Clinical and experimental dental researchCristian Scognamiglio, Gülce Çakmak, Martin Schimmel, Alessandro Perucchi, Samir Abou-Ayash
OBJECTIVES: To compare tissue-level (TL) and bone-level X (BLX) implants regarding peri-implant bone level alterations, survival, and complication rates over a 3-years. MATERIALS AND METHODS: In this retrospective, non-interventional clinical study, patients that had received either TL or BLX implants (both: Straumann AG), with at least one clinical follow-up (minimum 6 months), were included. Bone-level alterations and bone peaks were evaluated at baseline (implant placement) and at follow-ups from dental radiographs. In addition, clinical follow-ups included the recording of the presence of keratinized mucosa and the registration of technical complications (e.g., chipping fractures). For statistics, descriptive analyses, t-tests, and a random-effects linear regression analysis were applied. RESULTS: A total of 146 implants (73 TL and 73 BLX) were included. TL implants showed a survival rate of 100%, whereas BLX implants showed a survival rate of 98% after 3 years. TL implants showed significant mesial bone gain (0.08 mm, p = 0.018) between 2- and 3-year follow-ups, with a notable difference (0.21 mm, p = 0.041) compared to BLX implants. At distal bone levels, TL implants showed initial bone loss (0.12 mm, p = 0.020) at 6 months but gained bone (0.07 mm, p < 0.001) between 2 and 3 years, whereas BLX implants showed significant distal bone loss (0.15 mm, p = 0.038) over 3 years. The number of complications was higher in BLX implants. BLX implants with a band of keratinized mucosa > 2 mm showed smaller bone level alterations. CONCLUSIONS: Both TL and BLX implants performed similarly in terms of clinical and radiological outcomes. However, at the mesial aspect, bone level alterations in TL implants were smaller than in BLX implants, and complications were less frequent. Keratinized mucosa seems especially beneficial in BLX implants. As implant selection was based on clinical indication, the two groups differed in baseline characteristics, and this should be considered when interpreting the between-group comparisons.
Clinical implant dentistry and related researchYulan Wang, Jian Zhang, Runfa Wu, Gang Fu, Yan Xu, Zhe Yi, Qiang Li, Yangsheng Zhao, Ming Shen, Yufeng Zhang
OBJECTIVES: This multicenter prospective cohort study follows a 1-year period after a previously published randomized controlled trial, comparing the radiographic and clinical outcomes of implants placed with simultaneous guided bone regeneration (GBR) using bioceramic (BC) versus xenograft (BO). MATERIALS AND METHODS: Patients from the previous trial were recalled 1 year after crown delivery. The follow-up data focused on the buccal bone stability evaluated by CBCT and implant survival rate, Probing Depth (PD), Bleeding on Probing (BOP), Plaque Index (PI), and patient satisfaction through Oral Health Impact Profile-5 (OHIP-5). RESULTS: Out of 150 enrolled patients in a previous trial, a total of 97 patients completed the 1-year follow-up: 44 in the BC group and 53 in the BO group. The implant survival rate was 100% in both groups. Change in horizontal buccal bone thickness (△HBBT) at 1 year post-crown delivery versus immediately post-surgery was -0.28 ± 0.10 mm for the BC group and -0.91 ± 0.09 mm (mean ± standard error) for the BO group, with the BC group exhibiting less bone resorption along the implant than the BO group (p = 0.0000). No significant differences were observed in PI, BOP, or PD. Patient satisfaction remained high in both groups. CONCLUSIONS: GBR with bioceramic demonstrated stable radiographical bone on the buccal side of the implant 1 year after crown delivery.
