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Background and Aims: Migration of duodenal covered self-expandable metallic stents (C-SEMS) is the main cause of stent dysfunction in patients with malignant gastric outlet obstruction. However, the ideal method to prevent migration has not been clarified. We aimed to evaluate the feasibility and safety of duodenal C-SEMS fixation in this experimental study., Methods: We used the over-the-scope clip (OTSC), suture, and clip methods to fix duodenal C-SEMS and evaluated the gripping force of each device and invasion depth based on pathological findings., Results: The OTSC and suturing systems had a significantly higher mean gripping force compared with the clipping system (OTSC vs. clip: 13.2 vs. 1.0 Newtons [N], P < 0.001; suture vs. clip: 8.5 vs. 1.0 N, P < 0.001). OTSC compression was stronger compared with suturing (OTSC vs. suture: 13.2 vs. 8.5 N, P = 0.006). The submucosal layer, but not the muscle layer, was compressed more widely and deeply by OTSC compared with clips based on pathological findings by hematoxylin and eosin staining., Conclusion: Both OTSC and suturing methods used for duodenal C-SEMS fixation were feasible compared with the clipping method. The pathological evaluation of invasion depth indicated that OTSC may be safe even for preventive use. This study suggested that these methods can be applied clinically for duodenal C-SEMS fixation.

Defects in the face area caused by trauma, accident, tumor or congenital defects are treated with special facial prostheses. Besides esthetics, the most common problem with these prostheses is the retention of prostheses. In the present article review, the methods used for the retention of prostheses from past to present were researched, and the advantages of adhesives and implants, which are the most commonly used current methods, were evaluated. Current techniques, new materials, treatment options, and implementation procedures are described. The success of maxillofacial prostheses in meeting the expectations of patients and dentist doctors is increasing day by day with the development of adhesive material science, the emergence of technical knowledge, and the development of implant technology. Increasing the retention provides both ease of use and acceptance by the patient. Therefore, the chosen method for retention has great importance in the long-term prognosis of the prosthesis., Competing Interests: None

Objective: The aim of this study was to evaluate the performance of dual-mobility (DM) cup systems for revision total hip arthroplasty (rTHA) in patients who had high risk for instability., Methods: We prospectively followed up 34 hips of 30 patients (27 females, 3 males; mean age: 66.1 (range: 33 to 89) years) who underwent rTHA with DM cups for aseptic loosening in 23 hips, infection treatment as second or single stage in nine hips, and instability in two hips. Clinical functions of the patients were evaluated using the Harris Hip Score (HHS), and radiological migration or loosening of the DM cups were recorded. The survival of the components was calculated with the Kaplan-Meier survival analysis and failure was defined as any dislocation of the polyethylene (PE) insert, intraprosthetic dislocation (IPD), aseptic loosening of any component or total hip system revision due to any reason., Results: The mean duration of follow-up was 3.52 (range: 2.05 to 6.26) years. There was one dislocation of PE insert (2.9%), which was treated with closed reduction. There were two (5.8%) re-revisions for cemented DM cup due to migration. There was one PE insert and head change due to subacute infection. The mean HHS increased from 42.8 ± 6.7 (range: 34 to 60) points preoperatively to 87.3 ± 5.8 (range: 75 to 98) points postoperatively. The cumulative survival rate of the DM cup system was 91.2% (95% CI: 81.6-100%) with any revision, 94.1% (95% CI: 86.2-100%) with aseptic loosening and %97.1 (%95 CI: 91.4-100%) with dislocation as the end point at 3.5 years., Conclusion: Dual-mobility cups may provide good stability and represent a good option for revision acetabular reconstruction in patients who have high risk for instability., Level of Evidence: Level IV, therapeutic study., (Copyright © 2019 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.)

Purpose: Magnetically controlled implant systems have been established to treat severe progressive spinal deformity in children. The purpose of this study was to evaluate (1) the ratio between achieved and expected distraction length, (2) the complication rate and its risk factors as well as (3) the correlation of the distraction length and the length of the spine., Methods: A total of 40 patients with an average follow-up of 34 (14 to 57) months were prospectively included in the study. Children underwent lengthening procedures every three months. The ratio between the distraction lengths was determined by comparing the measured distraction length of the rod on radiographs with the distraction length displayed on the external remote controller for the magnetically controlled growing rod (MCGR). Age, weight, height, and complications were repeatedly recorded., Results: The analysis of 746 procedures showed the actual distraction to be 94.4% of the expected one. No difference between implants on the concave and convex spinal side was observed. The overall complication rate was 4.6% mainly because of failure of the implant or lack of implant extension, which was directly related to an increased BMI. There was also a strong correlation between achieved implant distraction length and gain in spinal length., Conclusions: Our study demonstrates a high ratio (0.94) between achieved and expected distraction length of magnetically controlled spinal rods. The complication rate was low (4.6%) and correlated to a high BMI. The correlation between the achieved implant distraction length and spinal length indicates the efficiency of the MCGR therapy., Level of Evidence: Therapeutic Level IV.

