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.

Influencing factors and survival rates in immediate vs. delayed dental implant placement: a six-year retrospective analysis

Objective

This retrospective cohort study aimed to compare survival rates between immediate (≤24 h post-extraction) and delayed (3-4 months post-extraction) dental implants and to identify patient- and site-specific risk factors for implant failure, with emphasis on anatomical site, sex, and osteoporosis.

Methods

We analyzed 1,500 implants (300 immediate, 1,200 delayed) from patients treated at the Guangdong Provincial Hospital of Traditional Chinese Medicine (2005-2023). Kaplan-Meier analysis evaluated cumulative survival rates over 72 months, with Cox regression modeling to assess predictors of failure. Propensity score matching (PSM) addressed baseline covariate imbalances.

Results

Delayed implants exhibited significantly higher survival rates than immediate implants at 72 months (81.1% vs. 53.2%, p < 0.0001). Survival divergence intensified after 24 months, with delayed implants retaining 979 patients at risk vs. 202 for immediate implants. Mandibular sites consistently outperformed maxillary sites in both strategies (delayed: 88.5% vs. 72.2%; immediate: 70.5% vs. 40.7%, p < 0.0001). Male sex (HR: 1.64, 95% CI: 1.28-1.88; p < 0.001) and osteoporosis (HR: 2.50, 95% CI: 1.17-4.52; p = 0.024) emerged as independent risk factors, while tobacco use, diabetes, and hypertension showed no significant associations. PSM resolved most baseline imbalances, with post-matching standardized mean differences (SMD) <0.1 for key covariates.

Conclusions

Delayed implantation at 3-4 months post-extraction provides superior intermediate-term survival, particularly in mandibular sites. Male patients and individuals with osteoporosis face elevated failure risks, warranting tailored clinical protocols. While both strategies remain viable, delayed placement is recommended for high-risk populations to optimize long-term outcomes.

Use of External Fixator Device for Mandible Fracture Related to War Injury: A Systematic Review

Background/Objectives: In maxillo-facial high-velocity complex war injuries, a rigid internal fixation is inappropriate, and external fixation is suitable with described benefits. This systematic review aimed to summarize the literature regarding the benefits, side effects and complications of external fixators in the management of mandibular war-related injuries. Methods: An electronic search was performed in the databases of PubMed and Google Scholar in December 2024. The title and abstracts from retrieved items were read by two reviewers to identify studies within the selection criteria. Included articles had to be published in English up to December 2024 and related to external fixators used in mandibular fracture war injuries. Results: The search strategy initially identified 445 studies through PubMed and 987 studies through Google Scholar. Following the application of inclusion criteria, 12 articles were selected for this review, describing the use of an external fixator for a mandibular fracture in a war injury. Conclusions: The external fixator offers effective treatment for severe mandibular fractures in war-related injuries with low rates of complications and high success rates. Where a manufacturer external fixator is not available, orthopedic external fixators and self-crafted external fixators are used.

Outcomes of Pediatric Maxillofacial Giant Cell Lesion Management in Syndromic Versus Nonsyndromic Patients: A 21-Year Review

BACKGROUND

Maxillofacial giant cell lesions (GCLs) may occur in isolation or as a part of a genetic syndrome, where they are often multifocal. The functional deficits and psychosocial impact necessitate urgent treatment; however, a consensus on management is lacking given the rarity and the variable presentation in children.

PURPOSE

This study aims to compare the treatment and outcomes of pediatric maxillofacial GCLs in syndromic and nonsyndromic subjects.

STUDY DESIGN, SETTING, AND SAMPLE

A retrospective cohort study of pediatric subjects with histologically confirmed maxillofacial GCLs at a tertiary children's hospital between 2003 and 2024 was performed. Patients with incomplete documentation and less than 6 months of follow-up were excluded.

PREDICTOR VARIABLE

The predictor variable was syndromic diagnosis.

MAIN OUTCOMES VARIABLE(S)

The primary outcome was tumor recurrence. The secondary outcome was final disease status (remission, progressive, or nonprogressive lesion).

