Palatal Implants Research Articles

Development of a five-axis printer for the fabrication of hybrid 3D scaffolds: From soft to hard phases and planar to curved surfaces

Three-dimensional (3D) printing of hybrid scaffolds with material gradients, combining soft and hard phases, is an appealing frontier in additive manufacturing. However, most 3D printers are limited to either three-axis or mono-material capabilities, rendering them unsuitable for fabricating hybrid scaffolds. Additionally, printing on curved surfaces requires advanced printing capabilities. Our work aims to advance additive manufacturing by developing a hybrid piezoelectric inkjet-extrusion printer equipped with five-axis functionalities. The printer could be used to fabricate customized hybrid scaffolds, surpassing conventional mono-material or linear three-axis printing strategies. The soft phase comprises a low-viscosity photocurable resin and a high-viscosity peptide hydrogel, while the hard phase comprises 3D-printed polylactic acid and hydroxyapatite parts. To validate the system, we fabricated three hybrid scaffolding use cases, characterized by multi-material porous structures fabricated on planar, single-curved, and free-form surfaces. The scaffolds were subsequently analyzed using digital microscopy to assess their accuracy, particularly the feature sizes of pores and struts (i.e., 0.8–3.6 mm). In the first part of the study, we demonstrated the versatility of inkjet and extrusion printing by hybrid printing an interconnected network in the soft phase on top of a planar ceramic hard phase. A pore width and height deviation of 6% was achieved compared to the intended design. In the second part of the study, we evaluated the 3D inkjet printing of a multi-material porous scaffold on a single-curved surface for osteochondral defects. The circumferential pore width and radial pore height deviated by 0.8% and 2%, respectively. Finally, we inkjet-printed a mesh structure on a free-form surface, which acted as a membrane for palatal implants. In this case, the pore width deviations were -16% in the printing direction and 2% perpendicular to the printing direction.

Midpalatal miniscrew insertion: The accuracy of digital planning and surgical placement

The objective of this study was to investigate the accuracy of palatal miniscrew insertion, evaluating the effect of guide fabrication and surgical placement. Guided insertion of bilateral paramedian palatal miniscrews was undertaken using Appliance Designer software (3Shape, Copenhagen, Denmark). A resin surgical guide (PPro Surgical Guide; Straumann AG, Basel, Switzerland) was used. Superimposition of the miniscrew position relative to the digital design was undertaken using bespoke software (Inspect 3D module, OnyxCeph; Image Instruments GmbH, Chemnitz, Germany) to assess surgical inaccuracy. Miniscrew position relative to the surgical guide was also assessed to isolate the effect of planning inaccuracies. Both horizontal and vertical discrepancies were evaluated at both implant locations. Twenty-seven patients having bilateral palatal insertions were examined. Mean discrepancies were<0.5 mm, both in the horizontal and vertical planes. The mean overall horizontal and vertical discrepancy between the digital design and final miniscrew position on the left side was 0.32 ± 0.15 mm and 0.34 ± 0.17 mm, respectively. The maximum horizontal discrepancy observed was 0.72 mm. No significant differences were observed in relation to the accuracy of mini-implant positioning on the basis of sidedness, either for horizontal (P= 0.29) or vertical (P= 0.86) discrepancy. High levels of accuracy associated with guided insertion of paramedian palatal implants were recorded with mean discrepancies of less than 0.5 mm both in the horizontal and vertical planes. No difference in accuracy was noted between the left and right sides. Very minor levels of inaccuracy associated both with surgical techniques and surgical guide fabrication were recorded.

Potential of computational models in personalized treatment of obstructive sleep apnea: a patient-specific partial 3D finite element study.