We describe the techniques available for retention of implant-supported prostheses: bar-clips, O-rings, and magnets. We present reported preferences and, although this is limited by the heterogeneity of methods used and patients studied, we hope we have identified the best retention systems for maxillofacial prosthetic implants. If practitioners know the advantages and disadvantages of each system, they can choose the most natural and comfortable prosthesis. We searched the PubMed and Scopus databases, and restricted our search to papers published 2001-13. MeSH terms used were Maxillofacial prosthesis and Craniofacial prosthesis OR Craniofacial prostheses. We found a total of 2630 papers, and after duplicates had been removed we analysed the rest and found 25 papers for review. Of these, 12 were excluded because they were case reports or non-systematic reviews. Of the remaining 13, 10 described group analyses and seemed appropriate to find practitioner's choices, as cited in the abstract (n=1611 prostheses). Three papers did not mention the type of prosthetic connection used, so were excluded. The most popular choices for different conditions were analysed, though the sites and retention systems were not specified in all 10 papers. The bar-clip system was the most used in auricular (6/10 papers) and nasal prostheses (4/10). For the orbital region, 6/10 favoured magnets. Non-osseointegrated mechanical or adhesive retention techniques are the least expensive and have no contraindications. When osseointegrated implants are possible, each facial region has a favoured system. The choice of system is influenced by two factors: standard practice and the abilities of the maxillofacial surgeon and maxillofacial prosthetist., (Copyright © 2017 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The loss of an eye and the associated facial disharmony has major physical, psychological, and social consequences for patients undergoing orbital exenteration. A magnet-retained prosthesis with an implant has various advantages over both adhesive and spectacle-retained prostheses for reconstruction of the exenterated orbit.The author demonstrates one representative patient with our orbital reconstruction patients with magnetic implants, which will be applied to various maxillofacial prosthesis strategies in the near future.

Statement of Problem: Currently, which type of suprastructure is preferred when fabricating implant-retained craniofacial prostheses is unknown., Purpose: The purpose of this systematic review was to identify the best retention system (bar-clips versus magnets) for implant-retained craniofacial prostheses., Material and Methods: This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of Medline/PubMed and Web of Science databases for clinical trials was conducted on implant-retained craniofacial prostheses published between 2005 and 2015. English-language studies that directly compared different types of retention systems or presented information on implant survival, periimplant soft tissue reactions, and prosthetic complications were included. Nonclinical studies were excluded to eliminate bias., Results: A total to 173 studies were identified, of which 10 satisfied the inclusion criteria. In total, 492 participants were included in these studies. Four selected studies displayed detailed information with regard to the number of implant failures according to the retention system. As reported, 29 (18.2%) of 159 implants with magnets failed, whereas 25 (31.6%) of 79 implants with bars failed. Overall auricular superstructures showed the highest survival (99.08%). In addition, 55.4% of all participants in the selected studies showed grade 0 of periimplant soft tissue reactions., Conclusions: A systematic search for clinical studies resulted in few studies with a short-term follow-up and small number of participants. The limited data collected indicated that magnets show fewer complications than bar superstructures; however, no hard conclusions could be drawn. Further research, preferably in the form of clinical trials, is needed to validate these findings., (Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Introduction: With the aim of preventing migration of cochlear implantation electrodes in the postoperative course, an electrode fixation clip has been developed. It is characterized by two clips of double U-geometry. The bone fixation clip will be clamped on the bony incus bridge, and the electrode fixation clip is clamped to the electrode lead. Although made of titanium, the detectability in radiologic imaging appears limited., Materials and Methods: Six patients, who received a cochlear implant between August 2014 and March 2015, were retrospectively analyzed for the detectability of the Med-El Electrode Fixation Clip in postoperative cone beam CT scans. For these patients, we randomly extracted appropriate control group patients without implanted clips (matched pairs). One instructed neuro-radiologist blindly evaluated postoperative radiographs on a visual, descriptive basis of both groups with the main outcome measure of clip detectability., Results: In total, images of 12 patients were evaluated. In five of the six (83%) study group patients, the clip was detected radiologically correct. One patient (17%) was appointed as false negative. All patients (100%) without a clip were correctly identified., Discussion: The electrode fixation clip can be identified, despite its small size, using cone beam CT. Sensitivity and specificity are high. This aspect assumes importance especially in postoperative monitoring, e.g. in cases of revision surgery. Thus, this study contributes to the overall safety in cochlear implant surgery.