COVARIATES

Demographic characteristics including syndromic diagnosis, tumor characteristics, and adjuvant pharmacologic therapy (APT), including duration of treatment and side effects, were collected. Lesions were classified as aggressive or nonaggressive according to Chuong et al. ANALYSES: Univariate and bivariate statistics were used to compare treatment characteristics and outcomes between syndromic and nonsyndromic cohorts, with statistical significance determined by P values less than .05. Time to tumor recurrence was estimated using Kaplan-Meier analysis.

RESULTS

The sample was composed of 28 subjects (16 nonsyndromic, 12 syndromic), with a mean age of 10.7 ± 4.8 years and 17 (60.7%) were male. Overall, 96.4% of lesions were aggressive. Nonsyndromic subjects were more frequently treated with APT compared to syndromic subjects (75.0 vs 25.0%, P = .020). Recurrence occurred in one nonsyndromic subject (6.2%) and 50% of syndromic subjects (P = .008). The estimated median time to recurrence was 89 weeks. Remission was achieved in 100% of the nonsyndromic cohort and only 8.3% of the syndromic cohort (P < .001).

CONCLUSION

The results of this study demonstrated that syndromic subjects were less likely to receive APT for the management of pediatric maxillofacial GCLs, and exhibited higher recurrence and lower remission rates compared to their nonsyndromic counterparts. These findings emphasize the importance of long-term surveillance and anticipatory counseling for families of syndromic patients.

A Comparative Evaluation of the Primary and Secondary Stability of Dental Implants with Progressive and Conventional Thread Designs: A Prospective Non-Interventional Study of 100 Implants in 62 Patients

Objectives: We wished to compare the primary and secondary stability of dental implants with a progressive design (PL) versus a conventional thread design (SL) across various clinical settings. Methods: A total of 100 implants (50 PL and 50 SL) were placed in 62 patients. The stability of the implants was assessed using a resonance frequency analysis (RFA) at the time of placement (T1) and 20 weeks postoperatively before prosthetic loading (T2). Bone density was measured in Hounsfield units (HU) using cone-beam computed tomography (CBCT). The ISQ values were recorded for each group and anatomical region, including both inter- and intragroup comparisons over time. Results: Both implant designs showed a significant increase in stability during the healing period. At T1, the ISQ values were comparable between groups (SL: 71.3 ± 8.6; PL: 71.1 ± 8.7). At T2, the ISQ values increased significantly in both groups (SL and PL: p < 0.01), with no statistically significant difference in the degree of the gain in stability. The ISQ values were generally lower in the maxilla compared to those in the mandible. In the posterior mandible, the SL implants demonstrated a greater increase in stability compared to that with the PL implants. A strong positive correlation between the HU and ISQ values was observed for both groups (SL: r = 0.95; PL: r = 1.00), without reaching statistical significance. Conclusions: While the progressive thread design aims to enhance the primary stability, it did not outperform the conventional design in this study. Both implant types proved effective in achieving stable and predictable clinical outcomes.

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.

Emerging risk factors for heart failure in younger populations: A growing public health concern

Heart failure (HF) is a growing public health concern, with an increasing incidence among younger populations. Traditionally, HF was considered a condition primarily affecting the elderly, but of late, emerging evidence hints at a rapidly rising HF incidence in youth in the past 2 decades. HF in youth has been linked to a complex interaction between emerging risk factors, such as metabolic syndrome, environmental exposures, genetic predispositions, and lifestyle behaviors. This review examines these evolving determinants, including substance abuse, autoimmune diseases, and the long-term cardiovascular effects of coronavirus disease 2019, which disproportionately affect younger individuals. Through a comprehensive analysis, the study highlights the importance of early detection, targeted prevention strategies, and multidisciplinary management approaches to address this alarming trend. Promoting awareness and integrating age-specific interventions could significantly reduce the burden of HF and improve long-term outcomes among younger populations.

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.