The upper airway experiences mechanical loads during breathing. Obstructive sleep apnea is a very common sleep disorder, in which the normal function of the airway is compromised, enabling its collapse. Its treatment remains unsatisfactory with variable efficacy in the case of many surgeries. Finite element models of the upper airway to simulate the effects of various anatomic and physiologic manipulations on its mechanics could be helpful in predicting surgical success. Partial 3D finite element models based on patient-specific CT-scans were undertaken in a pilot study of 5 OSA patients. Upper airway soft tissues including the soft palate, hard palate, tongue, and pharyngeal wall were segmented around the midsagittal plane up to a width of 2.5 cm in the lateral direction. Simulations of surgical interventions such as Uvulopalatopharyngoplasty (UPPP), maxillo-mandibular advancement (MMA), palatal implants, and tongue implants have been performed. Our results showed that maxillo-mandibular advancement (MMA) surgery of 1cm improved the critical closing pressure by at least 212.2%. Following MMA, the best improvement was seen via uvulopalatopharyngoplasty (UPPP), with an improvement of at least 19.12%. Palatal and tongue implants also offered a certain degree of improvement. Further, we observed possible interacting mechanisms that suggested simultaneous implementation of UPPP and tongue stiffening; and palatal and tongue stiffening could be beneficial. Our results suggest that computational modeling is a useful tool for analyzing the influence of anatomic and physiological manipulations on upper airway mechanics. The goal of personalized treatment in the case of OSA could be achieved with the use of computational modeling.

Surgical Outcomes for Obstructive Sleep Apnea in Korea

Obstructive sleep apnea (OSA) is a common chronic sleep disorder that causes oxygen desaturations, sympathetic hyperactivation, and sleep fragmentation. The gold standard for OSA treatment in adults is positive airway pressure (PAP) therapy, which is effective when used during sleep. However, about half of patients with OSA refuse or are non-adherent to PAP, and some patients have anatomical problems that can be alleviated surgically. Surgery can be considered for patients who are very likely to have successful surgical results, but who are intolerant to PAP or oral appliances because of anatomical abnormalities. There are various surgical modifications of the upper airway for OSA, including nasal surgeries (e.g., septoplasty, turbinoplasty, and endoscopic sinus surgery), nasopharyngeal surgeries, oral and oropharyngeal surgeries (e.g., uvulopalatopharyngoplasty and variations, tonsillectomy, and palatal implants), hypopharyngeal surgeries (e.g., tongue ablation, tongue-base resection, and genioglossus advancement), and multi-level surgeries. Much clinical research has reported the outcomes of various surgical procedures for OSA internationally based on the traditional surgical success rate (defined as ≥ 50% reduction in the postoperative apnea-hypopnea index [AHI], postoperative AHI &lt; 20), and AHI reduction ratio (defined as between the preoperative and postoperative AHI). In addition, many studies investigating the results of various OSA surgeries have been reported in Korea. In this article, we review the characteristics of various upper airway surgical procedures for OSA, global surgical results for OSA, and current surgical outcomes for OSA in Korea.

Finite Element Study to Compare Stress Distribution and Displacement in the Palatal Implant in Lingual Orthodontics in Four Different Combinations of Palatal Implant and Lever Arm

Introduction: The choice of orthodontic appliance depends upon the patients age, profession and availability of them. Lingual orthodontic appliances are preferred over labial by patients because of its invisibility. The aim of this research is to compare the Von Mises stress distribution and displacement of palatal implants in the lingual orthodontic system among four different combinations of palatal implant and lever arm. Materials and Method: Four Finite element models were constructed for the bilaterally extracted first premolar maxillary arch. In all these models 0.018” slot lingual brackets were placed at the center of the clinical crown. A similar retraction force (150gm) was applied with the help of NiTi closed coil spring for all the models but the length of the lever arm vary as well as the palatal implant position also varies in these models. Finite element analysis was then performed to compare the Von Mises stress distribution, and displacement of the palatal implant using ANSYS 12.1 software. Result: In this study, displacement was the same (0.0005 mm) for all four models. Highest amount von mises stress was observed in Model 3 (3.4798 MPa) as a comparison to Model 1 (2.5442 MPa), Model 2 (2.5018 MPa), and Model 4 (3.3854 MPa). The stress value for the palatal implant was within the acceptable fatigue limit of the titanium of 193 MPa therefore all four models combination was safe for the clinical application. Conclusion: Double palatal implant systems were more effective in comparison to the single palatal implant system in lingual orthodontics. In this study, we found that the displacement of the palatal implants was not affected by the length of the lever-arm and the amount of stress was decreased when we increase the length of the lever-arm.

