Treatment Planning Phase Research Articles

Digital planning in joint orthodontic-restorative care.

Combined orthodontic-restorative treatment represents an increasing proportion of our practice, mirroring increasing provision of adult orthodontics and refinements in appliance design. By harnessing simple digital technology, it may be possible to promote more predictable aesthetic, biological and functional interdisciplinary outcomes. In particular, digital approaches can be embedded in the diagnostic and treatment planning phase, enhancing our communication with patients and colleagues while also permitting more detailed analysis and more refined planning.

CBCT in Dental Implantology: A Key Tool for Preventing Peri-Implantitis and Enhancing Patient Outcomes.

(1) Introduction: Trust is a cornerstone of the patient-physician relationships. Unforeseen complications in the health care system could jeopardize patients' trust in their physicians. (2) Aim: This article presents a quantitative figure regarding foreseeing the necessity of a three-dimensional quantitative visualization of bone structure and concurrently preparing for an ancillary procedure by a dentist to successfully perform the surgery that could minimize unforeseen complications; (3) Materials and method: This retrospective study has been derived based on an analysis of 1134 patients who had received 4800 dental implants from January 2001 to August 2020, out of which 200 cases were randomly selected for this study. Each procedure during implant treatment was categorized as OPG (Orthopantomography) or OPG with CBCT as per all the procedures which included and were coded as follows, 1: Surgery & Restoration, 2: GBR (Guided Bone Regeneration), 3: GTR (Guided Tissue Regeneration), 4: Block Bone Graft, 5: Spreading, 6: Splitting, 7: Internal Sinus, 8: External Sinus, 9: PRF (Platelet Rich Fibrin). Any of the 200 cases in which implant placement could not have been performed for reasons related to a lack of CBCT were selected for this study. The surgery was aborted halfway through without implant placement in these cases due to a lack of bone quantity and/or lack of primary stability. These cases were registered for re-evaluation and statistical analysis; (4) Results: 7% of the cases that used OPG alone led the surgeon to unexpectedly abort in the middle of the surgery without implant placement. All (100%) of the patients who had CBCT during treatment planning were able to receive implants during the surgery. None of the patients left the surgery without receiving implants if CBCT was used (0%); (5) Discussion: Radiographic image quality is defined as the amount of information within the image that allows the radiologist to make a diagnostic decision with a particular level of certainty (Martin et al., 1999) and hence the importance of CBCT. The unexpected 7% of devastating situations for patients who started surgery but did not have implant placement led to [A] aborting the surgery, [B] procedural difficulties requiring an alternative treatment plan, [C] a negative impact on the patient's behavior, and [D] wanting to change doctor due to a lack of trust; (6) Conclusion: This study indicates that in implant dentistry patients' mistrust could be avoided by 7% if CBCT is obtained. It also shows the significance of cone-beam computed tomography as an adjunct to panoramic radiography during the diagnosis and treatment planning phase. The use of panoramic radiography alone can lead to a 7% likelihood of misdiagnosis. A lack of CBCT during treatment planning negatively affects the outcome of surgical procedures.

Interdisciplinary Collaboration in Head and Neck Cancer Care: Optimizing Oral Health Management for Patients Undergoing Radiation Therapy.

Radiation therapy (RT) plays a crucial role in the treatment of head and neck cancers (HNCs). This paper emphasizes the importance of effective communication and collaboration between radiation oncologists and dental specialists in the HNC care pathway. It also provides an overview of the role of RT in HNC treatment and illustrates the interdisciplinary collaboration between these teams to optimize patient care, expedite treatment, and prevent post-treatment oral complications. The methods utilized include a thorough analysis of existing research articles, case reports, and clinical guidelines, with terms such as 'dental management', 'oral oncology', 'head and neck cancer', and 'radiotherapy' included for this review. The findings underscore the significance of the early involvement of dental specialists in the treatment planning phase to assess and prepare patients for RT, including strategies such as prophylactic tooth extraction to mitigate potential oral complications. Furthermore, post-treatment oral health follow-up and management by dental specialists are crucial in minimizing the incidence and severity of RT-induced oral sequelae. In conclusion, these proactive measures help minimize dental and oral complications before, during, and after treatment.

