Journal of Oral and Maxillofacial Surgery最新文献

Background: Opioid prescribing by oral and maxillofacial surgeons has decreased in recent years in the context of educational and policy interventions. The impact of recent interventions on prescribing habits of surgeons across different experience levels is not well understood.

Purpose: This study measured the association between oral and maxillofacial surgeon experience (years in practice, YIP) and opioid prescribing rate to Medicare beneficiaries. It also compares prescription volume and duration across YIP groups.

Study design/sample: This retrospective cohort study used the 2022 Medicare Part D Prescribers Dataset focusing on providers with specialty of oral and maxillofacial surgery (OMS).

Predictor: The primary predictor was YIP, categorized as 0-3, 4-8, 9-13, and ≥14 years.

Outcomes: The primary outcome was opioid prescribing rate (% all annual prescriptions that were opioids). Secondary outcomes were opioid prescriptions per beneficiary and days' supply per claim.

Covariates: These included surgeon sex and region, total Medicare beneficiaries, and beneficiary demographics (percentage female, mean age, and mean hierarchical condition category score).

Analyses: Descriptive statistics, χ² tests, and Kruskal-Wallis tests with Dunn-Bonferroni post hoc comparisons were conducted. Multiple linear regression was performed with opioid prescribing rate as the dependent variable, YIP as a continuous predictor, and surgeon/beneficiary characteristics as covariates.

Results: The study included 7,097 oral and maxillofacial surgeons and 563,536 opioid prescriptions to Medicare recipients. Providers with ≥14 YIP comprised of 67.1% of all prescribers but 71.7% of all opioid prescriptions. Opioid prescribing rate for 9-13 YIP and ≥14 YIP were 22.9 and 24.6%, respectively, which were significantly higher than 14.6% for 0-3 YIP (P < .01). Opioid prescriptions per beneficiary and days' supply per claim were similar between YIP. In multiple linear regression, YIP was positively associated with opioid prescribing rate (b = 0.29; 95% CI, 0.19-0.39; P < .01). Surgeon male sex (P < .01) and practice outside the Northeast (P < .01) were also associated with higher prescribing rates.

Conclusions and relevance: These results suggest potential generational differences in opioid stewardship among oral and maxillofacial surgeons treating Medicare beneficiaries. Additional studies are needed to evaluate the effects of specific interventions on prescribing behavior.

Background: Prior studies have investigated postoperative radiation therapy (PORT) timing and its impact on head and neck squamous cell carcinoma (HNSCC) patients. However, the effect of timely initiation of PORT among the subset of oral cavity squamous cell carcinoma (OCSCC) patients has not been reported.

Purpose: The purpose of this study was to determine if starting PORT within 6 weeks of surgery versus 6 to 12 weeks was associated with improved survival among OCSCC patients.

Study design, setting, sample: This retrospective cohort study reviewed data from the National Cancer Database (NCDB) from 2004 to 2019. OCSCC patients treated with curative intent surgery followed by PORT were identified. Exclusion criteria included history of prior radiation, receiving PORT >12 weeks after surgery, multiple primary malignancies, or unknown survival time.

Predictor variable: The primary predictor variable was time to initiation of PORT, either within 6 weeks or at 6 to 12 weeks.

Main outcome variable: The primary outcome was overall survival (OS) defined as date of diagnosis until date of death or last follow-up.

Covariates: Demographic data, cancer-related variables, and treatment characteristics were collected.

Analyses: Univariate survival analyses were performed using the log rank test. A multivariable Cox proportional hazards regression analysis for overall mortality was performed using a set of demographically, clinically, and biologically pertinent predictors. Statistical significance was set at a P value of < .05.

Results: A total of 32,743 subjects were included. The mean age was 59.9 (18 to 90) years. Overall, 66.2% (n = 21,691) were male. The median follow-up was 42.6 months (IQR 19.4 to 79.5). Average overall survival was 55.3 months. In the univariate survival analysis, PORT timing was associated with OS when divided into 2 week (P < .001) and 6 week (P < .001) intervals. After accounting for covariates, starting PORT within 6 weeks was associated with improved OS compared to 6 to 12 weeks (HR 1.08; 95% CI 1.01 to 1.16; P = .037). The duration of radiation therapy did not influence OS (HR 1.00; 95% CI 1.0 to 1.0; P = .4).

Conclusions: Consistent with the NCCN guidelines, the findings suggest that initiating PORT within 6 weeks is associated with improved survival among OCSCC patients undergoing curative intent surgery.

