JMIR research protocolsRutuja Karamore, Prasad Dhadse, Sanehi Punse
BACKGROUND: Alveolar ridge resorption following tooth extraction can compromise subsequent implant placement. Socket preservation techniques aim to minimize dimensional changes and promote favorable bone healing. Chitosan nanoparticles combined with titanium-prepared platelet-rich fibrin represent a biologically active approach to ridge preservation. OBJECTIVE: This study aims to evaluate longitudinal changes in alveolar ridge dimensions and bone quality following socket preservation using chitosan nanoparticles combined with titanium-prepared platelet-rich fibrin. METHODS: This is a single-arm prospective clinical study involving systemically healthy participants requiring tooth extraction. Clinical, radiographic, and histomorphometric assessments will be performed at baseline and at follow-up visits at 3 and 6 months. Statistical analysis will be conducted using within-subject repeated-measures approaches. RESULTS: No external funding was received for this research. The manuscript was submitted before recruitment of participants had started and no clinical data had been collected or analyzed. Clinical, radiographic, and histomorphometric outcomes will be evaluated to assess changes in the dimensions of the alveolar ridge, bone density, and quality of regenerated bone during the postextraction healing period. Clinical and radiographic evaluation will be performed at baseline, 3 months, and 6 months. Histomorphometric analysis will be performed on bone core biopsy samples taken at the time of implant placement. The results of the study will be reported after data collection and analysis. CONCLUSIONS: This protocol outlines a standardized approach to evaluating the clinical, radiographic, and histomorphometric outcomes of socket preservation using chitosan nanoparticles combined with titanium-prepared platelet-rich fibrin. The findings from this study may inform the design of future controlled clinical trials. TRIAL REGISTRATION: Clinical Trials Registry of India CTRI/2025/06/089715; https://tinyurl.com/4u6698xs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/79532.
BMJ case reportsTanu Sharma, Shruti Sharma, Anshul Singla, Amrita Puri
This case report discusses the genetic influence and treatment of class III malocclusion in identical twin sisters, in their early 20s, who presented with mandibular prognathism. Both exhibited concave profiles with hypodivergent growth patterns, but Sister A had a more pronounced concavity. Diagnosis revealed skeletal class III malocclusion with mandibular prognathism and negative overjet (9 mm in Sister A, 6 mm in Sister B). Treatment involved pre-surgical orthodontics, bilateral sagittal split osteotomy (BSSO) with mandibular setbacks (7 mm for Sister A, 5 mm for Sister B), followed by post-surgical orthodontics and retention. Both sisters achieved improved facial aesthetics, class I occlusion and functional stability. However, Sister B experienced transient paraesthesia and a bad split, leading to temporary splinting of the second molar. The case highlights the genetic basis of mandibular prognathism, the effectiveness of BSSO and the importance of meticulous surgical planning and interdisciplinary management for optimal long-term results.
BMJ case reportsJanvi Dave, Bhavna H Dave, Seema Dinesh Bargale, Vaishnavi Patil
Children with intellectual disability often experience difficulties in accessing routine dental care because behavioural limitations and associated medical conditions make treatment challenging. Untreated dental infections in such patients may pose significant health risks, particularly when systemic conditions are present. A child in middle childhood with moderate intellectual disability presented with pain and progressive swelling in the right posterior mandibular region. The patient was non-verbal and had underlying cardiac dysfunction and encephalopathy, which further complicated clinical management. Clinical and radiographic examination revealed a grossly carious mandibular first permanent molar associated with a periapical cyst, along with severe ankyloglossia. Due to limited cooperation and medical complexity, comprehensive dental management was performed under general anaesthesia, including extraction, cyst enucleation, diode laser-assisted frenectomy and preventive care. Recovery was uneventful, and the patient was referred for speech therapy. This case highlights the importance of coordinated multidisciplinary management for medically complex children requiring comprehensive dental rehabilitation.
Clinical oral investigationsArwa Hosni, Mohamed Shawky, Mohamed Ibrahim Sakr, Waleed El-Beialy, Mostafa Ezz, Mohammed Atef
OBJECTIVES: The objectives of this study were; (1) to assess the accuracy of virtual surgical planning (VSP) and computer aided design and manufacturing (CAD/CAM) in creating an anatomically oriented, bone-borne fracture reduction/plate positioning patient specific surgical guide (PSSG) and a customized three-dimensional (3D) miniplate to achieve anatomical reduction and stabilization of fractured segments in mandibular angle fractures (MAF) via a more esthetic, less complication-laden intraoral access, and (2) to evaluate efficiency of customized 3D miniplates in reestablishment of masticatory function. METHODS: Twenty-four patients were included and randomly allocated into 2 groups; group I, where open reduction and internal fixation (ORIF) of MAF was performed using a fracture reduction/plate positioning PSSG and a customized 3D miniplate and group II, where ORIF of MAF was performed using a single 2.0 superior border miniplate (Champy's technique). Assessment of accuracy of VSP in group I was carried out by superimposition of 3D virtual models of virtually preoperatively reduced mandible over those of surgically reduced and stabilized mandibles at 1 week and 6 months postoperatively. Clinical assessments of maximum bite force in Newtons (N) using a bite force measurement device as well as occlusion status according to the following scale: satisfactory (no gap), mild derangement (gap of 1-2 mm) or marked derangement (gap more than 2 mm) were carried out at 1 week, 1, 3 and 6 months postoperatively. RESULTS: In group I, superimposition of 3D virtual models of surgically reduced and stabilized mandibles at 1 week and 6 months over the virtually preoperatively reduced mandible revealed a mean surface deviation of 0.36 ± 0.09 mm and 0.45 ± 0.08 mm, respectively. Bite force measurements in group I were significantly higher (p < 0.001) than those in group II at 1 week (20.48 ± 3.20N-13.24 ± 2.83N), 1 month (69.52 ± 3.42N-41.16 ± 3.02N) and 3 months (147.45 ± 3.00N-139.50 ± 3.44N), respectively, with large effect sizes (PES > 0.29). At six months, there was also a statistically significant difference (p = 0.003) between both groups (166.66 ± 2.8N-162.31 ± 3.19N respectively) with higher bite force in group I, however, the effect size was moderate (PES = 0.13). Difference in postoperative occlusion status was statistically insignificant between both groups across all time points. CONCLUSION: Assessment of accuracy of VSP revealed a minimal amount of discrepancy between 3D virtual models of surgically reduced and stabilized mandibles over those of virtually preoperatively reduced mandibles. An anatomically oriented, bone-borne fracture reduction/plate positioning PSSG aided significantly in customized 3D miniplate positioning and fracture reduction. Fractures stabilized with a customized 3D miniplate were associated with higher bite forces when compared to single miniplate fixation, however, this must be interpreted with caution. We recommend that future studies be conducted on a larger sample size. CLINICAL RELEVANCE: Based on the results of this study, we believe that utilizing VSP and CAD/CAM for guided ORIF of MAF using customized 3D miniplates seems to be a promising method, allowing for predictable 3D miniplate positioning and fixation through an intraoral approach and may allow for early reestablishment of masticatory function. CLINICAL TRIALS REGISTRATION: This study was registered on ClinicalTrials.gov (ID: NCT06392204), verification date April 2024. https://clinicaltrials.gov/study/NCT06392204.
BMC oral healthMohamed Gamal Hassanin Atia, Mohamed Said Hamed, Asmaa Yousri Abdallah, Ahmed Abdelmohsen Younis
BACKGROUND: Immediate loading significantly improves oral health related quality of life (OHRQoL) as well as satisfaction of patients. Future trials will determine the role of immediate loading protocol in clinical scenarios with various amounts of available jaw bone using different numbers of implants to retain a fixed prosthetic restoration in partially edentulous maxilla. The aim of this study is to evaluate and compare the clinical stability and radiographic difference of osteointegration between immediate and delayed loaded dental implants in the anterior and premolar regions of the maxilla. METHODS: Sixteen patients aged from 20 to 55 were divided into two equal groups. Group 1 consisted of 8 implants that were placed and loaded 6 months after placement, while group 2 consisted of 8 implants that were placed and immediately loaded with a provisional PMMA restoration; after 6 months, the provisional restoration was replaced by a fixed restoration. Each implant was clinically evaluated for implant stability using the Osstell device and radiographically evaluated for bone density around the implant using postoperative indirect standardized digital radiographs taken immediately after implant placement and after 3 and 6 months. RESULTS: Both groups had a significant decrease in pain and swelling after surgery over time, but the immediate loading group had consistently lower values on day 1 (p = 0.001), day 3 (p = 0.023), and day 7 (p < 0.001). Moreover, the immediate loading group also had a significantly lower edema at all-time points (day 1: p = 0.005; day 3 and day 7: p < 0.001). Implant stability (ISQ) increased over time in both groups, while no statistically significant between-group difference was observed at baseline or at 6 months. Peri-implant bone density showed no significant differences between groups at any time point. CONCLUSIONS: Immediate implant loading was found to be a better alternative than delayed loading, as it provides comparable bone density and implant stability while significantly reducing postoperative pain and edema, consequently enhancing quality of life, aesthetic results, and early patient comfort without compromising radiographic performance. TRIAL REGISTRATION: NCT07381283 (registration date: February 2, 2026).
