Faculty Bibliography

The aim of the study was to assess the effect of bulk material on the reliability and failure modes of narrow-diameter implants. Narrow implants (Ø3.5 × 10 mm - 11° internal conical connection) were manufactured from three different bulk materials: commercially pure titanium grade-IV (CP4), cold-worked titanium (CW), and 4Titude (4Ti), and were evaluated under fatigue testing. Eighteen samples per group were tested under step-stress accelerated life testing through 30° off-axis load application in mild, moderate, and aggressive loading profiles. The number of cycles and load at failure were used to calculate use-level probability curves and reliability for missions of 100,000 cycles up to 200 N, followed by fractographic analyses. Beta values suggested that damage accumulation dictated failures. Reliability analyses at 80, 120, and 150 N evidenced high reliability for narrow implants independent of bulk material. At 200 N, a decrease in reliability was observed for all groups (∼46%). Failure mode analysis depicted similar failures for all groups and comprised implant fracture, abutment fracture, and implant + abutment fractures. Narrow implants presented high reliability for physiologic masticatory forces in the anterior region. Characteristic strength, reliability, and failure modes were similar regardless of bulk material, suggesting that fatigue damage accumulation at thin wall implants dictated failure over bulk material strength.

Gender-affirming care has emerged as a critical component of healthcare, addressing the specific medical and psychosocial needs of transgender and non-binary individuals. In this review article, we address what we see as the most pressing evidence gaps in the gender health literature: long-term effects of pubertal blockers and gender-affirming hormone therapy and the lack of standardised outcome measures of gender-affirming care. Substantial uncertainties persist regarding long-term effects of hormone therapy and the implications of gender-affirming therapy on cancer risk. Though there is some uncertainty about the long-term effects of gender-affirming medical therapy, providers must also consider the potential negative consequences of prolonging a dysphoric experience. Additionally, there is a dearth of validated measures for patient-reported outcomes and a lack of standardisation in the reporting of data that is detrimental to the progress of understanding the impacts of gender-affirming care.

Virtual surgical planning (VSP) has revolutionized orthognathic and craniomaxillofacial surgeries by enabling precise 3-dimensional analysis, detailed osteotomy planning, and custom fabrication of surgical guides and fixation hardware. However, the visualization of registration holes-critical for accurate plate fixation-remains challenging, especially in a blood-filled surgical field. This paper presents a novel technique to enhance the visibility of registration holes using Bonney's blue dye. The technique involves injecting micro-aliquots of Bonney's blue dye (a mixture of crystal violet and brilliant green) into the registration holes before performing osteotomies. This approach ensures that the holes remain clearly marked despite potential visual contamination in the surgical field. The dye helps to identify screw placements and align patient-specific fixation plates more accurately. The proposed method addresses common difficulties in aligning registration holes with patient-specific plates during surgery. Bonney's blue dye provides a clear contrast against the bone, making the registration holes more visible and easier to locate. This improvement is particularly advantageous in a bloody surgical field and benefits less experienced surgeons by offering a straightforward solution to enhance accuracy and efficiency. The technique can also reduce overall operative time by minimizing the time spent locating and aligning the registration holes. Utilizing Bonney's blue dye in virtual surgical planning significantly improves the visibility and alignment of registration holes in orthognathic surgeries. This simple, cost-effective method enhances surgical precision and efficiency and can be applied to other computer-assisted surgical procedures in craniofacial surgery.

Giant cell tumors (GCTs) are benign but locally aggressive bone neoplasms that primarily affect skeletally mature individuals. They are characterized by a tendency for recurrence and being associated with significant morbidity. Traditional treatment has focused on surgical resection; however, the role of medical therapies, such as Denosumab, a bone anti-resorptive drug, which has been Food and Drug Administration (FDA)-approved for unresectable GCTs since 2013, recently has gained prominence. Denosumab is a human monoclonal antibody that inhibits receptor activator of nuclear factor kappa B ligand (RANKL). This article aims to consolidate the current literature on Denosumab's efficacy in treating GCTs, highlighting its mechanism of action, clinical evidence, and potential complications. Clinical studies have demonstrated that Denosumab effectively reduces tumor size improving patient outcomes. Yet, some clinicians maintain concerns and reservations regarding local recurrence and malignant transformation. This review discusses the biochemical background of GCTs, current treatment guidelines, challenges, and future directions for research. Ultimately, Denosumab represents a potentially viable advancement in the management of GCTs, particularly in cases where surgical options are limited.