Clinical implant dentistry and related researchNa Chen, Na Deng, Tian He, Huafeng Zhang, Tingting Shu, Tao Chen, Hong Huang, Yuanding Huang
OBJECTIVE: This study aims to evaluate the application of an autonomous dental implant robot combined with osseodensification drills for transcrestal maxillary sinus floor elevation (ADIR-OD-TSFE) and simultaneous implant placement. The following parameters, such as maxillary sinus elevation volume (MSV), maxillary sinus elevation area (MSA), membrane elevation height (MEH), implant protrusion length (IPL), implant placement accuracy, intraoperative Schneiderian membrane perforation rate, and operative time, were evaluated. In addition, the force feedback characteristics associated with different maxillary sinus floor morphologies were preliminarily investigated. MATERIALS AND METHODS: This study enrolled patients treated at the Stomatological Hospital of Chongqing Medical University between January and November 2024, with a residual bone height (RBH) of 4.00-8.00 mm, who underwent simultaneous implant placement using ADIR-OD-TSFE. Postoperative CBCT scans were imported into the design software to evaluate implant placement accuracy. The software's AI segmentation function was used to calculate the sinus floor augmentation outcome immediately after surgery (P1) and at 6 months postoperatively (P2). Force feedback characteristics were analyzed for two sinus floor morphologies (flat and sloped). The total operative time for osteotomy, sinus floor elevation, and implant placement performed with robotic assistance was recorded; the surgeon's learning curve was plotted, and the intraoperative complications were documented. RESULTS: A total of 18 implants were placed, with 9 in flat sinus floors and 9 in sloped sinus floors. The mean preoperative RBH was 5.92 ± 1.01 mm. Schneiderian membrane perforation occurred in 1 case (5.6%). The mean surgery time was 25.5 ± 9.8 min, and the surgeon's learning curve plateaued as case numbers increased. The coronal global deviation (CG), apical global deviation (AG), and angular deviation (AD) were 0.69 ± 0.36, 0.76 ± 0.41, and 1.64° ± 0.91°, respectively. The maxillary sinus floor elevation volume was 351.54 ± 151.74 mm3 immediately after surgery (P1) and 253.68 ± 160.60 mm3 at 6 months postoperatively (P2). Force feedback analysis showed that the breakthrough force was higher in flat sinus floors (Ff0) than in sloped sinus floors (Fs0), with a mean difference of 6.86 N, a 95% CI of 0.82 to 12.90 N, and a large effect size (Hedges' g = 1.08). CONCLUSION: The ADIR-OD-TSFE technique is effective for sinus floor elevation and implant placement, with the learning curve improving as the surgeon's experience increases. It demonstrates high implant placement accuracy and maintains relatively stable bone augmentation outcomes at 6 months postoperatively. Flat sinus floors require significantly higher breakthrough forces compared to sloped sinus floors. Overall, the ADIR-OD-TSFE system proves to be a safe and clinically reliable approach.
Clinical and experimental dental researchAdria Jorba-Garcia, Shengchi Fan, Feng Wang, James Chow, Atiphan Pimkhaokham, Nikos Mattheos, Alessandro Pozzi
Computer-assisted implant surgery (CAIS) represents a comprehensive digital workflow integrating prosthetically driven planning with various execution modalities. Among these, dynamic (d-CAIS) and robotic (r-CAIS) systems constitute two distinct yet interrelated approaches, sharing core technological principles as well as operative differences. This white paper aims to provide a structured overview of the fundamental concepts and workflows underpinning d- and r-CAIS, focusing on their shared components, procedural steps, and system-specific characteristics. Both approaches rely on accurate digital treatment planning, spatial positioning systems, registration protocols, and real-time feedback mechanisms to guide implant placement. However, while d-CAIS enables operator-controlled freehand execution under real-time navigation, r-CAIS introduces robotic assistance or task autonomy, integrating mechanical actuation into the surgical workflow. Rather than providing exhaustive technical instructions, this work aims to establish a conceptual framework to support clinicians in understanding and evaluating emerging CAIS technologies and their role in contemporary implant dentistry. Furthermore, it discusses current advantages, limitations, and challenges related to clinical implementation, cost, and training requirements.
BMC oral healthJaylane K Ghonima, Mohy El-Din El-Rashidy, Gehan Kotry, Samir R Nouh, Dina Nagui, Eman Thabet, Salma E El-Habashy
BACKGROUND: Furcation defects are considered among the most challenging periodontal lesions to regenerate given the complexity of the periodontal apparatus, inaccessibility and the limited blood supply to the area. The aim of the current study was to create and characterize a novel ternary hydrogel composed of hyaluronic acid (HA), chitosan (CS) and polyvinyl alcohol (PVA) and to evaluate its potentials in periodontal regeneration of furcation defects in dogs. MATERIALS AND METHODS: A composite hydrogel scaffold composed of hyaluronic acid, chitosan and polyvinyl alcohol was successfully prepared and characterized in terms of SEM, swelling and mechanical behaviors, FTIR analysis as well as biocompatibility assay and direct cell-scaffold interactions. In an in vivo study, thirty-two critical size class II furcation defects were created in eight mongrel dogs and randomly allocated to group I, hydrogel group and group II, negative control group. Histological analysis and histomorphometric evaluation of percentage of newly formed bone area were used to evaluate the regenerative potential of the novel hydrogel after one and three months, postoperatively. RESULTS: The prepared hydrogel was cytocompatible, had proper degradation rate, water uptake and mechanical strength as well as ease of handling clinically. Histologic results of the hydrogel group revealed superior bone, periodontal ligament and cementum formation compared to the negative control group at both time points. The hydrogel group showed a statistically significant increase in the percentage of newly formed bone surface area compared to the negative control group. CONCLUSIONS: The novel ternary hydrogel prepared using hyaluronic acid, chitosan and polyvinyl alcohol showed adequate cytocompatibility and mechanical properties. The in vivo results support that the novel scaffold might be effective for periodontal regeneration in furcation defects in dogs.