Clinical and experimental dental researchAspasia Pachiou, Viviane Laura Humm, Nadja Naenni, Eleana Kontonasaki, Ronald E Jung, Daniel S Thoma
OBJECTIVES: To evaluate the association between patient behavior and clinician emotional burden, perceived clinical performance, interaction difficulty, and decision-making in implant dentistry. MATERIAL AND METHODS: A cross-sectional online questionnaire was distributed via individual invitations to 150 dental professionals involved in implant dentistry. A total of 127 clinicians completed the survey (response rate: 84.7%). The questionnaire assessed demographic and professional characteristics, clinicians' perceptions of patient behavior, emotional responses, and the perceived impact of patient-related factors on clinical performance and decision-making. Composite domains for emotional burden and interaction difficulty were developed, and their internal consistency was assessed using Cronbach's α. Associations were evaluated using Spearman's correlation and linear regression analyses. RESULTS: More challenging patient behavior was significantly associated with increased emotional burden (ρ = 0.50, p < 0.001) and interaction difficulty (ρ = 0.46, p < 0.001). Similar findings were observed when patient behavior was compared with usual clinical cases (both p < 0.001). Procedural difficulty showed only weak or non-significant associations with emotional burden and interaction difficulty. Emotional burden was strongly associated with interaction difficulty (ρ = 0.84, p < 0.001), avoidance of scheduling similar patients (ρ = 0.47, p < 0.001), and lower perceived clinical performance (ρ = 0.27, p = 0.002). Regression analyses confirmed that patient behavior was significantly associated with emotional burden (p < 0.001). CONCLUSIONS: Patient behavior appears to be associated with clinician emotional burden and perceived clinical performance more strongly than case difficulty in implant dentistry.
Clinical implant dentistry and related researchMaryam Heidaryzadeh, Mohammad Mohammadi, Nazila Lashkarizadeh, Mahsa Kalantari Khandani
AIM: This study evaluated the efficacy of conventional flap and tunneling techniques for horizontal alveolar ridge augmentation using freeze-dried bone allograft (FDBA) particles combined with injectable platelet-rich fibrin (i-PRF). MATERIALS AND METHODS: Forty-five patients were randomly allocated to one of three groups (n = 15 each): conventional flap (CF), tunneling with membrane (TM), or tunneling without membrane (TnM). Preoperative ridge width was measured via cone beam computed tomography (CBCT). All augmentation procedures incorporated FDBA and i-PRF; an absorbable collagen membrane was applied in the CF and TM groups. Follow-up assessments, including CBCT imaging and histomorphometric analysis, were conducted 6 months postoperatively. For normally distributed data, ANOVA with Tukey's post hoc test and paired samples t-test were applied. Non-normally distributed data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed-rank tests. RESULTS: Statistical analysis was performed on 43 patients. All groups demonstrated an increase in ridge width after 6 months. At the 2 mm level, the mean width gain was 1.28 mm (95% CI: 0.17 to 2.40) in the TM group, 2.85 mm (95% CI: 1.80 to 3.89) in the TnM group, and 1.95 mm (95% CI: 1.07 to 2.83) in the CF group. However, statistical analysis revealed no significant intergroup variation (p > 0.05). Histomorphometric assessments similarly demonstrated comparable outcomes across all groups, with no statistically significant differences observed (p > 0.05). CONCLUSION: Within the limitations of this study, the tunneling technique, regardless of membrane use, appears to be a clinically viable alternative to the conventional flap method for horizontal alveolar ridge augmentation. However, further studies with longer follow-up periods are required to substantiate these findings. TRIAL REGISTRATION: irct.behdasht.gov.ir identifier: IRCT 20101204005305N21.
Clinical implant dentistry and related researchFrancesco Gianfreda, Luca Guarente, Marzia Lommi, Maria Scarpati Cioffari di Castiglione, Alberto Antonio Nativio, Carlo Raffone, Mirko Martelli, Patrizio Boll…
BACKGROUND AND OBJECTIVES: Pterygoid implants represent a graftless option for rehabilitation of patients with posterior maxillary atrophy, engaging the dense cortical bone of the pterygomaxillary complex. Despite clinical growth, a comprehensive synthesis of indications, surgical techniques, and complications is lacking. This review evaluated the prevalence of complications, implant survival rates, and marginal bone loss (MBL) associated with pterygoid implant placement. METHODS: The reporting of this review follows PRISMA 2020 guidelines. Six electronic databases (PubMed, Ovid, Scopus, WoS, CENTRAL, and Dentistry & Oral Sciences Source) were searched from 1 January 2020 to 31 December 2025. Included criteria comprised randomized and non-randomized clinical studies reporting outcomes of pterygoid implants (≥ 13 mm) in adult patients with posterior maxillary atrophy (minimum 10 implants). Risk of bias was assessed using JBI critical appraisal checklists. Proportions were pooled using the Freeman-Tukey double arcsine transformation under a random-effects model. Certainty of evidence was assessed using GRADE. RESULTS: Seventeen studies reporting 846 patients and 1915 pterygoid implants were included. The pooled survival rate was 97.9% (95% CI: 97.1%-98.6%; I2 = 0%; 14 studies) and the overall failure rate was 2.1% (95% CI: 1.4%-3.0%). Early failure rate was 0.9% (95% CI: 0.0%-3.0%; I2 = 59.5%). Late failure and MBL were summarized narratively. Certainty of evidence was low to very low. CONCLUSIONS: Pterygoid implants demonstrate excellent survival (97.9%) and low failure rates (2.1%), primarily early, supporting their reliability as a graftless solution for posterior maxillary atrophy. Complications appear infrequent though heterogeneously reported. Low evidence certainty necessitates prospective studies with standardized outcome reporting.
Journal of Indian Prosthodontic SocietySarah Latreche, Olina Rios, Franck Afota, Charles Savoldelli, Yannick Tillier
AIM: Finite element analysis (FEA) is widely used in implant prosthodontics to assess biomechanical behavior and support treatment planning in complex edentulous cases. This work aimed to evaluate stress distribution patterns associated with three implant configurations (all-on-four, all-on-six, and quad-zygomatic) in the edentulous maxilla using a single patient-specific finite element model under immediate loading conditions. SETTINGS AND DESIGN: Two CBCT scans from a single edentulous patient, acquired before and after full-arch bone grafting, were segmented to generate three digital twin models including the maxilla, implants, abutments, and a full-arch prosthesis. MATERIALS AND METHODS: A unilateral oblique load of 150 N at 45° was applied to the posterior region of the prosthesis using a non-deformable distribution tool to simulate immediate functional loading. Stress distribution and displacement patterns within bone and prosthetic components were evaluated. STATISTICAL ANALYSIS USED: A descriptive biomechanical evaluation based on stress magnitude and distribution patterns was conducted. RESULTS: The simulations demonstrated distinct biomechanical responses among the implant configurations. The all-on-six model showed a more uniform stress distribution with lower peak stress values compared to the other configurations. In this model, the difference between tensile and compressive cortical stress peaks was reduced relative to the all-on-four and quad-zygomatic configurations. In all scenarios, stress values remained within physiological limits reported for bone tissue. CONCLUSION: Within the limitations of a single patient-specific model and the absence of inferential statistical analysis, this single-case biomechanical evaluation suggests that digital twin-based finite element analysis may serve as an exploratory tool for biomechanical assessment and prosthodontic treatment planning in implant-supported rehabilitation of the edentulous maxilla.
Clinical and experimental dental researchSultan Ainoosah, Redhwan Saleh Al-Gabri, Omar M Alaryani, Ahmad Abdulkareem Alnazzawi, Ahmed E Farghal, Ahmed Yaseen Alqutaibi
BACKGROUND: Robotic computer-assisted implant surgery (r-CAIS) aims to improve implant placement trueness, but existing reviews include heterogeneous designs, and no review has exclusively synthesized RCTs to date. This review aimed to evaluate the positional trueness and clinical outcomes of r-CAIS compared with free-hand implant surgery (FHIS), dynamic computer-assisted implant surgery (d-CAIS), and static computer-assisted implant surgery (s-CAIS), through a systematic review and meta-analysis of RCTs. MATERIALS AND METHODS: This systematic review was conducted according to PRISMA 2020 guidelines. Electronic searches were performed in major biomedical databases from inception to March 2026. Only RCTs were eligible. Risk of bias was assessed using the RoB 2 tool and certainty of evidence was rated using the GRADE framework. Meta-analyses were performed using a random-effects model where feasible. RESULTS: Seven RCTs enrolling 529 implants were included. Moderate-certainty evidence demonstrated significantly improved positional trueness with r-CAIS over FHIS across all deviation parameters, with the largest effect observed for angular deviation (MD = -4.56°; 95% CI -6.25 to -2.86). High certainty evidence showed a significant angular deviation advantage of r-CAIS over d-CAIS (MD = -0.77°; 95% CI: -1.33 to -0.21), while platform and apical deviations did not differ significantly. All comparisons with s-CAIS were non-significant, rated low to very low certainty from a single small trial. Operative time evidence was very low certainty, precluding any directional conclusion. Early implant retention ranged from 93.3% to 100% across all modalities with no meaningful between-group differences. CONCLUSIONS: r-CAIS improves implant positional trueness compared with free-hand surgery, supported by moderate certainty evidence, with a high certainty angular deviation advantage over dynamic navigation. However, improved trueness has not been shown to translate into better clinical or patient-reported outcomes. Wider clinical use should depend on long-term, multicenter RCTs using standardized patient-centered outcomes.
