Patient- and clinician-reported outcomes of lower jaw contouring using patient-specific 3D-printed titanium implants

The main aim of this study was to assess patient-reported outcomes of jawline contouring with patient-specific three-dimensional (3D) -printed titanium alloy implants using validated Face-Q questionnaires. Four FACE-Q questionnaires (Appearance Appraisal Scale, Quality of Life Scales for Psychological and Social Function, and Adverse Effects Scale) were sent to 21 patients consecutively operated on by the same surgeon between 2014 and 2019. Thirteen patients responded. Mean Rasch Transformed Scores for Satisfaction, Psychological Function and Social Function (0-100) were 70.6, 73.2, and 71.1, respectively. These values are difficult to interpret, however, as comparative literature and prospective follow-up scores are lacking. The second objective was to correlate clinician-reported morphology improvement by panel scoring (Likert scale) with patient-reported appearance appraisal. As for satisfaction, we can conclude that an objective acceptable result does not corroborate patients' perceptions (Spearman Rho test r_s = -0.021). Psychological factors and results from previous surgeries probably modulate patients' views. The mean score for the Adverse Effect Scale (15-45) was low (18.6), indicating that the intraoral drop-in fit of customized titanium implants does not cause major side effects.

Topographic bone thickness maps to evaluate the intuitive placement of titanium miniplates for nasal prostheses

The aim of this study was to evaluate the intuitive placement of titanium miniplates. The hypothesis was that virtual planning can improve miniplate placement. Twenty patients were included in the study. These patients were fitted with 21 titanium miniplates (16 y-plates, three t-plates, and two u-plates) to retain nasal prostheses between 2005 and 2017. Colour-coded topographic bone thickness maps (TBTMs) were created in fused pre- and postoperative computed tomography. Implants were virtually transposed at the position of highest bone thickness. The bone thickness index (BTI) was calculated as the sum of points assigned at each screw (1 point per millimetre up to 4 mm, and 5 points for greater values) divided by the number of screws. One plate broke after 2.8 years, thus plate survival after 5 years was 91% using the Kaplan-Meier method. The BTI for all 21 plates increased from 3.4 to 4.1 points using virtual transposition (P<0.001). No significant changes were observed in t- and u-plates, but the median BTI increased from 3.1 to 4.1 points (P<0.0005) in 16 y-plates. The change was substantial (≥0.5 points) in 9/16 y-plates. Therefore, the hypothesis that virtual planning improves implant placement was accepted.