Prosthesis, Volume 6, Issue 5 (October 2024) – 21 articles

Percutaneous Osseointegrated Implants (POI) affix artificial limbs to the body after amputation. Several adverse events challenge mainstream uptake of this technology. This study aims to achieve a consensus regarding “the challenges and adverse events to POI integration and long-term fixation in limb amputation”. We sought a panel of clinical experts divided by profession into surgical, clinical, or clinical academic categories. We used a real time eDelphi method to develop consensus on both the challenges and adverse event items, enabling anonymity, iteration, controlled feedback, and statistical aggregation of group responses. The full panel agreed that the most impactful items are amongst 10 key challenges and eight adverse events. Panellists were in consensus regarding the five most impactful challenges, which were, in decreasing order: patient selection, absence of a multidisciplinary team, design of the implant, soft tissue stability and an experienced surgical team. Panellists considered the five most impactful adverse events, in decreasing order, to be the following: no biological fixation, deep infection, aseptic loosening, no mechanical fixation, and implant breakage. Consensus was obtained on implant breakage and deep infection items. The proportion of consensus from the whole panel across all items was in line with the literature, and we observed an improvement in consensus once the panel was stratified based on job, expertise and implant system. Full article

Background/Objectives: Periprosthetic joint infection (PJI) is one of the most common complications after joint replacement. Two-stage revision remains the standard of care in chronic infections. The aim of this systematic review was to investigate the outcomes, complications, and eradication rates of two-stage revision surgery to treat PJI of the shoulder, elbow, hip, and knee. Methods: A total of 36 studies were included. Patient demographics, follow-up, the visual analog scale (VAS) for pain, the Constant–Murley score (CMS) for shoulder, the Harris Hip Score (HHS) for hip, the Knee Society Score (KSS) for knee, the range of motion (ROM), number and types of complications, and eradication rate were recorded. Results: A total of 2484 patients were identified, of whom 145, 29, 1269, and 1041 underwent two-stage revision surgery for shoulder, elbow, hip, and knee infections, respectively. The overall mean follow-up was 5.7 ± 4.5 years. The overall mean time of re-implantation was 20.8 ± 21.3 weeks. The most common causative bacteria were Cutibacterium acnes (32.7%) for shoulder, Methicillin-Sensitive Staphylococcus aureus (44.4%) for elbow, and Staphylococcus coagulase negative (CNS) (31.3% and 23%) for hip and knee infection, respectively. The mean overall preoperative VAS score was 6.7 ± 2.3, while, postoperatively, the mean score was 4.5 ± 2.7 (p < 0.001). A total of 2059 out of 2484 patients (82.9%) experienced eradication. Conclusions: Two-stage revision is an effective procedure to treat PJI with an overall eradication rate of 83%. A significant recovery of functionality and a decrease in residual pain can be achieved after surgery. Aseptic loosening and re-infection were the most common complications in shoulder and hip infections. Death rate was high in knee infections. Full article

This study evaluated the effectiveness of atmospheric pressure plasma jet (APPJ) treatment on the surface characteristics and bond strength of zirconia and lithium disilicate ceramics for CAD-on restorations. A total of 70 cylindrical-shaped specimens of lithium disilicate and 70 disc-shaped specimens of Y-TZP zirconia were machined, thermally processed, surface-treated, and then resin-bonded. The specimens were grouped according to the following surface treatments: no surface treatment, sandblasting, plasma, sandblasting followed by plasma, sandblasting followed by universal adhesive, plasma followed by universal adhesive, and sandblasting and plasma treatment followed by universal adhesive. The treated surfaces were subjected to a wettability assessment via contact angle measurement and a topography assessment using scanning electron microscopy (SEM). The cemented assembly was subjected to shear bond strength testing with a universal testing machine, and the results were imported to SPSS 23.0 for statistical analysis. The results show that APPJ treatment induced a significantly low contact angle for both ceramics with no surface alteration upon scanning. Moreover, APPJ treatment produced a bonded assembly with a shear bond strength comparable to sandblasting. In conclusion, APPJ treatment should be considered an efficient surface treatment with a non-destructive nature that surpasses sandblasting with the provision of a high shear bond strength between CAD-on ceramics. Full article

