changes in upper airway dimensions and sleep quality.

Clinical relevance: The choice between SFA and COA for isolated mandibular setback surgery does not significantly influence surgical decision-making regarding upper airway changes and sleep quality.

Background: Plaster models have been considered the gold standard in traditional orthodontic model analysis. Modern imaging techniques and ever-advancing technologies have expanded the scope of digital diagnostic tools. These innovations allow the use of devices specifically designed for the diagnosis of 3D structures. The aim of this method comparison study was to determine the accuracy and efficiency of digital measurements compared to conventional manual measurements on plaster models.

Materials and methods: The present cohort constitutes the evaluation of pretherapeutic situation models of 247 orthodontically treated patients (129 females and 118 males, average age 16.76 +- 9.49 years) with mixed or permanent dentition who were treated at the University Hospital RWTH Aachen between January 2018 and December 2020. Plaster models were digitised using a model scanner, and an experienced examiner performed various measurements on blinded plaster models using a calliper and on digital models using the specially developed 'Tooth width analysis Aachen' patch in the OnyxCeph3TM-3D software. The intra-rater and inter-rater reliability were determined by a second, blinded assessor. Measurements included tooth width, crown height, arch width, arch length and arch circumference, as well as overjet and overbite. Differences between analogue and digital methods were calculated.

Results: Differences of up to 0.3 mm were observed between manual and partially automated digital measurements for sagittal, transversal and vertical parameters. Teeth with close proximal contact to adjacent teeth and teeth in jaws with a negative space analysis result showed an increased difference between manual and partially automated digital measurements, although this was not clinically relevant. The time required to perform digital measurements was statistically significantly reduced.

Conclusions: Partially automated digital impression analysis offers an accurate, highly efficient and time-saving alternative to traditional manual impression analysis.

Background: This study utilized MRI-based texture analysis to quantify structural alterations in the lateral pterygoid muscle (LPM) among MR images with unilateral anterior disc displacement (uADD) of the temporomandibular joint. Retrospective analysis of anonymized MR images from 232 uADD patients and 123 healthy individuals (January 2022- December 2024), approved by the Ethics Committee of Wenzhou Medical University Affiliated School of Stomatology (Ethics Number: WYKQ 2024008) with waived informed consent due to the use of de-identified retrospective data, was conducted to identify diagnostic markers and possible related pathological changes of disc displacement. According to the inclusion and exclusion criteria four groups of MR images were included in this study: the healthy temporomandibular joints (H-TMJ) of individuals with uADD, joints with anterior disc displacement with reduction (ADDwR), joints with anterior disc displacement without reduction (ADDwoR), and MR images from normal volunteers as the healthy group (HG). Four texture parameters were used for analysis: the angular second moment (ASM), Contrast, inverse difference moment (IDM) and Entropy.

Results: Statistically significant differences (P < 0.05) were found between groups for the ASM, Contrast, IDM, and Entropy variables, indicating their potential as diagnostic markers. Additionally, Entropy values differed significantly between the ADDwoR and ADDwR groups (P < 0.05), highlighting its diagnostic potential in distinguishing these two conditions. The severity of ADD disease showed varying degrees of correlation with specific texture parameters, with significant associations observed for ASM, Contrast, IDM, and Entropy (P < 0.05).

Conclusions: The texture parameters of the LPM exhibit significant changes in MR images with anterior disc displacement(ADD). Notably, the Entropy value of the LPM demonstrates high diagnostic utility in distinguishing ADDwoR from ADDwR, particularly in cases of complex disc displacement involving deformation or remodeling. Furthermore, the severity of ADD disease shows varying degrees of correlation with specific texture parameters. However, further research is required to validate the relationship between numerical texture changes in the LPM and their corresponding pathological alterations.

Clinical trial number: Not applicable.

Objectives: To determine the influence of a consumable auxiliary device, the O-I buckle, on the accuracy of intraoral scanning among complete arches.