Depressive Symptoms, Systemic Inflammation, and Survival Among Patients With Head and Neck Cancer

Patients with head and neck cancer experience high rates of depression. Depression and systemic inflammation have been found to be associated in numerous cancer types, often independently from disease status. Depression-related inflammation may elevate the risks for poor tumor response to treatment and early mortality, and comprises a mechanism by which depression is associated with survival in head and neck cancer. To assess mediation pathways incorporating pretreatment depressive symptoms, pretreatment inflammation, and tumor response posttreatment on overall survival among patients with head and neck cancer. This was a prospective observational cohort study of patients with head and neck cancer treated in a single multidisciplinary head and neck cancer clinic from May 10, 2013, to December 30, 2019, and followed up for 2 years. Data analysis was performed from June 29, 2022, to June 23, 2023. Patient-reported depressive symptoms using the Patient Health Questionnaire-9 item (PHQ-9) at treatment planning; pretreatment hematology workup for systemic inflammation index (SII) score; and clinical data review for tumor response (complete vs incomplete) and overall survival. Two-year overall survival. The total study cohort included 394 patients (mean [SD] age, 62.5 [11.5] years; 277 [70.3%] males) with head and neck cancer. Among 285 patients (72.3%) who scored below the clinical cutoff for depression on the PHQ-9, depressive symptoms were significantly associated with inflammation (partial r, 0.168; 95% CI, 0.007-0.038). In addition, both depression and inflammation were associated with early mortality (PHQ-9: hazard ratio [HR], 1.04; 95% CI, 1.02-1.07; SII: HR, 1.36; 95% CI, 1.08-1.71). The depression-survival association was fully mediated by inflammation (HR, 1.28; 95% CI, 1.00-1.64). Depressive symptoms were also associated with poorer tumor response (odds ratio, 1.05; 95% CI, 1.01-1.08), and the depression-survival association was partially mediated by tumor response (HR, 9.44; 95% CI, 6.23-14.32). Systemic inflammation was not associated with tumor response. In this cohort study, systemic inflammation emerged as a novel candidate mechanism of the association of depression with mortality. Tumor response partially mediated effects of depression on mortality, replicating prior work. Thus, depression stands out as a highly feasible target for renewed clinical attention. Even mild symptoms of depression during the treatment-planning phase may be associated with higher systemic inflammation in addition to poorer tumor response to treatment and survival outcomes; therefore, depression should be clinically addressed.

Causal analysis of radiotherapy safety incidents based on a hybrid model of HFACS and Bayesian network.

This research investigates the role of human factors of all hierarchical levels in radiotherapy safety incidents and examines their interconnections. Utilizing the human factor analysis and classification system (HFACS) and Bayesian network (BN) methodologies, we created a BN-HFACS model to comprehensively analyze human factors, integrating the hierarchical structure. We examined 81 radiotherapy incidents from the radiation oncology incident learning system (RO-ILS), conducting a qualitative analysis using HFACS. Subsequently, parametric learning was applied to the derived data, and the prior probabilities of human factors were calculated at each BN-HFACS model level. Finally, a sensitivity analysis was conducted to identify the human factors with the greatest influence on unsafe acts. The majority of safety incidents reported on RO-ILS were traced back to the treatment planning phase, with skill errors and habitual violations being the primary unsafe acts causing these incidents. The sensitivity analysis highlighted that the condition of the operators, personnel factors, and environmental factors significantly influenced the occurrence of incidents. Additionally, it underscored the importance of organizational climate and organizational process in triggering unsafe acts. Our findings suggest a strong association between upper-level human factors and unsafe acts among radiotherapy incidents in RO-ILS. To enhance radiation therapy safety and reduce incidents, interventions targeting these key factors are recommended.