Free tissue transfers are used to restore maxillofacial resected tissues during tumor ablative surgery. The maxillofacial prosthodontist remains an integral member of the therapeutic team, since conventional retained facial prostheses are in certain cases the most practical, trouble-free, cost-efficient, and successful means of rehabilitation.

Optimum functional and aesthetic facial reconstruction is still a challenge in patients who suffer from inborn or acquired facial deformity. It is known that functional and aesthetic impairment can result in significant psychosocial strain, leading to the social isolation of patients who are affected by major facial deformities. Microvascular techniques and increasing experience in facial transplantation certainly contribute to better restorative outcomes. However, these technologies also have some drawbacks, limitations and unsolved problems. Extensive facial defects which include several aesthetic units and dentition can be restored by combining dental prostheses and anaplastology, thus providing an adequate functional and aesthetic outcome in selected patients without the drawbacks of major surgical procedures. Referring to some representative patient cases, it is shown how extreme facial disfigurement after oncological surgery can be palliated by combining intraoral dentures with extraoral facial prostheses using individualized treatment and without the need for major reconstructive surgery., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Even though modern surgical techniques are dominating reconstructive facial procedures, the capability to use facial epitheses for reconstruction is still an important skill for the maxillofacial surgeon. We present an international multicenter analysis to clarify which techniques are used to fixate facial prostheses. We contacted all maxillofacial departments in Germany, Austria, Switzerland and Norway which were registered with the German society for oral and maxillofacial surgery (DGMKG). These centers were asked via electronical mail to provide information on the type of epithesis fixation systems currently in use. The return rate from 58 departments was 43.1% (n = 25). Overall, implant fixation was the preferred fixation system (92%). Plates were the second most common fixation technique (32%). No centers reported the standard use of non-invasive fixation techniques for permanent epithesis fixation. The main retention systems in use were magnets (24/25), other retention systems are used much less often. The current preferred fixation technique for facial epitheses consists of implant-based, magnet-fixated epitheses. For nasal prostheses, a plate-based, magnet-fixated system is often used., (Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

When aggressive cancer is surgically treated, the extent of the lesion dictates the amount of tissue excised. The removal of extensive amounts of tissue, including crucial landmarks, complicates prosthesis design. This clinical report details the rehabilitation of a patient who had a total maxillectomy coupled with extensive surgical removal of the midface. With the aid of computer-generated implant placement, a large computer-aided design and computer-aided manufacturing milled titanium framework, a Hader bar, and magnetic keepers, a successful implant retained definitive obturator and facial prosthesis were fabricated that satisfied both esthetic and functional needs., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Giving a natural surface texture to the maxillofacial prostheses is one of the major goals for the maxillofacial prosthodontists. This article describes a technique for application of an antiskid epoxy resin to the surface of the definitive mold before pouring the maxillofacial silicone elastomer. This technique produces evenly distributed and same-size pores that are more similar to the natural appearance of human skin., (Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Background and Purpose: There have recently been highly publicized examples of suboptimal outcomes with some newer implant designs used for total hip replacement. This has led to calls for tighter regulation. However, surgeons do not always adhere to the regulations already in place and often use implants from different manufacturers together to replace a hip, which is against the recommendations of the Medicines and Healthcare Products Regulatory Agency (MHRA) and the directions of the manufacturers., Patients and Methods: We used data from the National Joint Registry of England and Wales (NJR) to investigate this practice., Results: Mixing of components was common, and we identified over 90,000 cases recorded between 2003 and 2013. In the majority of these cases (48,156), stems and heads from one manufacturer were mixed with polyethylene cemented cups from another manufacturer. When using a cemented stem and a polyethylene cup, mixing of stems from one manufacturer with cups from another was associated with a lower revision rate. At 8 years, the cumulative percentage of revisions was 1.9% (95% CI: 1.7-2.1) in the mixed group as compared to 2.4% (2.3-2.5) in the matched group (p = 0.001). Mixing of heads from one manufacturer with stems from another was associated with a higher revision rate (p < 0.001). In hip replacements with ceramic-on-ceramic or metal-on-metal bearings, mixing of stems, heads, and cups from different manufacturers was associated with similar revision rates (p > 0.05)., Interpretation: Mixing of components from different manufacturers is a common practice, despite the fact that it goes against regulatory guidance. However, it is not associated with increased revision rates unless heads and stems from different manufacturers are used together.