Methods: A standard mandibular model with six implants was used as the master model and was scanned by a precise dental laboratory scanner to establish a reference. Three impression techniques were compared: the conventional splinted open-tray impression (CI group), the digital intraoral scanning technique (IOS group), and IOS with the auxiliary device (OI group). For OI group, six prefabricated O-I buckles were attached for each intraoral scan body (ISB) and the definite models were scanned 10 times. The STL datasets were imported into a 3D inspection software to obtain the trueness and precision values for three scanning ranges (BCDE, BCDEF, and ABCDEF). The trueness was the absolute value of the root mean square (RMS) between the reference and test models, while precision referred to the value of the test group subtracted from each other. The data were statistically analyzed using two-way ANOVA and post hoc multiple comparison tests.

Results: The impression method (p <.001) and scanning range (p <.001) significantly influenced the trueness and precision of implant impressions for complete edentulous arches. The IOS with O-I buckle showed higher trueness compared to the IOS group for all implant configurations with most being significantly different (p =.758, = 0.04, and = < 0.001 for BCDE, BCDEF, and ABCDEF, respectively) and significantly higher precision was seen in group ABCDEF (p <.001). For four and five implants (group BCDE and BCDEF), there was no significant difference comparing IOS with O-I buckle and CI (p >.05). As the range expanded, the trueness and precision of IOS and OI decreased (p <.05), whereas the accuracy of CI remained stable.

Conclusions: The auxiliary O-I buckle fixed to the ISBs significantly improved the multiple-implant intraoral scanning accuracy for digital impressions in complete arches; With CI as a reference, the accuracy of IOS with OI buckles were comparable for four and five implants.

Clinical relevance: The digitization accuracy of intraoral scanning for complete edentulous arches can be improved through IOS with OI buckles. This may lead to improved passive fit of the restoration, improving patient outcomes in a convenient and cheap way.

Background: Selecting the correct imaging technique for critical anatomical structures is essential in descriptive studies and for supporting clinical applications. Facial canal dehiscence poses a significant risk for iatrogenic facial nerve injuries during middle ear surgeries. Accurate imaging is critical for surgical planning and minimizing complications. Detection of facial canal openings in the clinic is performed using imaging methods such as high-resolution computed tomography (HRCT). Studies have shown that the sensitivity of this method is approximately 66%. A high-resolution, 3D imaging method was used to measure the sensitivity of HRCT in the most accurate way.

Aims/objectives: This study aimed to compare two radiological methods for measuring facial canal dehiscence. Specifically, we compared cone-beam computed tomography (CBCT) with high-resolution micro-computed tomography (micro-CT).

Materials and methods: Thirty-six temporal bone specimens without external defects were used. The specimens were scanned using both CBCT and micro-CT. The presence of facial canal dehiscence in the tympanic segment of the facial nerve (FN) was evaluated. A paired sample t-test was used for statistical analysis, with significance set at p < 0.05.

Results: Facial canal dehiscence was detected in 10 bones on micro-CT images, while 26 bones appeared intact. In contrast, CBCT images showed dehiscence in 25 bones, with 11 bones intact. Additionally, the mean dehiscence width was 3.469 mm (range: 1.577-8.921 mm) in micro-CT images, compared to 1.279 mm (range: 0.670-9.354 mm) in CBCT images. In the 10 bones where dehiscence was identified by both methods, the average width of the dehiscence measured 5.347 mm (range: 1.840-9.354 mm) in the CBCT images. The difference in measurements between CBCT and micro-CT was statistically significant (p < 0.05).

Conclusions and significance: The low resolution of CBCT was insufficient for visualizing the thin bony tissue lining the facial canal. These findings suggest that the frequency of facial canal dehiscence measured in preoperative CBCT images may be overestimated compared to actual anatomical conditions. These findings provide critical insights for preoperative evaluation and surgical planning in middle ear procedures.

Background: This study explored subjective tinnitus frequency in patients referred to an interdisciplinary orofacial pain clinic using the "web-based interdisciplinary symptom evaluation" (WISE) tool, which included a wide range of psychometric data. Our goal was to analyze the correlation between orofacial complaints and tinnitus, as well as their association with other psychometric data-an approach that, to our knowledge, has not been undertaken to this extent before.

Methods: From 2017 to 2020, we analyzed 1369 anonymized patient records using completed WISE. This included diverse questionnaires and symptom-related screener questions. Positive screening responses triggered additional assessments, such as short Tinnitus Handicap Inventory (THI-12) and Patient Health Questionnaire 4 (PHQ-4). Ear symptoms, tinnitus severity and tinnitus frequency were evaluated. Furthermore, Spearman correlations were performed with other questionnaires addressing pain, anxiety, depression, health, stress and insomnia.