Clinical oral investigationsLiang-Cheng Chen, Byron Fan, Hsiao-Hui Tsou, Shao-Yu Wang
OBJECTIVE: Impacted mandibular third molars pose significant clinical challenges, often leading to complications such as pericoronitis, adjacent tooth caries, and inferior alveolar nerve (IAN) injury during extraction. This study evaluates the effectiveness of the Kyola Distraction System, an innovative approach designed to gradually move impacted third molars away from the IAN, reducing surgical risks. METHODS: A retrospective analysis of 100 cases was conducted at Changhua Christian Hospital. Patients underwent Kyola Distraction, which combines coronectomy with orthodontic traction using an elastic-based anchorage system. The movement of the third molar relative to the inferior alveolar canal was assessed through panoramic radiographs. The study analyzed the distraction period, scooting distance, and potential nerve complications. RESULTS: Among 100 patients (57 male, 43 female, aged 18-60 years), 32 cases involved single-root third molars, and 68 cases had double-rooted teeth. The average distraction period was 61.3 days for single-root cases and 61.1 days for double-root cases. The estimated scooting distance was 1.38 mm for the mesial root and 1.59 mm for the distal root in double-root cases, while single-root molars moved an average of 1.42 mm. No cases of nerve damage were reported. CONCLUSION: The Kyola Distraction System presents a safe and effective alternative to conventional odontectomy for impacted mandibular third molars. By reducing the risk of IAN injury, minimizing postoperative complications, and promoting bone regeneration, this approach offers a promising advancement in third molar management. Further studies are recommended to evaluate its long-term clinical outcomes.
OBJECTIVES: We aimed to evaluate the clinical and radiographic effectiveness of locally applied insulin versus hyaluronic acid (HA), each combined with absorbable collagen sponge (ACS), using the single flap approach (SFA) in the management of periodontal intra-bony defects. MATERIALS AND METHODS: 21 periodontitis patients with intra-bony defects were randomly assigned to 3 groups: group I (SFA + insulin + ACS; n = 7), group II (SFA + HA + ACS; n = 7), and group III (SFA + ACS; n = 7). Primary outcome was clinical attachment level (CAL), assessed at baseline and 6 months postoperatively; secondary outcomes included probing pocket depth (PPD), measured at baseline and 6 months; postoperative pain, using visual analogue scale (VAS) at 24 and 48 h; and radiographic parameters, including radiographic linear defect depth (RLDD) and bone density, assessed at baseline and 6 months. RESULTS: PPD and CAL improved significantly over time in all groups (P < 0.001), with no intergroup differences. VAS scores were significantly lower in the insulin and HA groups than in controls at 24 h (P = 0.004) and 48 h (P = 0.007), with the lowest scores in the insulin group (P = 0.008). RLDD decreased significantly in all groups (P < 0.001), with a greater reduction in HA + ACS compared to insulin and controls at 6 months (P = 0.027). Bone density increased significantly over time in insulin + ACS (P < 0.001) and HA + ACS (P = 0.022), with no change in the ACS group (P = 0.860), with non-significant intergroup differences. CONCLUSION: In the management of periodontal intrabony defects, SFA with both insulin and HA soaked in collagen sponge showed favorable clinical and radiographic improvements. CLINICAL RELEVANCE: Local insulin may represent a promising, simple, and cost-effective biomaterial in periodontal treatment; however, more studies are needed. CLINICAL TRIAL REGISTRATION: NCT05746676.
Oral and maxillofacial surgeryJiaqi Yue, Guoliang Sa, Zhongxing Wu
PURPOSE: Inferior alveolar nerve (IAN) dissection and repositioning is critical for preventing iatrogenic IAN injury during combined mandibular border resection and sagittal split ramus osteotomy (SSRO) in patients with severe hemimandibular hyperplasia (HH). Traditional IAN repositioning includes two-stage and concurrent one-stage procedures. This study introduces a modified one-stage technique and compares the respective advantages and disadvantages of these three surgical protocols. METHODS: Four patients with HH were enrolled and treated with three different surgical protocols: one two-stage procedure, one conventional one-stage procedure, and two modified one-stage procedures. The modified technique features a vertical osteotomy placed 5 mm anterior to the mental foramen to protect the anterior loop of the IAN. RESULTS: All patients achieved satisfactory facial symmetry and aesthetic improvement postoperatively. Neurosensory assessment at 6-month follow-up confirmed complete recovery of lower lip sensation without persistent numbness. Compared with the two-stage and conventional one-stage approaches, the modified technique effectively preserved the IAN anterior loop, simplified surgical procedures, and minimized bony defects by maintaining buccal cortical bone integrity. CONCLUSION: The modified one-stage approach is a simplified and effective technique that provides reliable neuroprotection for the anterior loop of the IAN while minimizing bony defects during SSRO in HH patients. Given the limited sample size of this case series, further large-sample and long-term studies are required to fully validate tits efficacy, long-term stability, and complication profile.