A new technique of palatal implantation using platelet rich plasma and septal cartilage for management of obstructive sleep apnea

A new technique of palatal implantation using platelet rich plasma and septal cartilage for management of obstructive sleep apnea

Orthodontics mini implants – A brief review

In routine orthodontics practice anchorage is a critical factors that determining the success of an orthodontic treatment. For many years’ anchorage has been a strenuous factor. Many modalities have been tried for preventing the anchorage loss by using the extra oral and intraoral devices according to various scientific literature, yet the orthodontists did not find any convenient solutions to solve this problem until the mini- implants were emerged to the speciality. During the early 20 century introduction of various skeletal anchorage devices which includes prosthetic implants, palatal implants, mini-plates and screws. The implants used in orthodontics for the purpose of effective treatment are also known as Temporary Anchorage Devices (TADs), which helps in bringing down the strenuous efforts employed to prevent anchorage loss and they are easy and small and can be insert and remove without stenos efforts, they can be immediately loaded after insertion, and they can provide absolute anchorage for orthodontic treatment, which require minimal need patient compliance there by increasing its popularity. This article gives a brief reviews of indications, contraindications, safety zones for TADs, their insertion procedure, complications, failures and medico legal aspects.

Tads in Orthodontics

Anchorage is one of the important aspects of orthodontic treatment TAD have gained profound applications in contemporary orthodontic protocol. To treat almost every genre of malocclusion be it arising from dentoalveolar component, skeletal component or combination of both Various skeletal anchorage devices were introduced in the 20th century which includes prosthetic implants, palatal implants and implants, mini-plates and screws. This article reviews their classification, indications, contraindications, safety zones for TADs, their advantages, complications.

Accuracy of direct insertion of TADs in the anterior palate with respect to a 3D-assisted digital insertion virtual planning.

Direct and 3D-assisted methods are an available alternative when inserting temporary anchorage devices (TADs) in the anterior palate for orthodontic anchorage. This study aimed to evaluate the differences between a planned insertion versus a direct method on digital models. Seventy TADs were inserted by the direct insertion method in 35 patients who needed palatal TADs for orthodontic anchorage. For each patient, placement was independently planned by the superimposition of lateral cephalograms and corresponding plaster models. After mini-implant placement, impressions were taken with scanbodies. For the measurement of both linear and angle deviations, virtual planning models and postoperative oral scans were compared using 3D software for automatic surface registration and calculations. Comparing TADs positioned by the direct method and the digitally planned method, a mean linear distance was found of 2.54±1.51mm in the occlusal view and 2.41±1.33mm in the sagittal view. No significant difference has been found between TADs positioned in the right and left palatal sides. A mean distance of 7.65±2.16mm was found between the tip of the digitally planned TAD and the central incisors root apex. Both direct and 3D-assisted TAD insertion methods are safe and accurate in the anterior palate. However, the use of insertion guides facilitates TAD insertion, allowing less-experienced clinicians to use palatal implants.

Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment.

This systematic review provides supporting evidence for the accompanying clinical practice guideline on the referral of adults with obstructive sleep apnea (OSA) for surgical consultation. The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of upper airway sleep apnea surgery or bariatric surgery to no treatment as well as studies that reported on patient-important and physiologic outcomes pre- and postoperatively. Statistical analyses were performed to determine the clinical significance of using surgery to treat obstructive sleep apnea in adults. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for making recommendations. The literature search resulted in 274 studies that provided data suitable for statistical analyses. The analyses demonstrated that surgery as a rescue therapy results in a clinically significant reduction in excessive sleepiness, snoring, blood pressure (BP), apnea-hypopnea index (AHI), respiratory disturbance index (RDI), and oxygen desaturation index (ODI); an increase in lowest oxygen saturation (LSAT) and sleep quality; and an improvement in quality of life in adults with OSA who are intolerant or unaccepting of positive airway pressure (PAP) therapy. The analyses demonstrated that surgery as an adjunctive therapy results in a clinically significant reduction in optimal PAP pressure and improvement in PAP adherence in adults with OSA who are intolerant or unaccepting of PAP due to side effects associated with high pressure requirements. The analyses also demonstrated that surgery as an initial treatment results in a clinically significant reduction in AHI/RDI, sleepiness, snoring, BP, and ODI and an increase in LSAT in adults with OSA and major anatomical obstruction. Analysis of bariatric surgery data showed a clinically significant reduction in BP, AHI/RDI, sleepiness, snoring, optimal PAP level, BMI, and ODI and an increase in LSAT in adults with OSA and obesity. Analyses of very limited evidence suggested that upper airway surgery does not result in a clinically significant increase in risk of serious persistent adverse events and suggested that bariatric surgery may result in a clinically significant risk of iron malabsorption that may be managed with iron supplements. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. Kent D, Stanley J, Aurora RN, etal. Referral of adults with obstructive sleep apnea for surgical consultation: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(12):2507-2531.

