Update on the nature of central giant cell granuloma of the jaw with a focus on the aggressive subtype

Central giant cell granuloma (CGCG) is a benign, localised osteolytic lesion of the jaw ​that is categorised into non-aggressive and aggressive subtypes. In contrast to non-aggressive CGCG, aggressive CGCG is characterised by pain, paraesthesia, root resorption, rapid growth, a size of >5 cm, cortical perforation, or recurrence after surgical treatment. However, the nature of CGCG, especially aggressive CGCG, remains unclear. This study was performed to analyse the systematic and comprehensive characteristics of CGCG of the jaw, especially the aggressive subtype, and first explored the genetic variation of aggressive CGCG by whole-exome sequencing. In total, 42 CGCGs were analysed (including 25 non-aggressive and 17 aggressive subtypes). H3F3A mutations were not detected in these CGCGs through immunohistochemistry and Sanger sequencing. The inability to detect H3F3A mutations could help differentiate CGCG from giant cell tumour of bone, indicating the two diseases are not different stages of the same pathological entity. Additionally, fluorescence in situ hybridisation did not reveal USP6 gene rearrangement in CGCG, which could distinguish it from aneurysmal bone cysts, especially the solid type. Therefore, H3F3A mutation and USP6 gene rearrangement detection have great significance in the clinicopathological diagnosis of CGCG of the jaw in terms of their ability to exclude giant cell tumour of bone and aneurysmal bone cyst. Moreover, the whole-exome sequencing data indicated that LRP1B gene abnormalities might be related to the aggressive biological behaviour of CGCG, and that NOTCH4 mutation could be a novel therapeutic target for aggressive CGCG.

THE MANAGEMENT OF TEETH IN ODONTOGENIC KERATOCYST AND AMELOBLASTOMA AND ITS PROGNOSTIC ROLE IN RECURRENCE: A SYSTEMATIC REVIEW AND META-ANALYSIS WITH TRIAL SEQUENTIAL ANALYSIS

INTRODUCTION

Odontogenic Keratocystic (OKC) and Ameloblastoma (AB) are pathological entities characterized by aggressive behavior, slow growth, local invasiveness, and high recurrence rates. The aim of this systematic review with meta-analysis and trial sequential analysis (TSA) is to assess the prognostic role of extracting involved teeth during the surgical enucleation of OKCs and ABs in terms of recurrence risk.

MATERIALS AND METHODS

A search was conducted in PubMed/Medline, Scopus, and Web of Science databases for studies reporting data on teeth extraction and recurrence rates. This systematic review was performed according to guidelines in the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Meta-analysis was performed using the Mantel-Haenszel method with a random-effects model due to heterogeneity. The TSA was conducted to control and reduce for type I and II errors of statistical analysis.

RESULTS

Six studies were identified and analyzed qualitatively and quantitatively. A total of 737 lesions (674 OKCs and 64 ABs) were included, of which 508 had involved teeth. The meta-analysis included 451 OKCs; 367 lesions were treated with teeth extraction, and in 141 cases, the teeth were preserved. The overall Risk Ratio was 0.17 (95% CI: [0.04, 0.74]; P < .0001) for OKCs. Quantitative analysis could not be performed for ABs.

CONCLUSION

The analysis revealed that tooth extraction contextually to the enucleation of the lesion reduces the risk of recurrence by approximately 83% in the OKCs; this appears to have the same trend for ABs, but more evidence is needed.

Exploring mandibular buccal bifurcation cysts: a case series and a comprehensive literature review

OBJECTIVE

The objective of this study was to explore the clinical and microscopic findings of mandibular buccal bifurcation cysts (MBBCs) in an original case series and to perform a literature review of this lesion.

STUDY DESIGN

Paraffin-embedded tissue blocks from patients microscopically diagnosed with MBBCs were retrieved from 4 oral and maxillofacial pathology archives. Data, including clinical, radiographic, and microscopic characteristics, treatments used, and follow-up status, were collected from the pathology records.

RESULTS

A total of 23 cases were examined, consisting of 10 male subjects (43.47%) and 13 female subjects (56.52%). The mean age of the subjects was 10.52 years, with a range from 6 to 42 years. The majority involved the first molar, accounting for 19 cases (82.60%), whereas the second molar was affected in 4 cases (17.39%). Only 2 cases presented with bilateral lesions (8.69%), with the remaining 21 cases showing unilateral occurrence (91.30%). Treatment predominantly involved enucleation, utilized in 16 cases (69.56%). The average follow-up period was 6.5 months, ranging from 1 to 27 months.

CONCLUSIONS

This study highlights the diagnostic challenges and treatment considerations associated with MBBC, emphasizing the importance of a conservative approach, particularly in young patients, to preserve dental function and normal facial growth.

Bruxism and direct and indirect restorations failure: A scoping review

OBJECTIVE

To analyze and present the relationship between bruxism and the failure of direct and indirect dental restorations.

METHODOLOGY

The reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Human studies reporting on the failure of dental restorations in relation to bruxism were included.

SOURCES

MEDLINE (Ovid), Scopus and Pub Med databases were searched from 2012 to 2024. Additional hand searching was made using Google Scholar, and Scopus were utilized for snowball searching.

STUDY SELECTION

An initial systematic search was made of bruxism and dental restorations failures based on key terms using MeSH and other thesaurus terms appropriate for each database published between 2012 and 2024. Two reviewers screened ten articles using the established criteria for inclusion and exclusion, and a level of agreement of 90 % was established. The available literature on the frequency of studies of the relationship between Bruxism and failure of direct and indirect dental restorations and also identify gaps in the literature for further investigation.

CONCLUSIONS

There were 66 manuscripts for full-text evaluation. After further exclusion, 46 manuscripts were selected for data charting. The studies were on the relationship between bruxism and restorations failure: dental implants studies were 58.7 %; mixed restorations were 10.9 %; indirect restoration (Full Coverage Crowns and Fixed Partial Dentures) 15.2 %; indirect partial coverage restoration (inlays/onlays/overlays/crowns) 6.5 %; indirect restoration (veneers) 4.3 %; direct restoration also 4.3 %. The 87.5 % of the implant studies addressed the effects of bruxism on single implant restorations failure.

LIMITATIONS OF EVIDENCE

Most of the included studies were retrospective, with few prospective studies or clinical trials. However, Bruxism is a risk factor for the failure of direct and indirect restorations.

CLINICAL SIGNIFICANCE

Clinicians should be aware that direct and indirect restorations are at risk of failure in the presence of bruxism, with the exception of indirect monolithic Zirconia.

Changes in stability and marginal bone level around implants with hydrophilic and hydrophobic surfaces for posterior tooth replacement: A 1-year randomized clinical trial

AIM

This two-group parallel, double-blind, randomized clinical trial compared the 1-year changes in longitudinal stability and marginal bone level (MBL) between implants with hydrophilic (HPL) and hydrophobic (HPB) surfaces.

MATERIALS AND METHODS

Patients with single posterior edentulous spaces were randomly assigned to two groups (HPL and HPB), and implants were inserted using a guided protocol. Screw-retained provisional and metal-ceramic crowns were provided per the manufacturer's loading protocol. The implant stability quotient (ISQ) was measured immediately and after 15, 30, 45 (HPL loading), 60, 90 (HPB loading) days, and then at 15, 30, 45 days, 6 and 12 months after final loading. Bone level was assessed at baseline, and 2-weeks, 6 and 12 months after loading. Generalized Estimating Equations regression was used for data analysis due to dependent longitudinal measurements and pooled data from multiple implants within patients.

RESULTS

Thirty-two patients received 48 implants (HPL=22; HPB=26). The initial Mean ISQ was 65.4±10.7Ncm (HPL=63.3±10.4; HPB=67.4±10.7; p=0.191). There was an increase in ISQ in the short-term post-insertion period from T0 to T3 (45 days) in both groups, and no significant changes occurred until T2 (30 days). ISQ comparisons between the final restoration and 1-year follow-up showed significant improvement for HPB (p=0.007) and HPL (p=0.045) groups. The final regression model confirmed that ISQ measures were affected by the progression of time after insertion until 60 days (p=0.003), 180 days (p<0.001), and 1-year (p<0.001). HPB group showed higher ISQ at any time (p=0.048).

CONCLUSION

There was a progressive increase in secondary stability up to approximately 60 days, and the hydrophobic group showed slightly higher ISQ measurements at all time points.

CLINICAL SIGNIFICANCE

This study provides evidence on the comparative longitudinal performance of implants with hydrophilic and hydrophobic surfaces in the posterior region, showing a progressive increase in the secondary stability up to approximately 60 days in both groups. The hydrophobic surface group showed slightly higher ISQ measurements at all time points, however, with no relevant clinical impact on survival and marginal bone changes.

Clinical and Histologic Outcomes of Biologically Oriented Alveolar Ridge Preservation: A Prospective Observational Study

INTRODUCTION

This study aimed to evaluate the efficacy of Biologically oriented Alveolar Ridge Preservation (BARP) in minimizing post-extraction ridge modifications compared with unassisted socket healing.

METHODS

A prospective controlled observational study was conducted involving 30 patients requiring single-rooted upper premolar extractions. Patients were divided into two groups: the test (15 patients), which underwent a ridge preservation procedure combining absorbable collagen sponge in the middle and apical third of the socket and collagenated xenogeneic bone substitute in the most coronal part (BARP), and the control (15 patients), which healed spontaneously. Soft tissue contour changes after 6 months were analyzed using digital impressions. Moreover, histomorphometric analysis of the regenerated tissue was performed in the test group.