Medical science monitor : international medical journal of experimental and clinical researchEbru Sümer Ekin, Sozdar Başkan Uyar, Merve Güler, Emrah Ayna
BACKGROUND This study compared the accuracy of different scan body geometries under different implant angulation and interimplant distance conditions. Evidence regarding full-arch digital implant scanning under these conditions remains limited. MATERIAL AND METHODS In this in vitro study, 5 implants were placed in maxillary edentulous plaster models representing 3 implant systems (Bioinfinity, Meisinger, and Mode). The reference implant was positioned perpendicular to the ridge crest at the midline. Implant angulations (5° and 10°) and interimplant distances (5 mm and 10 mm) were standardized. Scan bodies were attached to the master model, and each model was scanned 10 times using an intraoral scanner (TRIOS 5). Three-dimensional deviations were calculated. Data were analyzed using 1-way ANOVA and Tukey HSD tests (alpha=0.05). RESULTS No significant differences were observed among the groups at 5° angulation (P>0.05), whereas significant differences were detected at 10° angulation for implants 1 and 5 (P<0.01). Bioinfinity showed higher deviation values at implant 1, while Meisinger demonstrated higher deviations at implant 5. At a 10-mm interimplant distance (implants 1 and 2), significant differences were found among the groups (P<0.001), with Bioinfinity exhibiting lower deviation values. At a 5-mm distance, no significant difference was observed at implant 4 (P>0.05), whereas a significant difference was found at implant 5 (P<0.001), with the highest deviation in the Meisinger group. CONCLUSIONS Increased implant angulation and interimplant distance are associated with reduced accuracy and higher deviation values in digital full-arch scans. The influence of scan body geometry varies depending on implant position.
OBJECTIVE: To introduce a practical, evidence-based and prognosis-oriented conceptual decision aid for the management of Class II furcation involvement, integrating defect-specific regenerative potential with long-term maintenance feasibility. MATERIALS AND METHODS: A structured narrative review of the literature on Class II furcation involvement regeneration, prognostic factors, and long-term maintenance outcomes was conducted using PubMed, EBSCO, and Scopus databases. Variables with documented influence on regenerative outcomes or long-term tooth survival were extracted and grouped into two conceptual axes: a Morphological Regenerability Score, capturing defect anatomy, and a Maintenance Accessibility Score, capturing site-related and patient-related factors. Scoring ranges and thresholds were derived from the magnitude and consistency of reported effect sizes. RESULTS: The Morphological Regenerability Score integrates five defect-related variables (vertical furcation involvement component, root divergence at crestal bone, furcation entrance width, defect location and root trunk length) with modifiers for mobility, cervical enamel projections, exposed furcation entrance, and enamel pearls, spanning - 5 to 9 points. The Maintenance Accessibility Score integrates seven maintenance-related variables (plaque control, supportive periodontal treatment compliance, smoking, diabetes control, site/operator accessibility, endodontic status and tissue phenotype), spanning 0 to 13 points. Midpoint thresholds (MRS ≥ 5; MAS ≥ 7) define four clinical quadrants guiding case selection between regeneration, staged treatment strategy, non-surgical or resective approaches, and extraction. CONCLUSIONS: The proposed framework consolidates heterogeneous evidence on Class II furcation involvement prognosis and proposed treatment strategies into a single transparent decision aid. Prospective validation is required before routine clinical adoption. CLINICAL RELEVANCE: This framework supports evidence-based, individualised decision-making for Class II furcation involvement based on defect regenerability and long-term maintenance, and highlights modifiable risk factors that should be addressed before attempting regenerative surgery.