Revue medicale suisseSibylle Chatelain, Gianmarco Widmer, Dominik Ettlin, Nenad Lukic, Michael Adler, Sandra Van Den Broecke, Martin Broome, Raphaël Heinzer, Karma Lambercy
Obstructive sleep apnea syndrome (OSAS) remains widely underdiagnosed, despite its well-established cardiovascular and cognitive consequences. Although continuous positive airway pressure (CPAP) remains the first-line treatment for severe OSAS and for moderate OSAS associated with comorbidities, adherence often remains suboptimal. Custom-made mandibular advancement devices (MAD) therefore represent an attractive therapeutic alternative for patients with symptomatic mild to moderate OSAS. Generally better tolerated than CPAP, they are associated with better adherence. This article guides clinicians through the different stages of patient management with MAD : indication, fabrication and treatment follow-up.
Clinical oral investigationsMelih M Bakacak, Jean Pierre T F Ho, Erik H van der Meij, Willem H Schreuder, Johannes N Lodders
OBJECTIVES: Maxillary canine, premolar and molar extractions may result in oroantral communication (OAC). Surgical closure aims to prevent the development of a persistent oroantral fistula (OAF), thereby reducing the risk of maxillary sinusitis. There is no consensus regarding the benefit of the use of perioperative antibiotics. This study evaluated the effect of postoperative antibiotics on complications after primary OAC closure following tooth extraction. MATERIALS AND METHODS: Eligible patients were identified by retrospectively reviewing the medical records of patients who underwent surgical closure of an OAC at Amsterdam UMC-VUmc and Amsterdam UMC-AMC from 2000 to 2025. Among these patients, the associations of various exposures, including postoperative antibiotic use, with overall complications, infectious complications, and persistent OAF were assessed. Group differences were assessed using the chi-square and independent t-tests, while univariate and multivariable associations were assessed using logistic regression (p < 0.05). Number needed to be exposed to benefit (NNEB) and harm (NNEH) were calculated. RESULTS: A total of 725 potentially eligible participants were identified, of whom 505 were eligible; 308 (61.0%) were male, and 251 (49.7%) received postoperative antibiotics. Overall complications occurred in 11.7%, infectious complications in 8.2%, and persistent OAF in 3.6%. Postoperative antibiotic use was significantly associated with fewer overall and infectious complications and fewer persistent OAFs. (NNEB 6.9, 6.9, and 21.4, respectively). Autoimmune disease and use of intra-alveolar hemostatic agent were associated with increased overall complications. Soft tissue (partial) impaction was associated with increased risk for infectious complications. Use of intra-alveolar hemostatic agent and soft tissue (partial) impaction were associated with increased risk for persistent OAF. CONCLUSION: Postoperative antibiotic use after primary OAC closure following tooth extraction was associated with reduced risk of overall and infectious complications and persistent OAFs. Prospective studies are needed to confirm these findings and guide antibiotic use. CLINICAL RELEVANCE: Oral healthcare professionals should be aware of the potential benefit of postoperative antibiotics in preventing complications. Therefore antibiotic prophylaxis could be considered in patients with obvious risk factors or if an uneventful outcome is highly desirable.
BMC research notesLoan-Chi Thi Bui, Son Hoang Le, Hien Thuc Huu Huynh, Bich-Ly Thi Nguyen
OBJECTIVE: To date, limited evidence exists regarding the clinical efficacy of MTA Flow™ Thick as a retrograde filling material in apicoectomy. This study aimed to investigate the clinical and radiographic outcomes over a 6-month follow-up period following apicoectomy with MTA Flow™ Thick as the retrograde filling material. RESULTS: A total of 24 teeth from 16 patients were included in this prospective study. All apicoectomies were performed by a single oral surgeon following a standardised surgical protocol. Clinical and radiographic outcomes were assessed at 3 and 6 months. All clinical symptoms-pain, swelling, and fistulas-showed a statistically significant reduction at both follow-up intervals (p < 0.001 for all). Periapical lesion size decreased at both time points (p < 0.001). Radiographic healing was observed in ≥ 85.5% of cases and demonstrated progressive improvement between the two follow-ups. The overall success rate increased significantly from 83.3% at 3 months to 91.7% at 6 months. Trial registration This study was registered at ClinicalTrials.gov (Identifier: NCT07254143, date 28 November 2025). This is a retrospectively registered trial.
Oral and maxillofacial surgeryHui Yuh Soh, Yao Yu, Zhiheng Feng, Wen Du, Shuo Liu, Xin Peng, Wen-Bo Zhang
PURPOSE: Reconstruction of extensive mandibular defects that cross midline is technically challenging, as the surgeons lack normal anatomical references. This study aims to compare multivariate linear regression and machine learning (random forest) algorithms in predicting the premorbid shape of the mandibular chin to guide surgical reconstruction. METHODS: Anatomical landmarks and measurements were extracted from the computed tomography (CT) data of the head. The multivariate regression model was developed based on Ordinary Least Squares (OLS), while the dataset was randomly split into training set (80%) and testing set (20%) to develop a machine learning-based algorithm. RESULTS: Correlation was observed among the maxillary intercanine distance, distance of bilateral zygoma, width of piriform aperture and the width of chin in multivariate linear regression model, and satisfactory performance was achieved, (MAE (2.35), R² (0.25)). No significant difference was noted between the predicted width of chin and actual measurement in paired t-test. (P = 0.092) Bootstrap validation with 500 repetitions demonstrated stable performance (MAE 2.45 mm; R² = 0.17). Machine learning models using the same predictors did not improve predictive accuracy. CONCLUSION: Both models demonstrated comparable accuracy in predicting chin width; however, the multivariate regression model achieved lower prediction error compared with machine learning approaches using the same predictors. The interpretability and simplicity of multivariate linear regression may make it more clinically practical for reconstructing midline mandibular defects. A straightforward regression model can provide surgeons with a reliable, accessible tool for preoperative planning in complex mandibular reconstructions, especially where advanced computational resources are limited.
BACKGROUND: Surgical removal of impacted mandibular third molars is frequently associated with postoperative morbidity, particularly facial swelling and pain. The extent to which surgical difficulty and operative time influence these outcomes remains incompletely understood. OBJECTIVE: To objectively evaluate postoperative facial swelling and pain following impacted mandibular third molar surgery and to investigate their association with surgical difficulty and operative time. METHODS: This prospective observational study included 45 patients who underwent surgical extraction of impacted mandibular third molars between September and December 2025. Surgical difficulty was assessed preoperatively using a modified Pedersen difficulty index and categorized as low, moderate, or high. Facial swelling was measured using standardized linear facial measurements obtained at baseline and on post-operative days 2 and 7. Pain intensity was assessed using a 10-cm Visual Analog Scale (VAS) on postoperative days 1, 2, and 7. Associations between surgical variables and postoperative outcomes were analyzed using Spearman correlation and multivariable linear regression. RESULTS: The mean operative time was 28.4 ± 8.6 minutes and increased significantly with surgical difficulty (p < 0.001). Facial swelling peaked on postoperative day 2 and decreased significantly by day 7 (p < 0.001). Surgical difficulty was positively correlated with swelling on day 2 (r = 0.52, p = 0.001) and pain on postoperative days 1 (r = 0.46, p = 0.002) and 2 (r = 0.41, p = 0.006). Operative time was also positively associated with swelling and pain during the early postoperative period. Multivariable regression identified surgical difficulty (β = 0.42, p = 0.002) and operative time (β = 0.31, p = 0.021) as independent predictors of post-operative swelling. CONCLUSIONS: Postoperative swelling and pain following impacted mandibular third molar surgery are significantly influenced by surgical difficulty and operative time. Preoperative difficulty assessment may help predict postoperative morbidity and improve patient counseling and treatment planning.