Silicone prostheses require constant repair and refabrication. Auricular prostheses retained with implants have better retention than adhesive-retained prostheses. However, refabrication is complicated if the patient is unwilling to surrender the metallic framework attached to the implants and revert to the use of adhesives. This article describes a technique by which the metal framework of the existing prosthesis need not be removed, thereby improving the patient's quality of life until the new prosthesis is delivered., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Traditionally, patients with maxillofacial defects have been challenging to treat. A multitude of challenges associated with maxillofacial prosthetic treatment are not typically seen with patients who need conventional prosthodontic treatment. These types of patients generally require replacement of significant amounts of hard and soft tissues than do conventional prosthodontic patients. Most maxillofacial patients also warrant more emotional support than do conventional prosthodontic patients. Successful maxillofacial prosthetics still need to embrace the traditional goals of prosthodontic treatment: stability, support, retention, and esthetics. It is unlikely that a maxillofacial prosthesis will exactly duplicate the anatomy and function of missing or damaged structures. Although craniofacial implants (CFI's) have lower cumulative survival rates (CSR's) than intraoral endosseous implants, osseointegrated CFI's have proven to be significant adjuncts to improving retention of maxillofacial prostheses. However, CSR's of CFI's have been reported to be lower than CSR's for intraoral endosseous implants. Lately, computer-assisted design and computer-assisted machining (CAD/CAM) has been used in dentistry to facilitate fabrication of implant-supported frameworks. CAD/CAM protocols have numerous advantages over conventional casting techniques, including improved accuracy and biocompatibility, and decreased costs. The purpose of this paper is to review the literature on cumulative survival rates (CSR's) reported for CFI's and to illustrate the treatment of a maxillofacial patient using CFI's and a CAD/CAM copy-milled framework for retention and support of a nasal prosthesis., (© 2014 by the American College of Prosthodontists.)

Diminution of the orbital contents post-surgical removal of a malignant tumor can have a severe psychological impact on the patient in terms of function and esthetics. Therefore, esthetic remedy should be planned subsequently, since tumor obliteration precedes cosmetic concern. A convenient option for successful rehabilitation in such patients is a simple, user-friendly, removable orbital prosthesis. Retention of the prosthesis is one of the key factors for the successful rehabilitation. Spectacle frame, conformers, adhesives, osseointegrated implants, magnets or buttons have been used to impart retention to the prosthesis. The use of semi precision attachments in maxillofacial prostheses is limited to the osseointegrated prostheses. This case report describes a conventional spectacle frame technique, to retain the silicone orbital prosthesis using two different types of stud attachments viz., dalla bona and O-ring attachment systems., (Copyright © 2013 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

The accurate reproduction of the form and surface details of missing body structures is an essential part of any successful prosthetic rehabilitation. It helps mask the prosthesis and gives confidence to the patient. This clinical report details the integration of multiple in-house digital technologies of laser scanning, rapid prototyping, and digital color scanning and formulating to improve the shape, texture, orientation, and color of auricular prostheses for 3 patients with missing unilateral ears. A structured light laser scanner was used to digitize the patient's nondefect ear. The digitized data were then manipulated in specialist software and mirrored to reflect the opposing side. A rapid prototyping machine was used to manufacture a 3-dimensional (3D) model of the soft tissue required. This 3D mirrored ear model allowed the accurate reproduction of missing soft tissue. A color spectrometer was used to accurately reproduce the skin tones digitally and physically., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Osseointegrated implants have been well documented for retaining an obturator prosthesis as well as a facial prosthesis. However, when the defect extends to both the facial area and the maxilla, it is difficult to rehabilitate those defects to the satisfaction of the patient, especially in cases where implants cannot be placed on both sites. This case report describes the use of magnets to connect two prostheses, thereby increasing retention and patient comfort.

This article describes the use of a laser-level paralleling device for the fabrication of a unilateral auricular prosthesis. Traditional methods require use of calipers to obtain orientation of contralateral auricular anatomy, which in turn can be difficult to replicate on the patient. The purpose of this clinical report is to describe a simple means to record unilateral auricular anatomy., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Implants provide patients with a safe and reliable method for anchoring auricular prostheses that enable restoration of their normal appearance and offer improved quality of life. In this case report, an auricular prosthesis was fabricated for a patient who had lost his right external ear in a traffic accident. Extraoral implants and bar-and-clip retention for the proper connection of the auricular prosthesis to the implant were used.