Immediate Implants in Extraction Sockets with Deficient Buccal Walls in the Maxillary Aesthetic Zone

Background: Immediate implant placement in fresh extraction sockets has become an accepted treatment in dentistry as a predictable procedure to restore failing teeth. One prerequisite for this immediate procedure in the anterior maxillary region is an intact facial wall. Unfortunately, the presence of fenestrations and dehiscences is very common. These defects occur due to the pathology responsible for the extraction of the teeth. Traditionally, hard and soft tissue grafting is necessary to repair these large bony defects before implant placement. However, there are many defects with facial wall deficiencies. Methods: This report reflects procedures used to provide successful functional outcomes using grafting techniques in conjunction with immediate implant placement in defective sockets. This clinical research study followed a qualitative methodology, and the results are based on observational outcomes of four patient surgical implant procedures. Each patient received the same protocol in an attempt to reach similar results. Results: Proper diagnosis, treatment planning, and clinical skills are key factors in achieving predictable results. With each of these four patients, the clinical soft tissue outcomes revealed that the midfacial gingival margin had minimal or no recession at two years with minimal pocket depths less than 3 mm. Conclusions: Although the procedure presented in this article has yet to be clinically validated, it is an available technique that can be used in the hands of an experienced practitioner and can provide excellent results for the patient.

Autofluorescence-Guided Surgery in the Management of Osteonecrosis of the Jaw: Correlation Between Bone Autofluorescence and Histopathological Findings in 56 Samples

(1) Background: Osteonecrosis of the jaw (ONJ) remains a challenging condition without a universally accepted treatment protocol. Surgical therapy, particularly Er:YAG laser-assisted surgery, has shown more predictable long-term results compared with non-surgical options. However, the identification of resection margins in ONJ surgery is complex and currently relies on the surgeon's intraoperative assessment, without standardization. Bone autofluorescence (AF) has been proposed as an intraoperative diagnostic tool for visualizing necrotic bone; under VELscope (LED Medical Diagnostics Inc., Barnaby, BC, Canada) illumination, healthy bone exhibits hyperfluorescence, while pathological bone appears dark brown/black (loss of autofluorescence, LAF). (2) Methods: 22 patients with ONJ requiring surgical therapy were included. After bone exposure, VELscope system was used to induce and visualize bone AF. Areas exhibiting absent or pale AF were identified as necrotic and removed; additional samples were collected from adjacent hyperfluorescent regions. (3) Results: Histopathologic evaluation of 56 specimens were conducted; 35 hypofluorescent samples were found to be necrotic bone tissue; in the 21 hyperfluorescent samples, 86% demonstrated normal, vital bone. The correlation between fluorescence and bone vitality was highly significant (p < 0.0000001). (4) Conclusions: Our data show that AF-guided surgical resection, combined with Er:YAG laser-assisted surgery, may improve clinical outcomes.

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.

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.

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.

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.

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.

Pathophysiology of Doxorubicin-Mediated Cardiotoxicity

Doxorubicin (DOX) is used for the treatment of various malignancies, including leukemias, lymphomas, sarcomas, and bladder, breast, and gynecological cancers in adults, adolescents, and children. However, DOX causes severe side effects in patients, such as cardiotoxicity, which encompasses heart failure, arrhythmia, and myocardial infarction. DOX-induced cardiotoxicity (DIC) is based on the combination of nuclear-mediated cardiomyocyte death and mitochondrial-mediated death. Oxidative stress, altered autophagy, inflammation, and apoptosis/ferroptosis represent the main pathogenetic mechanisms responsible for DIC. In addition, in vitro and in vivo models of DIC sirtuins (SIRT), and especially, SIRT 1 are reduced, and this event contributes to cardiac damage. In fact, SIRT 1 inhibits reactive oxygen species and NF-kB activation, thus improving myocardial oxidative stress and cardiac remodeling. Therefore, the recovery of SIRT 1 during DIC may represent a therapeutic strategy to limit DIC progression. Natural products, i.e., polyphenols, as well as nano formulations of DOX and iron chelators, are other potential compounds experimented with in models of DIC. At present, few clinical trials are available to confirm the efficacy of these products in DIC. The aim of this review is the description of the pathophysiology of DIC as well as potential drug targets to alleviate DIC.

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.