Factors influencing the removal torque of palatal implant used for orthodontic anchorage

BackgroundA non-invasive method has recently been introduced to remove osseo-integrated palatal implants by using the implantation ratchet which is designed to screw in or unscrew the implants. Although a proof of concept has been published, the torque involved to successfully explant have not been investigated so far. The aim of this study was to assess the removal torque required to explant osseo-integrated and orthodontically utilized palatal implants, and to identify potentially influencing variables.Materials and methodThirty-one consecutive patients (15 females, 16 males; mean age 24.1 ±7.4 years) with fully osseo-integrated and previously orthodontically loaded palatal implants (Orthosystem®: diameter 4.1mm/length 4.2mm/sandblasted with large grits (SLA) surface) were randomly assigned to either clockwise or counter-clockwise non-invasive explantation. The respective explantation tool with an electric torque control was placed on the abutment connection of the implant and secured by an occlusal screw.The primary outcome studied was maximal removal torque (MRT) needed to detach the implant from its socket which was recorded individually together with other potentially influencing secondary outcomes (gender, age, orthodontic loading time, use of local anaesthetics). Student’s t-test was used to contrast MRT difference for the gender, type of suprastructure, use of local anaesthetics, and rotational direction.Spearman correlations was used to investigate associations between MRT and patient’s age or duration loading time.ResultsAverage MRT (148.6 ± 63.2N/cm) using ratchet as a non-invasive removal method of palatal implant was considered safe. The triangular head fractured of palatal implant at a torque level of 300.1 Ncm. Significantly higher explantation were recorded for male patients compared to female patients (182.0 ± 63.0 Ncm vs 112.8 ± 40.8 Ncm; P=0.001). On the other side, the mean removal torque for palatal removal in clockwise direction was non-significantly different (158.3 ± 58.6 Ncm) compared to counter-clockwise direction (139.4 ± 67.9 Ncm). Neither patient’s age (p=0.324) nor loading time (p=0.214) were significantly correlated with removal torque values.ConclusionsPertinent literature on this subject is practically non-existent, as orthodontics is presumably the only discipline where implant removal represents a treatment success. Mean MRT for successful palatal implant removal was 148.6±63.2Ncm, but a large spectrum was observed (minimum 31.5Ncm, maximum 272.8Ncm). This obvious heterogeneity underlines the importance to investigate possible influencing factors. The safe and simple non-invasive method for palatal implant removal necessitates moderate, but not high torque MRTs, independently of the torque direction. The necessary MRT seems clearly influenced by gender, but less so by patient’s age or loading time.

Comparison of stability changes of various palatal implants.