The machining of implants and parts for dental prostheses to eliminate biofilm in the implantoplasty process causes a loss of mechanical properties and also characteristics of the surfaces, making tissue regeneration difficult. In the present work, treatments consisting of elements that can reduce infection, such as citric acid and magnesium, together with elements that can improve cell adhesion and proliferation, such as collagen, are proposed for implant–crown assembly. Titanium, zirconia, composite (PMMA + feldspar) and cobalt–chromium discs were immersed in four different solutions: 25% citric acid, 25% citric acid with the addition of collagen 0.25 g/L, 25% citric acid with the addition of 0.50 g/L and the latter with the addition of 1% Mg (NO₃)₂. After immersion was applied for 2 and 10 min, the roughness was determined by interferometric microscopy and the contact angle (CA) was evaluated. Human fibroblastic and osteoblastic line cells (HFFs and SaOS-2) were used to determine cell viability and proliferation capacity. Cell binding and cytotoxicity were determined by resazurin sodium salt assay (Alamar Blue) and cell morphology by confocal assay (immunofluorescence F-actin (phalloidin)) after 3 days of incubation. For the evaluation of bacterial activity, the bacterial strains Sptreptococcus gordonii (Gram+) and Pseudomonas aeruginosa (Gram−) were used. The antibacterial properties of the proposed treatments were determined by means of the resazurin sodium salt (Alamar Blue) assay after 1 day of incubation. The treatments considerably decreased the contact angle of the treated samples with respect to the control samples. The treatments endowed the surfaces of the samples with a hydrophilic/super-hydrophilic character. The combination of elements proposed for this study provided cell viability greater than 70%; considering the absence of cytotoxicity, it therefore promotes the adhesion and proliferation of fibroblasts and osteoblasts. In addition, it also endows the surface with antibacterial characteristics against from Gram+ and Gram− bacteria without damaging the cells. These results show that this mouthwash can be useful in oral applications to produce a new passivation layer that favors the hydrophilicity of the surface and promotes cellular activity for the formation of fibroblasts and osteoblasts, as well as showing bactericidal activity. Full article

Craniosacral rhythm is a manual therapy technique that focuses on the subtle, rhythmic movement of cerebrospinal fluid as it flows through the central nervous system and musculoskeletal system. Through light and delicate manipulation of the cranial bones, membranes and soft tissues of the head and neck, it promotes rebalancing and release from tension in the body, improving the circulation of the cerebrospinal fluid and the individual’s health. In the field of prosthetic dentistry, in rare cases, such as a full arch or removable partial denture, the patient perceives a sensation of constriction even though all procedures have been used correctly. In this work, a new design fora removable partial denture is proposed that does not interfere with the primary respiratory mechanism, reducing the sensation of constriction in the patient. The materials used are the same as those used for a normal removable partial denture, and the technique used is the “lost wax” one: the novelty is that the prosthesis is made in two separate parts that are joined by a central connection; the result is a removable partial denture with a small central thickening in the main joint represented by the connection of the two pieces. Craniosacral breathing movements are favored with this prosthesis as the metal structure is hyperstatic towards intrusion movements, more or less virtual in the opposite direction, i.e., extrusion towards the vestibule. Full article

Introduction: Polymethylmethacrylate (PMMA) is the most widely used denture base material due to its favourable properties. Several studies have tested the incorporation of anti-infective agents into PMMA as a strategy to prevent biofilm growth on the denture surface. This systematic review aims to evaluate the efficacy of incorporating inorganic antimicrobial particles into denture base resins in preventing antimicrobial growth, thereby identifying the most effective agents for enhancing PMMA’s antimicrobial properties. Materials and methods: This systematic review followed the PRISMA guidelines, and the research protocol was registered in PROSPERO. The search was performed by using Medical Subject Headings and free text combined with Boolean operators in PubMed/Medline^® and in Cochrane^® and a free text combination in Web of Science^® Core Collection. Data regarding the inorganic particles studied, their antimicrobial effect, and the type of samples produced were collected and analysed. Results: After screening, a total of fifteen studies were included in this review. Most samples were disk-shaped and of varying sizes, and the most tested microbial strain was Candida albicans. Silver was the most used antimicrobial particle, followed by gold, titanium, and copper. Conclusions: Overall, incorporating inorganic particles into PMMA has produced promising antimicrobial results, depending on the concentration. Due to the high heterogeneity observed in the samples, more studies are recommended, particularly clinical trials. Full article