Evaluation of Coronary Artery Disease and Ischemia by Echocardiography: Advances in Technology and Techniques

This review describes the role of echocardiography in the diagnosis and prognostication of coronary artery disease (CAD). It describes the diagnostic capabilities of echocardiography using rest and stress imaging, speckle tracking strain imaging with myocardial work index, as well as the use of myocardial perfusion imaging. It also evaluates the use of echocardiography in the assessment of common complications from CAD and the incremental value of incorporating right ventricular, left atrial, and diastolic function assessment in these patients. In addition, the review aims to highlight the prognostic value of echocardiography, especially in the determination of myocardial viability.

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.

Right ventricular lead migration to the abdominal cavity: a case report of an unexpected journey

Background

Lead perforation, though an uncommon complication of cardiac device implantation, is associated with significant morbidity, especially when leads migrate to extracardiac structures. Lead migration into the abdominal cavity is exceedingly rare, and management in such cases can be complex.

Case Summary

We present the case of an 82-year-old woman with known dementia who underwent single-chamber pacemaker implantation for symptomatic Mobitz Type II atrioventricular (AV) block. Two weeks post-implantation, the nursing home staff observed that the patient had bradycardia. Electrocardiogram on hospital admission demonstrated recurrence of Mobitz Type II AV block. Pacing checks confirmed there was no lead sensing. Imaging studies confirmed that the right ventricle lead had perforated the myocardium, passed through the diaphragm, and migrated into the abdominal cavity near the colon. The case was discussed in a multidisciplinary team. The final clinical decision was to extract the displaced lead to avoid the risk of further intra-abdominal organ perforations and the risk of developing pericardial effusion. A new lead was successfully implanted in the septal position, with subsequent follow-up showing stable pacing function. The patient received an extended course of antibiotics and made an uneventful recovery leading up to discharge.

Discussion

This case underscores the importance of prompt recognition and a multidisciplinary approach to managing instances of rare lead migration, particularly in elderly, frail patients. Careful imaging and risk assessment helped guide the decision-making process, balancing the risks of lead extraction against potential complications.

Marginal bone level of dental implants using computer-aided design/computer-aided manufacturing customized abutment and prefabricated abutment-A five-year follow-up

Background/purpose

Computer-aided design/computer-aided manufacturing (CAD/CAM) allows for the customization of implant abutments as an alternative to prefabricated options. The purpose of this study was to compare the marginal bone levels of dental implants using CAD/CAM customized abutments (CA) versus prefabricated abutments (PA) over a five-year follow-up period.

Materials and methods

Implants were divided into two groups based on abutment type: CA and PA. Marginal bone level (MBL), changes in MBL and bone-to-implant contact ratio (BIC), were assessed from baseline to 5 years post-prosthetics loading. Additionally, the study analyzed based on dental arches, opposing structure types, and the distance from implant platform to the cementoenamel junction of adjacent teeth (CEJ-PL).

Results

Overall, MBL increased significantly for all implants from baseline to 5 years. The CA group in the mandible showed significantly higher MBL compared to the PA group (0.98 ± 0.71 mm vs. 0.54 ± 0.55 mm). Implants opposed by fixed restorations (FRs) experienced significantly more MBL compared to those opposed by natural teeth (NT) after 5 years. Implants placed at a depth greater than 3 mm (CEJ-PL > 3 mm) exhibited significantly greater changes in MBL on the distal side after 5 years compared to those placed at a shallower depth (CEJ-PL ≤ 3 mm).

Conclusion

The MBL and changes in MBL showed similar trend between the CA and PA groups in the five-year follow-up. The CA group exhibited significantly more bone remodeling after one year, particularly for implants opposing FRs and those with a CEJ-PL distance exceeding 3 mm.