Journal of applied oral science : revista FOBMaria Pavli, Maria Georgaki, Nadia Theologie-Lygidakis, Nikolaos Nikitakis, Christos Perisanidis
INTRODUCTION: Leukocyte- and platelet-rich fibrin (L-PRF) has gained considerable attention due to its regenerative potential and biocompatibility in alveolar ridge preservation (ARP). OBJECTIVE: To evaluate the histological findings in post-extraction sockets after ARP with L-PRF (experimental group) and compare them with those obtained using allograft plus a collagen membrane (control group). Histological findings may contribute to the evaluation of bone quality and the rate of bone remodelling. METHODOLOGY: Twenty-six sites in 26 patients requiring extraction of a single-rooted maxillary or mandibular tooth were included in this study. Treatment options were randomly assigned. Post-extraction sockets were filled with either an L-PRF matrix or an allograft covered with a collagen membrane. Dental implant placement was performed subsequently. After 12 weeks, bone biopsies were obtained from the sites at the time of implant placement. Histological evaluation of the bone specimens assessed the area of new bone formation and the presence of osteoblasts, osteoclasts, osteolytic lacunae, osteocytes, and blood vessels. RESULTS: Histological evaluation showed that: a) the proportion of cases with >50% new bone formation was higher in the experimental group compared to the control group (53.8% [7/13] versus 30.8% [4/13]) (p=0.033) b) the presence of osteoblasts was higher (p=0.066) in the experimental group (100% versus 76.9%); c) the presence of osteoclasts was higher (p=0.004) in the experimental group (92.3% versus 38.5%); d) the presence of osteolytic lacunae was higher (p=0.063) in the experimental group (92.3% versus 61.5%); e) the presence of osteocytes was higher (p=0.03) in the experimental group (100% versus 69.2%); and f) the presence of blood vessels was higher (p=0.016) in the experimental group (84.6% versus 38.5%). The presence of osteoblasts and osteolytic lacunae were higher but were not statistically significant. CONCLUSIONS: Within the limitations of this study, ARP with L-PRF may result in accelerated healing, improved bone quality, and a higher rate of bone remodelling. These results reflect the exploratory nature of this study and support the need of additional research, preferably with a larger sample size.
BACKGROUND: This study compared intramasseteric versus pterygomandibular space dexamethasone injection for postoperative oedema and trismus after mandibular third molar surgery. METHODS: This prospective, randomised, participant- and outcome assessor-blinded, active-comparator split-mouth clinical trial with sequential interventions was conducted at Afyonkarahisar Health Sciences University between April 28, 2023 and April 27, 2024. Twenty adults aged 18-25 years, classified as American Society of Anesthesiologists Physical Status I and requiring bilateral surgical extraction of comparable mandibular third molars, were enrolled. The two interventions were performed in randomised order at a three-week interval. RESULTS: All 20 participants completed both interventions. Operative time did not differ between injection sites (18.1 ± 2.8 vs. 18.1 ± 2.9 min; p = 1.000). Change in oedema was lower in the intramasseteric group on days 2 (4 [1-8] vs. 6 [4-12]; p < 0.001; difference between site-specific medians favouring intramasseteric injection, 2.0 mm) and 7 (0.5 [0-1] vs. 1 [0-3]; p = 0.006; difference between medians, 0.5 mm). Trismus was less severe on days 2 (10.4 ± 2.7 vs. 13.1 ± 3.2 mm; p = 0.006; mean difference, 2.7 mm; 95% CI, 0.9 to 4.5) and 7 (0.7 ± 0.8 vs. 1.2 ± 1.2 mm; p = 0.006; mean difference, 0.5 mm; 95% CI, 0.2 to 0.8). Between-group pain, salivary cortisol level, Oral Health Impact Profile-14 score, and analgesic consumption differences were nonsignificant. CONCLUSIONS: Intramasseteric injection was associated with lower oedema and trismus severity. Patient-reported recovery outcomes did not differ significantly between the injection sites. The clinical relevance of these differences remains uncertain. TRIAL REGISTRATION: ClinicalTrials.gov NCT06604286; first submitted 17 September 2024 and first posted 19 September 2024 (retrospectively registered).
Sleep & breathing = Schlaf & AtmungIzabella P Manetta, Bruno B Duarte, Michel B Cahali
PURPOSE: To map the existing evidence on the impact of transverse craniofacial alterations on mandibular advancement device treatment outcomes in adults with obstructive sleep apnea, with the objective of identifying knowledge gaps and informing future research and clinical decision-making. METHODS: A systematic literature search was conducted in six databases. Additionally, gray literature sources were searched, and clinical trial registries, including ClinicalTrials.gov, were screened for RCT protocols. The reference lists of all included sources of evidence were also screened, and experts in the field were consulted. RESULTS: The literature search yielded a total of 1,508 references after duplicate removal. Nine studies and one conference report were found eligible for inclusion. The literature demonstrated heterogeneous associations between transverse craniofacial characteristics and mandibular advancement device treatment outcomes. Most studies (n = 7) did not identify significant associations between isolated transverse craniofacial measurements and treatment response. Greater mandibular transverse dimensions were associated with better therapeutic outcomes in two studies, whereas one study reported better treatment response in individuals with smaller mandibular transverse dimensions. Reduced maxillary width and unfavorable anatomical balance were more frequently associated with greater obstructive sleep apnea severity or poorer treatment outcomes. CONCLUSIONS: While some studies suggest that the response to mandibular advancement devices in obstructive sleep apnea is associated with transverse mandibular dimensions, most investigations have not identified this relationship. Future standardized and well-designed studies are needed to clarify the influence of this anatomical characteristic on the outcomes of this common treatment for obstructive sleep apnea.
Oral and maxillofacial surgeryRola Zahedah, Bircan Dinç
PURPOSE: To estimate early horizontal ridge-width and explicit buccal/facial vertical hard-tissue loss after alveolar ridge preservation (ARP) versus unassisted socket healing. METHODS: The review was registered in PROSPERO (CRD420261432689). PubMed/MEDLINE, Scopus, Web of Science Core Collection, Embase.com, and ClinicalTrials.gov were searched on 24 June 2026; CENTRAL provided supplementary verification on 1 July 2026. Two reviewers independently selected reports. One reviewer extracted data; the second verified classifications and effect inputs. Randomised direct comparisons were pooled using REML random-effects models with Hartung-Knapp inference. Risk of bias and certainty were assessed with RoB 2 and GRADE. RESULTS: Of 1,864 records, 1,739 were screened, and 62 underwent full-text assessment. 28 direct comparison reports were eligible; 20 randomised studies contributed quantitatively, and 8 reports were narrative-only. ARP was associated with less horizontal ridge-width loss (k = 18; MD - 1.37 mm, 95% CI - 1.80 to - 0.94; I² = 75.9%; prediction interval - 2.86 to 0.12) and less explicit buccal/facial vertical loss (k = 13; MD - 1.18 mm, 95% CI - 1.61 to - 0.75; I² = 74.3%; prediction interval - 2.54 to 0.17). Certainty was low for both. The exploratory broad vertical/buccal synthesis favoured ARP (k = 16; MD - 1.26 mm, 95% CI - 1.63 to - 0.89) with very low certainty. CONCLUSION: ARP may reduce early dimensional loss, but substantial heterogeneity and prediction intervals including no effect limit generalisability. Evidence does not establish universal indications, intervention superiority, or long-term implant, aesthetic, or patient-reported benefit.
JAAPA : official journal of the American Academy of Physician AssistantsMark A Fridman
The diagnosis and management of ankyloglossia, commonly referred to as tongue-tie, has become a controversial topic spanning multiple subspecialties within pediatrics, dentistry, and rehabilitation medicine. Changing perspectives on clinical significance, increased awareness of breastfeeding challenges, and a stronger emphasis on a multidisciplinary approach have contributed to a dramatic rise in both diagnosis and intervention in this condition. Between 1997 and 2012, inpatient diagnoses of ankyloglossia in the United States increased nearly 10-fold, from 3,934 to 32,837 cases, with a similar increase in lingual frenotomy procedures, from 1,279 to 12,406. Providers may encounter tongue-tie in diverse settings, ranging from the newborn nursery to outpatient pediatric primary care to otolaryngology clinics. In the absence of a validated standalone threshold for surgical intervention, clinical decision-making can be challenging. This article provides clinically relevant, evidence-based recommendations to guide the diagnosis and management of ankyloglossia. Current guidance emphasizes direct assessment of the breastfeeding dyad, skilled lactation support, close monitoring of milk transfer and growth, and treatment of competing causes before frenotomy is considered.