Background/Objectives: Dental implants have emerged as a modern solution for edentulous jaws, showing high success rates. However, the implant’s success often hinges on the patient’s bone quality and quantity, leading to higher failure rates in poor bone sites. To address this issue, short implants have become a viable alternative to traditional approaches like bone sinus lifting. Among these, Bicon^® short implants with a plateau design are popular for their increased surface area, offering potential advantages over threaded implants. Despite their promise, the variability in patient-specific bone quality remains a critical factor influencing implant success and bone turnover regulated by bone strains. Excessive strains can lead to bone loss and implant failure according to Frost’s “Mechanostat” theory. To better understand the implant biomechanical environment, numerical simulation (FEA) is invaluable for correlating implant and bone parameters with strain fields in adjacent bone. The goal was to establish key relationships between short implant geometry, bone quality and quantity, and strain levels in the adjacent bone of patient-dependent elasticity to mitigate the risk of implant failure by avoiding pathological strains. Methods: Nine Bicon Integra-CP™ implants were chosen. Using CT scans, three-dimensional models of the posterior maxilla were created in Solidworks 2022 software to represent the most challenging scenario with minimal available bone, and the implant models were positioned in the jaw with the implant apex supported by the sinus cortical bone. Outer dimensions of the maxilla segment models were determined based on a prior convergence test. Implants and abutments were considered as a single unit made of titanium alloy. The bone segments simulated types III/IV bone by different cancellous bone elasticities and by variable cortical bone elasticity moduli selected based on an experimental data range. Both implants and bone were treated as linearly elastic and isotropic materials. Boundary conditions were restraining the disto-mesial and cranial surfaces of the bone segments. The bone–implant assemblies were subjected to oblique loads, and the bone’s first principal strain fields were analyzed. Maximum strain values were compared with the “minimum effective strain pathological” threshold of 3000 microstrain to assess the implant prognosis. Results: Physiological strains ranging from 490 to 3000 microstrain were observed in the crestal cortical bone, with no excessive strains detected at the implant neck area across different implant dimensions and cortical bone elasticity. In cancellous bone, maximum strains were observed at the first fin tip and were influenced by the implant diameter and length, as well as bone quality and cortical bone elasticity. In the spectrum of modeled bone elasticity and implant dimensions, increasing implant diameter from 4.5 to 6.0 mm resulted in a reduction in maximum strains by 34% to 52%, depending on bone type and cortical bone elasticity. Similarly, increasing implant length from 5.0 to 8.0 mm led to a reduction in maximum strains by 15% to 37%. Additionally, a two-fold reduction in cancellous bone elasticity modulus (type IV vs. III) corresponded to an increase in maximum strains by 16% to 59%. Also, maximum strains increased by 86% to 129% due to a decrease in patient-dependent cortical bone elasticity from the softest to the most rigid bone. Conclusions: The findings have practical implications for dental practitioners planning short finned implants in the posterior maxilla. In cases where the quality of cortical bone is uncertain and bone height is insufficient, wider 6.0 mm diameter implants should be preferred to mitigate the risk of pathological strains. Further investigations of cortical bone architecture and elasticity in the posterior maxilla are recommended to develop comprehensive clinical recommendations considering bone volume and quality limitations. Such research can potentially enable the placement of narrower implants in cases of insufficient bone. Full article