RESULTS

BARP significantly reduced post-extractive mucosal ridge modifications compared to the control group. Mean vertical shrinkage at the mid-buccal part of the edentulous site was 1.61 ± 0.61 mm (BARP) vs. 2.51 ± 0.64 mm (control; t-test, df = 28, p < 0.001), and mean horizontal reduction was 3.37 ± 0.63 mm (BARP) vs. 4.34 ± 0.48 mm (control; t-test, df = 28, p < 0.001). Histomorphometric analysis of the regenerated tissue showed 39.7% ± 9.1% newly formed bone with minimal residual graft material (5.0% ± 5.4%).

CONCLUSION

BARP technique effectively minimizes post-extractive soft tissue contour modifications and supports natural bone regeneration, resulting in adequate bone dimensions for implant rehabilitation.

Influence of intermediate abutment height and timing of placement on marginal bone loss in single implant-supported crowns: a 12-month follow-up randomized clinical trial

OBJECTIVES

To determine the most effective combination of abutment height and timing of placement in reducing marginal bone loss (MBL).

MATERIALS AND METHODS

54 patients received at least one single screw-retained crown on an implant replacing a posterior tooth (60 implants). Implants were divided into six groups based on intermediate abutment height (1.5 mm, 2 mm, 3 mm) and timing of placement (immediate: surgery 1; delayed: surgery 2): Group A3I (height 3, surgery 1), Group A2I (height 2, surgery 1), Group A15I (height 1.5, surgery 1), Group A3D (height 3, surgery 2), Group A2D (height 2, surgery 2), Group A15D (height 1.5, surgery 2). Mesial and distal linear radiographic measurements were taken at five follow-up points: implant surgery, crown placement (T1), and 3 (T2), 6 (T3), and 12 months after loading (T4). Partial and total MBL were compared between groups.

RESULTS

After 12 months, the lowest MBL was found in groups A3I (0.13 ± 0.11 mm) and A2I (0.24 ± 0.11 mm), with no statistical difference between them. Groups A15I (0.70 ± 0.12 mm), A3D (0.66 ± 0.11 mm), A2D (0.62 ± 0.12 mm), and A15D (0.78 ± 0.11 mm) showed significantly higher MBL than groups 1 and 2, with no statistical difference among them.

CONCLUSIONS

Immediate abutments of 2-3 mm resulted in lower MBL compared to 1.5 mm immediate abutments or any delayed abutments.

CLINICAL RELEVANCE

This study provides data on the optimal combination of intermediate abutment height and placement timing in preventing MBL.

CLINICAL TRIAL REGISTRATION

Clinical trial registration number: NCT06667531. link: https://clinicaltrials.gov/study/NCT06667531 .

New Insights into Ameloblastic Fibromas, Fibrodentinomas, and Fibro-Odontomas: Findings from an International Multicenter Study

INTRODUCTION

Ameloblastic fibroma (AF), ameloblastic fibrodentinoma (AFD), and ameloblastic fibro-odontoma (AFO) are rare mixed odontogenic tumors. While some authors propose that some cases may evolve into odontomas, other tumors with aggressive clinical features suggest a neoplastic origin. A subset of AF and AFD/AFO harbor the pathogenic BRAF p.V600E mutation. SOX9, known for its role in the differentiation of various cell types, particularly in chondrogenesis, has not been previously studied in odontogenic tumors. In this study, we report the clinicopathologic features of a large international cohort of AF and AFD/AFO cases and analyze the immunohistochemical expression of BRAF p.V600E and SOX9.

MATERIALS AND METHODS

Clinical and radiographic data were collected from four Oral and Maxillofacial Pathology service archives spanning from 1991 to 2024. Deidentified slides were reviewed by two independent oral pathologists. Immunohistochemical staining for BRAF p.V600E and SOX9 was performed on non-decalcified tissue samples from cases with available specimens.

RESULTS

A total of 62 tumors were identified, including 30 AF cases and 32 AFD/AFO cases. The cohort consisted of 33 male and 29 female patients, with average ages of 15.3 years for AF and 12.3 years for AFD/AFO. Tumors predominantly affected the posterior mandible and appeared as unilocular or multilocular radiolucent or mixed lesions, often causing tooth impaction and cortical expansion, with an average size of 3.7 cm for AF and 2.5 cm for AFD/AFO. Two cases were classified as peripheral AF/AFD. Microscopically, all cases exhibited cellular mesenchymal components resembling dental papilla, with branching strands and islands of odontogenic epithelium. AFD/AFO cases also displayed dental hard tissue, and occasional chondromyxoid differentiation was observed within the stroma. Rare hybrid tumors were identified, including associations with calcifying odontogenic cysts, cemento-ossifying fibroma and central giant cell granuloma. BRAF p.V600E showed cytoplasmic positivity in the mesenchymal component of AF (81%) and AFD/AFO (54%). SOX9 exhibited diffuse nuclear immunoreactivity in both epithelial and mesenchymal components (92%).

CONCLUSION

This study represents one of the largest well-documented series of AF and AFO/AFD, providing valuable clinicopathologic and immunohistochemical insights. Additionally, the diffuse expression of SOX9 in both epithelial and mesenchymal components suggests a potential role in odontogenic differentiation, a novel finding that may have implications for understanding the histogenesis of these lesions. The aggressive behavior of some AFs and AFD/AFOs in our study supports their classification as odontogenic neoplasms rather than hamartomas.

Influence of implant internal thread deformation and repair on screw torque maintenance. An in vitro study

STATEMENT OF PROBLEM

Abutment or screw fracture is a complication of implant-supported prostheses that can damage the internal threads of the implant. Thread tapping can restore the function of the damaged implant but could affect mechanical performance.

PURPOSE

The purpose of this in vitro study was to evaluate the influence of the damage to and subsequent repair of the internal threads of dental implants on the maintenance of screw torque after functional loading.

MATERIAL AND METHODS

Ten external connection implants (Biomimetic Coral EC; Avinent) with 17-degree angled abutments for cemented restorations were used for the CONTROL group. The recommended torque (35 Ncm) was applied, and initial retrieval torque values (RT PRE) were recorded with a surgical motor (iChiropro; Bien Air). The specimens were subjected to the cyclic loading equivalent of 1 year of in vivo use (300 000 cycles, at 200 N and 2 Hz), and the final retrieval torque values (RT POST) were recorded. The specimens were subjected to internal thread deformation by the pressurized insertion of a drill, and the threads were repaired with a manual thread tapping tool to constitute the repaired implant group (REP). The same variables were recorded as in the CONTROL group. The data were evaluated for normality with the Shapiro-Wilk test; the Student t test was used for the variables that met normality, and the Mann Whitney U-test was used for nonnormal variables (α=.05).

RESULTS

Initial torque values (RT PRE) showed significant differences (P=.002) between the groups, with mean ±standard deviation values of 28.41 ±3.18 Ncm for the CONTROL group and 18.77 ±1.88 Ncm for the REP group. However, no statistically significant differences (P=.499) were observed in the final retrieval torque (RT POST) values between the groups, with mean ±standard deviation values of 18.66 ±3.26 Ncm for the CONTROL group and 20.38 ±5.53 Ncm for the REP group. Statistically significant differences were found in the difference in torque (ΔRT) between the groups (P<.001). No loosening was recorded, but one of the screws in the REP group fractured during cyclic loading.

CONCLUSIONS

The deformation and repair of the internal threads of implants negatively impacted the maintenance of the initial torque but did not affect the final torque after functional loading. Within the limitations of this study, thread repair could be an effective method of extending the lifespan of implants with damaged threads, as it is straightforward, conservative, and cost-effective. Further research in this area is required to evaluate the potential increase of stress generated in the screw.

DATA AVAILABILITY STATEMENT

The datasets used and analyzed during the current study are available from the corresponding author on request.

Validation of a digital, partly automated three-dimensional cast analysis for evaluation of orthodontic treatment assessment

BACKGROUND

Plaster models have been considered the gold standard in traditional orthodontic model analysis. Modern imaging techniques and ever-advancing technologies have expanded the scope of digital diagnostic tools. These innovations allow the use of devices specifically designed for the diagnosis of 3D structures. The aim of this method comparison study was to determine the accuracy and efficiency of digital measurements compared to conventional manual measurements on plaster models.

MATERIALS AND METHODS

The present cohort constitutes the evaluation of pretherapeutic situation models of 247 orthodontically treated patients (129 females and 118 males, average age 16.76 +- 9.49 years) with mixed or permanent dentition who were treated at the University Hospital RWTH Aachen between January 2018 and December 2020. Plaster models were digitised using a model scanner, and an experienced examiner performed various measurements on blinded plaster models using a calliper and on digital models using the specially developed 'Tooth width analysis Aachen' patch in the OnyxCeph3TM-3D software. The intra-rater and inter-rater reliability were determined by a second, blinded assessor. Measurements included tooth width, crown height, arch width, arch length and arch circumference, as well as overjet and overbite. Differences between analogue and digital methods were calculated.

RESULTS

Differences of up to 0.3 mm were observed between manual and partially automated digital measurements for sagittal, transversal and vertical parameters. Teeth with close proximal contact to adjacent teeth and teeth in jaws with a negative space analysis result showed an increased difference between manual and partially automated digital measurements, although this was not clinically relevant. The time required to perform digital measurements was statistically significantly reduced.

CONCLUSIONS

Partially automated digital impression analysis offers an accurate, highly efficient and time-saving alternative to traditional manual impression analysis.

Lateral periodontal cyst of the anterior maxilla: a rare case report

BACKGROUND

The lateral periodontal cyst (LPC) is a rare developmental odontogenic cyst, constituting approximately 0.4% of all odontogenic cysts and 0.7% of all jawbone cysts. It is an intraosseous, non-keratinized, non-inflammatory, developmental odontogenic cyst of epithelial origin, typically occurring adjacent to the root of a vital tooth. The lesion usually measures less than one centimeter in diameter. However, in the present case, the lesion was larger, measuring 3.5 × 2.4 × 2.4 cm. Radiographically, LPCs present as unilocular, round, oval or teardrop-shaped radiolucent lesions with a sclerotic border, located laterally to the tooth roots.