INTRODUCTION/UNASSIGNED:Ventral hernia repair (VHR) is a common procedure complicated by high hernia recurrence rates exceeding 30 % over ten years. The T-Line® Hernia Mesh is a synthetic, polypropylene mesh featuring mesh extensions designed to prevent anchor point failure by evenly distributing tension to reduce ventral hernia recurrences. This study evaluates the outcomes of the T-Line® mesh in VHR with 1-3 year follow-up. METHODS/UNASSIGNED:This study is a multi-institutional retrospective cohort study on patients who underwent VHR with T-Line® mesh between October 2020 and December 2022. Patient demographics, surgical details, and postoperative outcomes were collected. Patient-reported outcomes were assessed using HerQLes and ACHQC surveys. RESULTS/UNASSIGNED:= 7, 12.3 %). Of the five patients that reported feeling a slight bulge at their previous hernia site, upon clinical evaluation two patients had a recurrence (one recurrence was caused by the suture tearing through the underlying laparotomy repair while the mesh remained anchored intact above the repair, and the second recurrence was caused by inadequate mesh fixation at the caudal border of the mesh), while no patients reported using pain medication for abdominal wall discomfort. CONCLUSIONS/UNASSIGNED:The T-Line® Hernia Mesh demonstrated safety and effectiveness in ventral hernia repair, with low recurrences and postoperative complications rates over a 1-3-year period, suggesting it is a valuable tool for complex hernia repairs.

Computer-based simulation of complex local flap reconstructions of the face requires very high-density finite elements to render accurately due to the intricate incision designs frequently used. This is particularly true in detailed cleft lip/nose repairs. If the entire anatomic model is embedded in a high-resolution solid lattice, the element count becomes so high that simulator performance is very slow, even on a high-performance workstation. This article introduces a simulator in which the model is initially presented at a low, but acceptable physical resolution. As the surgeon operates on the model, only the areas impacted are recut at very high resolution. This surgical subvolume is then merged back into the rest of the model. The dramatic reduction in finite element count results in a surgical simulation program that is quite fast, even on a modest personal computer. This article presents examples of this simulator used in a variety of facial flap and cleft lip reconstructions. Future uses in plastic surgery for patient-specific simulation, education, and illustration are discussed. The simulator is available as free, open-source software.

BACKGROUND/UNASSIGNED:A seroma following prepectoral tissue expander (TE) reconstruction often begets other complications, which may compromise the reconstruction. This study investigated the association between seroma and subsequent complications. METHODS/UNASSIGNED:All consecutive prepectoral TE reconstructions performed between March 2017 and December 2022 at a single center were reviewed. Demographics, operative characteristics, and complications data were extracted for all patients and analyzed. RESULTS/UNASSIGNED:< 0.01). CONCLUSIONS/UNASSIGNED:Although causality cannot be determined, our data suggests that seroma may be the "kiss of death" in prepectoral TE reconstruction because half of all breasts with a seroma went on to develop other complications.

OBJECTIVES/OBJECTIVE:To elucidate the effect of microstructure on the strength and translucency of dental zirconia fabricated using additive (AM) and subtractive manufacturing (SM) technologies. METHODS:Twelve 3Y-TZP discs were fabricated using AM with two print orientations (0°: group AM0; 90°: group AM90; n = 6), and six via CAD/CAM machining (group SM). Density, composition, roughness, translucency parameter (TP), and biaxial flexural strength (σ) were evaluated. Fractographic analysis was conducted and defect size estimated. Based on the preliminary σ results (n = 6), the optimal print orientation was identified. Nine additional specimens were prepared for each of the AM90 and SM groups for Weibull σ analysis (n = 15). Differences in Weibull modulus were assessed via non-overlapping 95 % confidence intervals. An one-way ANOVA followed by Tukey's post-hoc test and an independent samples t-test were used (α = 0.05). RESULTS:The relative density was consistent across all groups (>99 %). The tetragonal and cubic phases were comparable among groups, with proportions exceeding 82 wt% and 17 wt%, respectively. Group SM exhibited significantly higher roughness (1.18 µm) than AM0 (0.71 µm) and AM90 (0.51 µm). Group SM exhibited the highest TP values, while groups AM0 and AM90 had statistically similar TP values. AM0 showed the lowest σ value (411.60 ± 73.99 MPa) and larger defects. Groups AM90 and SM (n = 15) possessed comparable σ values (969.85 ± 123.13 MPa and 989.72 ± 107.78 MPa, respectively) (p = 0.6417) and Weibull moduli (9.17 and 10.62, respectively). SIGNIFICANCE/CONCLUSIONS:SM zirconia showed higher translucency and roughness, while defects reduced translucency in AM zirconia. Flexural strength was lower for AM0 due to larger defects, whereas AM90 matched SM strength.