Oral and maxillofacial surgeryMax Lukas Linderkamp, Efthymios Papazacharias, Madlen Sophie Eich, Jan Gaessler, Pascal Eber, Alexander Rahman, Philipp Jehn, Fritjof Lentge, Michael-Tobias Ne…
PURPOSE: Children and young adults with severe pre-existing conditions frequently require dental treatment under general anesthesia (GA) and are commonly scheduled for postoperative inpatient surveillance due to presumed elevated anesthetic or surgical risks. Although this approach prioritizes safety, it may contribute to prolonged or unnecessary hospitalization, increased healthcare costs, and potential psychological burden, particularly in patients with neurodevelopmental or congenital disorders. In light of the reportedly low incidence of severe complications following dental treatment under GA, this study aims to evaluate the necessity of routine inpatient admission in pediatric patients (< 18 years of age) with comorbidities and to assess the frequency and severity of perioperative complications. METHODS: All pediatric patients with pre-existing conditions who underwent planned inpatient surgical dental treatment under GA at the Department of Oral and Maxillofacial Surgery at Hannover Medical School between 2014 and 2025 were included. The indications for inpatient treatment, anesthesiological parameters such as the American Society of Anesthesiologists (ASA) classification, and severe perioperative complications (corresponding to grade ≥ 2 of the Clavien-Dindo classification) were analyzed. It was assessed whether the ASA classification or the type of pre-existing condition significantly influenced the occurrence of perioperative complications. RESULTS: A total of 199 patients were analyzed. Patients who underwent surgery were mainly categorized as ASA II (n = 80, 40.2%) and III (n = 102, 51.3%), and mostly presented with cardiovascular (n = 68, 34.2%) or hematological/oncological preconditions (n = 47, 23.6%). Perioperative complications occurred in 8 cases (4.2%); of those, 6 were intraoperative (3.1%), and 2 were postoperative (1.0%). The probability of perioperative complications did not correlate with ASA classification or pre-existing conditions (p [Fisher] = 0.166, and p [Fisher] = 0.571, respectively). Age significantly influenced the probability of complications (U = 451.00, p = 0.050), indicating that older patients were more likely to experience complications than younger patients. CONCLUSION: As postoperative complications occur very rarely, even in patients with pre-existing conditions, inpatient surveillance should warrant thoughtful consideration to liberate hospital capacities. Interdisciplinary pre-, intra-, and postoperative assessment of the need for inpatient surveillance should ensure patient safety and provide further insights into risk factors for peri- and especially postoperative complications. The authors recommend validating risk scores and algorithms for decision-making regarding inpatient surveillance.
Oral and maxillofacial surgeryMisha L Tan, Max P A Balkenende, Damir Delic, Karel Kuik, Cornelis J Kleverlaan, Jan de Lange, Jean-Pierre T F Ho
PURPOSE: Le Fort I osteotomy is widely performed in orthognathic surgery for maxillary repositioning and for the treatment of dentofacial deformities and obstructive sleep apnea (OSA). Postoperative relapse remains a concern, particularly after large maxillary advancements, highlighting the importance of rigid fixation. This study aimed to determine which fixation technique provides the greatest rigidity. METHODS: In this in vitro study, the biomechanical rigidity of five commonly used fixation techniques for Le Fort I osteotomies was evaluated using 150 polyurethane specimens with advancements of 5 mm and 10 mm. The techniques included two L-plates (A), four L-plates of different thicknesses (B and C), two precontoured Le Fort I plates (D), and a hybrid configuration with two precontoured Le Fort I plates combined with two L-plates (E). Resistance to vertical displacement was measured at 1, 3, and 5 mm using a biomechanical testing machine. RESULTS: Fixation E consistently showed the highest resistance across both advancement distances and all displacement intervals, significantly outperforming fixations A, C, and D. Fixation B demonstrated resistance comparable to fixation E, whereas fixation C showed inferior performance despite a similar configuration. Fixations A and D showed the lowest resistance, particularly at 10 mm advancement. CONCLUSION: Overall, fixation E provided the greatest rigidity, while techniques relying on only two plates were biomechanically less effective. Further clinical studies are required to determine the clinical relevance of these findings.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineWanxin Zhang, Min Yu, Xu Gong, Weijing Dang, Xuemei Gao