Aim:The aim of this study was to comparatively evaluate stability changes in palatal implants during the early stages of bone healing with chemically modified sandblasted/acid-etched (modSLA) titanium surface compared with a standard sandblasted (SLA) titanium palatal implants.Materials and Methods:A statistically significant number (n = 40; 24 females and 16 males) of adult subjects who volunteered and have their informed consent for participating in the study were selected. These volunteers were randomly allocated to the experimental group (modSLA surface) and to the control group (SLA surface) with 20 subjects in each group. Documentation of implant stability was done by assessing resonance frequency analysis (RFA) at implant insertion, followed by subsequent assessments each week till 12th week from baseline (1–12 weeks). RFA values were expressed as an implant stability quotient (ISQ).Results:Immediately after installation of implant, the ISQ values for both surfaces tested were not significantly different and yielded mean values of 75.28 ± 5.23 for the control and 73.16 ± 4.81 for the test surface. In the first 2 weeks after implant installation, both groups presented only small changes and thereafter a reducing trend in the mean ISQ levels. In the test group, after 4 weeks a tendency toward increasing ISQ values was observed, and 6 weeks after surgery the ISQ values corresponded to those after implant insertion. For the SLA control group, the trend changed after fifth week and yielded ISQ values corresponding to the baseline after ninth week. After 12 weeks of observation, the test surface yielded significantly higher stability values of 78.68 ± 2.9 compared with the control implants of 75.5 ± 3.19, respectively.Conclusion:The results undoubtedly support and validate the potential for chemical modification of the SLA surface to positively influence the biologic process of osseointegration and also a faster healing.

Complications of Palatal Pillar Implants: An analysis of the MAUDE database and literature review.

The Pillar Palatal Implant System is a minimally invasive procedure for the treatment of obstructive sleep apnea and snoring. Prior studies have examined the effectiveness of this procedure, however no prior study has thoroughly evaluated its complications. We anticipate that this analysis will provide valuable insight into these procedures which can be used in patient education and post-operative follow-up. The Manufacturer and User Facility Device Experience (MAUDE) database was queried for cases reporting injury related to the pillar procedure. The case narratives were individually analyzed and categorized by type of complication. A comparison of extruding parts and select complications was also performed using chi-square analysis. Of the 261 cases reported, 73.6% reporting extruding parts, 47.5% described patient pain, and 38.7% included patients describing a foreign body sensation. Infection was reported in 7.7% of the cases with cellulitis and abscess formation specifically mentioned in one case. Cases describing pain and difficulty swallowing were significantly more likely to have reported extruding parts (p < 0.05). This study describes various complications associated with this procedure. The description of these complications and accompanying literature review may provide healthcare professionals and patients with an understanding of the scope of adverse events related to this procedure.

Predictive values of resonance frequency analysis as a diagnostic tool in palatal implant loss.

To determine the diagnostic value of resonance frequency analysis (RFA) in predicting palatal implant (PI) loss. RFA values of 32 patients (study center at Mainz and Dresden) were evaluated in a prospective randomized controlled trial addressing clinical performance of two loading concepts on PI (Orthosystem, Straumann, Basel, Switzerland). Group 1: conventional loading after a 12-week healing period vs group 2: immediate loading within one week after insertion. Stability was assessed by RFA after surgical insertion (T1), one week (T2), and 12 weeks (T3) later. All 32 PI were clinically stable after surgical insertion; 14 PI were loaded conventionally and 18 immediately. One implant in group 1 was lost 6 weeks after insertion. One drop-out was registered in group 2. One false positive and three false negative implant stability quotients (ISQ) were observed. ISQ values of clinically stable PI in group 1 were 67.2 (SD ± 9.5) at T1, 62.3 (SD ± 11.7) at T2, and 68.2 (SD ± 5.5) at T3. Group 2 showed 67.1 (SD ± 11.7) at T1, 65.4 (SD ± 10.4) at T2, and 72.3 (SD ± 5.6) at T3. Differences between groups were not statistically significant for starting time (P = .88) and change from T1 to T2: 0.08 but were significant from T1 to T3: P = .04; (regression analysis). RFA had no sensitivity for prediction of stability. General decrease after primary stability and increase with secondary stability gives support for specificity. Within the limits of the study, only the diagnostic value of RFA identifying stable palatal implants could be confirmed.

Failure rates of palatal implants or mini-screws for orthodontic anchorage.

