Background: Factors that increase the risk of malignant transformation of oral epithelial dysplasia (OED) are not completely elucidated. Methods: A retrospective chart review was performed assessing risk factors for transformation of OED, and cancer staging for transformed cases at Sunnybrook Health Sciences Centre. Results: Two-hundred four patients were diagnosed with OED, and 16.7% (34) underwent malignant transformation. Risk factors associated with transformation included: heavy tobacco smoking, excessive EtOH consumption, non-homogenous leukoplakia, size >200 mm 2 , moderate dysplasia or greater than moderate, progression of dysplasia grades, and immunosuppression.Transformed cases followed for a dysplastic lesion were associated with a stage-I cancer diagnosis, and cancer cases with no prior biopsy were associated with a stage-IV diagnosis.Conclusions: In addition to commonly cited risk factors, immunosuppression was associated with malignant transformation, including the use of topical steroids. Analyzing risk factors can help clinicians define risk of progression in patients with OED.
Clear aligner therapy is becoming a mainstay of contemporary orthodontic treatment. As such wide-spread adoption and case-selection for surgical-orthodontic treatment in patients with Clear aligner therapy is increasing. Passive aligners generally lack adequate rigidity for retention of segmental movements in the immediate postoperative period. In this report we discuss our techniques for maintaining retention in the weeks after segmental maxillary osteotomies by use of a modified clear aligner orthognathic splint, and a custom palatal horseshoe splint, including the relative indications of each method.
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