Analysis of the Effectiveness of 3D Printed Patient-Specific Implants for Reconstruction of Maxillary Defect Secondary to Mucormycosis

Introduction

Patients affected with mucormycosis of maxilla have been increasing following Covid-19 infections. We followed the reconstruction of the maxilla using 3D manufactured patient-specific implants. The additive manufacturing technology is capable of fabricating custom-made titanium implants precisely for oral and maxillofacial reconstructions.

Aim

To analyse the effectiveness of 3D manufactured patient-specific implants in the reconstruction of maxilla affected by mucormycosis secondary to Covid-19. Methodology: This study was conducted among 20 patients receiving patient-specific implants for surgical and prosthetic reconstruction of the maxilla. The parameters analysed at baseline, 3 months, 6 months, and 12 months were pain, implant exposure, infection, wound dehiscence, fit of implant, postoperative surgical rating scale, and patient experience evaluation rating scale.

Results

Inferential Statistics revealed a positive correlation.

Conclusion

From the present data, it can be concluded that within the limitations of the study, patient-specific implant systems are an effective treatment strategy for the reconstruction of the maxilla affected by mucormycosis secondary to Covid-19. More studies with larger sample size and longer follow-up periods are required to substantiate the results from the present study.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12663-023-01922-7.

3D-Printed Ergonomically Designed Feeding Aid for Patients With Limited Manual Dexterity

Self-eating is a difficult task when hand and finger movements are restricted. Many patients find difficulty in holding utensils because of slender handles. It is essential to have a customized handle that will allow a better grip on traditional feeding aid. When the handle is customized to the patient's hands and fingers, patients will have better control while eating. This reduces their dependency on others, thus helping to regain their lost self-esteem. This technical report describes a simple method of fabricating a three-dimensional (3D)-printed ergonomically designed handle for a feeding aid from materials readily available in the dental office.

Management of Sunken Cheeks With Magnet-Retained Cheek Plumpers

The loss of teeth, associated with sunken lips and cheeks, has a debilitating psychological effect on a person. It is essential for clinicians to incorporate facial esthetics into their treatment plan for complete denture patients in order to improve the patients' confidence and quality of life. Cheek plumpers ensure adequate support to facial muscles, which, in turn, minimizes the appearance of wrinkles, lines, and sagging over time. This case report describes the fabrication of detachable cheek plumpers using magnets to enhance the facial esthetics of a completely edentulous patient. Magnet-retained cheek plumpers, being small and lightweight, allow ease of placement and cleaning without the addition of weight to the prosthesis.

Management of Comminuted Fracture of Mandible Using Titanium Mesh

Comminuted mandibular fractures are common following a high-velocity injury to the face and jaws. The inherent nature of injury and damage to the underlying hard and soft tissues often complicate the management of comminuted fractures. Traditionally, comminuted fractures were managed by closed reduction and external skeletal fixation. Titanium mesh serves as an excellent alternative in the management of comminuted mandibular fractures. The present case report presents the successful management of comminuted mandibular fractures using titanium mesh.

Custom Sectional Impression Tray With Sectional Handle for Microstomia Patients

Microstomia presents a unique challenge to the dentist as well as the patient. Microstomia patients often face difficulty in inserting or removing removable dental prostheses due to constricted opening of the oral cavity. Dentists often face difficulty in inserting impression trays in these patients because of the limited mouth opening. Standard impression procedures need to be modified in such patients. This article describes a simple design for the fabrication of a sectional handle for a definitive impression in microstomia patients. The sectional handle could be sterilized and reused.

Three-Dimensional Printing of Customized Scaffolds with Polycaprolactone-Silk Fibroin Composites and Integration of Gingival Tissue-Derived Stem Cells for Personalized Bone Therapy

Regenerative biomaterials play a crucial role in the success of maxillofacial reconstructive procedures. Yet today, limited options are available when choosing polymeric biomaterials to treat critical size bony defects. Further, there is a requirement for 3D printable regenerative biomaterials to fabricate customized structures confined to the defect site. We present here a 3D printable composite formulation consisting of polycaprolactone (PCL) and silk fibroin microfibers and have established a robust protocol for fabricating customized 3D structures of complex geometry with the composite. The 3D printed composite scaffolds demonstrated higher compressive modulus than 3D printed scaffolds of PCL alone. Furthermore, the compressive modulus of PCL-Antheraea mylitta (AM) silk scaffolds is higher than that of the PCL-Bombyx mori (BM) silk scaffolds at their respective ratios. Compressive modulus of PCL-25AM silk scaffolds (73.4 MPa) is higher than that of PCL-25BM silk scaffolds (65.1 MPa). Compressive modulus of PCL-40AM silk scaffolds (106.1 MPa) is higher than that of PCL-40BM silk scaffolds (77.7 MPa). Moreover, we have isolated, characterized, and integrated human gingival mesenchymal stem cells (hGMSCs), an effective autologous cell source, onto the 3D printed scaffolds to evaluate their bone regeneration potential. The results demonstrated that PCL-silk microfiber composite scaffolds of Antheraea mylitta origin showed much higher bioactivity than the Bombyx mori ones because of arginine-glycine-aspartic acid (RGD) sequences present in the Antheraea mylitta silk fibroin protein favoring cell attachment and proliferation. By day 14, the metabolic activity of hGMSCs was highest in PCL-40AM (4.5 times higher than that at day 1). In addition, to show the translational potential of this work, we have fabricated a patient defect-specific model (mandible) using the CT scan obtained by the micro-CT imaging to understand the printability of the composite for fabricating complex structures to restore maxillofacial bony defects with precision when applied in a clinical scenario.