Data sources Medline, Embase, the Cochrane Oral Health Group's Trials Register, CENTRAL, ClinicalTrials.gov, the National Research Register and Pro-Quest Dissertation Abstracts and Thesis databases. Study selection Randomised controlled trials (RCTs) non-randomised, or quasi-randomised controlled trials, prospective and retrospective studies involving the assessment of success or failure of palatal implants or palatal mini-screws for orthodontic anchorage reinforcement were considered.Data extraction and synthesis Two reviewers independently selected the studies, extracted data and assessed risk of bias. A narrative synthesis was presented. Results Twenty-seven studies (four RCTs, 12 prospective and 11 retrospective studies) were included.Conclusions No clinically meaningful difference in failure risk seems to exist between palatal implants and mini-screws, however the quality of the available evidence is very low. The studies included between 9 to 384 palatal implants or mini-screws with follow up period ranging from 2 - 35.6 months (median = 17.9). The risk of failure (18 studies) ranged from 0.0 - 26.1% (median 6.0%). The risk of failure in the four RCTS ranged from 2.5 -26.1% (median = 8.8%).

Temporary Single Palatal Implant for Denture Stabilization During Augmentation and Implant Procedure: A Case Report

This case report introduces a temporary denture with reduced extension stabilized in the edentulous maxilla as a possible treatment method for patients with a severe gag reflex, allowing them to test the function, esthetics, and tolerance of the denture prior to hard tissue augmentation and implant placement. A 4-mm implant was placed in the central anterior palate and allowed to heal for 3 months. During the complete treatment period, a denture with reduced extension can be delivered on a fixed Locator abutment. This method was successfully applied in three patients, and the palatal implant remained stable until the final removable prosthesis could be delivered.

Skeletal anchorage in orthodontics: possibilities and limits

This presentation highlights the new treatment options by the introduction of Temporary Anchorage Devices (TADs) in orthodontics with special respect to the palatal implants and miniscrews. The indications and limitations of such TADs are presented on the basis of clinical cases and the scientific literature. TADs are mainly indicated for space closure of tooth agenesis, treatment of asymmetries and the extension of orthodontic treatment options in orthognathic borderline cases. The knowledge of the limits of such systems and their special biomechanics are fundamental. In growing children though, conventional anchorage systems may often be preferable.

Long-term results of palatal implantation for severe obstructive sleep apnea patients with prominent retropalatal collapse

BackgroundMost previous reports on palatal implantation for patients with severe obstructive sleep apnea have been anecdotal. Our objective in this study was to assess the long-term outcomes of palatal implantations from objective as well as subjective perspectives when applied to patients with severe obstructive sleep apnea and prominent retropalatal collapse. MethodsThis retrospective review was conducted in a single institution using subjective data (Epworth Sleepiness Scale and visual analog scales of snoring sounds and sleep quality) and objective data (respiratory disturbance index, minimum O2 saturation, sleep efficiency, and snoring index using a polysomnograph) before and after surgery. A total of ten patients were enrolled in this study. The median time between pre-operative sleep-related tests and the operation date was 1.0 months and the median time between operation date and post-operative sleep-related tests was 33.0 months. ResultsSignificant improvements were observed in the visual analog scale scores of snoring (p = 0.004), visual analog scale scores of sleep quality (p = 0.005), and Epworth Sleepiness Scale (p = 0.012). Eight of the ten patients reported a reduction of at least 50% on the visual analog scale of snoring sounds, which was the criterion of subjective surgical success. We also observed significant improvements in the respiratory disturbance index (p = 0.009) and minimum O2 saturation (p = 0.033). Two of the ten patients presented a reduction in respiratory disturbance index of ≥50% and a subsequent respiratory disturbance index of <20, which were the criteria of objective surgical success. A percentage change in respiratory disturbance index was negatively associated with prominent retrolingual collapse and the length of the soft palate. ConclusionPatients with severe obstructive sleep apnea and prominent retropalatal collapse may benefit from palatal implantation from a subjective perspective. Palatal implantation could be considered an alternate form of treatment for some cases of severe obstructive sleep apnea, due to the likelihood of improvement in clinical symptoms and the normalization of sleep quality.