The socket is the most important, patient-specific element of a prosthesis. Conventionally, the process of making a custom socket involves manually rectifying a plaster model of the residual limb. This process is time-consuming and often inconsistent among prosthetists because it is based on implicit knowledge. Hence, the aim of this work was to describe a novel process of generating a prosthetist-specific, digital “global” template and to illustrate that it can be automatically applied to rectify the shape of a transtibial residual limb. The process involved (1) the acquisition of a “training” dataset of unrectified and rectified positive models through manual data collection and digital 3D scanning, and (2) the unsupervised learning of the prosthetist’s rectifications by an artificial intelligence (AI) algorithm. The assessment of the process involved (1) evaluating whether the rectification rule learned by the AI was consistent with the prosthetist’s expectations, and (2) evaluating the template feasibility by applying the AI rectification process to a new residual limb and comparing the results to the prosthetist’s manual rectification for the same residual limb. The results suggest that the AI-rectified positive was consistent with the approach described by the prosthetist, with only small radial and angle errors and similar dimensions (volume and cross-sectional perimeters) as the hand-rectified positive. This study provides a proof-of-concept of the ability to integrate an AI algorithm into the fabrication process for transtibial prosthetic sockets. Once refined, this approach may provide a time-saving tool for prosthetists by automatically implementing typical rectifications and providing a good starting socket fit for individuals with amputation. Full article

In different applied load scenarios, this study evaluates the distribution of stress in the implant and bone exerted by zirconia, lithium disilicate, and cobalt chromium alloy. A 3D virtual model of a mandibular three-unit implant-supported prosthesis was created using SolidWorks 2022. The model featured two 12-mm Straumann Ti-Zr (Roxolid) implants with diameters of 4.5 mm and 4 mm. Zirconia, lithium disilicate, and cobalt chromium alloy were used as superstructure materials. Vertical loads of 100 N and 200 N were applied to the central fossa of the implant-supported prosthesis. The finite element analysis demonstrated that doubling the applied load leads to a proportional increase in von Mises stress on both the implant and bone in a mandibular posterior three-unit implant-supported prosthesis model. Zirconia and chromium cobalt as superstructure materials result in similar stress levels due to their closely matched elastic moduli of 200 GPa and 218 GPa, respectively. In contrast, lithium disilicate leads to the highest stress levels, which is attributed to its lower elastic modulus of 95 GPa. These findings highlight the critical role of superstructure material properties in stress distribution. Zirconia emerges as the preferred material for implant-supported prosthetics due to its favorable stress distribution. Full article

Objective: The aim of the present study was to evaluate the long-term clinical survival and success of chairside-fabricated single-tooth monolithic zirconia restorations on posterior teeth using the speed sintering process. Materials and Methods: Between 2012 and 2022, 250 single-tooth crowns were fabricated for 193 patients using the CEREC^® chairside workflow. Restorations were fabricated from monolithic 3Y-TZP zirconia (InCoris TZI, Dentsply Sirona©, Bensheim, Germany) as full-contour crowns. The same clinician performed all procedures. Luting was performed using self-adhesive resin-based cements or glass ionomer cement. Retrospective analysis was conducted, defining survival as crowns still in function regardless of any interventions, and success as crowns that remained functional without the need for intervention. Statistical analysis was performed using Kaplan–Meier analysis, considering “refabrication” and “intervention” as endpoints. Results: Of the 250 crowns, a total of 162 (64.8%) crowns showed success. Over the whole observation period, 44 crowns (17.6%) required refabrication, and 88 (35.2%) required intervention. Mean survival without refabrication was 7.43 years, with a 5- and 7.5-year survival of 86.9% and 76.6%. The mean survival without intervention was 6.5 years, with a 5- and 7.5-year survival of 70.8% and 59.9%. Conclusions: Under appropriate technical conditions, chairside-fabricated 3Y-TZP zirconia single-tooth crowns represent a viable fabrication method. Neither the cementation mode nor the crown position—whether on premolars or molars—significantly impacted the survival rates. Full article