European journal of trauma and emergency surgery : official publication of the European Trauma SocietyManuel Tousidonis, Borja Gonzalez-Moure, Diego Fernandez-Acosta, Cristina Rey-Valcarcel, Maria-Dolores Perez-Diaz, Maria J Troulis, Justin M Hintze, Santiago O…
PURPOSE: Electric scooters (e-scooters) have become a widely used mode of urban transportation, but their increasing popularity has been accompanied by a rise in trauma-related emergency department visits. Craniofacial injuries represent a particularly relevant subset due to the exposed riding position and the limited use of protective equipment. This study analyzed the epidemiological characteristics, fracture patterns, associated injuries, and treatment requirements of patients presenting with facial fractures after e-scooter accidents. METHODS: A retrospective observational study was conducted at a tertiary university hospital between January 2020 and December 2024. Adult patients presenting to the emergency department with facial fractures directly related to e-scooter accidents were included. Demographic variables, helmet use, alcohol and drug involvement, fracture distribution, associated systemic injuries, and treatment modalities were assessed. RESULTS: A total of 42 patients with facial fractures were identified. Mean age was 29.4 years, and 76.2% were male. Helmet status was documented in 10/42 patients (23.8%); among documented cases, 3/10 (30.0%) reported helmet use. Alcohol status was documented in 14/42 patients (33.3%); among documented cases, 10/14 (71.4%) were positive. Drug status was documented in 15/42 patients (35.7%); among documented cases, 8/15 (53.3%) were positive. More than 80 facial fractures were recorded, predominantly involving the midface. Orbital fractures were the most common injury pattern, followed by mandibular and maxillary fractures. Intracranial lesions were documented in 10/42 patients (23.8%), most commonly traumatic subarachnoid hemorrhage (8/42, 19.0%). Six patients (14.3%) required surgical treatment. Hospital admission was necessary in 38.1% of cases, including two intensive care unit admissions. CONCLUSION: E-scooter-related trauma is an increasingly relevant cause of craniofacial injury, predominantly affecting young adult males. Among cases with available documentation, alcohol positivity and absence of helmet use were frequent. Given the substantial missingness in these variables, these findings should be interpreted cautiously. Although most fractures were managed conservatively, the rate of associated intracranial injury highlights the need for preventive strategies, stricter safety measures, and careful emergency department assessment.
Acta odontologica ScandinavicaYingrui Zhou, Hongwei Ma, Yan Zhang, Haoliang Guo, Ran Ma
Root resorption is a common but unpredictable complication after delayed replantation of avulsed permanent teeth. Evidence from real-world settings regarding its long-term incidence and associated clinical factors remains limited. This study aimed to determine the incidence of root resorption and identify clinical factors associated with its occurrence following delayed replantation of permanent teeth in a real-world tertiary care setting. This retrospective cohort study analyzed patients aged 7-30 years who underwent delayed replantation (> 60 min extra-alveolar time) between 2019 and 2022 at a tertiary dental trauma center, with ≥ 12 months of follow-up. Clinical and radiographic data were reviewed, and root resorption was classified according to predefined radiographic and clinical criteria. Multivariable logistic regression was used to identify factors associated with the occurrence of root resorption, while Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to evaluate the time to first root resorption event. Competing-risk analysis was conducted, considering tooth extraction as a competing event. Among 120 eligible patients (mean age 14 ± 5 years), root resorption occurred in 72 teeth (60.0%), including inflammatory (41.7%) and replacement (58.3%) types based on radiographic and clinical classification. Among all delayed replanted teeth, the estimated tooth survival and functional retention rates at 24 months were 78.3% and 68.3%, respectively. Teeth with root resorption showed longer extra-alveolar times, more frequent dry storage, and delayed or absent root canal treatment (all P < 0.01). Multivariable logistic regression identified prolonged extra-alveolar time (> 2 h), dry storage, absence of root canal treatment, and delayed endodontic intervention (> 14 days) as factors associated with a higher occurrence of root resorption. Multivariable logistic regression identified prolonged extra-alveolar time (> 2 h), dry storage, absence of root canal treatment, and delayed endodontic intervention (> 14 days) as factors independently associated with a higher occurrence of root resorption. Root resorption occurred in 60% of delayed replanted teeth in this cohort. Prolonged extra-alveolar time, dry storage, and delayed or absent endodontic treatment were independently associated with a higher occurrence of root resorption. These findings highlight the importance of timely management and appropriate endodontic intervention after delayed replantation; however, the retrospective single-center design limits causal interpretation, and further prospective studies are needed to validate these associations.
BACKGROUND: Platelet-rich fibrin (PRF) has been increasingly used as an autologous biomaterial to enhance healing after tooth extraction because of its potential to modulate inflammation, promote angiogenesis, and stimulate tissue regeneration. However, evidence regarding its effectiveness across postoperative outcomes remains heterogeneous, and the comparative performance of PRF subtypes, particularly leukocyte-platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF), is not fully established. This systematic review and meta-analysis evaluated the effects of PRF on postoperative outcomes following mandibular third molar extraction, with emphasis on postoperative pain and comparison of PRF subtypes. METHODS: A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted from inception to March 2026. Randomized controlled trials comparing PRF with natural clot healing after mandibular third molar extraction were included. The primary outcome was postoperative pain. Secondary outcomes included alveolar osteitis (AO), edema, trismus, analgesic consumption, and bone-related outcomes. Risk of bias was assessed using RoB 2. Meta-analyses were performed using random-effects models, and heterogeneity was evaluated with the I2 statistic. RESULTS: Twenty-eight studies were included. PRF significantly reduced the incidence of AO (RR = 0.17, 95% CI: 0.06-0.49), postoperative pain from day 1 to day 7, and analgesic consumption at postoperative days 2-3. Significant improvements were also observed in trismus at all assessed timepoints. Bone density, assessed descriptively across six studies due to substantial methodological heterogeneity in imaging methods, showed a consistent trend favoring PRF, although this could not be quantitatively pooled. Edema reduction was inconsistent, with only modest short-term benefits. L-PRF demonstrated more consistent effects across outcomes than A-PRF, although evidence for A-PRF was limited to a single trial. Heterogeneity was substantial in some analyses, likely due to differences in PRF protocols and outcome assessment methods. CONCLUSION: PRF, particularly L-PRF, reduces postoperative morbidity after mandibular third molar extraction, although further standardized trials, particularly head-to-head comparisons of L-PRF and A-PRF, are needed to clarify subtype-specific effects.
BMC oral healthAlaa A Salem, Mohamed S Hammed, Ahmed M ElRawdy, Hesham ElHawary
BACKGROUND: Whether grafting peri-implant jumping gaps exceeding 2 mm during immediate implant placement improves outcomes remains uncertain. This trial evaluated the effect of β-tricalcium phosphate (β-TCP) grafting on implant stability and peri-implant radiodensity in such sites. METHODS: In this prospective, parallel-group randomized controlled trial, 16 patients (8 per group) receiving 39 immediate maxillary anterior/premolar implants at sites with a jumping gap exceeding 2 mm were randomized 1:1 to no grafting (control) or injectable β-TCP (test); the patient was the unit of analysis. The pre-specified primary comparison was implant stability quotient (ISQ) at 6 months. Peri-implant radiodensity was monitored on standardized periapical radiographs (grayscale value) at baseline, 3, and 6 months, and quantified by cone-beam CT (CBCT) at 6 months only (ALARA principle); CBCT values are relative, arbitrary gray-value radiodensity, not true Hounsfield units. Between-group differences were analyzed with independent-samples t tests, within-group changes with repeated-measures ANOVA, and group×time interactions with mixed-design ANOVA (α = 0.05). RESULTS: No statistically significant between-group differences were detected in baseline age or jumping-gap width. No significant between-group difference in ISQ was detected at any time point, and the ISQ group×time interaction was not significant (p = 0.49); ISQ increased significantly over time in both groups. Periapical grayscale value increased significantly faster in the test group on unadjusted analysis (group×time interaction, p = 0.009), but this was no longer significant after adjusting for a small baseline difference (ANCOVA, p = 0.39). On 6-month CBCT, radiodensity was significantly higher in the test group (1224.0 ± 237.0) than control (931.9 ± 100.4 arbitrary units; mean difference 292.1; 95% CI 87.7 to 496.5; p = 0.010), a secondary outcome not included in the a priori sample-size calculation. CONCLUSIONS: β-TCP grafting of jumping gaps exceeding 2 mm did not significantly affect ISQ or baseline-adjusted periapical grayscale value. The test group showed significantly higher 6-month CBCT-derived radiodensity, but this was not prospectively powered and may partly reflect residual graft material, so it should be interpreted cautiously. Larger, adequately powered equivalence trials are needed before conclusions about grafting necessity can be drawn. TRIAL REGISTRATION: ClinicalTrials.gov, NCT07709676. Registered 2026-07-12. Retrospectively registered.