OBJECTIVES: To evaluate objective and subjective adherence to oral appliance (OA) therapy in obstructive sleep apnea (OSA) and identify predictors of adherence. METHODS: Forty-nine adults with OSA (27 males, 22 females) underwent baseline polysomnography, sleep questionnaires, craniofacial measurements, and personality assessment. Objective adherence was monitored for 3 months using an embedded thermal microsensor. Subjective adherence was self-reported at 3 and 12 months. Predictors of adequate adherence (mean nightly use ≥ 4 h) were identified using multivariate logistic regression under a modified intention-to-treat approach. RESULTS: OA therapy reduced AHI from 16.6 ± 10.3 to 4.16 ± 3.05 events/h. Forty-three participants (87.8%) completed the 3-month follow-up, and were all contacted at 12 months. During the first 3 months, mean use was 7.05 h on nights worn and 3.85 h/night overall, with OA used on 3.7 days/week and ≥ 4 h on 55.7% of nights. Participants overestimated use frequency (P < 0.001) but not nightly duration. At 3 months, 49% were adherent, showing stable use, whereas non-adherent users wore the appliance on fewer nights; at 12 months, 44% remained adherent, while most non-adherent users discontinued therapy. Older age and lower baseline ESS predicted 3-months adherent, while older age and smaller mandibular plane angle predicted 12-months adherent. CONCLUSION: Adherence to this type of OA was suboptimal in this study, with patients overestimating use frequency but accurately reporting nightly duration. Older age predicted adherence at both 3 and 12 months, while lower baseline sleepiness and smaller mandibular plane angle were associated with 3- and 12-month adherence, respectively. CURRENT KNOWLEDGE/STUDY RATIONALE: Subjective adherence to oral appliance (OA) therapy in patients with obstructive sleep apnea (OSA) may overestimate actual device use, whereas longitudinal adherence patterns and their clinical implications remain poorly understood. STUDY IMPACT: Objective adherence to OA therapy was substantially lower than self-reported adherence, particularly among poorly adherent patients. Early adherence patterns may help clinicians identify patients who require additional adherence support. In the absence of regular adherence reminders, OA use frequency remained insufficient, potentially limiting the systemic benefits of OA therapy for OSA. Long-term, objective, and individualized adherence care and monitoring may be important in routine clinical practice.
Clinical oral investigationsLucas M Ritschl, Bastian Schwaiberger, Katharina Pippich, Jannik Ketschau, Victoria Kehl, Wolff Klaus-Dietrich, M Probst, Andreas Fichter, Jonathan Mohr
OBJECTIVES: The aim of this retrospective study was to determine the incidence of inferior alveolar nerve (IAN) injury in patients with mandibular fractures by correlating fracture displacement and mandibular canal involvement on preoperative computed tomography (CT) imaging with clinically documented nerve deficits - and to develop the first CT-based displacement classification for predicting the likelihood of IAN injury. MATERIALS AND METHODS: We retrospectively reviewed mandibular fractures and available preoperative CT scans. Fracture location, cortical and canal displacement, and nerve function were recorded. Receiver operating characteristic (ROC) curve and logistic regression analyses evaluated associations between displacement thresholds and IAN injury risk. RESULTS: A total of 208 patients (237 fractures) were included; preoperative IAN deficits occurred in 74/237 fractures (31.2%) and persisted at ≥ 6 months in 3/237 fractures (1.3%). ROC analysis yielded area under the curve (AUC) values of 0.71, 0.73, 0.75, and 0.75 for cortical displacement cut-offs of > 3.60 mm (transverse), > 1.68 mm (sagittal), > 1.29 mm (vertical), and > 9.61 mm (summed displacement), respectively. Multivariate logistic regression demonstrated that exceeding these thresholds was associated with significantly increased risk of IAN hypoesthesia - OR 6.4, 4.8, 6.8, and 7.9, respectively (all p < 0.001). Mandibular canal displacement showed limited predictive value for IAN hypoesthesia, with ROC AUCs of 0.63 (axial), 0.63 (coronal), 0.64 (sagittal), and 0.64 (summed displacement). CONCLUSION AND CLINICAL RELEVANCE: This study establishes specific, plane-based CT displacement thresholds that may help to identify mandibular fractures at high risk of IAN injury. Our proposed CT-based classification enables objective preoperative risk stratification, enhances patient counseling, guides surgical decision-making, and supports the standardized medico-legal assessment of potential permanent sensory deficits.
BMJ case reportsGayatri Kulkarni, Somakshi Pise, Vaibhav Alone, Ankita Chugh, Komal C Suvarna
Acute pancreatitis is a rare postoperative complication in children, particularly following non-abdominal surgery. Its occurrence after paediatric oral and maxillofacial procedures performed under general anaesthesia is exceedingly uncommon and can be easily overlooked due to non-specific clinical manifestations. We report the case of a boy in early childhood who underwent uneventful marsupialisation of a mandibular odontogenic cyst with extraction of multiple deciduous teeth under total intravenous anaesthesia with propofol. Within hours of surgery, he developed diffuse abdominal pain. Laboratory investigations revealed markedly elevated serum amylase and lipase levels, while abdominal ultrasonography demonstrated a bulky, hypoechoic pancreas with peripancreatic fluid, confirming acute pancreatitis. The case was classified as mild acute pancreatitis per the revised Atlanta Classification. The child was managed conservatively with bowel rest, intravenous fluids, antibiotics and analgesia under multidisciplinary supervision. His symptoms resolved completely and follow-up imaging at 1 month showed full recovery. This case highlights the importance of considering acute pancreatitis in the differential diagnosis of unexplained postoperative abdominal pain in children undergoing maxillofacial surgery and emphasises that early recognition and supportive care are key to achieving favourable outcomes.