Detecting outliers beyond tolerance limits derived from statistical process control in patient-specific quality assurance.

Tolerance limit is defined on pre-treatment patient specific quality assurance results to identify "out of the norm" dose discrepancy in plan. An out-of-tolerance plan during measurement can often cause treatment delays especially if replanning is required. In this study, we aim to develop an outlier detection model to identify out-of-tolerance plan early during treatment planning phase to mitigate the above-mentioned risks. Patient-specific quality assurance results with portal dosimetry for stereotactic body radiotherapy measured between January 2020 and December 2021 were used in this study. Data were divided into thorax and pelvis sites and gamma passing rates were recorded using 2%/2mm, 2%/1mm, and 1%/1mm gamma criteria. Statistical process control method was used to determine six different site and criterion-specific tolerance and action limits. Using only the inliers identified with our determined tolerance limits, we trained three different outlier detection models using the plan complexity metrics extracted from each treatment field-robust covariance, isolation forest, and one class support vector machine. The hyperparameters were optimized using the F1-score calculated from both the inliers and validation outliers' data. 308 pelvis and 200 thorax fields were used in this study. The tolerance (action) limits for 2%/2mm, 2%/1mm, and 1%/1mm gamma criteria in the pelvis site are 99.1% (98.1%), 95.8% (91.1%), and 91.7% (86.1%), respectively. The tolerance (action) limits in the thorax site are 99.0% (98.7%), 97.0% (96.2%), and 91.5% (87.2%). One class support vector machine performs the best among all the algorithms. The best performing model in the thorax (pelvis) site achieves a precision of 0.56 (0.54), recall of 1.0 (1.0), and F1-score of 0.72 (0.70) when using the 2%/2mm (2%/1mm) criterion. The model will help the planner to identify an out-of-tolerance plan early so that they can refine the plan further during the planning stage without risking late discovery during measurement.

Quality of life of patients with Parkinson’s disease and their families

Abstract Aim. The purpose was to determine the quality of life of Parkinson’s disease patients and their family members and to identify the factors that affect it. Material and methods. The research sample included 183 patients with Parkinson’s disease and 78 family members. Quality of life was assessed using the Czech Quality of Life Questionnaire of Patients with Progressive Neurological Disease. Results. Patients with a longer duration of the disease had a lower overall quality of life. The connection between higher dependence of patients on daily activities, and higher degree of motor disability was associated with a poorer quality of life in patients. In family members, an association was demonstrated between older age and a lower quality of life in the domain of normal daily activity, social and spiritual area. With older age, the higher burden of symptoms also increased and deteriorated overall quality of life. The connection between higher dependence of patients on daily activities and a worse quality of life of caregivers in the three domain was confirmed. Conclusions. Regular assessment of the impact of Parkinson’s disease on the quality of life of patients and their family and the identification of factors that affect it can help prioritize the treatment planning phase.

The future of MRI in radiation therapy: Challenges and opportunities for the MR community.

Radiation therapy is a major component of cancer treatment pathways worldwide. The main aim of this treatment is to achieve tumor control through the delivery of ionizing radiation while preserving healthy tissues for minimal radiation toxicity. Because radiation therapy relies on accurate localization of the target and surrounding tissues, imaging plays a crucial role throughout the treatment chain. In the treatment planning phase, radiological images are essential for defining target volumes and organs-at-risk, as well as providing elemental composition (e.g., electron density) information for radiation dose calculations. At treatment, onboard imaging informs patient setup and could be used to guide radiation dose placement for sites affected by motion. Imaging is also an important tool for treatment response assessment and treatment plan adaptation. MRI, with its excellent soft tissue contrast and capacity to probe functional tissue properties, holds great untapped potential for transforming treatment paradigms in radiation therapy. The MR in Radiation Therapy ISMRM Study Group was established to provide a forum within the MR community to discuss the unmet needs and fuel opportunities for further advancement of MRI for radiation therapy applications. During the summer of 2021, the study group organized its first virtual workshop, attended by a diverse international group of clinicians, scientists, and clinical physicists, to explore our predictions for the future of MRI in radiation therapy for the next 25 years. This article reviews the main findings from the event and considers the opportunities and challenges of reaching our vision for the future in this expanding field.