Velopharyngeal incompetence is a contributing factor to speech disorders and implies the presence of hypernasality, inappropriate nasal escape, and decreased air pressure during speech. One prosthetic treatment is a rehabilitative procedure employing a palatal lift prosthesis (PLP), which reduces hypernasality by approximating the incompetent soft palate to the posterior pharyngeal wall and consists of two parts, the anterior denture base and the palatal lifting plate, which are connected with steel wires; however, it seems difficult to reproduce the mobility of the soft palate in speaking, and it is therefore likely that the palatal lifting plate stimulates or oppresses the tissue of the soft palate and hinders rather than assists articulatory function. To avoid these disturbances we devised an adjustable PLP with a flexible conjunction between the denture base and the palatal lifting plate to obtain the optimal vertical lifting angle. The palatal plate was adapted to conform in a passive manner to the soft palate with light-cured resin. The designed PLP simplified the procedure and reduced the number of adjustments and visits., (© 2013 by the American College of Prosthodontists.)

Purpose: Total hip arthroplasty (THA) has been efficacious for treating hip fractures in healthy older patients. However, in those patients with fractures a widely variable prevalence of dislocation has been reported, partly because of varying durations of follow up for this specific end-point. The purpose of the present study was to determine the cumulative risk of dislocation in these patients with fractures and to investigate if retentive cups decrease the risk of dislocation., Methods: Between 2000 and 2005, 325 patients with neck fracture underwent primary THA using a retentive (325 hips) cup. The results of these 325 acetabular cups were compared to 180 THA without retentive cups performed for neck fractures in the same hospital between 1995 and 2000 by the same surgical team. The mean age of the 505 patients was 75 years (range 65-85). All patients were followed for a minimum of five years for radiographic evidence of implant failure. The patients were followed at routine intervals and were specifically queried about dislocation. The cumulative risk of dislocation and recurrent dislocation was calculated with use of the Kaplan-Meier method., Results: For patients without retentive cups, the cumulative risk of a first-time dislocation was 5 % at one month and 12 % at one year and then rose at a constant rate of approximately 1 % every year to 16 % at five years. For patients with retentive cups, the cumulative risk of a first-time dislocation was 1 % at one month, 2 % at one year and then did not changed at five years. There were no differences in the mortality rates or in loosening rates among the treatment groups. The rate of secondary surgery was highest in the group without retentive (10 % for recurrent dislocation) compared with 1 % in the group treated with retentive cups. In absence of retentive cups, multivariate analysis revealed that the relative risk of dislocation for female patients (as compared with male patients) was 2.1 and that the relative risk for patients who were 80 years old or more (as compared with those who were less than 80 years old) was 1.5. Two underlying diagnoses occurring during follow up-cognitively impaired patients or neurologic disease-were also associated with a significantly greater risk of dislocation in absence of retentive cup. For these patients the risk was also decreased with a retentive cup., Conclusion: With standard cups the incidence of dislocation is highest in the first year after arthroplasty and then continues at a relatively constant rate for the life of the arthroplasty. Patients at highest risk are old female patients and those with a diagnosis of neurologic disease. Retentive cups in these patients are an effective technique to prevent post-operative hip dislocation.

Patients who have had a partial or full surgical resection of the maxillary or mandibular lip experience difficulties with articulation of speech, swallowing, and salivary control. This is further complicated by significant alterations in facial esthetics and lowered self-esteem. This clinical treatment will describe the fabrication of a two-piece tooth-retained maxillofacial prosthesis. An intraoral retentive portion and an extraoral section restoring lip anatomy were attached by retentive elements. This prosthesis restored the patient's esthetics, oral function, and self-esteem., (© 2013 by the American College of Prosthodontists.)