BMJ case reportsHoratiu Urechescu, Cristiana Cuzic, Felicia Streian, Marius Pricop
Supernumerary teeth may lead to crowding, eruption disturbances and orthodontic complications, particularly when located in the mandibular premolar region. We report the case of a male teenager referred for orthodontic assessment in whom cone-beam CT (CBCT) revealed two impacted supplementary supernumerary teeth positioned lingually in the left mandibular premolar region, in close proximity to the adjacent roots and without cortical perforation.Surgical removal was indicated. A comparison of potential access routes based on CBCT analysis showed that a buccal approach would have required a longer transosseous path and more extensive bone removal across the adjacent roots. Therefore, a lingual approach was selected as the most direct and least invasive option. The supernumerary teeth were removed under local anaesthesia using a lingual full-thickness flap and limited osteotomy.Healing was uneventful, with no neurosensory deficit and stable radiographic findings at the 2-year follow-up. This case highlights that the choice of surgical approach should be based on a CBCT-guided comparison of access pathways. In selected mandibular premolar cases, a lingual approach may reduce bone removal and risk to the adjacent teeth when it provides the shortest and safest route, provided that lingual soft tissue risks are carefully managed.
Annals of medicineXiaoxuan Hu, Chong Fu, Guorong Bi, Qiyun Tan, Yaoyu Ying, Weiming Zhao, Xuechun Cai, Nan Yin, Xin Wang, Hong Liu, Lingzhong Meng, Fu-Hai Ji, Qiang Sun, Baojian…
INTRODUCTION: Emergence agitation (EA) is a clinically significant complication during early recovery from general anesthesia. This protocol describes a randomized controlled trial designed to determine whether intraoperative low-dose remimazolam maintenance reduces the incidence of EA without prolonging emergence time in patients undergoing oral surgery. PATIENTS AND METHODS: This multicenter, randomized, controlled clinical trial will enroll 388 patients scheduled for oral surgery under general anesthesia. Patients will be randomly allocated in a 1:1 ratio to either the remimazolam group, receiving a low-dose intraoperative infusion of remimazolam, or the control group, receiving an equivalent volume of normal saline. The primary outcome is the incidence of emergence agitation; the key secondary outcome is emergence time. Emergence time will be evaluated within a non-inferiority framework, whereas the incidence of emergence agitation will be tested for superiority. Additional endpoints comprise pain scores, analgesic use, the rate of postoperative nausea and vomiting (PONV), recourse to rescue antiemetics, the occurrence of postoperative sleep disturbance (PSD), time spent in the post-anesthesia care unit (PACU), postoperative hospital length of stay, overall recovery quality, the frequency of perioperative adverse events, and patient satisfaction. DISCUSSION: This trial will investigate the efficacy and safety of intraoperative low-dose remimazolam maintenance in patients undergoing oral surgery. The findings may provide evidence supporting a practical pharmacological intervention to reduce EA and enhance postoperative recovery. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2600116544).
International dental journalJiajin Shen, Xi Yang, Junbiao Zhang, Xiaohuan Lu, Guangneng Chen, Yin Liu, Bin Ye, Minxian Ma
INTRODUCTION AND AIMS: This study aimed to devise a deep learning-based model for the automated identification of anatomical mandibular lingual concavities in the posterior mandible and the prediction of biologically guided three-dimensional implant positions. METHODS: Cone-beam computed tomography (CBCT) images with single-tooth posterior mandibular edentulism were included. A deep learning framework was constructed utilizing 3D U-Net and Swin-Transformer. This framework was designed to perform automated segmentation of teeth, mandible, and the mandibular nerve canal; to classify morphological types of lingual concavities; and to identify implant key points with coordinate prediction. Model performance was assessed via five-fold cross-validation. RESULTS: The proposed model achieved Dice similarity coefficients ranging from 0.87 to 0.91 for dental segmentation. In the classification of mandibular lingual concavities, an accuracy of 0.92 to 0.97 was attained. Regarding the prediction of three-dimensional implant positions, the automatically generated plans maintained a safety margin of 3.20 to 3.89 mm from the mandibular nerve canal. Furthermore, sufficient bone volume was preserved at both cervical and apical implant levels, with buccal/lingual cervical bone widths averaging 4.94 to 5.78 mm. CONCLUSION: The deep learning model in this experiment performed well across different views and learning tasks in a retrospective internal validation setting. Furthermore, it demonstrated the ability to accurately identify relevant anatomical structures, and the predicted three-dimensional implant positions showed clinically acceptable safety margins in the internal validation cohort. CLINICAL RELEVANCE: This model provides a preliminary AI-assisted framework for identifying critical mandibular anatomical structures and generating biologically guided preliminary implant position suggestions, thereby helping to mitigate intraoperative complications and reduce the risk of postoperative mechanical and biological complications in preclinical evaluation.
