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Background: The purpose of this retrospective study was to evaluate the surgical performance, clinical usability and outcome of a new variable square pulsed (VSP) Er:YAG laser for bone cutting in oral and maxillofacial surgery. Materials and Methods: In 40 patients an Er:YAG laser with pulse energy of 1,000 mJ, pulse duration of 300 μs and a frequency of 12 Hz was used for different intraoral osteotomies. The spot size was 0.9 mm, and the handpiece was kept at a distance of 10 mm from the bone surface. Additionally, histological analyses of the fresh osteotomy rims of lasered bone were performed. Results: Er:YAG laser osteotomy revealed a remarkable cutting efficiency without any visible, negative, thermal side effects. There was no damage of adjacent soft tissue structures. However, depth control was limited to visual inspection. Histologically, a 5- to 10-μm-wide zone of a characteristic laser fingerprint appeared on the cut edges. However, there was no sign of thermal tissue damage to the underlying bone structures. Conclusions: VSP Er:YAG laser osteotomy is clinically practicable without any signs of charred tissue and wound healing disturbances. However, the lack of depth control and the necessity for careful handling are still technical limitations to be overcome.

Implant-borne prosthetic rehabilitation of bone-grafted clefts with nonsubmerged ITI Straumann implants with 3 months' loading represents a reliable treatment option with high success rates in the long term. Functional aspects are comparable to those of noncleft patients. The oral-health-related quality of life of cleft patients is similar to that of noncleft patients. Aesthetics are restricted but satisfactory to patients and dental professionals. Aesthetics of peri-implant soft tissues should be improved in the future.

Objective : Prosthetic rehabilitation of edentulous patients presenting with severely scarred oronasal cleft defects. To document the outcome of telescopic obturator prostheses attached to zygomatic implants in edentulous cleft lip and palate patients. Patients and Methods : Four edentulous patients suffering from the consequences of cleft lip and palate were selected from a cohort of 52 patients who had received zygomatic implants between 1998 and 2010. Oronasal communication had persisted and severe scars and chronic infection were noted in the cleft region. Bone grafting procedures were contraindicated due to high risk for dehiscence. For the functional support of telescopic prostheses, nine zygomatic implants and two standard dental implants had been placed. Results : The zygomatic implants and the telescopic prostheses survived an average of 62 months (37 to 99 months) and were successful. Patients' satisfaction and oral function improved (on visual analog scale and oral health impact profile). Conclusions : Telescopic obturator dentures supported by zygomatic implants represent a feasible option for the prosthetic rehabilitation of cleft lip and palate patients with severe impairments of the edentulous ridges including atrophy, scar tissue, ridge defects, oronasal communication, and chronic infection in the cleft region.

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