CASE PRESENTATION

A 42-year-old female presented to the Oral and Maxillofacial Surgery outpatient department with a chief complaint of swelling on the anterior maxilla for one year. The swelling was asymptomatic, with no associated pain or discomfort. Clinical examination revealed a non-tender, fluctuant swelling on the left side of the anterior maxilla, located between the lateral incisor and canine teeth. A computed tomographic scan confirmed the presence of a lytic lesion on the left side of the anterior maxilla. Surgical enucleation of the cyst was performed through an intraoral crevicular approach under general anesthesia. The excised specimen was sent for histopathological examination. Histopathological examination of the cyst wall revealed a non-keratinized, non-ciliated stratified squamous epithelial lining, ranging from 1 to 5 cell layers in thickness. Interspersed among the epithelial cells were foci of Periodic Acid-Schiff (PAS) positive, glycogen-rich clear cells. Additionally, focal nodular areas of epithelial thickening with a whorled, swirling architecture were observed in continuity with the epithelial lining. The underlying subepithelial connective tissue was fibrous and exhibited a zone of hyalinization. These features were consistent with a diagnosis of lateral periodontal cyst. The healing process was uneventful, and no complications were observed during the one-year follow-up.

CONCLUSION

Although the lateral periodontal cyst is a rare developmental odontogenic cyst, it should be considered in the differential diagnosis of cystic lesions adjacent to the root of a vital tooth. Surgical enucleation remains the treatment of choice, with histopathological examination confirming the diagnosis. Recurrence of lateral periodontal cysts is infrequent.

Effects of Bisphosphonates and Denosumab on Dental Implants: A Systematic Review With Meta-Analysis

OBJECTIVE

This review aimed to evaluate the effects of bisphosphonates (BP) and denosumab on dental implants, including implant failure (IF), marginal bone loss (MBL), and medication-related osteonecrosis of the jaw (MRONJ).

MATERIALS AND METHODS

A literature search was conducted in four databases and OpenGrey. Studies examining IF/MBL/MBRONJ associated with BP or denosumab were included. ROBINS-I was used to assess the risk of bias. Trial sequential analysis and the GRADE approach were used to examine the certainty of evidence. Statistical analyses were conducted using R version 4.3.1.

RESULTS

Twenty-one studies were included. BP was associated with IF only at the implant level (RR 1.74; 95% CI: 1.10-2.75) but not at the patient level (RR 1.01; 95% CI: 0.35-2.91). The analysis of two studies indicated no significant correlation between BP and MBL (MD 0.05; 95% CI: -0.12 to 0.21). BP was associated with MRONJ (RR 3.45; 95% CI: 2.56-4.65), whereas denosumab showed no significant statistical correlation with MRONJ (RR 25.98; 95% CI: 0.31-2165.63).

CONCLUSION

In patients with dental implants, the existing very low certainty level evidence suggests that BP intake may be associated with greater risks of IF and MRONJ but not with MBL, whereas it is currently unknown whether denosumab is associated with MRONJ.

Assessing Precision in All-Ceramic Fixed Restorations: Unveiling the Marginal Fit Through Digital and Traditional Impressions-A Comprehensive Systematic Review and Meta-Analysis

The marginal fit of all-ceramic fixed restorations is critical to long-term success. This comprehensive study and meta-analysis assessed the marginal fit of restorations manufactured using digital versus conventional impression procedures. We conducted a comprehensive search of electronic databases such as PubMed, Cochrane CENTRAL, Web of Science, and Scopus for publications published up to 2023. Eligible papers comparing the marginal fit of all-ceramic permanent restorations made using digital and conventional impressions were considered. A total of 19 studies met the inclusion criteria. The pooled analysis revealed that restorations fabricated from digital impressions exhibited a significantly better marginal fit than those from conventional impressions and showed a mean marginal gap of -13.76 µm (95% confidence interval: [-24.77, -2.76], p-value = 0.01). Subgroup analysis by type of digital impression system demonstrated consistent superiority of zironica material over other ones. However, high heterogeneity was observed among the included studies (I 2 = 90.74%). Digital impression restorations show superior marginal fit compared with conventional impressions, but high heterogeneity requires cautious interpretation and further well-designed studies to validate results.

Selective Serotonin Reuptake Inhibitors May Increase Implant Failure

BACKGROUND

Patients receiving dental implants may take selective serotonin reuptake inhibitors (SSRI). There may be an association with taking an SSRI at implant placement and implant failure.

PURPOSE

The study's purpose was to estimate the association between SSIR exposure and implant failure.

STUDY DESIGN

The study design was a retrospective cohort study. The sample was patients who received dental implants between December 1, 2007, and February 29, 2020. Patients were excluded if the follow-up was <12 months.

PREDICTOR VARIABLE

The predictor variable was SSRI exposure at the time of implant placement coded as exposed or not exposed.

OUTCOME VARIABLE

The primary outcome variable was implant status at 1 year, coded as survived or failed.

COVARIATES

The covariates were age, sex, and implant location and per subject, and comorbidities included smoking, diabetes, osteoporosis, and frailty.

ANALYSES

Bivariate statistics assessed the association between SSRI exposure at the time of implant placement and failure with significance at P value < .05.

RESULTS

The sample was composed of 1,611 subjects (mean age 57.3 ± 15.8 years, 893 (55.4%) females) with 3,184 implants placed. There were 1,514 (94%) subjects who did not take an SSRI at implant placement (mean age 57.5 ± 15.5 years, 813 (53.7%) females) and there were 97 (6%) subjects who did take an SSRI at implant placement (mean age 61.6 ± 13.1 years, 80 (82.5%) females). The failure rate was 6.7% (101 subjects) for non-SSRI exposed subjects and 18.6% (18 subjects) who took an SSRI at implant placement. SSRI exposure was associated with implant failure at 1-year relative risk = 2.8; 1.8-4.4 (relative risk, 95% confidence interval). Covariates with association with failure: smoking odds ratio (OR) = 0.98, 1.5-5.5 (OR, 95% confidence limits, P < .0001), diabetes (OR = 1.8, 95% confidence interval [CI], P = .048), alcohol (OR = 1.9, 95% CI, P = .045), osteoporosis (OR = 14.1, 95% CI, P < .0001), debilitation (OR = 20.7, 95% CI, P < .0001), and bisphosphonates (OR = 0.09, 95% CI, P = .004).

CONCLUSIONS

Patients who take SSRI at the time of implant surgery may have an increased risk for implant failure.

Antiresorptive Therapy to Reduce Fracture Risk and Effects on Dental Implant Outcomes in Patients With Osteoporosis: A Systematic Review and Osteonecrosis of the Jaw Taskforce Consensus Statement

OBJECTIVE

Placement of a dental implant in a patient on antiresorptive therapy has been hypothesized to increase the risk of medication-related osteonecrosis of the jaw (MRONJ) and/or impact implant survival. In patients with osteoporosis, the risk of MRONJ with antiresorptive therapy is only marginally higher than observed in the general population.

METHODS

The International ONJ Taskforce conducted a systematic review of the literature and evaluated the outcomes of implant placement in individuals with osteoporosis receiving antiresorptive therapy.

RESULTS

The data were reviewed by the International Taskforce, and consensus was achieved on the following GRADEd recommendation. In patients with osteoporosis on antiresorptive therapy, the Taskforce suggests that antiresorptive therapy does not need to be stopped prior to proceeding with dental implant (weak recommendation, very low-quality evidence). Long-term bisphosphonate use maybe associated with a small increase in the risk of MRONJ (3 cases per 1000 patients; adjusted hazard ratio: 4.09, 95% CI: 2.75-6.09, P < .001, moderate certainty).

CONCLUSION

Current evidence does not suggest an association between antiresorptive therapy in patients with osteoporosis and dental implant failure. Implants may be safely placed in the presence of concomitant use of bisphosphonates or denosumab in patients with osteoporosis with no evidence of an increased risk of implant failure/compromise.

Cumulative success rate and marginal bone loss for immediate and early loading protocols in a single implant-supported crown: A randomized controlled split-mouth clinical trial

STATEMENT OF PROBLEM

New loading protocols with reduced treatment time have gained popularity because of their advantages. However, whether the success rate with immediate loading (IL) is worse than with early loading (EL) is still unclear.

PURPOSE

The purpose of this randomized controlled trial with a split-mouth design was to evaluate the marginal bone loss and the cumulative success rate (CSR) 1 year after an IL protocol in single implant-supported crowns. The test groups were loaded after less than 24 hours (test group) and EL at 60 days (control group).

MATERIAL AND METHODS

Seventeen participants received 34 implants. The recall appointments were at baseline, 30 days, 60 days, and 1 year. The outcome measures evaluated were pain, implant clinical mobility, probing depth measurements, peri-implant disease, marginal bone loss, implant insertion torque, implant stability quotient (ISQ) value, and the CSR. A 2-way repeated measures ANOVA identified the significant differences for probing depth and ISQ. A 3-way repeated measures ANOVA followed by a pairwise t test analyzed marginal bone loss, and a nonparametric Wilcoxon test analyzed insertion torque (α=.05).

RESULTS

No differences were found between the insertion torque, ISQ, and marginal bone loss values (P>.05). When analyzing probing depth, no differences were found when comparing IL versus EL at baseline, 30 days, and 1 year (P>.05). The global CSR was 91.17%, 88.23% for the IL group and 94.11% for the EL group.

CONCLUSIONS

When analyzing marginal bone loss, the groups were similar. The global CSR was 91.17%, 88.23% for the IL group, and 94.11% for the EL group.