Journal of dentistryErika da Silva Mello, Anna Carolina Ratto Tempestini Horliana, Cícero Dayves da Silva Bezerra, Kristianne Porta Santos Fernandes, Luciana Toledo Costa Salviatt…
BACKGROUND: Postoperative pain, swelling, and functional limitations are common after mandibular third molar surgery, affecting recovery and quality of life. This randomized, double-blind clinical trial evaluated the effects of preemptive photobiomodulation therapy with infrared LED on postoperative pain, as well as edema and trismus. METHODS: Eighty healthy participants requiring lower third molar extraction were randomly assigned to a photobiomodulation group or a sham group. Nine patients from each group were excluded from the sample because they did not comply with the postoperative instructions. The treated group received photobiomodulation (850 nm, 100 mW, 24 J) 1 hour before surgery and additional applications at 48 h and 7 days postoperatively. Pain intensity, swelling, trismus, and quality of life were assessed at baseline, 48 h, and 7 days after surgery. RESULTS: The photobiomodulation significantly reduced pain at 48 h (p < 0.001) compared to sham, although no difference was observed on day 7. Swelling resolution was superior in the photobiomodulation group, with facial measurements returning to baseline by day 7, unlike in the sham group. No significant difference was found for trismus. Quality-of-life scores favored photobiomodulation, particularly regarding social activities, swallowing, and sleep quality. CONCLUSIONS: Preemptive photobiomodulation with infrared LED effectively reduces early postoperative pain and accelerates edema resolution in lower third molar surgery. This simple, non-invasive, and low-cost intervention improves recovery and enhances patient comfort. Further studies are warranted to confirm these findings and optimize treatment protocols. CLINICAL SIGNIFICANCE: Preemptive photobiomodulation using infrared LED may serve as an effective adjunctive therapy to improve early postoperative recovery after mandibular third molar surgery. Its ability to reduce pain and accelerate edema resolution can enhance patient comfort and quality of life while offering a non-invasive and cost-effective approach easily integrated into routine clinical practice.
Photobiomodulation, photomedicine, and laser surgeryYongqing Ma, Miaomiao Yang, Jiang Sun
BACKGROUND: Inferior alveolar nerve (IAN) sensory disturbance after mandibular third molar extraction can persist and affect speech, mastication, and quality of life. Photobiomodulation (PBM) has been used to promote peripheral nerve recovery, but the most suitable irradiation strategy remains unclear. Laser acupuncture (LA) delivers PBM to predefined acupoints and may provide both local and central neuromodulatory effects. OBJECTIVE: To compare standardized LA with direct nerve-trajectory PBM for post-extraction IAN hypoesthesia in a randomized, double-blind, sham-controlled trial. METHODS: Adults aged 18-60 years with unilateral IAN hypoesthesia lasting ≥7 days and ≤12 weeks were randomized (1:1:1) to LA, direct PBM along the external IAN projection, or sham treatment. All participants received mecobalamin (0.5 mg, three times daily) for 30 days. PBM was delivered using an 808-nm diode laser (continuous wave, 100 mW; beam area 1.0 cm2), 90 s/site (9 J; 9 J/cm2), every other day for 15 sessions. LA used a fixed 5 + 2 prescription: ST4, ST6, ST7, CV24, Jiachengjiang (EX-HN19), plus LI4 and PC6. Primary outcomes were two-point discrimination (TPD) and Semmes-Weinstein monofilament examination (SWME) at day 30. Secondary outcomes included Visual Analog Scale (VAS) numbness, additional sensory tests, and day-60 follow-up. RESULTS: Sixty participants completed the intervention. Both active groups improved more than sham for TPD and SWME (group × time p < 0.01). Mean TPD change at day 30 was -3.2 ± 1.8 mm (LA) and -2.6 ± 1.7 mm (direct PBM) versus -0.8 ± 1.1 mm (sham). SWME improved by ≥1 grade in 85%, 80%, and 25%, respectively. VAS numbness decreased by 60%, 48%, and 12%, respectively, and the improvement was largely maintained at day 60. No treatment-related adverse events occurred. CONCLUSIONS: Under matched PBM dosimetry, both irradiation strategies improved sensory recovery compared with sham. LA produced comparable results and was associated with greater improvement in patient-reported numbness.