Muller, Olivia M.

Objective Identify sociodemographic factors and comorbidities predictive of nasoalveolar molding (NAM) treatment completion and noncompletion in infants with cleft lip with or without (+/–) cleft palate in a rural-suburban population. Design Retrospective cohort study. Setting Tertiary medical center. Patients, Participants Infants diagnosed with cleft lip +/- cleft palate who initiated NAM treatment between 2013 and 2023. Forty-seven patients met inclusion criteria. Main Outcome Measure(s) Prevalence of NAM treatment completion, defined as continued attendance of NAM appointments until initial lip repair surgery. Results NAM treatment noncompletion rate of 23.4%. Noncomplete NAM treatment was associated with greater additional unscheduled NAM visits ( P < .001); increased days inpatient after birth ( P < .001); NICU admission ( P < .001); public insurance ( P = .007); preterm birth ( P = .008); history of social work visits ( P = .024); increased comorbidities ( P = .028); non-Caucasian race ( P = .034); and presence of siblings ( P = .036). Associated comorbidities included use of feeding tube ( P < .001); and conditions related with renal ( P < .001); cardiac ( P = .004); failure to thrive ( P = .009); syndromes ( P = .009); orthopedic ( P = .011); pulmonary ( P = .022); and ophthalmologic systems ( P = .041). Conclusions Increased overall health complexity, public insurance status, and need for social work support were identified as factors associated with NAM noncompletion. These variables can help identify patients at risk of noncompletion and empower providers to supply individualized support and resources.

Background: Approximately 75% of all head and neck cancer patients are treated with radiotherapy (RT). RT to the oral cavity results in acute and late adverse events which can be severe and detrimental to a patient’s quality of life and function. The purpose of this study was to explore associations between RT dose to a defined oral cavity organ-at-risk (OAR) avoidance structure, provider- and patient-reported outcomes (PROs), opioid use, and hospitalization. Methods: This was a retrospective analysis of prospectively obtained outcomes using multivariable modeling. The study included 196 patients treated with RT involving the oral cavity for a head and neck tumor. A defined oral cavity OAR avoidance structure was used in all patients for RT treatment planning. Validated PROs were collected prospectively. Opioid use and hospitalization were abstracted electronically from medical records. Results: Multivariable modeling revealed the mean dose to the oral cavity OAR was significantly associated with opioid use (p = 0.0082) and hospitalization (p = 0.0356) during and within 30 days of completing RT. Conclusions: The findings of this study may be valuable in RT treatment planning for patients with tumors of the head and neck region to reduce the need for opioid use and hospitalization during treatment.

AbstractPurposeProton treatment plan perturbation by common dental fixtures such as amalgams (Am) and porcelain‐fused‐to‐metal (PFM) crowns has, to date, been uncharacterized. Previous studies have been conducted to determine the physical effect of these materials within the beam path for single spots, but their effects on complex treatment plans and clinical anatomy have not yet been quantified. The present manuscript aims to study the effect of Am and PFM fixtures on proton treatment planning in a clinical setting.MethodsAn anthropomorphic phantom with removable tongue, maxilla, and mandible modules was simulated on a clinical computed tomography (CT) scanner. Spare maxilla modules were modified to include either a 1.5 mm depth central groove occlusal amalgam (Am) or a porcelain‐fused‐to‐metal (PFM) crown, implanted on the first right molar. Modified tongue modules were 3D printed to accommodate several axial or sagittal oriented pieces of EBT‐3 film. Clinically representative spot‐scanning proton plans were generated in Eclipse v.15.6 using the proton convolution superposition (PCS) algorithm v.15.6.06 using a multi‐field optimization (MFO) technique with the goal of delivering a uniform 54 Gy dose to a clinical target volume (CTV) typical of a base‐of‐tongue (BoT) treatment. A typical geometric beam arrangement of two anterior oblique (AO) beams and a posterior beam was employed. Plans optimized without any material overrides were delivered to the phantom A) without implants; B) with Am fixture; or C) with PFM crown. Plans were also reoptimized and delivered with inclusion of material overrides to equate relative stopping power of the fixture with that of a previously measured result.ResultsPlans exhibit slightly greater dose weight towards AO beams. The optimizer accounted for inclusion of fixture overrides by increasing beam weights to the beam closest to the implant. Film measurements exhibited cold spots directly within the beam path through the fixture in plans with and without overridden materials. Cold spots were somewhat mitigated in plans including overridden materials in the structure set but were not entirely eliminated. Cold spots associated with Am and PFM fixtures were quantified at 17% and 14% for plans without overrides, respectively, and 11% and 9% with using Monte Carlo simulation. Compared with film measurements and Monte Carlo simulation, the treatment planning system underestimates the dose shadowing effect in plans including material overrides.ConclusionsDental fixtures create a dose shadowing effect directly in line with the beam path through the material. This cold spot is partially mitigated by overriding the material to measured relative stopping powers. Due to uncertainties in modeling perturbation through the fixture, the magnitude of the cold spot is underestimated using the institutional TPS when compared to measurement and MC simulation.