Treatment of mandibular condyle fractures with a rhombic 3D condylar fracture plate - Does the surgical approach matter?

Fractures involving the mandibular condyle are a significant subset of mandibular fractures, demanding specialized implant design considerations for effective surgical treatment. The core objective of this study was to assess the clinical and radiographic results in patients treated with a single rhombic-shaped implant according to the surgical approach used. This retrospective cohort investigation, spanning a ten-year recruitment window, included individuals with unilateral fractures who underwent surgical treatment with a rhombic-shaped implant. These patients were subject to follow-up examinations at one, three, and six months post-surgery, along with corresponding orthopantomograms and clinical assessments. Patients were allocated into four groups depending on the fracture pattern and level as well as the approach used for fracture treatment. The primary outcome variables under scrutiny encompassed parameters such as occlusion, maximum interincisal distance, mandibular excursion across different postoperative time points, and radiographic measurements of mandibular height and the gonion angle. A total of 236 patients, comprising 161 males and 75 females, with an average age of 40.2 ± 19.2 years, were included in the study. Satisfactory occlusion was exhibited in 99.6% of patients at the six-month follow-up. Furthermore, all parameters associated with mandibular excursion displayed significant enhancements (p < 0.01). These improvements were accompanied by a reduction in ramus height and increased gonion angle on the fractured side. The investigation of the clinical and radiographic results suggest a tendency of the choice of the approach depending on the fracture pattern, but no statistically significant recommendations could be identified.

Clinical behavior of two-piece zirconia implants. A systematic review

BACKGROUND

This systematic review aimed to evaluate the clinical behavior of two-piece zirconia implants (T-PZI) in terms of overall implant survival and success rates, marginal bone loss (MBL) complication rates, and others biological parameters.

MATERIAL AND METHODS

PRISMA guidelines were followed, and the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). An automated search was conducted in four databases (Medline/PubMed, Scopus, Web of Science, and Cochrane Library), as well as a manual search for relevant clinical articles published until 18 May 2024. The review included human studies with at least five patients in which T-PZI were placed. Quality of evidence was evaluated using the Newcastle-Ottawa Quality Assessment Scale and the Cochrane risk-of-bias tool for randomized trials version 2 (RoB 2).

RESULTS

Six studies met the inclusion criteria and were included for analysis, with a total of 298 T-PZI. A survival rate of 96.31% was recorded with follow-up periods ranging from 18.4±10.4 months to 111.1±2.2 months. The success rate ranged from 63 to 100% and MBL ranged from 0.130.6 to 1.38±0.81mm Conclusions: T-PZI may offer a reliable alternative to titanium dental implants, achieving a survival rate of 96.31%, acceptable rates of MBL and adequate biological parameters. However, the findings of the review must be treated with caution, as the data obtained are derived from the early stages of this new development in ceramic dental implants. More comparative studies are needed in order to determine the viability of T-PZI in different clinical situations.

Antibacterial and osteogenic gain strategy on titanium surfaces for preventing implant-related infections

Infection and insufficient osseointegration are the primary factors leading to the failure of titanium-based implants. Surface coating modifications that combine both antibacterial and osteogenic properties are commonly employed strategies. However, the challenge of achieving rapid antibacterial action and consistent osteogenesis with these coatings remains unresolved. In this study, a functional composite coating (PDA/PPy@Cu/Dex) was prepared on titanium surfaces using layer-by-layer self-assembly and electrochemical deposition techniques. The hydroxyl groups grafted by polydopamine's (PDA) self-polymerization and the enhanced conductivity and uniform electric field distribution provided by polypyrrole (PPy) allowed for the even dispersion of copper nanoparticles and dexamethasone (Dex) on the titanium surface. This synergistically coupled the photothermal ion antibacterial properties of copper nanoparticles with the osteogenic promotion of dexamethasone. In vitro antibacterial experiments revealed that the heat generated by photothermal effects and reactive oxygen species enhanced the antibacterial activity of copper ions, reducing the antibacterial time to six h and achieving antibacterial enhancement. In vitro cell experiments showed that the long-term slow release of copper ions and dexamethasone enhanced the osteogenic differentiation of stem cells, thereby achieving osteogenic benefits. Moreover, in vivo toxicity experiments demonstrated that the composite coating had no adverse effects on normal tissues. Therefore, the antibacterial and osteogenic enhancement strategy for titanium surfaces presented in this study offers a new potential approach for preventing implant-associated infections.

Relationship Between Cigarette Smoking and Awake Bruxism: Does Smoking Increase the Frequency of Masticatory Muscle Activities?

BACKGROUND

Despite the aetiology of awake bruxism (AB) being prevalently linked to psychological factors, several studies suggested that the use of certain substances, such as tobacco smoking, can contribute to the increase in masticatory muscle activities (MMA) during wakefulness.

OBJECTIVE

The aim of this study is to assess whether there is a correlation between the frequency of awake bruxism behaviours and smoking habits.

METHODS

Participants were recruited, without gender or ethnic restriction, at the University of Siena, Siena, Italy, by advertising. Participants completed a questionnaire containing the four-item patient health questionnaire for anxiety and depression (PHQ-4) and some items from the Global Adult Tobacco Smoking (GATS) questionnaire. Moreover, they performed one week of awake bruxism behaviours monitoring via the ecological momentary assessment (EMA).

RESULTS

A total of 100 participants (university employees, dentists, undergraduate and post-graduate students) were included in the study (34 males and 66 females, mean age 24.5 years). Of them, 39% were smokers and 61% were non-smokers. The multiple variable linear regression analysis results showed a statistically significant correlation between the frequency of awake bruxism behaviours and the PHQ-4 scores. Specifically, for every 1% increase in PHQ-4 score, the mean frequency of the AB behaviours increases 5-fold. Awake bruxism behaviours did not show any statistically significant correlation with the number of smoked cigarettes (p > 0.05). Mandible bracing significantly correlated with the number of years of smoking (B = 1.58, p = 0.002).

CONCLUSIONS

According to the present study's findings, the frequency of awake bruxism behaviours correlated with symptoms of anxiety and depression but not with smoking status.

Novel Histologic Features in Ameloblastoma With RASQ61R Mutation

Ameloblastoma is characterized histologically by evidence of ameloblastic differentiation and molecularly by MAPK pathway alterations, most frequently BRAFV600E mutation and RAS mutations, as well as by SMO mutations. This mutational profile is present across all histologic variants, including those occasionally lacking overt histologic evidence of ameloblastic differentiation, such as desmoplastic ameloblastoma and granular cell ameloblastoma. Recently, we have come across 4 cases of maxillary ameloblastoma demonstrating peculiar histologic features not accounted for by recognized histologic variants. Three intraosseous tumors were remarkably similar in histologic appearance and demonstrated a proliferation of spindled to basaloid cells in solid/sheet-like, cystic, and ribbon-like growth patterns within dense fibrous connective tissue. One case had numerous squamous morules and only 1 case, focally, demonstrated ameloblastic differentiation, yet all 3 cases harbored NRASQ61R mutation. A fourth case harbored HRASQ61R mutation and arose peripherally, in palatal (maxillary) gingiva, as a follicular-patterned neoplasm with bland squamoid morphology and scattered foci of ameloblastic differentiation. RAS Q61R immunohistochemistry was positive in both the tumor and overlying surface epithelium, in support of surface derivation. These 4 cases demonstrate that ameloblastoma may occasionally present with non-traditional histologic features, lacking categorization into known histologic variants and sometimes lacking any evidence of ameloblastic differentiation. In this setting, the differential diagnosis may be broad and include more indolent odontogenic neoplasms such as adenomatoid odontogenic tumor or squamous odontogenic tumor, odontogenic carcinomas, and non-odontogenic neoplasms. A high index of suspicion, followed by confirmatory molecular testing or mutation-specific immunohistochemistry, is necessary for accurate diagnosis.

Autonomous dental robotic surgery for zygomatic implants: A two-stage technique

Zygomatic implants (ZIs) can be a treatment option for patients with severe atrophy in the maxilla, but deviation during ZI placement could lead to serious complications. Surgical guides and dynamic navigation have been used to improve the accuracy of ZI placement, but both techniques are subject to human error. A 2-stage technique is described that enabled an autonomous dental robot to overcome mouth-opening restrictions for ZI placement. The technique enables the complete digitalization of ZI placement, further improving the accuracy of the drilling process.

New mechanistic approach of TiCN film-coated NiTi substrate toxicity: impairment in mitochondrial electron transfer in diabetic rat tooth gum cells

In recent years, researchers have focused on using new materials for screws in bone jaw tissue replacement. However, concerns regarding the cytotoxicity and biocompatibility of these materials for cells remain a subject of ongoing discussion. In this study, a novel implant for bone jaw tissue regeneration was fabricated by depositing the titanium carbo-nitride (TiCN) film on NiTi shape memory alloy substrate using the Cathodic Arc Physical Vapor Deposition (CAPVD) technique. Our study emphasized positive cellular responses of TiCN-coated NiTi substrate on diabetic rat tooth gum cells for 1, 15, and 30 days. Initially, the evaluation focused on the characterization and distribution of NiTi alloy in tissues. Then, the levels of factors such as components of White Blood Cells (WBC), ATP, oxidative stress parameters, cytochrome c release and damage to the lysosomal membrane were evaluated in all groups. The results indicated that in the group of diabetic rats with TiCN-coated NiTi substrate, the level of oxidative stress parameters decreased. In addition, the cell viability, glutathione (GSH) intracellular and ATP increased and the rate of cytochrome c release, and damage to the lysosome membrane decreased. It can be concluded that the TiCN-coated NiTi screw is a promising material for bone jaw tissue replacement in diabetic patients due to its low cytotoxicity.