The palatal septal cartilage implantation for snoring and obstructive sleep apnea

ObjectivePatients with snoring and obstructive sleep apnea frequently have nasal and palatal obstruction. The objective of this study was to investigate the safety and feasibility of a palatal septal cartilage implant (SCI) for snoring and obstructive sleep apnea. MethodsThis was a preliminary study of 10 consecutive patients who were enrolled retrospectively from electronic charts. The patients had undergone a single-stage operation including septoturbinoplasty and palatal SCI at a tertiary referral hospital. After nasal surgery, the harvested cartilage was prepared and trimmed into strips for palatal implantation. Key procedures of palatal SCI include vertical tunneling of the midline and paramedian soft palate, insertion of the septal cartilage strips, and fixation suture of the implants. The primary outcome measures were adverse events, including implant extrusion, infection, bleeding, velopharyngeal insufficiency and globus symptoms, assessed by the Glasgow–Edinburgh Throat Scale (GETS) questionnaire (10-item, 8-grade [0–7] Likert scale). Secondary outcomes were subjective snoring loudness (visual analogue scale, VAS), excessive daytime sleepiness (Epworth sleepiness scale, ESS) and objective apnea-hypopnea index. All patients were followed up for at least 1 year. ResultsNone of the aforementioned adverse events were noted during the one-year follow-up. Among the ten items of the GETS, the median score of nine items was 0, and the median score of the total GETS was 2.0, which was classified as “asymptomatic”. The snoring loudness improved significantly from 8.0 points (IQR 8.0–9.0) preoperation to 4.0 points (IQR 2.5–6.0) at 3 months postoperation and 4.5 points (IQR 3.3–6.0) at 1 year postoperation (P=0.002 and P=0.002, respectively). The ESS score improved significantly from 11.5 points (IQR 8.3–18.5) preoperation to 8.0 points (IQR 6.3–10.8) at 3 months postoperation and 8.5 points (IQR 6.3–10.8) at 1 year postoperation (P=0.004 and P=0.004, respectively). The apnea-hypopnea index significantly decreased from 54.7 (IQR 23.4–62.8) to 20.5 (IQR 14.7–45.6) (P=0.047) in patients with a lower tongue position (modified Mallampati class≤II; n=7). ConclusionPalatal SCI is a safe and feasible procedure. The advantages include providing implants of tailor-made length, biocompatible autologous cartilage and no need for extra-payment for the implant material. By using the SCI procedure, both nasal obstruction and sleep-disordered breathing can be managed in a single-stage operation. The long-term effectiveness of SCI deserves further research.

Success of palatal implants or mini-screws placed median or paramedian for the reinforcement of anchorage during orthodontic treatment: a systematic review.

To assess the failure rates of palatal implants and palatal mini-screws, independently and comparatively, used for supplementing anchorage during orthodontic treatment. The protocol was not registered prior to the study. This study was not registered in any publicly assessable database. Screening for inclusion eligibility, quality assessment of studies, and data extraction was performed independently by two authors. The electronic databases MEDLINE, EMBASE, and CENTRAL, as well as unpublished literature, were searched with no restrictions on publication date or language using detailed strategies. The main outcome assessed was palatal implant or mini-screw failure. Randomized controlled trials were evaluated according to the Cochrane risk of bias tool. Prospective and retrospective studies were graded employing the adjusted predetermined criteria of Bondemark. Twenty-seven studies satisfied the inclusion criteria. Four were RCTs of low risk of bias, 12 were prospective (2 low, 7 unclear, 3 high risk of bias) and 11 were retrospective studies (6 unclear, 5 high risk of bias). Only one retrospective study assessed both palatal implants and mini-screws. Seventeen studies, including the four RCTs, assessed solely palatal implants and nine studies palatal mini-screws. The median failure risk of palatal implants was 6.0 per cent (range: 0.0-26.1%) and of mini-screws 6.1 per cent (range: 0.0-33.3%). The median follow-up period was 17.9 months for palatal implants and 6 months for mini-screws. Significant clinical and methodological heterogeneity among studies and highly variable outcomes. Both palatal implants and mini-screws have quite low failure rates that are also comparable, though the median follow-up period of palatal implants was quite larger. Therefore, in regular orthodontic cases, the choice between anchoring devices may rely on other factors, such as costs, patient comfort, personal preferences, familiarity with the device, and insertion procedures.