Injuries to the ear can result in partial or complete loss of the external ear. Resection of the external ear may be necessary secondary to malignant tumor or infection. This article discusses the diagnosis and management of acquired defects of the external ear. Because autogenous reconstruction is not always possible, both autogenous and prosthetic reconstruction are presented as well as the indications for both. This information should help guide the clinician in the decision-making process. In the hands of experienced clinicians, reconstruction of the external ear can result in an excellent outcome, with improved quality of life for the patient., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Implant-retained auricular prostheses are a successful treatment modality for children with microtia. They involve only minor surgical intervention of implant placement and result in an esthetically pleasing outcome. Integration of digital technologies (DT) in the prosthetic reconstruction process is a new approach toward enhancing outcomes. In this report we present a case of auricular prosthetic reconstruction following two implant placements in the right mastoid region. The ear prosthesis was constructed with the aid of various DTs. A structured light laser scanner was used to digitize the nondefect patient ear. The digitized 3D ear was then manipulated in specialist software, mirrored to reflect the opposing side, and a Rapid Prototyping (RP) machine (Z-Corp) was used to manufacture the soft tissue required. This RP-mirrored ear model allows very accurate reproduction to replicate missing soft tissue. A color Spectrometer was used to accurately reproduce skin tones. The use of these technologies is now routine practice at our unit. They enhance prosthetic outcomes and esthetics, save the prosthetist's time, and are digitally stored and subsequently readily available and reproducible., (© 2012 by the American College of Prosthodontists.)

Statement of Problem: Clinical studies on implant-retained maxillofacial prostheses have focused on biological outcomes. An assessment of the effect of prostheses on patients' quality of life (QOL) by using specific questionnaires developed for this patient population provides important information on treatment outcomes from the patients' perspectives., Purpose: The purpose of this study was to report patient-based outcomes of implant-retained maxillofacial prostheses and to evaluate the effect of implant-retained maxillofacial prostheses on QOL of participants in a prospective study., Material and Methods: Eighty-two participants were treated with implant-retained maxillofacial prostheses. Participants were divided into 2 groups: a retrospective group (participants treated and under care) and a prospective group (participants willing to be treated). The posttreatment patient satisfaction scores for each question were statistically analyzed by 2-way ANOVA with variables of defect type and retention type. The Student-Newman-Keuls test was used to determine any significant differences among the groups. In the prospective group, mean scores before and after prosthetic treatment were compared with the paired t test (α=.05)., Results: The details of 54 retrospective and 28 prospective participants were reviewed. The posttreatment results of 82 patients showed that patient satisfaction with implant-retained maxillofacial prostheses was significantly different for cleaning the prostheses and recommending treatment to other people, depending on the defect and retention type. In the prospective group, participants reported significant increases in satisfaction for all questions., Conclusions: Implant-retained prostheses were considered highly satisfactory, indicating good QOL for patients with maxillofacial defects. A comparison of pretreatment and posttreatment assessments revealed that implant-retained maxillofacial prostheses increased patient QOL., (Copyright © 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Obtaining an accurate impression of facial tissues with undercuts and extraoral implants has always been a challenge for both clinicians and patients. This report describes a three-step, two-piece technique that enables an accurate and comfortable impression of undercut tissues and extraoral implants in an orbital defect. An impression of the basal tissue surface of the defect area was made using a medium-body polyether impression material followed by an impression of the entire face of the patient made with a polyvinyl siloxane (PVS) impression material. First, the PVS impression material was removed; second, the impression posts were removed from the magnets; and third, the polyether impression was removed from the defect. The impression posts were attached to the implant analogs and placed in the negative spaces in the polyether impression. The polyether impression, which carries the implant analogs and impression posts, was placed in the PVS impression through the negative spaces. This technique minimizes trauma to the soft tissues and implants during impression making and also does not require additional materials.

Background: Aseptic loosening is one of the greatest problems in hip replacement surgery. The rotation center of the hip is believed to influence the longevity of fixation. The aim of this study was to compare the influence of cemented and cementless cup fixation techniques on the position of the center of rotation because cemented cup fixation requires the removal of more bone for solid fixation than the cementless technique., Methods: We retrospectively compared pre- and post-operative positions of the hip rotation center in 25 and 68 patients who underwent artificial hip replacements in our department in 2007 using cemented or cementless cup fixation, respectively, with digital radiographic image analysis., Results: The mean horizontal and vertical distances between the rotation center and the acetabular teardrop were compared in radiographic images taken pre- and post-operatively. The mean horizontal difference was -2.63 mm (range: -11.00 mm to 10.46 mm, standard deviation 4.23 mm) for patients who underwent cementless fixation, and -2.84 mm (range: -10.87 to 5.30 mm, standard deviation 4.59 mm) for patients who underwent cemented fixation. The mean vertical difference was 0.60 mm (range: -20.15 mm to 10.00 mm, standard deviation 3.93 mm) and 0.41 mm (range: -9.26 mm to 6.54 mm, standard deviation 3.58 mm) for the cementless and cemented fixation groups, respectively. The two fixation techniques had no significant difference on the position of the hip rotation center in the 93 patients in this study., Conclusions: The hip rotation center was similarly restored using either the cemented or cementless fixation techniques in this patient cohort, indicating that the fixation technique itself does not interfere with the position of the center of rotation. To completely answer this question further studies with more patients are needed.