Results: Among 1369 patients with orofacial complaints, 69% were female. Notably, 19.7% (269) completed THI-12 due to severe ear symptoms; of these, 62.1% were female. Female mean THI-12 score was significantly lower (p = 0.007) with 9.3 (SD = 7.0) compared to males 11.6 (SD = 6.8). Additionally, there was a significantly different gender distribution between all patients with tinnitus and those with severe tinnitus (p = 0.032), with an increased proportion of men in the latter group. THI-12 positively correlated with all WISE questionnaires, strongest with PHQ-4 (p < 0.01).

Conclusions: Our study unveils a common co-occurrence of orofacial and ear complaints, particularly tinnitus. The practical implication of the observed gender differences suggests that in male patients presenting with orofacial pain, tinnitus and its associated distress should be actively addressed to initiate a multidisciplinary treatment approach.

Clinical trial number: Not applicable. Since this study was a retrospective analysis of anonymized data, trial registration was not necessary.

Background: This study aimed to evaluate the effects of surgically assisted rapid maxillary expansion (SARME) and rapid maxillary expansion (RME) groups on midpalatal suture (MPS).

Methods: CBCT records who underwent RME and SARME between 2013 and 2024 were included in the study. CBCT axial sections taken preoperatively (T0) and after a 3-month retention period (T1) were evaluated using the MPS. Fractal Analysis (FA) method using the ImageJ program and compared between the groups.

Results: 9 patients underwent SARME (%37.5) and 15 patients underwent RME (%62.5). FA values ​​of the SARME and RME groups at T0 were found to be 1.02 ± 1.17 and 1.46 ± 0.09, respectively. FA values ​​of the SARME and RME groups at T1 were found to be 0.98 ± 1.08 and 1.32 ± 0.08, respectively. The difference between T1 and T0 in the SARME and RME groups was 0.02 ± 0.09 and 0.34 ± 0.08, respectively. When FA differences were compared between the groups, no statistically significant difference was found. (p > 0.05) CONCLUSION: The potential effect of increasing retention time on the clinical recovery process has been clarified. In patients who underwent RME and SARME, after 3 months of retention, MPS density decreased compared to the initial density. The findings suggest that increasing the retention time in both RME and SARME groups for increased ossification. FA provides a useful method for evaluating skeletal effects of RME and SARME.

Background: Low-intensity pulsed ultrasound (LIPUS) and low-level laser therapy (LLLT) are proposed adjunctive therapies to enhance healing after dental implant surgery. However, direct comparisons of their effects on peri-implant marginal bone preservation and soft tissue healing remain limited. This randomized controlled trial aimed to compare the effectiveness of LIPUS and LLLT on peri-implant marginal bone preservation, soft tissue healing, pain levels, and oral health-related quality of life following dental implant placement.

Methods: This single-blind, randomized controlled trial included 63 patients undergoing maxillary or mandibular implant placement, randomly allocated to LIPUS (n = 21), LLLT (n = 21), or control (n = 21) groups. LIPUS was applied twice weekly for 4 weeks, while LLLT was administered in 4 sessions over 2 weeks post-implant. Marginal bone loss (MBL) and OHRQoL (OHIP-14) were assessed at baseline, 6, and 12 weeks. Soft tissue healing (Landry Healing Index) and pain (VAS) were evaluated at baseline, 7-, 14-, 21-, and 30-days post-implant.

Results: LIPUS significantly reduced marginal bone loss at 6 weeks and 3 months post-implant compared to LLLT and control groups (p < 0.05). LLLT demonstrated superior soft tissue healing at 7-, 14-, 21-, and 30-days post-implant (p < 0.05). Both interventions significantly decreased pain intensity and improved OHRQoL at various time points compared to the control group (p < 0.05).

Conclusions: LIPUS and LLLT significantly enhance peri-implant marginal bone preservation, soft tissue healing, pain management, and OHRQoL in dental implant patients compared to standard care. LIPUS was more effective for peri-implant marginal bone preservation, while LLLT excelled in soft tissue healing.

Trial registration: This study was registered at ClinicalTrials.gov (NCT05938868) on July 11, 2023.