Is there any relation between proton pump inhibitors and risk of dental implant failure? A large-scale retrospective study using the BigMouth repository

The aim of this retrospective large-scale study was to investigate long-term the association between proton pump inhibitors (PPIs) and risk of dental implant failure. This is a retrospective analysis of a cohort of patients rehabilitated with dental implants in the dental clinics of the universities that contribute data to the BigMouth network. Patients' characteristics including age, gender, ethnicity, race, tobacco use, systemic medical conditions, and intake of PPIs were analysed. Implant failure was defined as the removal of a dental implant for any reason. A total of 20,274 patients who received a total of 50,333 dental implants over a 12-year period were included. At the patient level, omeprazole users exhibited 1.77 (95% CI: 1.30 to 2.42) odds of experiencing implant loss compared with non-users. The use of PPIs was significantly associated with implant loss, with PPI users demonstrating 1.40 (95% CI: 1.04 to 1.88) odds of implant failure. At the implant level, implants placed in pantoprazole users showed a significant protection against implant loss, while implants in omeprazole users demonstrated a significantly lower survival time compared with those in non-users. Cox regression analysis demonstrated that implants placed in omeprazole users exhibited a significantly higher hazard ratio (HR: 1.45, 95% CI: 1.07 to 1.96) compared with those placed in non-users. Within the limitations of this study, omeprazole was significantly associated with implant failure both at a patient and implant level. At patient level, PPI users demonstrated a significantly higher risk of dental implant failure.

Fixation of Medially Displaced High Condylar Fracture of Mandible Using Lag Screw: A Twin Case Report

Management of high condylar fractures involves never-ending controversies between open and closed management. Conservative treatment is the preferred treatment in high condylar head fractures. This article aims to report two clinical cases of high condylar fractures, where medial pole was fixed with open treatment, using lag screw fixation using a modified preauricular approach according to AO/ASSIF protocols and recommendations. We advocate open surgical treatment for the management of high condyle fractures, it provides an immediate physiological function to the TMJ joint and restores form.

A novel system for classification for midpalatal suture ossification based on pseudocolored and multilayer reconstructed coronal slices: Indication for selection of maxillary expansion methods

INTRODUCTION

A novel method was established for the staging of midpalatal suture (MPS) ossification based on a pseudocoloring stack of anterior and posterior MPS coronal slices obtained by cone-beam computed tomography (CBCT).

METHODS

CBCT scans of 240 subjects aged 5-35 years were pseudocolor processed. The slice thickness of stacked anterior and posterior coronal observation planes was set at 5.0 mm. The ossification status of both anterior or posterior MPS was classified as the tunnel, partially ossified, or ossified type. MPSs were classified into 5 stages: stage I, anterior and posterior MPSs are the tunnel type; stage II, anterior and posterior MPSs are the tunnel and partially ossified type, respectively; stage III, anterior and posterior MPSs are the partially ossified type; stage IV, anterior and posterior MPSs are the tunnel or partially ossified type and ossified type, respectively; and stage V, anterior and posterior MPSs are the ossified type. The weighted κ value was used to assess the intraexaminer and interexaminer agreement of the MPS classifications.

RESULTS

Intraexaminer and interexaminer reliability of the proposed staging method was substantial. The largest proportions of patients aged 5-15 years and 16-35 years were classified as stages I and III, respectively. Among adults, 31.0% of males and 7.1% of females were classified as stage I or II.

CONCLUSIONS

The pseudocolor imaging technique and the stack of CBCT slices provide relatively intuitive and comprehensive information on MPS ossification. The novel classification of MPS ossification is expected to serve as an indication of the necessity of surgical intervention for maxillary expansion treatment.

Accuracy of freehand surgery, static and dynamic computer assisted surgery on zygomatic implant placement: A systematic review and meta-analyses

