Purpose: Evaluation of the accuracy of implants position using two different types of computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guides, including bone supported and mucosa supported guided templates. Materials and methods: Twelve completely edentulous patients were selected for this study and divided into two groups six each. all patients received a radiopaque radiographic template. A cone beam computed tomography was taken to simulate the position of the two implants, virtual implants were drawn in its place, fabrication of surgical guide template using rapid prototyping technique to match the position of virtual implant according to patient' group. Group I bone supported surgical guide(BSG) and group II mucosa supported surgical guide (MSG). The implants were installed for each patient using surgical guide templates according to the group. The positions and angulations of the placed implants in comparison to those of the planned ones were determined using special software that matched pre-and postoperative computed tomography (CT) images, and deviations were calculated and compared between the two guide templates using a software program to detect any difference in linear and angular deviation. Data were collected; tabulated and analyzed using student T test. Results : There was no significant difference of both linear and angular measurements between virtual and the surgically placed implants for both groups. Also there was insignificant difference in accuracy between group I (bone supported) and group II (mucosa supported). Conclusions: Using template-guided surgery enables the clinician to optimize implant position, angle, diameter and length by dictating the drilling position and angulation. Cone beam CT has accurate measurements in distances between two implants as clinical measurements. The bone supported surgical guide as well as the mucosa supported surgical guide has the same accuracy in implant positioning.
This study was aimed to evaluate and compare the posterior pharyngeal wall augmentation using muscular flap versus musculomucosal flap for correction of velopharyngeal incompetence (VPI).Patients and methods: this study was conducted on twenty children (13 males and 7females) complaining from VPI with age ranging between 6.5 and 13 years with a mean of age 8.7 years. All patients were treated surgically using posterior pharyngeal wall augmentation. Patients were classified into two equal groups according to the type of flap technique used for posterior pharyngeal wall augmentation. Group I included10 patients (7 males and 3 females) were treated by muscular flap. Group II included10 patients (6 males and 4 females) were treated by musculomucosal flap. The preoperative and postoperative assessments for patients with VPI included clinical examination of the voice, nasopharyngoscopy and computed tomography (CT) scans. Results:Regarding clinical presentation (hypernasality and nasal regurgitation of fluid), all patients in both groups had no nasal regurgitation of fluid or food which represents 100%. As regard the overall nasalance results (Nasal sentence) measured by nasometry in both groups there was noticeable improvement. But when comparing overall nasalance results between both groups there was no significant difference .Competence and borderline closure was achieved in 65% for patients of both groups. The VP gap size reduction was achieved in both groups, however there was no significant difference regarding reduction of median VP gap size. Conclusion:At the end, as there no significant difference in the results of both groups: the myomucosal flap technique for posterior pharyngeal wall augmentation is simple and easier than the muscular flap technique and the posterior pharyngeal wall augmentation is a good technique for treatment of VPI KEY WORDS: VPI, Posterior pharyngeal wall augmentation, nasometer.(1230) Mahmoud E. Khalifa, et al.
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