Proliferative verrucous leukoplakia (PVL) is a rare and clinically aggressive form of oral leukoplakia with a high rate of malignant transformation and recurrence. Given its aggressive clinical behavior, surgical excision has traditionally been the primary treatment modality. The effectiveness of topical chemotherapeutics in treating potentially malignant oral lesions has recently become a topic of considerable debate. Herein, we report the treatment outcome of a middle-aged female patient who declined surgical intervention and was instead managed solely with topical imiquimod, a Toll-like receptor 7 (TLR7) agonist. To date, no signs of recurrence have occurred.

Background: Peri-implantitis is a biologic complication of implant therapy that compromises long-term function and esthetics. With obesity rising globally, determining whether body mass index (BMI) independently contributes to peri-implantitis is critical for identifying at-risk patients and improving implant success.

Purpose: The purpose of this study was to measure the association between BMI and peri-implantitis.

Study design: This was a retrospective cohort study of implants placed at the Philadelphia Veterans Authority Medical Center between 2006 and 2019. Patients were included in the study if they had complete medical and dental records and a BMI recorded within 3 months of placement. Patients with systemic confounders such as bisphosphonate therapy, head and neck radiation, or incomplete data were excluded.

Predictor variable: The primary predictor variable was BMI, which was utilized as a binary variable as either nonobese (<30 kg/m2) or obese (≥30 kg/m2).

Main outcome variable: The outcome was time from implant placement to peri-implantitis, defined as radiographic evidence of crestal bone loss with clinical bleeding on probing, with or without suppuration.

Covariates: Covariates included age, sex, diabetes status, smoking history, alcohol use, implant location, and prior bone grafting.

Analyses: Kaplan-Meier curves were constructed for each predictor, and time-to-event curves were compared with log-rank tests to identify significant predictors of peri-implantitis. Multivariate analysis of significant predictors was performed using Cox proportional hazard models to estimate adjusted hazard ratios. Statistical significance was set at P < .05.

Results: Our database included 325 subjects who received 1,138 implants. Utilizing a subject-level analysis, 325 implants (28.6%) composed the final study sample after randomly selecting 1 implant per subject. The mean subject age was 59.3 ± 10.6 years, and 310 (95.4%) of subjects were male. Peri-implantitis occurred in 80 implants (24.6%). The 5-year peri-implantitis rates were 22.7 and 34.0% for subjects with BMI<30 kg/m² and BMI≥30 kg/m², respectively (P = .04). In the multivariable Cox proportional hazards model, BMI ≥ 30 kg/m² remained independently associated with an increased risk of peri-implantitis (hazard ratio, 1.56; 95% CI, 1.00 to 2.44; P = .04).

Conclusions and relevance: Elevated BMI is an independent predictor of peri-implantitis. These findings emphasize the need for integrating BMI and metabolic screening into implant planning and maintenance. Recognition of obesity-related inflammatory mechanisms may improve preventive strategies and long-term implant outcomes in clinical practice.

This report presents a digital workflow for fabricating a unilateral customized nasal conformer to achieve nasal symmetry, reduce relapse, and maintain airway patency following unilateral cleft lip repair. A silicone impression of the infant's nose and lip was obtained and scanned to produce an standard tessellation language (STL) file, which was processed in 3-Matics software. The conformer was designed by mirroring the normal nostril and applying a 1-mm offset, with incorporated suture holes for intraoperative fixation, and then 3D printed in polymethylmethacrylate. Following Fisher unilateral cleft lip repair, the conformer was secured in place using two 4-0 polypropylene sutures and retained for 3 months. Patients were evaluated 1 year postoperatively for symmetry. The customized conformer maintained nostril patency, improved nasal symmetry, and reduced relapse, contributing to enhanced nasolabial esthetics and stable airway support.

Background: Cleft lip/palate (CL/P) affects patients' appearance, function, and mental health. The CLEFT-Q is the first condition-specific tool to assess quality of life (QoL) in CL/P patients, yet limited data exist on postoperative outcomes, especially in nonwestern populations.

Purpose: The purpose of this study was to measure the QoL of CL/P patients who had undergone secondary surgical correction for deformities following cheiloplasty.

Study design, setting, sample: A prospective cross-sectional study was conducted at the Plastic Surgery Hospital from July 2023 to June 2024, enrolling individuals aged 8-29 years, including CL/P subjects who had undergone secondary surgical correction after cheiloplasty and healthy controls.

Predictor variables: The primary predictor variable was disease status (CL/P vs healthy controls). Within the CL/P group, cleft phenotypes served as the secondary predictor variable.

Main outcome variable: The outcome variable was QoL, quantified by the CLEFT-Q scale. Higher scores indicate better patient-reported outcomes.

Covariates: Age, household income, and parental education were identified as significant confounders and included as covariates in the final multivariable models.