This study aimed to evaluate the fracture resistance of endodontically treated molars restored with ceramic indirect restorations with and without cervical margin relocation. A total of 120 extracted human maxillary molars were used after MOD cavities preparations with the mesial boxes located 2 mm below CEJ. Specimens were randomly assigned to six groups according to the margin location of each indirect restoration type (n = 20); crown without CMR, crown with CMR, endocrown without CMR, endocrown with CMR, onlay without CMR, and onlay with CMR. Mesial proximal boxes of the MOD cavities were elevated with composite resin in cervical margin relocation groups. Each group was further divided according to indirect restoration material (n = 10); CEREC Tessera and Celtra Press. The specimens were subjected to fracture resistance testing in a universal testing machine. Fracture analysis was performed using stereo and scanning electron microscopes. Data were analyzed by using 3-way ANOVA, 1-way ANOVA and the Tukey HSD tests (α = 0.05). The mean fracture resistance values ranged between 2136.57 and 950.47 N. Significantly higher values were detected among Celtra Press than Cerec Tessera in crown restorations. Unrestorable fracture patterns were seen through all study groups. Crown restorations represented the best restorative option in terms of fracture resistance. Cervical margin relocation adversely affected fracture resistance. However, the material of the indirect restorations had no significant impact on fracture resistance. Full article

The precision of the luting protocol plays a crucial role in the success and survival rate of porcelain laminate veneers (PLVs). This in vitro study aimed to evaluate the influence of different luting techniques on the positioning of PLVs through a novel, noninvasive, scanning-based technique. A total of 45 ceramic PLVs were milled and cemented on human tooth replicas. Specimens were divided into three groups of 15, each subjected to a different luting protocol: flowable composite (Group A), dual-cure resin cement (Group B), and preheated composite resin (Group C). After luting procedures, specimens were scanned, and every STL file was superimposed with the original tooth design in Geomagic Control X version 2022.1 software to assess linear (incisal, mid, cervical) and angular discrepancies. Statistical analysis was performed using one-way ANOVA, Tukey’s HSD tests, and regression analysis. ANOVA results showed no statistically significant differences for incisal (F = 0.327, p = 0.723), mid (F = 0.287, p = 0.752), cervical (F = 0.191, p = 0.827), and angular (F = 0.026, p = 0.975) measurements. Tukey’s HSD post hoc tests confirmed the lack of significant pairwise differences between groups. The study demonstrated that the type of luting agent used does not significantly impact the final position of PLVs. This suggests flexibility in the choice of luting agents without compromising the accuracy of PLV placement. Full article

Ceramic dental restorative materials have growing popularity, albeit their brittle and stochastic nature are acknowledged shortcomings that impact the prosthesis lifespan. The mechanical performance of ceramics is dominated by the constitutional microstructural and fracture toughness mechanisms, as well as externally applied triggers. Thus, there is ongoing expanding research in the sphere of ceramic material engineering and thermal refinement, addressing concerns regarding toughness, machinability, reliability, stainability, and biodegradation. While the current trend in dental ceramic manufacturing has transitioned from micrometric crystalline sizes to submicrometric and nanometric ranges, there is an unclear understanding of the microstructural implications on ceramic behaviour. Therefore, this review covers the comprehensive characterisation approaches commonly employed in the scientific literature to describe the multifaceted performance aspects as well as clinical-related prerequisites of dental ceramics. Moreover, updated standardised testing parameters and performance thresholds pertaining to ceramic mannerisms are described in an attempt to translate their clinical applicability. Full article

Zirconia crowns are capping materials used in dentistry for tooth capping and are very popular due to their optical properties and natural-looking visuals. In vitro aging protocols measure zirconia’s optical properties, which are vital in order for it to look natural. This study aims to conduct a systematic review to explore the effect of in vitro aging protocols on the optical properties and crystalline structure of high-translucency (HT) zirconia. A correlation matrix was obtained using Microsoft Excel, which was later transferred into SPSS for confirmatory factor analysis (CFA) and hierarchal clustering and to obtain a dendrogram in order to display the distribution of clusters for each key term relevant to the study. Further, for qualitative analysis, 17 studies were screened and reviewed. The result demonstrates that high translucency has been observed in the crystalline structure of zirconia capping. However, quantitative and qualitative results did not demonstrate the in vitro protocol; instead, neglect of the in vitro protocol’s vitality in zirconia crown capping was alarming. Overall, zirconia has good optical properties when combined with catalysts such as aluminum and lithium to obtain a more sustainable crystalline structure. Full article

