Ultrasound stimulation of mandibular bone defect healing

The conclusions of the experimental work presented in this thesis are: 1. Low intensity pulsed ultrasound is not effective in stimulating bone growth into a rat mandibular defect, either with or without the use of osteoconductive membranes. 2. Low intensity pulsed ultrasound does not seem to have an effect on the early bone formation in the vertically distracted, severely resorbed mandible. This thesis focused on a small area in the field of ultrasound and bone healing that had not been explored before. The animal experimental work indicates that ultrasound does not stimulate mandibular bone defect healing with or without the use of osteoconductive membranes in healthy animals. This may be related to the ultrasound field variables used, to an optimal healing tendency of the head and neck region, or to limitations of the animal model. To reveal which of these possibilities is the most plausible, additional research is needed. For now, it is not recommendable to apply ultrasound in maxillofacial surgery to stimulate bone defect healing. In situations where mechanical loading or blood perfusion is limited, as for example in the case of mandibular fractures or osteoradionecrosis, ultrasound might have an effect. More importantly, unravelling the mechanism of action as to how ultrasound stimulates bone healing in certain cases may eventually predict if, and if so, when, ultrasound may be of value in maxillofacial surgery.

A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening

Objective: to systematically review the efficacy of microfocused ultrasound (MFU) for facial skin tightening.Methods: A systematic search was performed (Pubmed, Embase) to assess the efficacy of single MFU treatments for facial skin tightening. Eligible studies included randomised controlled trials, controlled trials, cohort studies and case series (n ≥ 10). Objective and subjective outcomes were assessed.Results: A total of 693 studies were identified of which 16 studies were eligible. All the studies involved female patients. MFU is capable of tightening the skin, as observed in studies measuring the results of brow lifts (0.47–1.7 mm) and submental lifts (measured as a 26–45 mm2 reduction in the submental area on lateral photographs). Data from the Global Aesthetic Improvement Scale (GAIS) were pooled, and the day 90 pooled subjective investigator reported scores (IGAIS) (n = 337) showed that 92% of the patients demonstrated an improvement in skin tightening and/or in wrinkle reduction which continued up to one year. Longer-term follow-up data are not available. The patient-reported pooled scores (SGAIS) (n = 81) showed that the skin improvements were mild and continued to increase from 42% (90 days) to 53% (360 days) post-treatment. The MFU treatment was moderately painful and caused transient erythema with or without oedema. Other adverse effects were rare (2%), including dysesthesia (numbness or hypersensitivity), bruising and stinging, mandibular burns, striations and contact dermatitis. Various device settings, treatment protocols and energies were applied. Excessive skin laxity and a BMI &gt; 30 were posed as relative contraindications for MFU treatment because positive results declined with an increase in laxity and BMI.Conclusions: MFU treatment is effective in tightening female patients’ mildly to moderately lax facial skin. Future studies should focus on objective treatment outcomes, optimising treatment regimens and male patients.</p

Patients' appreciation of pre-implant augmentation of the severely resorbed maxilla with calvarial or anterior iliac crest bone:a randomized controlled trial

BACKGROUND: Little is known about the impact of bone graft harvesting for pre-implant augmentation of the maxilla from a patient's perspective. To assess patient-reported outcome measures (PROMs) related to augmentation of the extremely resorbed edentulous maxilla with calvarial or anterior iliac crest bone. MATERIALS AND METHODS: For this randomised controlled trial, 20 consecutive edentulous patients needing extensive pre-implant surgery of the maxilla were randomly assigned to either calvarial (n = 10) or anterior iliac crest (n = 10) bone harvesting. Patient reports on procedure-related satisfaction, questionnaires on oral functionality (denture satisfaction, chewing ability) and oral health-related quality of life (OHIP-49NL) and subjective donor site-related outcomes (e.g. of post-operative pain, scar formation, physical mobility) were assessed. RESULTS: Irrespective of the harvesting site, patients were generally satisfied (median VAS score 93 (86-99) mm, p = 0.400) with the procedure and its final results. Post-operative pain was mild (median 40 (20-40) mm) and decreased to no pain (4 (0-16) mm) within 14 days. Early post-operative pain was significantly higher following anterior iliac crest harvesting (p < 0.00). Impact on physical mobility, daily functioning and satisfaction with the scar formation were similar in both groups. CONCLUSIONS: The assessed PROMs confirmed that bone graft harvesting from the calvarium or anterior iliac crest is an appropriate procedure, reflected by high levels of satisfaction, minor long-term sequela and improvement of perceived oral health. For clinical decision-making, decisions can be based on individual features and preferences. TRIAL REGISTRATION: NTR, NTR3968 , registered 1 July 2013

Calvarial bone grafts to augment the alveolar process in partially dentate patients:a prospective case series

BACKGROUND: Calvarial bone grafts as a pre-implant augmentation procedure are mostly used to reconstruct the edentulous maxilla, although calvarial grafts could also be used in the partially dentate patients needing extensive bone grafting.METHODS: In 7 consecutive partially dentate patients needing bone grafting because of a large bony defect as a result of trauma (n = 1), oligodontia (n = 1), failed previous bone augmentation (n = 1), or atrophy (n = 4), the alveolar process was reconstructed with calvarial bone as a pre-implant procedure.RESULTS: A total of 30 implants was placed either immediate at the time of bone grafting (13 implants) or after a healing time of 4 months when immediate placement was not possible (17 implants). One wound dehiscence occurred that needed secondary intervention. During follow-up (40 ± 14 months), one implant was lost due to peri-implantitis with an infected osteosynthesis screw. Marginal peri-implant bone loss was 0.65 ± 0.47 mm during this period.CONCLUSION: Calvarial bone is a sound extra-oral donor site when aiming for reconstruction of a large bony defect of the alveolar process of partially dentate patients.</p

A Systematic Review of the Efficacy of Microfocused Ultrasound for Facial Skin Tightening

Objective: to systematically review the efficacy of microfocused ultrasound (MFU) for facial skin tightening.Methods: A systematic search was performed (Pubmed, Embase) to assess the efficacy of single MFU treatments for facial skin tightening. Eligible studies included randomised controlled trials, controlled trials, cohort studies and case series (n ≥ 10). Objective and subjective outcomes were assessed.Results: A total of 693 studies were identified of which 16 studies were eligible. All the studies involved female patients. MFU is capable of tightening the skin, as observed in studies measuring the results of brow lifts (0.47–1.7 mm) and submental lifts (measured as a 26–45 mm2 reduction in the submental area on lateral photographs). Data from the Global Aesthetic Improvement Scale (GAIS) were pooled, and the day 90 pooled subjective investigator reported scores (IGAIS) (n = 337) showed that 92% of the patients demonstrated an improvement in skin tightening and/or in wrinkle reduction which continued up to one year. Longer-term follow-up data are not available. The patient-reported pooled scores (SGAIS) (n = 81) showed that the skin improvements were mild and continued to increase from 42% (90 days) to 53% (360 days) post-treatment. The MFU treatment was moderately painful and caused transient erythema with or without oedema. Other adverse effects were rare (2%), including dysesthesia (numbness or hypersensitivity), bruising and stinging, mandibular burns, striations and contact dermatitis. Various device settings, treatment protocols and energies were applied. Excessive skin laxity and a BMI &gt; 30 were posed as relative contraindications for MFU treatment because positive results declined with an increase in laxity and BMI.Conclusions: MFU treatment is effective in tightening female patients’ mildly to moderately lax facial skin. Future studies should focus on objective treatment outcomes, optimising treatment regimens and male patients.</p