Analyses: Independent samples t-tests, χ² tests, nonparametric methods, Spearman's correlation analyses, one-way analysis of variance, and multivariable linear regression were employed. Statistical significance was set at P < .05, with Benjamini-Hochberg and posthoc Bonferroni corrections applied to control for multiple comparisons.

Results: A total of 133 participants were enrolled, including 100 (75.2%) CL/P subjects and 33 (24.8%) healthy controls. Bivariate screening identified age, household income, and parental education as statistically significant covariates, whereas sex and surgical characteristics demonstrated no statistically significant confounding effects. In multivariable models adjusting for these covariates, the CL/P group demonstrated a statistically significant reduction in appearance scores compared to control group (all P ≤ .005, unstandardized B < 0). Conversely, no statistically significant differences were observed in any health-related QoL subscales (all P > .2). Furthermore, subgroup analyses within the CL/P group revealed that cleft phenotype was not statistically significantly associated with QoL following Benjamini-Hochberg correction.

Conclusions and relevance: CL/P was independently associated with lower self-perceived appearance scores. Higher household income and parental education levels served as protective factors, whereas increasing age was inversely associated with QoL.

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse effect of antiresorptive therapy, and optimal surgical management remains challenging. Understanding whether drug type affects outcomes is clinically relevant for treatment planning.

Purpose: The study purpose was to compare postoperative healing and reoperation between denosumab and zoledronate in surgically treated MRONJ.

Study design, setting, sample: This retrospective cohort study at Ewha Womans University Medical Center included MRONJ subjects treated surgically after exposure to denosumab or zoledronate; subjects with dual exposure, exposure to other antiresorptive agents, or insufficient follow-up data to ascertain study outcomes were excluded.

Predictor variable: The predictor variable was antiresorptive agent type (denosumab vs zoledronate).

Main outcome variables: The primary outcome was therapeutic effect measured using time to complete clinical healing, defined as the time from surgery to complete mucosal coverage without exposed bone and no clinical evidence of infection; the secondary outcome was reoperation during follow-up, coded as yes or no.

Covariates: Covariates included age, sex, indication, and duration of antiresorptive therapy, MRONJ stage and site, and surgical factors.

Analyses: Kaplan-Meier/log-rank and Cox regression were used for healing, and logistic regression was used for reoperation.

Results: A total of 90 subjects were included: denosumab, 61 (67.8%) and zoledronate, 29 (32.2%). The mean age was 70.5 ± 10.7 years, and 79 (87.8%) were female. During a median follow-up of 10.5 months (interquartile range, 4 to 23), healing occurred in 76 subjects (84.4%). Median time to complete clinical healing was 3.0 months (95% CI, 2.0 to 4.0) for denosumab and 5.0 months (95% CI, 0.9 to 9.1) for zoledronate (log-rank P = .2). Antiresorptive agent type was not associated with time to complete clinical healing (adjusted hazard ratio, 1.20; 95% CI, 0.61 to 2.36; P = .6), whereas bone metastasis indication was associated with a lower hazard of healing (adjusted hazard ratio, 0.42; 95% CI, 0.20 to 0.89; P = .023). Reoperation occurred in 21 subjects (23.3%) and was not associated with antiresorptive agent type (adjusted odds ratio, 0.93; 95% CI, 0.21 to 4.07; P = .9), whereas bone metastasis indication and MRONJ stage 3 were associated with reoperation.

Conclusions and relevance: Outcomes after MRONJ surgery were more strongly associated with indication for antiresorptive therapy and MRONJ stage than with antiresorptive agent type, aligning with AAOMS guidance emphasizing stage-based management and distinct clinical contexts across indications.

Background: Idiopathic bone cavities (IBCs) of the jaw may resolve spontaneously, creating controversy over optimal management (curettage vs active surveillance).

Purpose: The purpose of this study was to compare lesion control and radiographic bone fill outcomes between curettage and active surveillance for IBCs of the jaw.

Study design, setting, sample: Ambispective cohort study of IBC subjects treated at Peking University School of Stomatology (2008 to 2024).

Exclusion criteria: involvement of carious or root canal-treated teeth, use of bone grafts (operative group), or incomplete clinical or imaging data.

Predictor/exposure/independent variable: The predictor variable was therapeutic approach, grouped into curettage and active surveillance.

Main outcome variable: The main outcome variable was lesion control rate (6 months and overall), calculated as (complete radiographic bone fill + partial radiographic bone fill + no change)/sample size.

Covariates: The covariates were demographic characteristics, clinical characteristics and radiographic characteristics.