Comparison of feldspathic veneer surface treatments on colour stability after debonding of orthodontic brackets: An in vitro study

OBJECTIVES

To analyse the colour stability of feldspathic porcelain veneers treated with different surface preparation methods after bonding and debonding orthodontic brackets.

MATERIAL AND METHODS

Twenty-five feldspathic porcelain veneers samples were divided into groups according to surface treatment procedures: (S) glaze-layer retained; (SHF) hydrofluoric acid etch; (SOXA) sandblasting; (SB) diamond burs; (C) control. Specimens were primed using silane and brackets were bonded. After removal of brackets, colour stability (NBS score National Bureau of Standards Score) was determined following coffee staining for 21 days. Group comparisons at each time point (T0 and T1) were performed using one-way ANOVA, followed by Tukey's HSD test for pairwise comparisons when a significant difference was detected. To evaluate the effect of time within each surface treatment group (T0 vs. T1), a paired t-test was performed.

RESULTS

No significant interclass difference was identified between overall colour stability for the four test groups (S, SHF, SOXA and SB). All test groups showed a statistically significant increase in colour change compared to the control.

CONCLUSIONS

Surface treatment resulted in a significant decrease in colour stability with no statistical difference between treatments. Regardless of surface preparation method, bonding and debonding of orthodontic bracket results in decreased colour stability of feldspathic porcelain veneers.

Fracture resistance of a second generation of zirconia implants after artificial ageing: An in vitro study

OBJECTIVES

The aim of this study was to determine the bending moments of a further developed generation of a one-piece zirconia implant system, which, for example, has a reduced diameter in the neck area compared to the predecessor model.

METHODS

A total of 48 one-piece ceramic implants with diameters of 3.6 mm and 4.1 mm were included. After preparation of the abutments of 50 % of the implants, 32 out of the 48 implants were subjected to artificial ageing in a chewing simulator (Force: 98 N; 1.2 or 5 million loading cycles; thermocyclicing: 5 °C / 55 °C). The implants were then subjected to static loading until fracture in order to determine the maximum load forces to calculate the bending moments.

RESULTS

Implants tested after 1.2 million loading cycles exhibited the highest bending moments (3.6 mm diameter without abutment preparation: 496.1 ± 50.6 Ncm; 3.6 mm diameter with abutment preparation: 507.9 ± 53.5 Ncm; 4.1 mm diameter without abutment preparation: 612.5 ± 49.0 Ncm; 4.1 mm diameter with abutment preparation: 656.9 ± 26.8 Ncm). In contrast, unloaded implants showed the lowest values (3.6 mm diameter without abutment preparation: 443.0 ± 38.6 Ncm; 3.6 mm diameter with abutment preparation: 436.1 ± 42.8 Ncm; 4.1 mm diameter without abutment preparation: 570.3 ± 64.8 Ncm; 4.1 mm diameter with abutment preparation: 560.9 ± 51.5 Ncm), while implants subjected to 5 million cycles of loading showed bending moment values between these two groups.

CONCLUSIONS

Within the limits of the present study, preparation of the abutment did not appear to have a negative effect on stability. Also, artificial ageing did not seem to have a negative effect on the fracture resistance; a possible negative effect on the bending moment would have to be investigated with >5 million loading cycles. The measured maximum fracture loads were generally higher than the masticatory forces described in the literature.

CLINICAL SIGNIFICANCE

The investigated zirconia implants seem to be a viable alternative to titanium implants.

Melanotic Neuroectodermal Tumor of Infancy: Clinicopathological Evaluation of a 10-Year Consecutive Case Series from a Tertiary Cancer Center

PURPOSE

Melanotic Neuroectodermal Tumor of Infancy (MNTI) is a rare, locally aggressive tumor with distinct pathological features and treatment paradigms commonly occurring in the head and neck region. Microscopically, it consists of a biphasic population of small neuroblast-like cells and larger melanin-containing epithelioid cells. The main purpose of this study is to characterize clinicopathological and immunohistochemical features of MNTI at a single institution and discuss challenges in the differential diagnosis.

METHODS

We performed a retrospective analysis of MNTI cases diagnosed at our center during a 10-year period and discussed the differential diagnoses.

RESULTS

Eleven MNTI cases were identified. Median patient age was 5 months. Male to Female ratio was 1.75:1. Tumor distribution was in the Maxilla (n = 8), Mandible (n = 1) greater wing of Sphenoid (n = 1), and Temporal bone (n = 1). All tumors revealed classic biphasic morphology in the resection specimens. By immunohistochemistry, 9/9 (100%) cases were positive for both AE1/AE3 and HMB45 in the larger epithelioid cells and 6/6 (100%) were positive for Synaptophysin in the smaller neuroblast-like cells. One patient had unique nested areas composed of mature glial tissue. One patient who had incomplete resection was given adjuvant radiotherapy. One patient developed a solitary ipsilateral lymph nodal metastasis. Follow-up period ranged from 1 to 93 months. All the patients were alive with no evidence of disease at the last follow-up (median: 16 months).

CONCLUSIONS

Lack of consideration of MNTI in the differential diagnosis can lead to misdiagnosis and undue exposure to cytotoxic therapies. Awareness of the classic biphasic morphology and distinct immunoprofile of MNTI is essential.

Timing of implantation and extraction in aesthetically sensitive anterior tooth region, part 1: Clinical case reports

RATIONALE

Immediate implantation after anterior tooth trauma is the safest method for completely preserving the alveolar structures. However, based on evidence, most anterior tooth trauma occurs in childhood when implantation is not possible owing to growth in the jaw area.

PATIENT CONCERNS

In adulthood, long-term effects can occur with cyst formation or chronic infections in traumatized teeth. The loss of an anterior tooth leads to the loss of alveolar structures and aesthetic limitations due to recession, scar tissue, or surgical augmentation procedures.

DIAGNOSES

Patient 1 was a 21-year-old woman with an extensive radicular cyst following anterior tooth trauma in early childhood. She had incomplete root growth and an open apex. Patient 2 was a 24-year-old woman with a history of anterior tooth trauma in 11 and 21 during adolescence. She also had fistulas in regions 11 and 21.

INTERVENTIONS

In both patients, optimally timed implantation and minimally invasive surgery resulted in tissue preservation without additional augmentation procedures.

OUTCOMES

This case series highlights varying clinical presentations of childhood anterior tooth trauma and their long-term effects in adulthood.

LESSONS

By optimizing the timing of extraction and implantation, alveolar structures were fully preserved without the need for additional augmentation procedures.

Gap arthroplasty with disc repositioning for pediatric TMJ ankylosis secondary to intracranial condylar dislocation: A case report

INTRODUCTION AND IMPORTANCE

A rare consequence of maxillofacial trauma of an intracranial dislocation of the mandibular condyle into the middle cranial fossa. We present a case involving the management of this dislocation, complicated by temporomandibular joint (TMJ) ankylosis.

CASE PRESENTATION

An 11-year-old boy was transferred to a tertiary hospital following a road traffic accident. Examination revealed a dislocation of the right mandibular condyle into the middle cranial fossa. After closed reduction by intermaxillary fixation (IMF), the patient developed TMJ ankylosis and the initial mouth opening was 8 mm due to prolonged IMF. He subsequently referred to the National Maxillofacial Unit in Muscat, Oman for expert management and treatment.

CLINICAL DISCUSSION

A pre-operative CT scan revealed an ankylotic bone mass in the left TMJ area. The patient underwent TMJ gap arthroplasty and disc repositioning under general anesthesia. Post-operatively, the patient's mouth opening improved to 43 mm.

CONCLUSION

Multidisciplinary team for management and close monitory such cases is crucial to prevent further surgical complications.

Low intensity pulsed ultrasound versus low-level laser therapy on peri-implant marginal bone preservation and soft tissue healing following dental implant surgery: a randomized controlled trial

BACKGROUND

Low-intensity pulsed ultrasound (LIPUS) and low-level laser therapy (LLLT) are proposed adjunctive therapies to enhance healing after dental implant surgery. However, direct comparisons of their effects on peri-implant marginal bone preservation and soft tissue healing remain limited. This randomized controlled trial aimed to compare the effectiveness of LIPUS and LLLT on peri-implant marginal bone preservation, soft tissue healing, pain levels, and oral health-related quality of life following dental implant placement.

METHODS

This single-blind, randomized controlled trial included 63 patients undergoing maxillary or mandibular implant placement, randomly allocated to LIPUS (n = 21), LLLT (n = 21), or control (n = 21) groups. LIPUS was applied twice weekly for 4 weeks, while LLLT was administered in 4 sessions over 2 weeks post-implant. Marginal bone loss (MBL) and OHRQoL (OHIP-14) were assessed at baseline, 6, and 12 weeks. Soft tissue healing (Landry Healing Index) and pain (VAS) were evaluated at baseline, 7-, 14-, 21-, and 30-days post-implant.

RESULTS

LIPUS significantly reduced marginal bone loss at 6 weeks and 3 months post-implant compared to LLLT and control groups (p < 0.05). LLLT demonstrated superior soft tissue healing at 7-, 14-, 21-, and 30-days post-implant (p < 0.05). Both interventions significantly decreased pain intensity and improved OHRQoL at various time points compared to the control group (p < 0.05).

CONCLUSIONS

LIPUS and LLLT significantly enhance peri-implant marginal bone preservation, soft tissue healing, pain management, and OHRQoL in dental implant patients compared to standard care. LIPUS was more effective for peri-implant marginal bone preservation, while LLLT excelled in soft tissue healing.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov (NCT05938868) on July 11, 2023.