A Simple Technique to Manage Anxiety During Tooth Extraction

Pain‐free dental treatment is important for reducing anxiety, treatment completion, and enhancing acceptance of future dental treatment. Injectable local anesthesia assists this pain‐free approach but can cause anxiety in few patients. Achieving proper anesthesia is important to complete the procedure successfully, thereby adding to patient's care and comfort. This article describes a simple technique to manage dental anxiety using virtual reality headset. Audio visual aid helped the patient to relax and eliminate the phobia of local anesthesia injection during surgical tooth extraction. The simple technique enhanced the patient’s ability to continue the dental procedure.

Customized Pen for Patients With Arthritis

Patients with arthritis present with pain, stiffness and limited movement of fingers and hands. Performing tasks independently lead to a lot of anxiety and emotional trauma. Holding simple things like a toothbrush or pen is a cumbersome task. This article describes a simple technique to customize a pen for arthritis patients. The pen holder is customized to the patient's fingers making it easier to write.

Facial soft-tissue changes after anterior maxillary osteotomy: A prospective study

AIMS

The aim of this study was to analyze and assess the soft-tissue response in patients treated by anterior maxillary osteotomy (AMO) in the postoperative period at 3, 6, and 9 months and to qualitatively assess the outcome of the surgery by the patients.

PATIENTS AND METHODS

The study included twenty adult healthy patients between 18 and 25 years with skeletal Class II malocclusion and requiring AMO setback for the correction of facial deformity. Preoperative and postoperative lateral cephalograms were taken and soft-tissue changes that occurred following AMO were compared at 3, 6, and 9 months postoperatively. The stability and acceptance of the soft-tissue changes were analyzed, and the patient's acceptance for the soft-tissue changes was measured on the surgical rating scale (SRS).

RESULTS

All the soft-tissue parameters showed noticeable changes following AMO. Statistically significant difference was observed with nasolabial angle, upper lip, and lower lip inclination. All the patients were moderately satisfied with the outcome of the surgery.

CONCLUSION

This study aims in quantifying the soft-tissue changes following the AMO and the quality of the changes were recorded based on the SRS by the patients. Although there are changes associated with all the parameters assessed, significant differences was observed in nasolabial angle, upper lip, and lower lip inclination. The surgeon must be aware of the soft-tissue adaptation following the surgery for better outcomes.

Individually Modeled 3D Printed Toothbrush and Interproximal Brush Handle With Name for Patients With Limited Manual Dexterity

Maintenance of proper oral hygiene is a cumbersome task when hand and finger movement is restricted. The customized handle allows better grip on the toothbrush, making it easier to brush teeth or dentures. This increases self-esteem by reducing their dependency on others. This article describes a method of fabricating a 3D printed two-in-one customized handle for a patient with limited manual dexterity. The 3D printed handle is simple and requires less fabrication time than other methods. The customized handle is strong, durable, and resistant to water absorption. It also allows reuse with a new brush design, thus saving additional time and cost. In addition, using a customized toothbrush handle is more effective in oral plaque control than a standard toothbrush.

Arthroplasty Followed by Distraction Osteogenesis Versus Distraction Osteogenesis Followed by Arthroplasty in the Management of TMJ Ankylosis: A Comparative Study

Aim

To compare treatment outcome of arthroplasty followed by distraction osteogenesis (AFD) and distraction osteogenesis followed by arthroplasty (DFA) in the management of mandibular deficiencies in temporomandibular joint (TMJ) ankylosis.

Materials and methods

A total of 20 patients with TMJ Ankylosis were included in the study. Patients were randomly divided into two groups. Group 1 consisted of patients for whom arthroplasty was done prior to distraction osteogenesis (AFD) for the correction of deficient mandible. Group 2 included patients where distraction osteogenesis was performed prior to arthroplasty (DFA). The treatment outcome was assessed based on maximum interincisal distance, overjet, corpus length, ramus height, upper airway, lower airway, duration of the procedure and the complications for the treatment at the end of 3, 6 and 12 months.