Real-time surgical navigation systems (dynamic computer-aided surgery, d-CAIS) and static guided surgery (static computer-aided surgery, s-CAIS) have been shown to enhance the accuracy of zygomatic implant (ZI) placement. The objective of this systematic review was to evaluate and compare the accuracy and risk of complications associated with d-CAIS and s-CAIS in ZI placement. A systematic review of published studies involving more than 4 patients was conducted to assess and compare the accuracy of d-CAIS and s-CAIS in zygomatic implant placement. Only one study included freehand ZI placement as a control. The primary outcomes measured were the accuracy of implant placement relative to preoperative planning, with a secondary focus on evaluating any potential complications. Out of 903 screened studies, 14 met the inclusion criteria. Freehand zygomatic implant placement was used as a control in only 1 study. The results revealed a mean apex deviation of 2.07 mm (95% CI: 2.01 to 2.13; I2 = 83.14%) for d-CAIS, 1.29 mm (95% CI: 1.15 to 1.43; I2 = 94.5%) for s-CAIS, and 4.98 mm (95% CI: 3.59 to 6.37; I2 = not assessable) for freehand placement. Reported complications included mucositis, reversible bilateral sinusitis, oroantral fistula, unspecified reversible postoperative complications, and fracture of the anterior wall of the zygoma. Both CAIS systems demonstrated high accuracy and safety in ZI placement, with a nearly 99% success rate at 6 months of follow-up. These findings suggest that both d-CAIS and s-CAIS are reliable methods for improving the precision and reducing the risks associated with ZI procedures.

The Accuracy of Immediate Implantation Guided by Digital Templates and Potential Influencing Factors: A Systematic Review

BACKGROUND

Immediate implantation guided by digital templates has drawn a great attention in the aesthetic zone, while the accuracy of immediate implantation guided by digital templates has yielded mixed results and many potential factors are known to affect its accuracy. The purpose of our systematic review was to evaluate the accuracy of implant placement guided by the digital template and summarizing its potentials influencing factors.

MATERIALS AND METHODS

We conducted an electronic search of publications upto July 2023, using PubMed, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science to identify studies on accuracy of immediate implant placement surgery guided by digital templates. We selected cohort studies (prospective and retrospective studies) and randomized controlled trials (RCTs). The primary outcome was accuracy of immediate implant placement surgery guided by digital templates.

RESULTS

Seven studies in total fulfilled the inclusion criteria, comprising two prospective studies and five retrospective studies. We collected data including names of authors, publication period, study design, total sample size, clinical conditionas, planning/preoperative details, surgical procedure information, and evaluation criteria. Average global coronal deviation, apical deviation, depth deviation and angular deviation were respectively 0.74 mm (95% confidence interval [CI] 0.41-1.08, I2 = 99.0%), 1.01 mm (95% CI 0.83-1.20, I2 = 94.0%), 0.50 mm (95% CI 0.36-0.65, I2 = 75.3%) and 2.34° (95% CI 1.68-3.00, I2 = 94.5%). The quality assessment was conducted at a medium to high level.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Our systematic review demonstrates that immediate implantation guided by digital templates generally achieves acceptable accuracy. Factors influencing accuracy include the type of surgical guide, method of guide fabrication, surgical protocols, anatomical variability, and preoperative planning challenges. To improve clinical application, it is crucial to enhance the reporting of patient-centred outcomes and socioeconomic benefits.

Time to Recurrence of Ameloblastoma and Associated Factors in a Multi-institutional Black Patient Cohort

Ameloblastoma is a highly recurrent odontogenic neoplasm with variable global distribution. However, impact of race and ethnicity on ameloblastoma recurrence are still unclear. The primary aim of this study was to assess duration of time between primary and recurrent ameloblastomas in a predominantly Black multi-institutional patient cohort and secondarily to determine whether recurrent ameloblastomas are more readily discovered when clinically-symptomatic rather than by radiographic surveillance. A retrospective cross-sectional design was used to evaluate demographic, clinical, and pathological information on recurrent ameloblastomas patients. Outcome variable was time to recurrence, determined as period between the diagnosis of primary and recurrent ameloblastomas. We assessed associations between outcome variable and race, time lapse between primary and recurrent ameloblastomas and clinical symptoms of recurrent ameloblastomas at time of diagnosis. Among 115 recurrent ameloblastomas identified, 90.5% occurred in adults, 91.3% in Blacks, and similarly, 91.3% were conventional ameloblastomas. About 41% affected the posterior mandible. 93.9% were clinically symptomatic at time of presentation while 6.1% non-symptomatic lesions were discovered by routine diagnostic radiology. Median time to presentation of recurrent tumor was significantly longer in females (90 months, p = 0.016) and clinically symptomatic group of ameloblastoma patients (75 months, p = 0.023). Ameloblastoma recurrence was distinctively high in Black patients, occurred faster in males than females and was located mostly in the posterior mandible. Concomitant with delayed access to healthcare of Black individuals, routine post-surgical follow-up is essential because time lag between primary and recurrence tumors was longer in clinically symptomatic ameloblastomas at the time of diagnosis.