A Novel MRI Diagnosis Method for Brain Tumor Classification Based on CNN and Bayesian Optimization.

Brain tumor is one of the most aggressive diseases nowadays, resulting in a very short life span if it is diagnosed at an advanced stage. The treatment planning phase is thus essential for enhancing the quality of life for patients. The use of Magnetic Resonance Imaging (MRI) in the diagnosis of brain tumors is extremely widespread, but the manual interpretation of large amounts of images requires considerable effort and is prone to human errors. Hence, an automated method is necessary to identify the most common brain tumors. Convolutional Neural Network (CNN) architectures are successful in image classification due to their high layer count, which enables them to conceive the features effectively on their own. The tuning of CNN hyperparameters is critical in every dataset since it has a significant impact on the efficiency of the training model. Given the high dimensionality and complexity of the data, manual hyperparameter tuning would take an inordinate amount of time, with the possibility of failing to identify the optimal hyperparameters. In this paper, we proposed a Bayesian Optimization-based efficient hyperparameter optimization technique for CNN. This method was evaluated by classifying 3064 T-1-weighted CE-MRI images into three types of brain tumors (Glioma, Meningioma, and Pituitary). Based on Transfer Learning, the performance of five well-recognized deep pre-trained models is compared with that of the optimized CNN. After using Bayesian Optimization, our CNN was able to attain 98.70% validation accuracy at best without data augmentation or cropping lesion techniques, while VGG16, VGG19, ResNet50, InceptionV3, and DenseNet201 achieved 97.08%, 96.43%, 89.29%, 92.86%, and 94.81% validation accuracy, respectively. Moreover, the proposed model outperforms state-of-the-art methods on the CE-MRI dataset, demonstrating the feasibility of automating hyperparameter optimization.

Digital and microscopic tools for ultimate esthetics and precision.

This clinical report describes and illustrates step-by-step protocols for interdisciplinary esthetic treatment with current digital and microscopic tools. Digital dentistry is no longer limited to impression making and restoration fabrication but starts already in the diagnostic and treatment planning phase. In particular, digital smile design tools have significantly improved clinical and laboratory workflows, allowing for natural and facially driven smiles, based on the patient's specific needs and preferences. Digital technologies also facilitate high precision and accuracy in the laboratory, which are interconnected with the quality of the clinical care. Precision and minimally invasive dentistry require visual magnification aids through high-power loupes or, even better, surgical microscopes. For optimal clinical success, however, these tools must be integrated into efficient workflows and made part of a comprehensive clinical and laboratory concept. Digital and high-magnification tools in clinics and dental laboratories facilitate highly esthetic and precise outcomes when integrated into a comprehensive treatment concept. While a plethora of new tools and technologies is available for the dental laboratory and clinical practice, they can be daunting. Clear step-by-step workflows and protocols must be followed to apply them in a most efficient and effective manner for optimal outcomes.

Examinarea unor explanturi prin microscopie electronică şi corelaţii cu scorul biomecanic al restaurǎrilor protetice cu sprijin implantar