Assessment of pediatric mandibular fracture management in France

Mandibular fractures in children present management challenges due to pediatric-specific factors such as mandibular growth and the presence of dental germs. There are few surgeons specifically trained to treat these fractures, and there are no national or international guidelines. Management depends on several factors, including the child's age and the location of the fracture. Treatment options include functional treatment, closed reduction with or without immobilization, and surgery. The aim of this study was to assess the current management strategies for pediatric mandibular fractures in France, based on a national survey. A questionnaire based on two clinical cases of children of different ages, presenting mandibular fractures in different locations, was sent to the referring pediatric surgeon of 25 centers in France that manage pediatric maxillofacial trauma. The questions focused on the choice of treatment, postoperative instructions, and follow-up. The data were analyzed descriptively. Off the 25 centers, all responded to the questionnaire. For the first patient, 92 % of the surgeons hospitalized the child. Among them, 76 % opted for open reduction and internal fixation (ORIF) for the parasymphyseal fracture, and 72 % adopted the same approach for the mandibular body fracture. In most cases, the fixation material was left in place for at least three months. For the second patient, 88 % of the surgeons also hospitalized the child. For condylar fractures, 84 % chose functional treatment. 56 % of practitioners opted for ORIF for the mandibular body fracture. Regarding the use of resorbable plates, only 1 out of 25 centers used this type of material. Concerning the specific training of surgeons, the study shows that among the 25 centers: 52 % reported having surgeons with specific pediatric training. 48 % of the centers had access to a dental prosthetist capable of fabricating retention splints. This study is the first on this subject in France. It highlights significant variability in the management of pediatric mandibular fractures in France and underscore the need for standardized treatment protocols. Future studies should focus on developing standardized guidelines and evaluated long-term outcome to improve both surgical and conservative approaches.

Effectiveness of advanced platelet-rich fibrin on post-exodontia socket healing in patients who had undergone head and neck radiation

OBJECTIVE

Osteoradionecrosis (ORN) of the jaw is one of the most significant complications of radiotherapy (RT) for head and neck cancer (HNC), and is primarily attributable to tooth extraction. The objective of this study was to assess the efficacy of advanced platelet-rich fibrin (A-PRF) in preventing ORN after tooth extraction in patients with post-irradiated HNC and other postoperative complications.

METHODS

The study population comprised 30 patients who previously underwent radiotherapy for HNC and subsequently underwent tooth extraction, with a total of 134 extractions performed. Extraction sockets were randomly assigned to receive either A-PRF (n = 67 [experimental group]); or clot maintenance alone (n = 67 [control group]). Patients were clinically evaluated at 7, 14, 30, 60, 90, and 120 days postoperatively to assess pain and healing of the surgical site. The intensity of postoperative pain was quantified using a visual analog scale. Patients were clinically evaluated for up to 120 days to diagnose ORN. Other postoperative complications, including edema, bleeding, tissue color, consistency, and suppuration, were also evaluated.

RESULTS

In terms of pain and healing, there was no statistically significant difference between the two groups. No ORN or other surgical complications were observed. The use of A-PRF demonstrated no statistically significant differences compared with the control group in most of the parameters evaluated.

CONCLUSION

A-PRF yielded no additional benefits and did not influence the healing process in the short or medium term. RBR- 3 TDK22P: Date of registration: 02/14/2022.

Mesh-assisted regenerated site for alveolar ridge preservation: A case report

BACKGROUND

The proposed technique utilizes the osteoconductive regenerative properties of bone-substitute materials (BSMs) and the space-maintaining function of titanium mesh to restore the alveolar ridge at extraction sites with lost labial plates in a single procedure. This approach may reduce the need for extensive ridge augmentation procedures, shorten treatment duration, minimize complications, and potentially lower overall costs for patients.

METHODS

Both patients presented with hopeless dentition, characterized by chronic infection and loss of the labial plates. To regenerate the alveolar ridge, a titanium mesh was utilized in combination with a layered application of xenograft and allograft BSMs. The success of this technique depended on mesh stabilization, thorough site debridement, and the absence of soft-tissue tension.

RESULTS

The technique effectively restored the lost labial plates and regenerated sufficient bone to accommodate dental implants. Significant bone regeneration was achieved in both cases, with minimal complications. In one case, a minor mesh exposure occurred; however, it did not affect the healing and was managed during the re-entry surgery.

CONCLUSION

The presented technique effectively regenerated the lost labial plates. It represents a novel alveolar ridge preservation approach to restore the alveolar ridge at extraction sites with lost labial bone plates, even in the presence of chronic infection. However, future studies with sound methodology, larger sample sizes, and long follow-up periods are recommended to validate these findings.

KEY POINTS

The Mesh-Assisted Regenerated Site (MARS) technique restores the alveolar ridge at sites with lost labial plates by combining the osteoconductive properties of bone substitutes with the space-maintaining function of titanium mesh in a single procedure. This approach may reduce the need for extensive augmentation, shorten treatment duration, minimize complications, and potentially lower long-term treatment costs. The success of this approach depends on minimally traumatic extraction, meticulous socket debridement, careful soft tissue management, and precise placement of titanium mesh and bone substitutes under optimal magnification. Although effective, this technique has limitations, including potential vertical bone loss, time-consuming procedures, possible need for additional augmentation, occasional challenges with mesh retrieval, and infection risk, all of which may compromise regeneration and implant success. Proper case selection and precise application of the technique are essential to mitigate these challenges and optimize clinical outcomes.

PLAIN LANGUAGE SUMMARY

When teeth are removed, the surrounding bone can shrink. Techniques to preserve this area, known as alveolar ridge preservation, help prevent this shrinkage. This novel technique uses specialized bone materials and a titanium mesh to rebuild the bone in areas where the front portion is missing. The author used a combination of bone materials and a titanium mesh to rebuild the lost bone. Key steps included stabilizing the mesh, thoroughly cleaning out any infection, layering the bone materials, and ensuring the gum tissue was not overly tight. The technique successfully reconstructed the missing bone, making it possible to place standard dental implants. Both cases showed significant bone growth with minimal issues. In one case, a small part of the mesh was exposed but did not impact healing and was addressed during follow-up surgery. This technique effectively rebuilt the lost bone, even with the presence of a long-standing infection. It shows promise for preserving and regenerating bone in these areas, but more extensive studies are needed to confirm the results and improve the method.

Electrolytic Cleaning of Dental Implants: A Scoping Review of Clinical Studies

Background/Objectives: This literature review aims to systematically analyze the efficacy of electrolytic cleaning for treating peri-implantitis, including its impact on disease resolution, re-osseointegration of treated implants, and peri-implantitis recurrence. It also compares various study and treatment protocols used in the selected papers. Methods: A comprehensive search was conducted in MEDLINE (via PubMed) and the Cochrane Central Register of Controlled Trials using the keywords "electrolytic cleaning implant" or "GalvoSurge". Studies published until 31 December 2024 were considered for inclusion. Results: Out of 141 articles retrieved, four publications were selected for the review. These studies were analyzed for implant type, number, evaluation methods, observation periods, surgical procedures, and additional treatments. Disease resolution was reported in one study, while peri-implantitis recurred in the remaining studies. However, re-osseointegration of treated implants was observed in all selected papers. Conclusions: Due to the limited and heterogeneous nature of the studies, it is difficult to draw definitive conclusions about the effectiveness of electrolytic cleaning as a treatment for peri-implantitis. To ensure consistent trial outcomes and improve predictability, clear clinical guidelines and surgical protocols for electrolytic decontamination are essential.

Adjunctive photochemical therapy for management of inflammatory peri-implant diseases: A systematic review and meta-analysis

This study aimed to systematically review the data on interventions involving adjunctive photochemical therapy in treating peri-implant mucositis (PIM) and peri-implantitis (PI). The electronic search was conducted through six databases in October 2023, seeking studies relying on any kind of adjunctive photochemical therapy in treating inflammatory peri-implant diseases (PIDs). To showcase the effect size, mean differences along with 95% confidence intervals were utilized. Forty-seven studies were deemed eligible for qualitative synthesis, 14 of which were included in the meta-analysis. Low-level light therapy and photodynamic therapy led to enhanced improvements in clinical and radiographic indices, such as bone level (BL), bleeding on probing (BoP), clinical attachment level (CAL), and probing depth (PD), during the 3-month follow-up. However, the differences in efficacy between treatments incorporating adjunctive photochemical therapy and those relying solely on mechanical debridement, considered the gold standard, lessened over extended follow-up periods of 6, 9, and 12 months. Significant differences were observed when comparing the treatment outcomes following adjunctive photochemical therapy between obese and smoker patients with healthy subjects. Incorporating adjunctive photochemical therapy for PID treatment might improve clinical and radiographic parameters in a short-term follow-up of 3 months, but longer-term benefits appear comparable to routine treatments.

Complete-arch implant rehabilitation and adjunctive orthognathic surgery of a patient with hypohidrotic ectodermal dysplasia utilizing a digital workflow: A clinical report

Hypohidrotic ectodermal dysplasia (HED) is a rare genetic disorder characterized by congenital anomalies in ectodermal tissues, with dental manifestations commonly including hypodontia or oligodontia. Addressing the significant aesthetic, functional, and psychosocial challenges associated with HED requires early surgical and prosthodontic intervention following skeletal maturation. This clinical report details a digital workflow for complete-arch implant rehabilitation of the maxilla and mandible, combined with orthognathic surgery, in an adolescent patient with HED. Integrating digital technologies enhanced treatment planning, surgical precision, and prosthetic outcomes, improving aesthetics, functionality, and overall patient quality of life.