A scientometric study on research trends and characteristics of ameloblastoma

Background/purpose

Ameloblastoma is a benign tumor derived from odontogenic epithelium in the jaws. The purpose of this study was to analyze the scientometric characteristics and research trends of ameloblastoma.

Materials and methods

All the papers on ameloblastoma were comprehensively retrieved from the Scopus database. The years of publication were divided into before 2014 and 2014-2024 in the analysis of research trends.

Results

There were 2507 papers on ameloblastoma, with total citations of 34,691 and the h index of 70. The related disorders of the diagnosis of ameloblastoma were mandibular neoplasms, maxillary neoplasms, ameloblastic carcinoma, odontogenic cyst, lung neoplasms, and teratoma. Before 2014, bone graft/transplantation, osteotomy, reconstructive surgical procedures, surgical flaps, cell differentiation, and cytology were more frequent keywords. After 2014, biology research on BRAF protein, gene mutation, cytokeratin 19, biomarkers, epithelial mesenchymal transition, signal transduction, tumor microenvironment, and carcinogenesis were more frequent keywords. Clinical studies on cohort analysis, cone beam computed tomography, quality of life, fine needle aspiration biopsy, incisional biopsy, surgical margin, and hemi-mandibulectomy were more common. Experiment methods such as dog, tumor cell line, cell migration, gene expression, real time polymerase chain reaction, and western blotting were also more frequent keywords after 2014.

Conclusion

This scientometric study elucidated the current scenario and research trends of ameloblastoma, and would help in improving in reciprocal collaboration and communication for investigations on this tumor.

Three-dimensional assessment of mandibular canal in different sagittal and growth patterns for safe placement of temporary skeletal anchorage devices: A prospective study

INTRODUCTION

The primary objective of this study was to assess the 3-dimensional position of the mandibular canal (MC) in different craniofacial patterns to know about the safe placement of temporary skeletal anchorage devices using cone-beam computed tomography (CBCT). The secondary objectives were to assess sex differences and correlate the MC position with various factors.

METHODS

This prospective, observational study was conducted on 90 patients, divided into 3 groups based on the sagittal pattern: skeletal Class I, Class II, and Class III. Similarly, based on the growth pattern of the patients, the sample was divided into 3 groups: horizontal, average, and vertical growth pattern. The skeletal and growth patterns were assessed using lateral cephalograms, and the position of the MC was assessed using CBCT. The position of the MC was assessed in 3 regions: the distal surface of the second molar (region 1), the interdental area between the first and second molars (region 2), and the interdental area between the first molar and second premolar (region 3). Data were subjected to statistical analysis.

RESULTS

The statistically significant differences were noticed in the buccolingual position of MC in regions 2 and 3 in different skeletal patterns, whereas no statistically significant differences were noticed for the superoinferior position. In region 1, the MC was positioned closest to the alveolar crest among vertical growers. No statistically significant sex differences were observed between groups. A statistically significant positive correlation was observed between the buccolingual position of the MC and the skeletal pattern.

CONCLUSIONS

It is essential to know the 3-dimensional position of the MC in different craniofacial patterns using CBCT for safe placement of temporary skeletal anchorage devices.