Analyses: Intergroup comparisons were analyzed with χ² or Fisher's exact test. Lesion control rate was analyzed with Kaplan-Meier curves, and Cox regression assessed the effect of treatment on time to complete radiographic bone fill. P < .05 indicated statistical significance.

Results: The sample was composed of 88 subjects with a mean age of 17.9 (±10.5) years, 34 (38.6%) were male, and the median follow-up was 1 [IQR: 0.58 to 2.87] years. There were 47 (53.4%) and 41 (46.6%) subjects treated operatively and nonoperatively, respectively. Six months lesion control rate was 82.1% for the operative group and 89.2% for the nonoperative group (P = .4). Overall lesion control rate was 97.9% for the operative group and 97.6% for the nonoperative group (P = 1). Six months complete radiographic bone fill rate was significantly higher in the operative group than in the nonoperative group (46.2 vs 10.8%, P < .05). No statistically significant difference in the 6 months partial radiographic bone fill rate between the 2 groups (33.3 vs 27.0%, P = .6). Operative costs were higher, with complications observed only in the operative group (4 vs 0).

Conclusions and relevance: Curettage provides significantly faster and higher initial radiographic bone fill rates but incurs greater costs and complication risks. If a nonoperative approach is undertaken, long-term clinical follow-up is required to ensure lesion stability.

Background: Large language models (LLMs) such as Chat Generative Pre-Trained Transformer (ChatGPT; OpenAI, San Francisco, CA) and Claude (Anthropic, San Francisco, CA) are increasingly used by patients seeking information about surgical procedures, including external sinus lifting. However, the accuracy, quality, and readability of these artificial intelligence (AI)-generated explanations remain uncertain.

Purpose: The study purpose was to measure and compare 2 AI language models regarding the reliability, quality, usefulness, and readability of their responses to frequently asked patient questions about external sinus lifting.

Study design, setting, and sample: This cross-sectional study assessed computer-generated responses provided by LLMs, referred to as decoder-only-based LLM (DO-LLM) and transformer-based LLM (TB-LLM) to standardized patient questions.

Predictor variable: The predictor variable was AI model type (DO-LLM vs TB-LLM).

Main outcome variables: Outcome measures included reliability, quality, usefulness, and readability. These were assessed using the modified DISCERN instrument, Global Quality Score, a 4-point usefulness scale, and 2 readability indices (Flesch Reading Ease and Flesch-Kincaid Grade Level). Seventy-two standardized questions across 10 clinical domains were submitted to both models. Responses were independently evaluated by one oral and maxillofacial surgeon and 2 periodontists, followed by consensus scoring.

Covariates: Not applicable.

Analyses: Descriptive statistics summarized outcomes. Depending on normality, comparisons used the independent samples t-test or Mann-Whitney U test. Associations between categorical variables were analyzed using Pearson's χ² or Fisher's Exact test.

Results: For modified DISCERN, DO-LLM scored 21.88 (3.09), 22.14 (2.04), and 22.63 (2.56) in preoperative preparation, graft materials, and risks/complications, whereas TB-LLM scored 13.88 (4.52), 17.29 (4.27), and 19 (1.77), respectively (P < .05). For Global Quality Score in lifestyle and behavioral recommendations, TB-LLM scored 4 (0) compared with 3.29 (0.49) for DO-LLM (P < .05). Moderate-quality responses were more common with DO-LLM (56.9%), while TB-LLM produced a higher proportion of good quality scores (29.2%) (P < .05).

Conclusion and relevance: Both AI models demonstrated potential value for patient education on external sinus lifting, though their strengths differed by content domain. DO-LLM provided stronger procedural and risk-related explanations, whereas TB-LLM offered more comprehensive lifestyle-related guidance. Continued refinement of dental-specific AI tools and integration of patient-centered considerations remain essential.

In the traditional jaw in a day technique, discrepancies between the virtual surgical plan and final implant positions are accommodated by creating oversized access openings in the prefabricated prosthesis, allowing passive adaptation around implant cylinders before registering definitive implant positions with autopolymerizing or light-curing resin. Utilizing digital scanning and 3-dimensional printing, a direct-to-multiunit abutment dental prosthesis can be fabricated as a fully digital alternative to this analog method. Although direct-to-multiunit abutment connections have been reported in head and neck reconstruction using the IPS Preprosthetic System, their application in jaw in a day has not been previously described. This digital workflow eliminates restorative materials unsuitable for the operative environment, maintains sterility, simplifies intraoperative handling, and enhances mechanical integrity through minimized access openings. Moreover, it transfers prosthetic fabrication to the dental laboratory, allowing concurrent production during surgical reconstruction and enabling immediate intraoperative delivery.