Orvosi hetilapFanni Bolya-Orosz, István Gera, Dániel Palkovics, Péter Windisch
Dental implant therapy has become an increasingly widespread option for rehabilitation worldwide, with a substantial rise in both the number of implants placed and the patients seeking this type of treatment. As a result, the prevalence of biological and mechanical complications has also increased. Peri-implant inflammatory diseases - especially peri-implantitis, which involves progressive bone loss - have emerged as a major clinical challenge, as they can ultimately lead to the loss of the implant and the associated restoration, imposing significant financial and health burdens on patients. The primary etiological factor of peri-implantitis is the accumulation of bacterial biofilm. The condition most commonly occurs in patients with a history of unsuccessfully treated periodontal disease. Nevertheless, several additional risk factors contribute to its development, including insufficient alveolar bone support, weak peri-implant tissue, the lack of supportive periodontal and peri-implant maintenance therapy following implant placement. To ensure long-term treatment success, prevention and regular maintenance are crucial. Comprehensive management includes meticulous preoperative planning, ideal implant positioning, prosthetic designs that facilitate effective oral hygiene, and continuous professional supportive therapy. The following case report demonstrates that even in severe, full-arch peri-implantitis cases, favorable outcomes can be achieved through a multidisciplinary therapeutic approach when followed by strict maintenance. Long-term follow-up highlights that with proper rehabilitation and strong patient compliance, implant function can be preserved even in the presence of compromised peri-implant hard tissue environment. Orv Hetil. 2026; 167(38): 1523-1531.
BMC oral healthGiacomo Scuzzo, Giuseppe Scuzzo, Elena Calzadilla-Suárez, Mario Alvarado-Lorenzo, Laura Criado-Pérez, Adrián Curto, Alfonso Alvarado-Lorenzo
BACKGROUND: Although the twin block is the most commonly used appliance for the treatment of Class II malocclusion, the clear aligner industry has developed systems with integrated mandibular advancement. The purpose of this study was to evaluate and compare the effects of Twin block appliances, standard AngelAligner clear aligners and AngelAligner A6 mandibular advancement clear aligners as early orthodontic interventions for patients who develop Class II division 1 malocclusion. METHODS: The study sample comprised 60 patients with a mean age of 12.4 ± 1.3 years, who were divided into three homogeneous groups of 20 patients each and received different treatments: Twin Block (GTB), AngelAligner aligners (GAA) and AngelAligner A6 for mandibular advancement (GA6). Clinical and radiographic assessments were performed at baseline (T0), immediately prior to appliance placement, and repeated after the completion of treatment objectives (T1). RESULTS: Class II malocclusion was corrected with all three appliances. The GA6 and GTB groups showed similar mandibular advancement, with an increase in the SNB angle of 2.1° and 2.3° respectively, and correction to Class I in 85-90% of cases, outperforming the GAA group, which showed an increase in the SNB angle of 1.2° and correction to Class I in 70% of cases. The duration of treatment was shorter in the GA6 group (15.2 months). CONCLUSION: These findings suggest that the AngelAligner A6 MA and Twin Block are superior for skeletal correction, whereas the standard AngelAligner is effective for milder cases with aesthetic priorities. CLINICAL TRIAL NUMBER: ClinicalTrials.gov, NCT07591025. Registered 6 May 2026. Retrospectively registered.
BMC oral healthBaocheng Yao, Shiyu Qiu, Chengyi Wang, Qiao Ling, Ning Ma
OBJECTIVE: To evaluate the clinical and radiographic outcomes of second molars (M2s) affected by external root resorption (ERR) following impacted third molar (M3) removal, and to assess the influence of adjunctive guided bone regeneration (GBR). METHODS: This retrospective cohort study included patients presenting with ERR of M2s associated with impacted M3s who underwent M3 extraction with or without concurrent GBR. Cone-beam computed tomography (CBCT) was used to assess ERR progression and distal alveolar bone levels before surgery and at least 6 months postoperatively. Pulp sensibility was also evaluated. Changes in distal bone height were compared between groups. Generalized estimating equations (GEE) were used to evaluate the association between treatment modality and bone gain while adjusting for baseline defect severity and potential confounders. Interaction analysis was performed to assess whether the effect of GBR varied according to baseline defect severity. RESULTS: The Wilcoxon signed-rank test revealed no significant pre- to post-treatment change in root length among teeth with root length alteration (Z = 0.110, 95% CI - 0.185 to 0.380, P = 0.457), nor in the vertical dimension of the defect among teeth without root length alteration (Z = 0.033, 95% CI - 0.248 to 0.283, P = 0.785), supporting the radiographic stability of the resorptive defect following M3 removal. Regarding pulpal status, excluding one tooth that had undergone preoperative root canal treatment, all remaining teeth (64/64, 100%) maintained positive pulp sensibility at the final follow-up, as assessed by cold testing. The between-group difference was 2.03 mm (Hodges-Lehmann estimate, 95% CI, 0.56-3.82 mm), with significantly greater bone gain in the GBR group (6.32 ± 2.67 mm) compared with the Extraction-Only group (4.08 ± 3.50 mm), P = 0.007. After adjustment for baseline defect severity and other covariates, treatment modality remained a significant predictor of distal bone gain in the GEE model with exchangeable correlation structure (QIC = 1123.229), with GBR associated with greater bone gain compared with extraction alone (β = 2.244, 95% CI, 0.612-3.875, P = 0.007). To assess the robustness of this estimate to potential unmeasured confounding, the E-value was calculated: the E-value for the point estimate was 3.25, while the E-value for the lower bound of the 95% CI was 1.68. The interaction term between treatment modality and baseline distal bone height was not statistically significant (β = 0.008, 95% CI (-0.229, 0.245), P = 0.945), suggesting that the effect of GBR on distal bone gain did not vary significantly across the range of baseline defect severities observed. CONCLUSION: Among M2s with available follow-up, no radiographic progression of ERR was detected following M3 removal. The findings do not support routine prophylactic root canal treatment in asymptomatic M2s with preserved pulp sensibility. However, spontaneous periodontal recovery of ERR-associated distal defects appeared incomplete. Adjunctive GBR was associated with enhanced distal bone regeneration. CLINICAL RELEVANCE: External root resorption of second molars associated with impacted third molars appears to stabilize after extraction of the third molar, with preservation of pulp sensibility. However, the distal bone defect frequently persists radiographically without full resolution. Guided bone regeneration was associated with greater radiographic bone gain in affected second molars.
ToxinsAudra Janovskienė, Justina Stučinskaitė-Maračinskienė, Žygimantas Petronis, Jan Pavel Rokicki, Dainius Razukevičius, Loreta Pilipaitytė
BACKGROUND: Botulinum toxin type A (BoNT-A) has been proposed as an adjunct to orthognathic surgery because its temporary neuromuscular effects may reduce muscular loading during postoperative healing and potentially influence fixation stability, skeletal relapse, and postoperative recovery. This systematic review aimed to evaluate the available clinical evidence regarding the adjunctive use of BoNT-A in orthognathic surgery. METHODS: A systematic literature search was conducted in PubMed, the Cochrane Library, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies directly comparing orthognathic surgery with and without adjunctive BoNT-A administration and reporting outcomes related to mechanical stability, skeletal stability, or postoperative recovery were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials and ROBINS-I for the non-randomized study. RESULTS: Three studies met the eligibility criteria, comprising two randomized controlled trials and one retrospective comparative study. Considerable heterogeneity was observed in surgical procedures, targeted muscles, BoNT-A doses, timing of administration, and evaluated outcomes. Individual studies reported associations between BoNT-A administration and a lower incidence of fixation plate fracture, reduced anteroposterior skeletal relapse at the Pogonion, or lower preanalgesic pain scores and postoperative opioid consumption. However, these findings were derived from different studies evaluating distinct interventions and outcomes and were not consistently demonstrated across comparable outcome measures. CONCLUSIONS: BoNT-A may represent a promising adjunct to orthognathic surgery, with potential benefits for fixation-related mechanical stability, selected parameters of skeletal relapse, and postoperative pain management. However, the limited number of studies, methodological limitations, and substantial clinical heterogeneity preclude definitive conclusions. Further well-designed randomized controlled trials with standardized injection protocols and longer follow-up are required before routine clinical use can be recommended.
International journal of oral implantology (Berlin, Germany)Priyanshu Priyam, Neha Jain, Vidushi Saxena
PURPOSE: This systematic review and meta-analysis evaluated the accuracy of dental implant placement using digital surgical guides in the anterior maxilla. The anterior maxilla was assessed as a region-specific subgroup due to its unique anatomical constraints, high aesthetic demands and increased sensitivity to positional deviations compared to other arch regions. MATERIALS AND METHODS: A comprehensive literature search was conducted across the PubMed, Google Scholar, and EBSCOhost databases. The search followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and included studies reporting the accuracy of digital surgical guides used for implant placement in the anterior maxilla. Six studies met the inclusion criteria for qualitative synthesis, of which five were eligible for quantitative meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute checklists tool for clinical studies and the Quality Assessment Tool for In Vitro Studies for in vitro designs. Meta-analysis was performed using a random-effects model and certainty of evidence was further evaluated using the Grading of Recommendations Assessment, Development and Evaluation analysis. RESULTS: All included studies reported deviation metrics between the virtually planned and postoperative implant positions. The pooled meta-analysis demonstrated mean apical deviation of 0.89 mm (P 0.00001), depth deviation of 0.43 mm (P 0.00001) and angular deviation of 2.47° (P 0.00001). Substantial heterogeneity (I2 > 90%) was observed among the included studies; therefore, a random-effects model was used. According to the the Grading of Recommendations Assessment, Development and Evaluation assessment, the certainty of evidence was moderate for apical deviation but low for depth and angular deviation. CONCLUSION: Digital surgical guides demonstrated implant placement deviations within commonly reported clinical thresholds in the anterior maxilla, suggesting acceptable accuracy in appropriately selected clinical scenarios. However, due to substantial heterogeneity among studies and low-to-moderate certainty of evidence, these findings should be interpreted with caution. CONFLICT-OF-INTEREST STATEMENT: The authors declare that there are no conflicts of interest relating to this study.