Sustained release of Sr and Ca from a micronanotopographic titanium surface improves osteoblast function

The surface chemistry and topographical features of dental implants play a crucial role in influencing the osseointegration process. Alkaline earth elements such as strontium (Sr) and calcium (Ca) exert beneficial effects in promoting bone formation. This study aimed to evaluate micronanotopographic cpTi substrates that doped these elements, Sr and Ca. The composition and morphology were analyzed by X-ray photoelectron spectroscopy, scanning electron microscopy (SEM), and atomic force microscopy (AFM). Wettability assays, Sr and Ca release tests, and electrochemical behavior were also conducted. Proliferation, adhesion, and differentiation of MC3T3-E1 cells on this surface were evaluated in vitro. Direct fluorescence assays and SEM, cell viability, alkaline phosphatase (ALP) activity, and mineralization nodule formation were performed. The biological results showed the absence of cytotoxicity after the treatments, increased cell spreading on the micronanotopographic substrates, and greater mineralization nodule formation on surfaces doped with Sr and Sr/Ca. Gene and protein expression of osteoblastic markers were assessed through PCR and ELISA, and some genes were regulated on the doped surfaces at three and seven days of cell culture, like Bglap, Ibsp, Spp, Col1a1, and Runx2. The micronanotopographic substrates modified the physicochemical properties and morphology of the pre-osteoblasts. The results indicate that the biological effect of implants treated with Sr and Sr/Ca was significantly superior to that of polished surfaces and undoped micronanotopographic implants. Furthermore, the addition of Sr alone was sufficient to improve events related to osseointegration.

Clinical Outcomes and Success Factors of Pterygoid Implants in the Posterior Atrophic Maxilla: A Prospective Study

Introduction Pterygoid implants serve as an alternative for rehabilitating a posterior atrophic maxilla without requiring extensive bone grafting or sinus augmentation. This study aimed to evaluate the clinical outcomes and success rates of pterygoid implants over a one-year follow-up period and assess the influence of bone quality, complications, and other patient-related factors on implant success. Materials and methods A total of 34 patients with a posterior atrophic maxilla received 35 pterygoid implants. Preoperative cone-beam computed tomography (CBCT) was used to assess bone quality, and the implants were placed using a standardized surgical protocol. Clinical parameters, including primary stability, marginal bone loss, postoperative complications, and patient-reported outcomes, were recorded. Implant success was defined as the absence of pain, mobility, radiographic bone loss beyond 1.5 mm during one-year follow-up, or infection. Patient-reported outcomes were evaluated using the Oral Health Impact Profile (OHIP-14). Statistical analysis was conducted to determine the correlation between implant success and influencing factors such as bone density, complications, smoking history, age, and implant length. Results The overall success rate was 31 (88.57%) pterygoid implants within the one-year follow-up period. Bone quality significantly affected implant success, with D3 showing a higher failure rate than D2 (p = 0.029). Complications, including implant fracture, prosthetic failure, and nerve injury, were significantly associated with implant failure (p = 0.001). Marginal bone loss was higher in the failed implants, supporting its role as a predictive factor of long-term success. Patient age, sex, smoking history, and implant length did not significantly influence outcomes. OHIP-14 scores indicated that patients with successful implants reported improved function and quality of life. Conclusion The pterygoid implants demonstrated a high success rate and served as a viable treatment for posterior maxillary rehabilitation. Bone quality and complications were the key determinants of implant success, whereas age, sex, smoking history, and implant length had no significant impact. Marginal bone loss has emerged as a crucial factor for implant failure, highlighting the importance of postoperative monitoring.

Management of an Atypical Case of Adenomatoid Odontogenic Tumor

Adenomatoid Odontogenic Tumor (AOT) is a benign tumor of rare recurrence, most prevalent in females and anterior region of the maxilla. We report an atypical occurrence of follicular AOT in the anterior mandibular region in male patient and its surgical approach. Twenty-six years-old male presented swelling in the right anterior mandibular region. Radiography showed a radiolucent well-circumscribed lesion, associated with unerupted tooth right permanent mandibular canine. Incisional biopsy and installation of decompressive device were performed. First histopathological diagnosis was not conclusive suggesting dentigerous cyst, however follow-up of 1-year showed non-regression of the lesion. A new approach was performed through enucleation and curettage, and the second diagnosis was conclusive of AOT. At 18-months follow-up, bone formation was observed and patient presented no complaints. Surgical enucleation is the treatment indicated for AOT, which is easily removed due to its fibrous capsule. Due to its mimetic features, AOT can be misdiagnosed. Therefore, the correct diagnosis is important to offer the patient adequate treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-025-05404-9.