AbstractWith complex head and neck diseases that closely approximate crucial organs or have advanced spread and cannot be surgically resected, intensity modulated proton beam radiotherapy is favored due to its superior dose targeting through magnetic manipulation of the proton energy. A radiation mask and an oral positioning device immobilize craniofacial, cervical, and oral structures for accurate and reliable radiation delivery. Widely available prefabricated thermoplastic oral positioning devices are manufactured in standardized forms and materials that unpredictably affect the proton beams’ pathways and range. This technique article showcases a workflow that combines analog and digital dental techniques to produce a customized 3D‐printed oral positioning device within 2 appointments.

AbstractAmyloidosis of the tongue can result in significant and irreversible alterations of tooth position and function due to prolonged application of imbalanced force on the teeth by the enlarged tongue. Due to the rarity of this oral form of systemic disease, little has been elucidated on management of the resulting impaired oral function. While surgery can address the size of the tongue, it carries significant morbidities, enlargement can recur, and does not address adverse tooth positioning. Prosthetic rehabilitation can more aptly restore oral function but it also needs to be tailored based on the patient's expectations and goals as well as biologic and mechanical parameters of treatment. This report discusses an effective and noninvasive application of a tooth‐supported, removable prosthesis with an onlay occlusal design to restore occlusion, speech, and esthetics in a patient with tongue‐based amyloidosis.

AbstractPurposeTo identify associations between early implant failure and prosthodontic characteristics that could be used to guide subsequent continuous quality improvement efforts of patient care.Materials and MethodsAn implant‐level analysis was performed in which data were abstracted from a prospective clinical database of all adult patients treated with implants and followed up from January 2000 through December 2014 at the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. These data were used to determine time to implant failure. Associations between prosthodontic characteristics and early implant failure were evaluated with Cox proportional hazards regression models and summarized with hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsAmong 8762 implants in 2787 patients, 395 (4.5%) failed within the first year of placement at a mean (SD) of 127 (97) days (range, 2‐364 days). Univariable analysis showed no associations between early implant failure and use of a cover screw, prosthesis, or definitive or provisional prosthesis at implant placement. Three of 25 single crowns failed, and use of a single crown was significantly associated with early implant failure (HR, 3.94; 95% CI, 1.08‐14.35; P = 0.04). This study identified no significant associations between prosthodontic characteristics identified after implant placement and early implant failure.ConclusionsUse of a prosthesis at implant placement, use of a definitive or provisional prosthesis, and early mechanical complications were not associated with increased risk of early implant failure. Quality improvement efforts should focus on aspects of decision making that aim to decrease surgical complications.

Abstract Purpose Systematic monitoring of important clinical outcomes is increasingly important for health‐care decision making, especially in the context of continuous quality improvement. Dental implant failure within the first year (early failure) has been previously shown to be more common than subsequent failure. The purpose of this study was to identify associations between early implant failure and patient factors, surgical manipulations, and systemic conditions. Materials and Methods The authors retrospectively identified the records of consecutive adult patients with dental implants seen between 2000 and 2014 in the Department of Dental Specialties, at the Mayo Clinic. Demographic, surgical, and medical data were extracted from the database and individual medical records to determine time to first implant failure. Cox proportional hazards regression models were used to assess associations of demographic, surgical, and systemic conditions with implant failure during the first year post‐implantation, summarized as hazard ratio (HR) (95% confidence interval [CI]). Results Among 8540 implants identified during the study period, 362 (4.2%) failed within the first year of placement at a mean (SD) of 129 (96) days after placement. On univariate analysis, most candidate predictors were not shown to influence first‐year failure. Preplacement surgical manipulations associated with increased early implant failure were bone augmentation only (HR, 1.45; 95% CI, 1.02‐2.05; p = 0.04), socket preservation (HR, 2.67; 95% CI, 1.33‐5.38; p = 0.006), and xenogenic material (HR, 2.12; 95% CI, 1.11‐4.04; p = 0.02). Alveoloplasty only at placement was associated with decreased early implant failure (HR, 0.33; 95% CI, 0.17‐0.65; p = 0.001). Overall, 318 implants (3.7%) had surgical complications within the first year of placement at a mean (SD) of 110 (114) days after placement; any surgical complication was significantly associated with early implant failure (hazard ratio, 15.84; 95% CI, 11.10‐22.61; p < 0.001). After adjustment for age, sex, and implant era, no single or multiple medical condition(s) and no single or multiple medication(s) increased patient risk of implant failure in the first year after placement. Conclusions These findings support a targeted effort to reduce the incidence of surgical complications to reduce early failure of dental implants.