Lasers in medical scienceAhmet Anaç, Bozkurt Kubi̇lay Işık, Zeynep Asude Bozkır
Postoperative pain, edema, and trismus are frequent complications following impacted mandibular third molar surgery. While photobiomodulation (PBM) is a proposed adjunctive therapy, clinical evidence remains controversial. This study evaluated the effects of single-session extraoral dual-wavelength PBM (650 + 904 nm) applied immediately after extraction on postoperative pain, edema, trismus, and quality of life (QoL). This prospective RCT enrolled 70 patients (mean age: 22.04 ± 2.61 years) with asymptomatic mesioangular impacted mandibular third molars (Pell-Gregory Class IB). Participants were randomized to a PBM (n = 35) or control (n = 35) group. Following standardized surgical extraction by a single surgeon, the PBM group received a 10-minute extraoral application (650 + 904 nm, GaAlAs laser). The primary outcome was postoperative pain, assessed by VAS on postoperative days 2 and 7. Secondary outcomes included QoL (VAS, days 2 and 7), edema (sum of three facial distances), and trismus (maximum interincisal distance), the latter two evaluated at baseline and on postoperative days 2 and 7. On postoperative day 2, pain VAS scores were significantly lower in the PBM group (20.34 ± 24.38 vs. 41.43 ± 25.15; p < 0.001) and QoL scores significantly higher (69.83 ± 25.87 vs. 50.51 ± 23.24; p = 0.002) compared to controls. By day 7, a statistically significant but clinically negligible between-group difference persisted in pain (Mann-Whitney U = 776.5, p = 0.040; mean difference 2.6 mm), while QoL no longer differed significantly between groups (p = 0.154). No significant between-group differences were observed for edema or trismus at any time point (p > 0.05). Single-session extraoral dual-wavelength PBM significantly reduces early postoperative pain and improves QoL on the second postoperative day following impacted third molar extraction, with no significant effect on edema or trismus. The clinically meaningful pain and QoL benefits resolved by day 7, and sham-controlled multi-session trials are warranted.
International journal of oral implantology (Berlin, Germany)Margherita G Liguori, Franz J Strauss, Alessandro Crea, Daniel S Thoma, Leonardo Mancini, Enrico Marchetti
PURPOSE: To evaluate the medium-term clinical, radiographic and aesthetic outcomes of polished-collar implants placed with simultaneous horizontal guided bone regeneration and transmucosal healing after a minimum follow-up period of 3 years. MATERIALS AND METHODS: Patients treated with implant placement and simultaneous guided bone regeneration between January 2021 and November 2022 were screened. Inclusion criteria included placement of a polished-collar implant, horizontal guided bone regeneration and transmucosal healing. Baseline was defined as 7 to 14 days after delivery of the final prosthetic restoration and follow-up was performed after at least 3 years. The primary outcome was change in marginal bone level. Secondary outcomes included probing depth, bleeding on probing, plaque control record, keratinised tissue, midfacial recession and Pink Esthetic Score. Non-parametric tests were applied. RESULTS: Twenty patients (12 men, 8 women) were included, with a mean follow-up period of 42.0 ± 5.2 months. Mean marginal bone level was 1.06 ± 0.55 mm at baseline and 1.10 ± 0.52 mm at follow-up (change in marginal bone level -0.08 ± 1.02 mm). Fifty percent of implants showed no bone loss or slight gain, 45% 1 mm loss and 5% between 1.0 and 1.5 mm; no implants showed loss ≥ 1.5 mm. Probing depth, bleeding on probing, keratinised tissue and midfacial recession remained unchanged (P > 0.05), while plaque control record increased (P = 0.013). Pink Esthetic Score improved from 10.40 ± 1.79 to 11.90 ± 1.80 (P 0.001). Implant survival rate was 100%. Peri-implant health was observed in 85% of cases and mucositis in 15%, with no peri-implantitis. CONCLUSION: Simultaneous horizontal guided bone regeneration with transmucosal healing around polished-collar implants resulted in stable marginal bone levels and favourable clinical and aesthetic outcomes after 3 years of loading. CONFLICT-OF-INTEREST STATEMENT: The authors declare that there are no conflicts of interest relating to this study.
Pediatric surgery internationalJunsujee Wakhanrittee, Jiraporn Khorana, Siriphut Kiatipunsodsai
PURPOSE: To compare breastfeeding outcomes between early and late frenulotomy in infants with problematic tongue-tie to determine optimal intervention timing. METHODS: Conducted over two years at Thammasat University Hospital, this prospective cohort study divided mother-infant pairs into an early group (n = 103; <72 h postpartum) and a late group (n = 123; 7-14 days postpartum). Primary outcomes focused on exclusive breastfeeding (EBF) success at three months of age, while secondary outcomes measured LATCH scores improvement, pain reduction, and weight regain. RESULTS: Both groups showed significant postoperative improvements. Median LATCH scores increased from 5 to 6 to 9, and latching pain decreased significantly within one week. However, the early group demonstrated a significantly higher EBF rate at three months (78.64% vs. 66.67%). Using inverse probability of treatment weighting (IPTW), early frenulotomy was associated with a higher likelihood of EBF success (RR = 1.60; p < 0.001) and superior pain reduction (RR = 1.33). No significant differences were observed in weight regain or LATCH score between groups. CONCLUSION: For infants with symptomatic tongue-tie, performing a frenulotomy within 72 h of birth provides greater benefits in terms of EBF success and latching pain reduction compared to delayed intervention, suggesting early correction is the preferred clinical approach.
Oral and maxillofacial surgeryMinakshi Tibrewal, Dhruv Ahuja, Puneet Batra, Sana Bint Aziz, Ashish Kumar Singh
PURPOSE: To interpret postoperative changes in temporomandibular joint (TMJ) joint space dimensions and condylar position following orthognathic surgery in patients with skeletal malocclusions, and to determine whether reported alterations represent clinically meaningful displacement or physiological adaptive remodeling. MATERIALS AND METHODS: A comprehensive search of PubMed, SCOPUS, Web of Science, EBSCOhost, and Cochrane Library was performed to assess pre- and postoperative TMJ changes using three-dimensional imaging. Joint spaces including anterior (AJS), superior (SJS), and posterior (PJS) and condylar morphology were evaluated. Methodological quality was appraised using the Joanna Briggs Institute (JBI) checklist. Due to methodological and clinical heterogeneity, findings were synthesized narratively with attention to malocclusion type and surgical movement. RESULTS: A total of 16 studies consisting 628 patients undergoing BSSO, Le Fort I osteotomy, vertical ramus osteotomy, or bimaxillary surgery were included. Most studies reported minor, adaptive postoperative changes in AJS, SJS, and PJS. Class II patients showed more consistent increases in AJS/SJS, whereas Class III patients demonstrated variable posterior or anterior remodelling depending on surgical movement. Volumetric analyses revealed region-specific adaptations without significant condylar displacement. Postoperative temporomandibular disorder symptoms were infrequent, and no consistent evidence supported detrimental TMJ effects attributable to surgery. CONCLUSION: Postoperative TMJ joint space changes after orthognathic surgery primarily represent physiological adaptive remodeling rather than pathological condylar displacement, with reported variability driven by malocclusion type, surgical movement, fixation method, and imaging protocol. Recognizing these predictable patterns is essential to prevent overinterpretation of postoperative imaging and to improve clinical assessment through standardized three-dimensional and long-term evaluation strategies.