Background: The absence of an ear, which can be the result of a congenital malformation, surgical tumour resection or traumatic injury, is a significant aesthetic problem. Attachment of ear prostheses with adhesives can cause local irritation for the wearer and affect the colour of the prostheses. Use of implants in craniofacial reconstruction can improve the retention and stability of prostheses giving to patient greater comfort and security relative to adhesive attachment., Objective: The aim of this report was to present a clinical case of a mutilated patient who was rehabilitated by means of installing an ear prosthesis fixed through osseointegrated implants., Materials and Methods: The patient had two implants installed in the mastoid region that were linked by a bar, and a clip-type system was used. The ear prosthesis was constructed from medical-use silicone, pigmented to match the patient's skin colour and linked to the retention system., Conclusion: The patient's rehabilitation was satisfactory from both a functional and an aesthetic point of view, making it possible for the patient to return to a normal social life and regain lost self-esteem., (© 2012 The Gerodontology Society and John Wiley & Sons A/S.)

Microtia is a major congenital anomaly of the external ear. It includes a spectrum of deformities from a grossly normal but small ear to the absence of the entire external ear. These deformities account for three in every 10,000 births, with bilaterally missing ears seen in fewer than 10% of all cases. Congenital abnormalities of the ear are unlikely to result in the complete absence of the ears, but the patient presented in this article had bilateral congenitally missing ears. There was loss of anatomic landmarks and alteration of normal bony architecture. Minimal tissue was available for retention; therefore, conventional techniques could not be used for achieving retention. A two-implant-supported auricular prosthesis was planned, but the patient was found to have deficient bone in the implant site. Hence the implants were placed posterior to these sites, and the superstructure was modified to accommodate for this change in position of the implant to ensure the esthetic positioning of the prosthesis., (© 2012 by the American College of Prosthodontists.)

Orbital defects with total loss of eyelids and eyeball cannot be satisfactorily repaired by reconstructive surgery. Prosthetic replacement is the treatment of choice owing to its acceptable lifelike appearance. The use of semiprecision attachments in maxillofacial prostheses is limited to osseointegrated prostheses. Therefore, this article describes a conventional glasses frame technique, to retain the silicone orbital prosthesis using a Dalla Bona stud attachment., (© 2012 by the American College of Prosthodontists.)

A 72-year-old man was referred from the surgery department for rehabilitation following surgical resection of Basaloid carcinoma. The first surgical intervention involved the anterior palatal region and was restored with a simple obturator. Two years later further surgery was undertaken to excise a recurrent tumor in the nose and part of the cheek. This resulted in an exposed nasal cavity and maxillary sinus. In addition, there was a small oral aperture composed of thin tissue that stretched to its maximum due to scar formation. The defect was restored with a full thickness skin flap but it subsequently broke down leaving the midface exposed with limited mouth opening due to tissue contraction and scar formation after the flap operation. The defect was rehabilitated with Co-Cr obturator intraorally and a silicone nose retained to the naso-palatal extension of the obturator by a magnet extraorally. This resulted in practically good retention, placement, and adaptation of the two parts of the prosthesis.

The esthetic result of an auricular prosthesis is influenced by the position of the prosthesis incorporating the implants. The entire surface of the patient's head is captured by means of a conventional computed tomography (CT). The digital data are used to mirror the contralateral unimpaired ear for restoration of the impaired side. The virtual ear is integrated into a template covering the auricular defect and indexed to the nasal area with computer-aided technology (CAD/CAM). This virtual template is converted into an acrylic resin template. With that the surgeon and the anaplastologist should determine the optimal implant position of the auricular prosthesis., (Copyright © 2012 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Purpose: The purpose of this pilot study was to apply resonance frequency analysis (RFA) to measure the clinical stability of craniofacial implants and compare the RFA measurements over a 12-month period., Materials and Methods: Patients with auricular or orbital defects were treated with prostheses retained by two or three implants. After healing periods of 3 months for auricular implants and 6 months for orbital implants, prostheses were fabricated. RFA measurements were performed immediately after implant placement, at abutment connection, and at 6 and 12 months. All stability measurements were repeated three times for each implant, and the mean value was used for analyses. For measurements performed after prosthesis delivery, connecting bars and abutments were removed prior to RFA. The stability of both types of implants was compared at different time intervals., Results: Fifty-four implants were placed in 10 patients with auricular defects (26 implants) and 10 patients with orbital defects (28 implants). All auricular implants survived, and four orbital implants in four different patients failed. For auricular implants, statistically significant differences in stability values were noted between implant placement, abutment connection, and 6 months; there was no significant difference between 6 and 12 months. For orbital implants, no significant differences were found between implant placement and abutment connection, a significant increase was observed at 6 months, and no significant difference was seen between 6 and 12 months. No significant differences were found for auricular versus orbital implants between placement and abutment connection, but auricular implants showed significantly higher stability values than orbital implants at 6 and 12 months., Conclusions: The stability of surviving auricular and orbital implants increased with time according to RFA. Prior to failure, the failed implants showed RFA values that were below the mean.