This in vitro investigation aimed to compare the trueness, precision, internal fit, and marginal adaptation of Varseo Smile Crown Plus (VSCP), CROWNTEC (C), and milled Enamic crowns (E) using a 5-axis dental milling machine (prograMill PM7). 39 crowns (VSCP, E, C; n = 13) were designed and fabricated. Internal/marginal adaptation, precision, and trueness were assessed via die scans with/without a fit checker. Dimensional discrepancies were determined by superimposing the scans. One-way ANOVA (α = 0.05) analyzed the results. No significant differences were found in internal fit or marginal adaptation between groups. However, group E exhibited the best fit (axial: 82.9 µm). Trueness differed significantly (p < 0.05) across all groups and areas. Group E had the highest trueness (intaglio: 25.8 µm), while VSCP had the lowest (marginal: 31.9 µm). Precision varied significantly within the occlusal area of printed groups (highest for C: 17.8 µm) and the marginal area between printed/milled (VSCP vs. E) and C vs. E (lowest for E: 20.5 µm, highest for VSCP: 27.9 µm). In conclusion, both milled and 3D-printed crowns achieved comparable internal fit and marginal adaptation. However, group E displayed superior fit and trueness. While C exhibited higher occlusal precision, E had higher marginal precision. These findings suggest the potential for 3D-printed hybrid polymer crowns, warranting further investigation. Full article

Dissatisfaction among upper limb prosthetic users is high, reaching over 70%, and 52% of upper limb amputees abandon their prosthetic devices due to limitations such as limited functionality, poor design/aesthetic, and improper fit. The conventional procedure of making prosthetics is time-consuming and expensive. This study was conducted to provide an alternative solution for the several issues of current prosthetic devices. 3D printing technology offers a promising alternative, providing greater accuracy, reduced labor time, and improved fit and comfort. This research explores the application of 3D printing for creating custom silicone prosthetic fingers, using Fused Deposition Modelling (FDM) for the mold. A high-resolution 3D scanner was employed to capture the precise anatomy of the patient’s hand, and CAD software was used to design molds that satisfied the patient preference and were reusable. The resulting prosthetics demonstrated good fit and patient satisfaction, though exact color matching remains a challenge, but still, it did demonstrate that it is possible to fabricate colored prosthetics. Performance tests, such as the Jebsen–Taylor Hand Function Test, indicated that while initial performance with the prosthetic was slightly lower, patient satisfaction and potential for improved functionality over time were high. This study underscores the potential of 3D printing to enhance the customization, cost-effectiveness, and overall quality of prosthetic devices, contributing to Sustainable Development Goals related to health and industry innovation. Full article

Background: Nanocomposite resins have been widely used in modern denture manufacturing. However, their long-term color stability is a concern for both dental professionals and patients. Purpose: to evaluate the effect of different beverages on the color stability of 3D-printed denture base resins modified with zirconium dioxide nanoparticles (ZrO₂NPs). Methods: A total of 440 specimens were fabricated and distributed into 11 groups (n = 40/group). The control group of heat polymerized (PMMA) and five groups of two different 3D-printed resins (NextDent and ASIGA) as experimental groups with various concentrations of ZrO₂NPs added to the 3D-printed resins (0.5 wt%, 1 wt%, 3 wt%, 5 wt%) in addition to one unmodified group per resin. Specimens per group are sorted into four subgroups (n = 10) according to tested beverages, as follows: coffee, tea, cola, and mineral water. Before immersion, all the specimens were exposed to 5000 thermal cycles. Color changes (ΔE₀₀) were assessed prior (T0) and following immersion for 6 days (T1) and 12 days (T2) using a spectrophotometer. Color difference values were calculated by using CIEDE2000 color difference. Data was analyzed by ANOVA and post hoc Tukey test with a significant level of less than 0.05. Results: Tea produced the highest color change for both NextDent and ASIGA materials, whereas water caused the least color change on PMMA at T2. Increasing the immersion time resulted in more color changes, with tea and coffee showing significant differences. PMMA had considerably less color change than 3D-printed resins. The color change of 3D-printed increased after adding ZrO₂NPs. Conclusions: Beverage type and immersion time have an impact on the color stability of unmodified and ZrO₂NP-modified denture base resins with significant change after immersion in tea and coffee. Full article