Brazilian oral researchCinthia Oliveira Lisboa, Sergio Luiz Mota-Júnior, José Thiers Carneiro Junior, Eduardo Luis de Sousa Cruz, Lucia Helena Soares Cevidanes, Eduardo Franzotti San…
This study evaluated three-dimensional (3D) soft tissue changes and their correlations with hard tissue movements after combined bimaxillary orthognathic surgery. A retrospective analysis was performed using cone-beam computed tomography scans obtained from 22 adults before surgery (T1) and at least 6 months after surgery (T2). Participants were divided into two groups according to the surgical procedure performed: mandibular setback combined with maxillary advancement (MdSet + MxAdv; n = 10) or mandibular advancement combined with maxillary impaction (MdAdv + MxImp; n = 12). Three-dimensional displacements of hard and soft tissue landmarks were assessed using ITK-SNAP and 3D Slicer software. Pearson's and Spearman's correlation coefficients were used to identify associations between hard and soft tissue changes. Significant correlations between anteroposterior hard and soft tissue movements were observed in the subnasal region in the MdSet + MxAdv group (% = 75/70; r = 0.768/0.875) and in the upper lip (% = 83/87/71; r = 0.689/0.760/0.812) and lower lip (% = 54; r = 0.755) regions in the MdAdv + MxImp group. Soft tissue responses in the lower lip and chin regions were significantly correlated with underlying hard tissue movements in both groups; however, the MdAdv + MxImp group demonstrated greater soft tissue response magnitudes (% = 123/136; r = 0.975/0.982) than the MdSet + MxAdv group (% = 75/70; r = 0.810/0.727). Significant vertical correlations in the MdAdv + MxImp group were identified at point A' (% = 86; r = 0.851) and mandibular landmarks (% = 67/109/108; = 0.855/0.981/0.996), whereas the MdSet + MxAdv group showed significant correlations at the lower lip and Pog' point (% = 137/73; r = 0.785/0.921). Both groups demonstrated stronger correlations for mandible-related soft tissues in the anteroposterior and vertical directions. These quantified soft-to-hard tissue ratios may improve the prediction of facial soft tissue changes and contribute to more accurate planning of combined bimaxillary orthognathic procedures.
Revista de saude publicaCristiane Maria da Costa Silva, Juliane Franco Martins, Gustavo Fernando Silva, Walbert de Andrade Vieira, Carlos José Soares, Luiz Renato Paranhos
OBJECTIVE: To analyze the time trend of dental extractions performed in primary health care and their association with human development indicators and oral health coverage in municipalities at the extremes of wealth distribution. METHODS: An ecological study using secondary data from August 2019 to July 2024, with Brazilian municipalities as the units of analysis. A total of 200 municipalities were selected, comprising the 100 with the lowest and the 100 with the highest gross domestic product per capita. The number of tooth extractions was obtained from national health information systems, and rates were calculated per 1,000 inhabitants. The temporal trend was estimated using generalized least squares regression with an autoregressive structure, and the annual percentage change was calculated. Comparisons between the groups were performed using a mixed-effects model with a negative binomial distribution, adjusted for indicators of oral health coverage, socioeconomic status, and demographics. A significance level of 5% was used. RESULTS: A total of 355,218 tooth extractions were recorded during the study period. The rates showed stationary trends in both groups, although municipalities with higher per capita gross domestic product exhibited a borderline trend towards an increase (p = 0.06). The Municipal Human Development Index was inversely associated with the outcome, while population coverage of primary patternsoral health care was positively associated with it. Per capita gross domestic product was not significantly associated with tooth extraction rates in the adjusted model. CONCLUSION: The stability of tooth extraction rates throughout the time series, regardless of municipal wealth, suggests that factors related to human development and the organization of services may be more relevant for understanding the distribution of this procedure within the Unified Health System.
The American journal of case reportsTaifu Hirano, Tadashi Kawai, Shu Suzuki, Noriaki Takahashi, Mitsuru Izumisawa, Hiroyuki Yamada
BACKGROUND If a tooth fragment is displaced into the floor of the mouth during mandibular third molar extraction, surgical retrieval can be challenging because the fragment cannot be directly visualized in the operative field. Several studies have described the use of navigation systems or endoscopic techniques individually. However, to the best of our knowledge, no reports have described their combined use for this condition. CASE REPORT A 37-year-old man underwent extraction of a left mandibular third molar at a dental clinic in May 2021, during which a root fragment was displaced into the floor of the mouth. An attempt to retrieve the fragment under general anesthesia at another hospital was unsuccessful, and the patient was subsequently referred to our department. Because direct retrieval was considered technically difficult, surgical retrieval was performed by using a combination of electromagnetic navigation and endoscopic guidance. The fragment was successfully removed via an intraoral approach with minimal surgical invasion. Postoperatively, the wound healed uneventfully and no lingual nerve injury was observed. CONCLUSIONS Electromagnetic navigation systems provide real-time spatial localization based on preoperative imaging, and are particularly useful when the target is difficult to palpate or directly visualize. Endoscopic guidance provides enhanced illumination and direct visualization within confined anatomical spaces, thereby facilitating minimally invasive surgery. In the present case, the combined use of electromagnetic navigation and endoscopic guidance can facilitate accurate intraoperative localization and minimally invasive retrieval of a displaced mandibular root fragment on the floor of the mouth.
International medical case reports journalNoy Norman Kambuaya, Iwan Fuadi
Awake tracheal intubation (ATI) is recommended for patients with predicted difficult airways. This approach preserves spontaneous ventilation until the airway is secured. In this case, a 52-year-old male (ASA II) with a large anterior mandibular tumor underwent segmental mandibulectomy. Awake fiberoptic intubation (AFOI) was performed nasally via a flexible bronchoscope in a semi-sitting, face-to-face position. Topical anesthesia was achieved by combining nebulized 2% lidocaine (4 mL, 80 mg) with the spray-as-you-go technique (2-4 mL of 2% lidocaine). The total dose used was approximately 120-160 mg, or 1.8-2.5 mg/kg for a 65-kg patient. Sedation was achieved with dexmedetomidine (loading dose 1 µg/kg over 10 minutes, then maintenance at 0.4 µg/kg/hour). As HFNO was unavailable due to limited equipment availability, oxygenation was maintained using a low-flow nasal cannula at 3 L/min. Tracheal tube placement was confirmed by direct visualization and capnography. No episodes of desaturation occurred. This report highlights the practical adaptability of the DAS sTOP framework for AFOI when HFNO availability is limited, demonstrating that low-flow nasal oxygen combined with dual-method topicalization and a single sedative agent may serve as a feasible alternative.
Medical engineering & physicsSema Dutar Çomurlu, Ümit Ertaş, İrfan Kaymaz, Osman Yavuz
This study investigated the biomechanical effects of multidirectional maxillary repositioning combined with mandibular advancement and rotation on temporomandibular joint (TMJ) components using patient-specific finite element analysis. Patient-specific three-dimensional models, reconstructed from the preoperative computed tomography (CT) data of six distinct patients presenting with varying dentofacial deformities, were used to generate the six virtual orthognathic surgery configurations, including isolated mandibular advancement, bimaxillary repositioning, vertical maxillary movements, and asymmetric rotational components. Under identical loading and boundary conditions, stress distributions in the condyle, articular disc, and glenoid fossa were evaluated. The results showed that isolated mandibular advancement produced higher and more asymmetric stress concentrations, whereas bimaxillary configurations resulted in lower and more homogeneous stress distribution. Vertical maxillary repositioning and rotational asymmetry increased unilateral and unbalanced joint loading. These findings suggest that bimaxillary surgical approaches may provide a more favorable biomechanical environment for the TMJ, while large mandibular advancements and rotational components should be planned cautiously because of their potential to increase postoperative joint loading.
BMJ case reportsYoshiyuki Nagamine, Takuro Endo, Masayuki Iwashita, Takashi Suzuki
This case report describes a man in his 50 s who developed septic cavernous sinus thrombosis secondary to odontogenic maxillary sinusitis complicated by a non-aneurysmal subarachnoid haemorrhage (SAH). He presented with visual loss, altered consciousness and shock. CT revealed SAH near the left Sylvian fissure; right maxillary sinusitis and thrombosis of the cavernous sinuses, superior ophthalmic veins and internal jugular veins without an aneurysm. Despite intensive treatment, including broad-spectrum antibiotics, anticoagulants, tooth extraction and endoscopic sinus drainage, he developed a haemorrhagic venous infarction and subsequently died from cerebral herniation due to progressive brain swelling. Streptococcus dysgalactiae subsp. equisimilis (Group C Streptococcus) was isolated from both blood cultures and purulent material was aspirated during tooth extraction. This case highlights the pathogenic potential of Group C Streptococcus and the importance of recognising septic cerebral venous thrombosis as a cause of SAH.
Temporomandibular joint (TMJ) defects primarily arise from congenital malformations, bony ankylosis, and radical tumor resection. As a pivotal structure for regulating maxillofacial development and maintaining stomatognathic homeostasis, the anatomical restoration and functional reconstruction of the TMJ are essential for rehabilitating the dentofacial complex. Distinct from standard mandibular reconstruction, TMJ reconstruction is inherently more complex, with treatment heavily dependent on etiology, age, defect extent, and coexisting dentofacial deformities-factors that invariably require patient-specific protocols. This review systematically evaluates current reconstructive paradigms, including free bone grafting (costochondral and coronoid process grafting, vertical ramus osteotomy), vascularized free flaps (vascularized fibula, vascularized medial femoral condyle, and deep circumflex iliac artery flaps), mandibular ramus distraction osteogenesis, and total joint replacement. We provide a critical analysis of their respective clinical indications, advantages, and limitations, while discussing emerging trends and future perspectives in the field.