Objectives. The objective of our study was to evaluate the bone-implant interface in 10 cases of failure of fixed implant-prosthetic treatment by electron microscopy and spectrophotometry, in correlation with the evolution of Renouard-Rangert biomechanical scoring. Material and method. The study material was represented by 10 dental implants of 3 different morphological types (A, B, C), from the Biomat © collection, Polytechnic University of Bucharest, which were examined under the Phenom ProX electron microscope. The studied samples had a file in which there was noted the biomechanical score Renouard-Rangert from the treatment planning phase, but also from the patient dispensary phase. The survival time of the analyzed samples at the level of the maxillary bones was 7-24 months. Results. Following the examination at the electron microscope, the presence of an adherent neoformation bone tissue was detected on every implant, which covered each implant relatively uniform, with different degrees of mineralization depending on the type of implant, the duration of bone implantation and evolution of biomechanical scoring in red or yellow. Discussions. The use in our study only of standard size implants is an important advantage over other studies using mini-implants or temporary implants. The cases in which the biomechanical scoring reached "red" showed a lower degree of mineralization, and those that reached "yellow" had a higher degree of mineralization. Among the cases with biomechanical soring "in yellow" were samples collected from the posterior maxillary region, generally considered a risk area in implantology. Conclusions. In our study we found a correspondence between the modification of the Renouard-Rangert biomechanical scoring and the degree of mineralization of the bone deposited on the surface of the explants. Regardless of the evolution of biomechanical scoring, on all 10 analyzed samples we found a close contact between the neoformation tissue and the implanted devices, which indicates the high biocompatibility of the three types of implants. The relatively small number of samples analyzed is a limitation of our study. In the future, we recommend, in order to validate the results, to extend the study to a greater number of cases.

Dental software classification and dento-facial interdisciplinary planning platform.

Despite all advantages provided by the digital workflow, its application in clinical practice is still more focused on device manufacturing and clinical execution than on treatment planning and communication. The most challenging phases of treatment, comprehensive planning, diagnosis, risk assessment, and decision-making, are still performed without significant assistance from digital technologies. This article proposes a new dental software classification based on the digital workflow timeline, considering the moment of patient's case acceptance as key in this classification, and presents the ideal software tools for each phase. The proposed classification will help clinicians and dental laboratories to choose the most appropriate software during the treatment planning phase and integrate virtual plans with other software platforms for digitally guided execution. A dento-facial interdisciplinary planning platform virtually simulates interdisciplinary clinical procedures and assists in the decision-making process. The suggested classification assists professionals in different phases of the digital workflow and provides guidelines for improvement and development of digital technologies before treatment plan acceptance by the patient. Three-dimensional interdisciplinary simulations allow clinicians to visualize how each dental procedure influences further treatments. With this treatment planning approach, predictability of different procedures in restorative dentistry, orthodontics, implant dentistry, periodontal, and oral maxillofacial surgery is improved.

APPLICATION OF DIGITAL TECHNOLOGY IN IMPLANT DENTISTRY-AN OVERVIEW

Implants are considered as potential alternatives while replacing missing teeth. Accurate planning and placement of implants in a predetermined position, plays an important role in determining the success of the prosthesis. Digital technology refers to the usage of computer controlled components that minimize manual work. In the past decade, digital technologies, like cone beam computer tomography, have been used right from diagnostic phase to treatment planning phase. With the advent of augmented reality, digital technology can be used even during the surgical phase.

Value-addition of lateral cephalometric radiographs in orthodontic diagnosis and treatment planning.

To investigate the value-addition of obtaining lateral cephalometric radiographs during the treatment planning phase of orthodontic treatment. The records of 100 orthodontic patients were presented to seven scorers during two phases that were 6 weeks apart. In the first phase, scorers completed a seven-question survey with questions regarding treatment planning. They were given various diagnostic records that did not include a lateral cephalometric radiograph. Six weeks later, the same scorers completed the same survey for the same patient cases with the same diagnostic records that additionally included a lateral cephalometric radiograph. Correlation coefficients were used to calculate intrarater agreement and inter-rater agreement within the study. Cohen's kappa values showed moderate to almost perfect agreement for the majority of survey questions. Intrarater agreement ranged between 0.430 and 1. Cronbach's alpha reliability statistics showed good interrater agreement for all questions in the survey. Agreement ranged from 0.710 to 0.913 across the survey questions. Diagnosing Angle classification of occlusion had the highest level of agreement and differentiating between skeletal and dental malocclusion had the lowest level of agreement. The lateral cephalometric radiograph is not a necessary diagnostic tool for most cases in orthodontic diagnosis and treatment planning. Weighing the usefulness of a lateral cephalometric on a case-by-case basis should be recommended to align with the principle of ALARA (as low as reasonably achievable), especially in a primarily pediatric population.