Background: For optimal clinical outcomes in full mouth rehabilitations, it is vital to determine the optimal jaw relations and confirm the appropriate vertical dimension of occlusion (VDO). The current study aims to evaluate various facial measurements as an adjunct in determining VDO in dentate individuals. Methods: A total of one hundred and twenty subjects, sixty males and sixty females, of the age group 19-30 were selected for the study. VDO (chin–nose distance) and other facial measurements like the glabella to subnasion (G-S) distance, both right and left pupil to rima oris (P-R) distance, both right and left corner of mouth to outer canthus of eye (M-E) distance, and both right and left ear to eye (E-e) distance were measured using a Vernier caliper. Results: The mean ± standard deviation of the C-N distance, G-S distance, right P-R distance, right M-E distance, left M-E distance, right E-e distance, and left E-e distance were 67.70 mm ± 3.22 mm, 60.29 mm ± 3.67 mm, 65.99 mm ± 3.72 mm, 66.00 mm ± 3.91 mm, 69.51 mm ± 3.71 mm, 69.48 mm ± 3.68 mm, 69.59 mm ± 3.98 mm, and 69.51 mm ± 3.95 mm, respectively. Pearson’s correlation coefficient between the C-N distance and M-E distance was found to be 0.739 (right), 0.730 (left); that between the C-N distance and E-e distance was found to be 0.738 (right), 0.732 (left); that between the C-N distance and P-R distance was found to be 0.660(right), 0.670(left); and that between the C-N distance and G-s distance was found to be 0.417. Conclusions: The present study reported a high positive correlation between the chin to nose distance and the distance between both the right and left lateral corner of the mouth to the outer canthus of the eye, and the distance between both the right and left ear to the eye. Hence, these measurements can be used as an adjunct for establishing VDO in the edentulous patient. Full article

Objectives: To assess the overall mental health of enucleated or eviscerated patients after high-density porous polyethylene OCULFIT implantation and external prosthesis over a 1-year follow-up. Methods: Patients with an indication of enucleation or evisceration with OCULFIT implantation were included in a prospective study. The patients completed four questionnaires regarding mental health at three different visits (baseline, 3–6 months, and 9–12 months post-surgery). The questionnaires used were the following: SF-12 for multidimensional health-related quality of life (scale 0–100); Rosemberg self-esteem scale (scale 0–40); Patients Health Questionnaire-4 (PHQ-4) (scale 0–6); and a Lifetime Major Depression and Anhedonia questionnaire (categorised in groups with/without symptoms). Results: A total of 33 patients (16 enucleations and 17 eviscerations) were included in the study. The physical domain of the SF-12 questionnaire did not change between visits, but the mental domain significantly improved from the baseline to the last visit (41.71 ± 12.72 vs. 46.80 ± 10.68, p = 0.04). The number of patients with high, moderate, and low self-esteem (Rosemberg scale) was similar between the baseline and the last visit. The depression and anxiety scores of the PHQ-4 were not significantly different among visits. The number of patients with no symptoms (depression or anhedonia) improved from the baseline (42.2%) throughout the follow-up (66.7% at the last visit). Conclusions: OCULFIT orbital implant and external prosthesis placement maintained and/or improved the quality of life related to mental health in eviscerated and enucleated eyes. The number of patients with no symptoms improved from the baseline throughout the follow-up. The patients’ self-esteem was already high before implantation and remained stable over the follow-up. Full article