Optimizing implant osseointegration, soft tissue responses, and bacterial inhibition: A comprehensive narrative review on the multifaceted approach of the UV photofunctionalization of titanium

Titanium implants have revolutionized restorative and reconstructive therapy, yet achieving optimal osseointegration and ensuring long-term implant success remain persistent challenges. In this review, we explore a cutting-edge approach to enhancing implant properties: ultraviolet (UV) photofunctionalization. By harnessing UV energy, photofunctionalization rejuvenates aging implants, leveraging and often surpassing the intrinsic potential of titanium materials. The primary aim of this narrative review is to offer an updated perspective on the advancements made in the field, providing a comprehensive overview of recent findings and exploring the relationship between UV-induced physicochemical alterations and cellular responses. There is now compelling evidence of significant transformations in titanium surface chemistry induced by photofunctionalization, transitioning from hydrocarbon-rich to carbon pellicle-free surfaces, generating superhydrophilic surfaces, and modulating the electrostatic properties. These changes are closely associated with improved cellular attachment, spreading, proliferation, differentiation, and, ultimately, osseointegration. Additionally, we discuss clinical studies demonstrating the efficacy of UV photofunctionalization in accelerating and enhancing the osseointegration of dental implants. Furthermore, we delve into recent advancements, including the development of one-minute vacuum UV (VUV) photofunctionalization, which addresses the limitations of conventional UV methods as well as the newly discovered functions of photofunctionalization in modulating soft tissue and bacterial interfaces. By elucidating the intricate relationship between surface science and biology, this body of research lays the groundwork for innovative strategies aimed at enhancing the clinical performance of titanium implants, marking a new era in implantology.

Evaluation of factors affecting implant failure: A 13-year retrospective cohort study

Dental implant failure remains a significant concern in oral rehabilitation, with multiple risk factors contributing to early and late implant failure. While numerous studies have examined implant failure rates, limited research distinguishes between early implant failure (EIF) and late implant failure (LIF) based on patient-related, implant-specific, and surgical variables. This study aimed to evaluate the risk factors associated with EIF and LIF and to determine the impact of patient-related, implant-specific, and surgical variables on implant survival. This retrospective cohort study was conducted at Ondokuz Mayıs University. It is based on the treatments provided by an experienced surgeon to individuals who applied for implant treatment between January 2011 and January 2024. This study analyzed 490 patients who met the inclusion criteria out of 3720 who received implant treatment during the relevant years. The patients' ages ranged from 21 to 90, with a mean age of 53.92 ± 13.82 years. Sex, smoking, and implant length (≤10 mm) were identified as risk factors in analyzing parameters affecting EIF, while maxilla, implant length (<8 mm), SLA surface modification, sinus lift procedures, smoking, and short osteointegration duration were identified as risk factors in analyzing parameters affecting LIF. Our findings highlight the distinct risk profiles for EIF and LIF, emphasizing the importance of patient selection, surgical technique, and implant characteristics in optimizing long-term success rates. Recognizing EIF and LIF risk factors enables clinicians to refine treatment protocols and reduce implant failure rates, ultimately improving patient outcomes.

Implant failure of facial prostheses: systematic review and meta-analysis

The aim of this systematic review was to evaluate craniofacial implant failure in the auricular, orbital, and nasal regions, including the impact of radiotherapy and evaluation of early (<1 year) and late (>1 year) implant failure. Five electronic databases were searched for articles reporting studies on implant failure in auricular, nasal, and/or orbital prostheses. The PRISMA guidelines were followed. Sixteen studies (3630 implants in 1127 patients) were included. The pooled implant failure rate was 3.5% in the auricular region, 18.7% in the orbital region, and 8.8% in the nasal region. Compared to the auricular region, implants inserted in the orbital (risk ratio (RR) 4.54) and nasal (RR 3.00) regions had a significantly higher risk of failure. Auricular (RR 2.17) and orbital (RR 2.07) implants had an increased risk of failure in irradiated bone. Regarding early failure (<1 year), 79.8% of nasal implants that failed were found to fail early, compared to 21.4% and 35.4% of failed auricular and orbital implants, respectively. This meta-analysis is novel in studying the timing of implant failure. Future studies should cover long observation periods and adequately report failure rates. There is a lack of high-quality studies and well-defined standardized outcome parameters. Results should be interpreted with caution due to low levels of evidence. DATA AVAILABILITY: This review has been registered with the Open Science Framework (doi:10.17605/OSF.IO/EBUC4). The study protocol and data files are publicly accessible.

Graftless complete arch rehabilitation using a facial approach for enhanced bone anchorage and prosthetic outcomes: A clinical report

This clinical report introduces a novel approach to the placement of anterior implants in maxillae with severe atrophy, with the objective of reducing anterior cantilever length and enhancing bone anchorage. By sagittally tilting the anterior implants to emerge facially rather than palatally, the procedure enhances the prosthetic screw position and decreases the risk of a bulky prosthesis. Two zygomatic implants were placed posteriorly for additional support, and bilateral paranasal prostheses helped restore midfacial contours. Early follow-up showed stable implants and good soft tissue health. Longer-term studies and clear patient selection criteria are needed to confirm the effectiveness of the technique.

The usefulness of different imaging modalities in mandibular osteonecrosis and osteomyelitis diagnosis

To examine the CT-imaging features of subjects with bacterial osteomyelitis (OM), osteoradionecrosis (ORN), and medication-related osteonecrosis of the jaw (MRONJ) with histopathological confirmation, and to examine the diagnostic efficacy of panoramic radiography and MRI in detecting these disease features. 150 cases with preoperative CT data were selected: 61 bacterial OM, 19 ORN, and 70 MRONJ. 143 cases underwent panoramic X-ray examination, and 47 underwent MRI. The assessment criteria for imaging findings included: (1) bone resorption, (2) osteosclerosis, (3) clarity of the mandibular canal, (4) periosteal reactions, (5) cortical bone perforation, (6) sequestrum, and (7) pathological fractures. CT was considered the gold standard for assessing these features. Compared with CT, all panoramic radiographs were detectable for diagnostic features of the disease. Bone resorption was detected in 123 cases (sensitivity 91.1%), and osteosclerosis was detected in 131 cases (sensitivity 98.5%). With panoramic radiography, most changes to clarity of the mandibular canal and pathological fractures were detected (sensitivities of 87.8% and 68.8%, respectively). However, the sensitivities for detection of periosteal reactions, cortical bone perforation and sequestration were low (19.6%, 17.8% and 19.4%, respectively). Sensitivity of MRI for detecting periosteal reactions, cortical bone perforation, sequestration, and pathological fractures (27.3%, 73.5%, 35.7%, and 60.0%, respectively) was equivalent or superior to panoramic imaging. MR-specific characteristics of bone marrow edema were depicted on almost all examinations. Panoramic radiography may be adequate for identifying bone resorption and osteosclerosis. However, MRI provides more value than panoramic radiography in detecting periosteal reactions, cortical bone perforation, sequestration, and bone marrow edema.

Impact of three-dimensional stabilization thread design on biomechanical fixation and osseointegration of endosteal implants

BACKGROUND

Implant's primary stability is determined by the intimate and immediate contact between the implant and osteotomy wall, whereas secondary stability is primarily influenced by healing chambers that facilitate the bone formation and remodeling processes following placement. Therefore, modifications to macro-geometric parameters are essential to elicit the desired in vivo response and to ensure successful osseointegration. Three-dimensional (3D) stabilization thread forms comprise both curved and linear geometric surfaces across the thread's crest maximizing retention forces while constraining lateral movement under load relative to conventional buttress-threaded implants.

METHODS

This study utilized Ti-6Al-4V ELI implants with (i) a buttress thread design [Tapered Pro, BioHorizons®, Birmingham, AL, USA] (TP - control) compared to (ii) a novel, patented, 3D stabilization trimmed-thread design (TP 3DS - experimental). Implants were placed in the mandible of sheep (N = 14 sheep, 6 implants per group per sheep) and allowed to heal for 3- and 12-weeks (N = 7 sheep per time point). During implant placement (T = 0 weeks), the maximum insertion torque value (ITV) and implant stability quotient (ISQ) were measured by torque-in testing and resonance frequency analysis, respectively. After the healing periods, subjects were euthanized, and samples harvested en bloc for biomechanical evaluation via lateral loading tests in addition to histomorphometric and nanoindentation analysis.

RESULTS

ITV values were significantly lower in the TP 3DS group compared to TP (p < 0.001). Both groups presented ISQ values ≥ 70, indicating high primary stability. Relative to the TP group, TP 3DS exhibited a significant (∼1.85-fold) increase in lateral load at 3 weeks (p = 0.029) and comparable load values at 12 weeks (p > 0.05). No quantitative differences in percentage of bone-to-implant contact (BIC) and bone-area-fraction-occupancy (BAFO) were observed at either time points between the two thread designs (p > 0.05). Similarly, no differences in bone's mechanical properties (Young's modulus (E) and Hardness (H)) between TP and TP 3DS were observed at 3- and 12- weeks (p > 0.05). Qualitatively, scattered microcracks were apparent at the outer threads of the implant, particularly within the TP group, whereas small bone chips were interspersed between threads of the 3DS implant serving as additional nucleation sites for bone formation.

CONCLUSION

The TP 3DS design reduced insertion torque, improved lateral loading competence, and resulted in a healing pattern, that are beneficial during early stages of osseointegration compared to TP implants.

Evaluation of Biomechanical Effects of Mandible Arch Types in All-on-4 and All-on-5 Dental Implant Design: A 3D Finite Element Analysis

This study evaluates the biomechanical effects of different implant configurations in various mandibular arch types using finite element analysis (FEA). Stress distribution and deformation patterns were analyzed under different loading conditions in square, U-shaped, and V-shaped arches. The results indicate that increasing the number of implants generally reduces cortical bone stress, particularly in U and V arches, while implant-level stress tends to increase. Under molar loading, cortical bone stress in the square arch decreased by 16.9% (from 90.61 MPa to 75.27 MPa) with the All-on-5 system, while implant stress in the V arch dropped by 46.26% (from 142.35 MPa to 76.5 MPa). Additionally, the cantilever effect in All-on-4 configurations resulted in higher stress on the prosthesis and implants, particularly in V arches. While the All-on-5 system provided better load distribution, the study highlights the importance of optimizing implant positioning based on mandibular anatomy. Despite limitations such as the use of static forces and standardized arch types, these findings offer valuable insights into the biomechanical performance of full-arch implant rehabilitations, supporting future clinical applications and research.