Ultrasonography for diagnosis of peri-implant diseases and conditions: a detailed scanning protocol and case demonstration.

Ultrasonography has shown its promising diagnostic value in dental implant imaging research in the three treatment phases, namely, planning, intraoperative, and postoperative phase. With increasing awareness of peri-implant diseases and a lack of an efficient diagnostic method, the aim is to propose ultrasound imaging as a potential solution by providing a detailed scanning protocol and case demonstration. Ultrasound device specification and the setup for optimizing peri-implant tissue imaging was described. Two useful imaging modes, viz. B-mode and color flow, were introduced. Important anatomical structures for accurate diagnosis of peri-implant diseases were illustrated. Finally, a detailed scanning sequence was proposed. Ultrasound images were acquired on live humans to exemplify the four peri-implant diseases and conditions, endorsed by the 2017 World Workshop organized by the American Academy of Periodontology and the European Federation of Periodontology. Ultrasound can provide not only cross-sectional anatomical images but also functional images (color flow images) that may be useful for evaluating the degree of peri-implant tissue inflammation. High-frequency ultrasonography could be another cross-sectional imaging modality in adjunct to radiographs for diagnosing imminent peri-implant diseases and conditions that negatively influence quality of life of millions of patients with implants. This case study provides a framework for future related research work and clinical scanning guidelines.

Ultra‐widefield fundus photography for radiation therapy planning of ocular tumours

The use of planar ultra-widefield fundus photography (UWF) may result in distortions and inaccurate measurement. The aim of the study was to evaluate the accuracy of UWF instead of the standard narrow field (SF) for the treatment planning phase of ocular tumours. Distortions between conformal SF and UWF were assessed in 43 patients with choroidal melanoma treated with either proton therapy or brachytherapy. imagej software was used to measure distortion. The median interquartile range ([IQR]) distortion for all cases was 3.7% [1.7-10.8]. For cases with tumours within 6mm of the optic disc, distortions appeared clinically nonsignificant. For peripheral and/or large tumours, significantly larger distortions were observed on UWF (median 4.4% [2.7-22.6] for tumours ≥6mm from the optic disc versus 3.3% [1.6-9.9] for those <6mm, p=0.04). Images can be subdivided into three groups: minimal distortion (79.1% of eyes), similar level of major distortion for both measured distances (11.6%) and distortion with unequal level of distortion between the measured distances (9.3%). Distortions with UWF appeared minimal in posterior regions of the fundus and increased with the distance from the posterior pole. UWF could therefore be used for treatment planning of ocular tumours as the planned radiation dose to the macula and optic disc are not impacted.

Positional changes of the anterior maxillary teeth adjacent to single implants during 11 years + a case report

Background Single-implant treatment introduces a new biomechanical situation in the dentate patient. Various levels of infraposition of single-implant restorations have been observed in long-term follow-up studies, but little knowledge is available on the biological mechanism behind this pattern. Another post-treatment complication that has been reported increasingly during the last decade is the loss of the proximal contact point between the restored implant's crown and the adjacent natural teeth. Aim/Hypothesis To assess of tooth movements adjacent to single-implant crown in a long-term study, and to discuss these changes in relation to changes after 11 years. Material and Methods A 19-year-old healthy female, non-smoker patient was treated with one single implant in the upper central incisor after trauma. The results of the measurements of the casts and photographs were compared with clinical photographs taken at the time of treatment (2008), after 6 years (2014), and after 11 years (2019) in function. Results The clinical photographs showed obvious signs of implant infraposition after 6 years. New crowns were made in the incisor region after 6 years (2014), but signs of infraposition were again present at the final examination (2019). The small measured vertical eruption of the teeth was less than the observed clinical infraposition of the implant crowns, indicating that the vertical position of the palatal may have changed in relation to the implants as well. The vertical step measured on radiograph and photograph varied approximately 1.0 mm. Conclusion and Clinical Implications Single-implant restoration in the anterior upper jaw may present small degrees of infraposition in long-term perspectives. Obvious dentofacial changes may take place in adult patients. The clinician should carefully consider these potential changes in the treatment-planning phase, especially in young patients but also in adults of any age, with respect to the tendency of these changes to reduce with age.