Results

After the treatment was ended, the patients of both groups had increase in mouth opening and appearance was improved remarkably. There was general increase in all the parameters in both the groups. But at the end of 12 months, airway and the ramus height were more stable and the control of the proximal segment was superior in DFA group. Open bite was noticed in 2 cases of AFD group which was treated by elastics. There required additional surgery for the removal of distractors in the AFD Group. Establishing the airway during the surgery was easier in AFD group.

Conclusion

The study concludes that distraction followed by arthroplasty was a better procedure for the management of TMJ ankylosis owing to its stable results and less number of surgeries.

Endodontic Management of Canal Calcification in Maxillary Central Incisor Using 3D Prototyping Technique: A Case Report

Teeth with calcific metamorphosis pose a challenge to the endodontist in achieving proper access, identification, and debridement of the root canal. With the conventional technique, radiographs and bur orientation have dictated the access cavity preparation, which leads to the removal of more sound tooth structure and iatrogenic errors. To overcome these issues, the recent diagnostic imaging techniques such as cone beam computed tomography followed by three-dimensional fabrication of template have been proposed, which aid the clinician to accurately locate and negotiate the obliterated canal. The present case report describes the importance of conservative access cavity preparation with the use of the guided endodontic technique for the treatment of calcified canals in the maxillary central incisor.

Comparative Analysis of Intravenous Midazolam with Nasal Spray for Conscious Sedation in Minor Oral and Maxillofacial Surgeries

Aim:

The aim of the current study was to evaluate the efficacy of nasal spray midazolam by collating it with conventional intravenous midazolam for conscious sedation in minor oral surgeries.

Materials and Methods:

Sixty patients were selected randomly and divided into two groups: group A for intranasal midazolam atomized spray (n = 30) and group B for intravenous midazolam (n = 30). Physiological parameters, anxiety score, sedation rating, patient’s cooperation score, and retrograde and anterograde amnesia were recorded for each patient during preoperative, intraoperative, and postoperative period. Final evaluation of safety and efficacy in the nasal and intravenous routes of midazolam drug during minor oral surgery was compared.

Results:

In this study, both intranasal and intravenous groups showed decrease in systolic blood pressure and diastolic blood pressure intraoperatively but within physiological limits and increase in the average pulse rates in both the groups. The average oxygen saturation levels were maintained to normal range in both the groups. The average respiratory rate decreased in both intranasal and intravenous groups during surgical procedure. The preoperative to postoperative anxiety scores were decreased significantly in the both groups and there was no significant difference in pre- to postoperative anxiety scores between the groups.

Conclusion:

Both intravenous and intranasal administration of midazolam showed better patient cooperation, satisfaction, and clinical effectiveness. Intranasal midazolam spray is effective in the reduction of subjective stress, reliable anxiolysis while preserving protective reflexes.

Transport Distraction Osteogenesis in Reconstruction of Condyle: Use of a 3D Model for Vector Planning

Introduction

The temporomandibular joint (TMJ) is a complex joint, and it allows bilateral synchronous rotatory and translatory movements. TMJ reconstruction has evolved as an important step in the management of conditions affecting the TMJ like ankylosis, traumatic injuries and congenital deformities. Distraction osteogenesis (DO) is a biological process of forming new bone and adjacent soft tissues by gradual and controlled traction applied on osteotomized bone segments.

Case report

Here is a case report of bilateral TMJ ankylosis which was managed effectively by resection of ankylotic mass and reconstruction of TMJ by transport distraction osteogenesis with preoperative vector planning using a 3D printed model.

Conclusion

Distraction osteogenesis can be considered as an effective means of condylar reconstruction for an anatomical and functional TMJ with minimal complications. Use of 3D models can help making such complex TMJ reconstruction procedures simpler.

Versatility of Dieffenbach's Modification of Weber Fergusson's Approach for Treatment of Maxillary Pathologies

OBJECTIVE

The aim of the study is to evaluate the usage of Dieffenbach's modification of Weber-Fergusons approach in the treatment of lesions involving maxilla.

STUDY

In this study five different maxillary pathologies were approached through Dieffenbach's modification of Weber-Fergusons approach. Partial and subtotal procedures were performed depending on the type of pathology and the extent of the lesion which was assessed both clinically and radiologically. The study evaluates the easy exposure of the site, post operative complications like scar formation and infra orbital nerve parasthesia.

RESULTS

There were two subtotal maxillectomy procedures and three partial maxillectomy procedures approached through Dieffenbach's modification of Weber-Fergusson's approach. All the cases recovered well in the post operative healing period without noticeable scarring. There was parasthesia in three cases which subsided in 3 months.

CONCLUSION

The approach through Dieffenbach's modification of Weber-Fergusons incision gave better visibility and accessibility to the lesions of maxilla. Because there is direct access to the pathology, the inadvertent resection of the un-involved structures is prevented thus minimizing the morbidity.