Ex vivo comparison of drilling techniques for optimizing primary stability of zirconia dental implants in different bone densities

PURPOSE

The objective of this study was to investigate the primary stability of zirconia implants using varying drilling protocols, with a focus on the impact of thread cutting on insertion torque in both mixed (D2/D3) and soft (D4) bone types. The study aimed to evaluate whether reducing thread cutting could increase insertion torque and consequently improve primary stability.

METHODS

Four drilling protocols were developed, each varying in the degree of thread cutting: no thread cut, one-third thread cut, two-thirds thread cut, and full thread cut. Implants were placed into fresh porcine hip and tibia bones simulating D2/D3 and D4 bone. The protocols followed each implant system's manufacturer recommendations. Insertion torque was measured using a torque indicator, and statistical analysis was conducted with the Mann-Whitney U test, with p < 0.05 considered statistically significant.

RESULTS

Significant differences in primary stability were observed between implant systems and drilling protocols, particularly in D4 bone. Three of the four implant systems showed improved primary stability in D4 bone when the thread cut was reduced (p < 0.05). One system achieved the recommended insertion torque with a full thread cut. In contrast, in D2/D3 bone, all implant systems required a full thread cut to remain within the manufacturer's torque guidelines.

CONCLUSIONS

Zirconia implant systems exhibit substantial variability in primary stability based on the selected drilling protocol and bone quality. Reducing thread cutting demonstrated improved stability in soft bone. However, excessive torque should be avoided to prevent mechanical failure, especially in systems with lower fracture resistance.

Application of Fixed Implant Superstructures Following Multistage Maxillary Reconstruction in Osteosarcoma Patients: A Case Report

Extensive resections of the maxillary bone often result in significant defects that affect oral functions, such as speech and chewing. Although dentomaxillary prostheses are common, they frequently lead to instability and reduced chewing ability. Vascularized bone grafts, including the fibula, are increasingly used to address these challenges due to their anatomical suitability and functional restoration benefits. Despite advances, problems remain, including insufficient bone height for stable implantation. A 60-year-old Japanese woman presented with swelling of the right maxilla and nasal obstruction and was diagnosed with osteosarcoma. Following chemotherapy and partial maxillary resection, she experienced discomfort with dentomaxillary prosthetics, prompting subsequent reconstruction with fibula and particulate cancellous bone and marrow (PCBM) grafts. This patient was taking methotrexate regularly for rheumatoid arthritis, so there was concern that she would be immunosuppressed. Therefore, we did not choose a zygomatic implant, which would be difficult to control in the event of infection. In addition, the fibula alone was insufficient for reconstruction; sufficient vertical and horizontal bone augmentation was required, and we chose a combination of titanium mesh and PCBM that met these requirements. Sequential implant procedures culminated in fixed superstructures that significantly improved occlusal function and prosthetic stability over a 6-year follow-up period. This case highlights the challenges of prosthetic instability following maxillary resections and demonstrates the effectiveness of multistage reconstructions using fibula grafts and PCBM for alveolar ridge augmentation. The structured approach to maxillofacial reconstruction provides valuable insights into optimizing functional outcomes following surgical procedures and highlights the importance of tailored treatment strategies in complex maxillofacial cases.

Understanding Radiology and Imaging for the Prosthodontic Patient

Radiology is essential in prosthodontics for diagnosis and treatment planning, utilizing intraoral radiographs, panoramic imaging, and cone beam computed tomography (CBCT) while adhering to the as low as reasonably achievable principle. CBCT provides 3 dimensional (3D) evaluations of bone quality, dimensions, and proximity to vital structures, aiding implant placement and reducing surgical risks. Artificial intelligence (AI) and computer-assisted surgery have transformed prosthodontics, improving treatment planning and implant precision and reducing complications. The future of prosthodontic radiology will increasingly integrate AI-driven imaging and robotic assistance to enhance precision and treatment success.

Efficacy of non-surgical mechanical debridement with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implantitis among patients undergoing chemotherapy

OBJECTIVE

Studies have shown that a single session of antimicrobial photodynamic therapy (aPDT) as an adjunct to mechanical debridement (MD) is effective for treating peri‑implant diseases. The objective was to assess the efficacy of MD with and without adjunct aPDT in treating peri‑implantitis among patients undergoing chemotherapy.

METHODS

Patients with peri‑implantitis were included. These individuals were divided into two groups (a) patients with peri‑implantitis undergoing chemotherapy; (b) systemically healthy patients with peri‑implantitis. These individuals were further subclassified into two subgroups: (a) individuals that received NSMD alone and (b) individuals that underwent NSMD with adjunct aPDT. Non-surgical MD was performed using plastic curettes. The aPDT was performed using a 680 nm diode laser at a power and power density of 150 mW and 1.1 mW/cm2, respectively. The photosensitizer was placed in the peri‑implant pocket and left in place for 60 s following which the laser was applied using a using an optical fiber with a diameter of 600 μm. Peri-implant modified plaque and gingival indices (mPI and mGI), probing depth (PD) and crestal bone loss (CBL) were measured at baseline and after three months. Group comparisons were performed using one way analysis of variance and Bonferroni post-hoc adjustment tests. P-values <0.05 were considered statistically significant.

RESULTS

At baseline, there was no statistically significant difference in peri‑implant mPI, mGI, PD and CBL among patients undergoing chemotherapy and systemically healthy individuals with peri‑implantitis. At three months' follow up, there was no statistically significant difference in peri‑implant mPI, mGI, PD and CBL among patients undergoing chemotherapy and systemically healthy individuals with peri‑implantitis compared to their respective baseline scores.

CONCLUSION

Among patients undergoing chemotherapy and systemically healthy individuals, a single session of aPDT and NSMD is ineffective in the treatment of peri‑implantitis. Nevertheless, poor oral hygiene of the participants and the short-term follow-up may have influenced the results. Hence further long-term follow-up clinical trials involving multiple sessions of aPDT after MD are needed.

Linear Computed Tomographic Measurement of Soft Tissue Herniation into the Maxillary Sinus as an Indicator for Orbital Floor Fracture Surgery: A Preliminary Study

Introduction

Computed tomography (CT) is the gold standard radiological assessment for orbital floor fractures and several evaluation methods have been developed. However, no definitive consensus has yet been achieved. We propose a new, linear radiological parameter that may help surgeons to decide when to treat an orbital floor fracture.

Materials and Methods

This study retrospectively analysed 328 patients with orbital floor fractures. Both operative or conservative treated patients were included. All CT scans were examined and the linear extents of soft tissue herniation into the maxillary sinus were calculated.

Results

The 328 patients were subdivided into three groups: Group A who did not undergo surgery (77.74%); group B (12.2%) who underwent surgery to treat maxillofacial fractures, not orbital floor fractures (12.2%); and group C (10.06%) who underwent surgical repair of the orbital floor. The mean soft tissue herniations were 2.72, 3.21 and 7.48 mm in groups A, B, and C. An ROC (Receiver Operating Characteristics) curve was drawn to identify the optimal cutoff dividing patients who did or did not undergo surgical repair of orbital floor fractures; this was 4.3 mm (sensitivity = 90.91%; specificity = 73.56%).Our proposed radiological parameter seems to accurately correlate with the surgical indications for orbital floor fracture treatment.

Trends in Research of Odontogenic Keratocyst and Ameloblastoma

Odontogenic keratocyst (OKC) and ameloblastoma (AM) are common jaw lesions with high bone-destructive potential and recurrence rates. Recent advancements in technology led to significant progress in understanding these conditions. Single-cell and spatial omics have improved insights into the tumor microenvironment and cellular heterogeneity in OKC and AM. Fibroblast subsets in OKC and tumor cell subsets in AM have been analyzed, revealing mechanisms behind their biological behaviors, including OKC's osteolytic features and AM's recurrence tendencies. Spatial transcriptomics studies of AM have identified engineered fibroblasts and osteoblasts contributing to matrix remodeling gene and oncogene expression at the invasion frontier, driving AM progression. Three-dimensional culture technologies such as organoid models have refined analysis of AM subtypes; uncovered the role of AM fibroblasts in promoting tumor cell proliferation and invasion; and identified signaling pathways such as FOSL1, BRD4, EZH2, and Wnt as potential therapeutic targets. Organoid models also served as preclinical platforms for testing potential therapies. Although preclinical models for AM exist, reliable in vitro and in vivo models for OKC remain scarce. Promising mimic models, including human embryonic stem cells-derived epithelial cells, human oral keratinocytes, human immortalized oral epithelial cells, and HaCaT keratinocytes, show promise, but the advancements in 3-dimensional culture technology are expected to lead to further breakthroughs in this area. Artificial intelligence, including machine learning and deep learning, has enhanced radiomics-based diagnostic accuracy, distinguishing OKC and AM beyond clinician capability. Pathomics-based models further predict OKC prognosis and differentiate AM from ameloblastic carcinoma. Clinical studies have shown positive outcomes with targeted therapies. In a study investigating SMO-targeted treatments for nevoid basal cell carcinoma syndrome, nearly all OKC lesions resolved in 3 patients. A recent clinical trial with neoadjuvant BRAF-targeted therapy for AM demonstrated promising radiologic responses, potentially enabling organ preservation. This review highlights recent advancements and trends in OKC and AM research, aiming to inspire further exploration and progress in these fields.