The Effect of Crown Lengthening on the Outcome of Endodontically Treated Posterior Teeth: 10-year Survival Analysis

IntroductionThe purpose of this study was to investigate the effect of a crown lengthening (CL) procedure and the crown-root ratio after CL on the long-term survival of endodontically treated teeth (ETT). MethodsPermanent posterior teeth with opposing dentition that had received adequate nonsurgical root canal treatment (NSRCT) and a full-coverage crown between January 1, 2006, and January 1, 2016 were included in this retrospective study. The data collected included dates of the NSRCT, time of extraction if extracted, age, sex, location, the crown-root ratio after CL, and the presence of a lesion. All included ETT were divided into 2 groups:1.the CL group, CL was indicated and performed after NSRCT before crown placement and2.the control group: ETT with adequate ferrule after NSRCT. Data were analyzed using the Kaplan-Cox regression model (α = 0.05). Results5-year survival rates of ETT in the control and CL groups were 88.6% and 82.2%, respectively (P > .05). The 10-year survival rates of ETT in the control and CL groups were 74.5% and 51%, respectively (P < .05). ETT that received the CL procedure after NSRCT were almost 2.3 times more likely to get extracted compared with ETT that did not need the CL procedure at the 10-year follow-up (hazard ratio = 2.29, P < .05). Also, ETT with an inadequate crown-root ratio (1:1) after CL showed the lowest survival rate (40%) compared with ETT with an adequate crown-root ratio (<1:1). ConclusionsA crown-root ratio of 1:1 after osseous CL may affect the long-term survival of ETT. Despite the promising survival rate of ETT with an adequate crown-root ratio after CL, the long-term survival of NSRCT with an inadequate crown-root ratio (1:1) should be considered in the treatment planning phase. Also, it is worth mentioning that the results of the present study should be evaluated in future prospective studies.

Facial burn during orthognathic surgery: Case report

Despite the fact that the advances in surgical techniques have contributed to the reduction in the number of complications associated with orthognathic surgery, problems resulting from different phases of treatment, treatment planning, and postoperative period may occur. This paper presents a case of facial soft tissue lesion, burn in the lower lip region, in a patient with Class III malocclusion during orthognathic surgery. A 22-year, 3-month-old male patient with Class III malocclusion was burned in the paramedian region of the lower lip due to unnoticed overheating of the low-speed handpiece during sagittal osteotomy of the left mandibular ramus. The injury to the patient could have resulted in legal repercussions against the dental surgeon. However, that did not occur. The satisfaction with the aesthetic and functional results, from the standpoint of both dental and facial aspects, was more important for the patient than the aesthetics of the burn sequelae. Although orthognathic surgery is a safe and widely used procedure in association with orthodontic treatment, the risk of complications always exists. No matter how skilled and self-confident the surgeon is, careful attention to the variables that can be controlled should be taken into account in order to reduce the chance of complications that may result in irreversible damages.

Integration of intraoral digital scans with a 3D facial scan for anterior tooth rehabilitation

This article describes a digital technique that combines intraoral digital scans with a 3-dimensional facial scan to predict the outcome of prosthodontic treatment of anterior teeth at the treatment planning phase. This approach may increase patient acceptance of the definitive treatment, as the altered facial appearance is visualized with definitive prosthodontic restorations, thereby improving communication before treatment begins.