This article describes a time-saving technique for fabricating a new implant-retained orbital prosthesis using the patient's existing prosthesis. The location of the ocular component is transferred; the position and openings of the palpebral anatomic structures and the precise anatomic details of the existing orbital prosthesis are duplicated. Making the impression, fabricating the definitive cast, alignment of the ocular component, and completing the wax sculpture of the prosthesis are accomplished in one appointment., (© 2011 by the American College of Prosthodontists.)

Purpose: Laparoscopic ventral hernia repair is commonly performed with mesh prostheses; however, there is no standard for fixation devices used to secure mesh to the abdominal wall. This study is a functional comparison of novel, screw-type absorbable and permanent fixation devices with a traditional titanium fixation device., Methods: Fifteen pigs each underwent the laparoscopic placement of two 11 × 14-cm mesh prostheses and were randomized for mesh fixation with either titanium spiral tacks (TS), absorbable screw-type fasteners (SF), or permanent screw-type fasteners (PF) (n = 10 mesh prostheses for each fixation group). Adhesions were assessed laparoscopically at 4 weeks. The fixation devices were also embedded in porcine abdominal rectus muscle for ex vivo mechanical testing along with partial thickness polypropylene suture (PR) as a control group (n = 40 for each group). Maximum pull-off forces were measured. All statistical tests were two-tailed, and a P-value < 0.05 was considered to be significant., Results: The mean tenacity adhesion scores were 1.40 ± 0.52 (PF), 1.7 ± 0.82 (SF), and 2.6 ± 1.07 (TS). Adhesions in the PF group were significantly less tenacious compared with the TS group (P = 0.01). Quantitative adhesion scores were not significantly different among groups. The maximum pull-off forces, measured in Newtons, were 28.61 N ± 4.89 N (TS), 22.71 N ± 7.86 N (SF), 16.98 N ± 7.59 N (PF), and 20.83 N ± 6.25 N (PR). The pull-off force in the TS group was higher than all of the other groups (P < 0.001). The SF group also had a higher pull-off force compared with the PF group (P < 0.001)., Conclusions: The screw-type absorbable and permanent fixation devices provided adequate fixation and were associated with decreased adhesions in this porcine model.

Statement of Problem: The tissue surrounding craniofacial implants is prone to inflammation; however, no adequate instrument is currently available to measure this objectively., Purpose: The purpose of this study was to describe the parameters influencing the sulcus fluid flow rate in the extraoral periimplant tissue environment., Material and Methods: Thirty-four patients with 112 craniofacial implants participated. The sulcus fluid flow rate (SFFR) was measured with standardized paper strips. The influence of cleansing liquids, implant location, presence of purulent exudates, smoking habits, depth of crevice, and previous irradiation on the sulcus fluid flow rate were evaluated with covariate adjusted finite mixture models., Results: Two latent subgroups of SFFR were identified based on a mixed model. The majority (95.5%) had a mean value of 1.44 mm, and the smaller subgroup (4.5%) had a mean value of 10.4 mm. The SFFR values were increased when purulent exudates were present (regression coefficient 1.41), 95% CI (0.67, 2.16). The depth of the crevice influenced the SFFR per unit depth (regression coefficient 0.37), 95% CI (0.22, 0.53). Additional covariates, such as the implant location, history of smoking, and prior irradiation, had no statistical effect on SFFR., Conclusions: SFFR can be measured objectively in the extraoral periimplant tissue., (Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.)

Maxillofacial trauma refers to any injury to the face or jaw caused by physical force, trauma, the presence of foreign objects, animal or human bites, and burns. Facial defects can be devastating in their impact on physical structure and function of the affected individual, leading to potential compromises in quality of life. Restoration of facial defects, especially nasal defects, is a difficult challenge for both the surgeon and the prosthodontist. Here is a case report of partial nasal defect caused by trauma, rehabilitated with a magnetic nasal prosthesis made with silicone elastomers using mechanical and anatomical retentive aids.