Journal of Oral and Maxillofacial Surgery最新文献

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.

Background: Surface electromyography provides an objective, noninvasive method for assessing masseter muscle function and postoperative recovery following open reduction and internal fixation (ORIF) of mandibular condylar fractures.

Purpose: The purpose of the study was to compare masseter muscle power and contractility following ORIF of unilateral mandibular condylar fractures using the transparotid (TP) and transmasseteric anterior parotid (TMAP) approaches.

Study design, setting, sample: This retrospective cohort study included adult subjects who underwent ORIF for unilateral condylar fractures using TP or TMAP approaches between January 2021 and December 2022. Subjects with pretraumatic temporomandibular joint disorders, additional surgical approaches, or incomplete surface electromyography data were excluded. Twenty-two subjects were analyzed (11 per group).

Predictor variable: The predictor variable was surgical approach (TP vs TMAP).

Main outcome variables: The primary outcome variables were maximum amplitude and mean power. The amplitude is the maximum peak of the negative phase to the maximum peak of positive phase in electromyography. Power is defined as the sum of action potentials produced in the muscle.

Covariates: The covariates were age, sex, and fracture patterns.

Analyses: Longitudinal changes were analyzed using repeated measures analysis of variance. Operated and contralateral sides were compared using paired t-tests. Kaplan-Meier survival analysis assessed time to ≥80% recovery (P < .05).

Results: The mean age was 32.8 ± 11.2 years in the TP group and 27.8 ± 8.5 years in the TMAP group (P = .3), with male predominance (86.3%, n = 19). Repeated-measures analysis of variance demonstrated a significant effect of time on both amplitude and power within group (P < .001), with no significant time × approach interaction. Kaplan-Meier analysis showed that all subjects achieved ≥80% recovery by the earliest postoperative interval (7-10 days), with no difference between approaches (P = .4). At 3 months, a small but significant reduction in mean power persisted on the operated side in the TMAP group (P = .024).

Conclusion and relevance: Regardless of the approach used, the masseter muscle achieved ≥80% functional recovery within 7-10 days. Recovery is primarily time-dependent, allowing the choice of surgical approach to be guided by fracture characteristics and surgeon expertise.

Background: Osteoradionecrosis (ORN) is a severe adverse effect of radiation therapy for head and neck cancers. Despite advances in radiation techniques and surgical management, reliable predictors of ORN prognosis remain lacking.

Purpose: The purpose of this study was to measure the association between systemic inflammatory biomarkers and ORN prognosis.

Study design, setting, sample: This retrospective cohort study included patients with ORN treated between January 2010 and March 2022 at the Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine. Patients with unavailable blood test data were excluded.

Predictor variable: The predictor variables were pretreatment systemic inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio (LMR). The cutoff values for NLR, platelet-to-lymphocyte ratio, and LMR were determined using receiver operating characteristic curve analysis. Each marker was calculated at the time of diagnosis of ORN.

Main outcome variable: The outcome variable was prognosis. Subjects had a good prognosis if the ORN stage improved. The prognosis was poor if the ORN stage was stable or worse over time.

Covariates: Sex, age, stage, onset region, primary tumor site, radiation dose, smoking history, medical history, steroid therapy, clinical symptoms, treatment methods, and computed tomography image findings were covariates.

Analyses: Statistical analysis was performed using Mann-Whitney U nonparametric test, Fisher's exact test, χ² test, and Cox regression analysis. Statistical significance was set at P < .05.

Results: The sample consisted of 75 subjects, of whom 16 (21.3%) had a poor prognosis. The median follow-up period was 88 (53 to 122) months. Bivariate analysis revealed that high NLR (P < .01) and low LMR (P = .02) were significantly associated with poor prognosis. In multivariate Cox regression analysis, poor prognosis was significantly associated with advanced age (hazard ratio [HR], 5.33; 95% CI, 1.61 to 17.65; P < .01), ORN stage 3, 4 (HR, 0.18; 95% CI, 0.06 to 0.56; P < .01), high NLR (HR, 14.78; 95% CI, 3.50 to 62.35; P < .01), and periosteal reaction (HR, 19.15; 95% CI, 4.65 to 78.87; P < .01).

Conclusions and relevance: We identified high NLR as a risk factor for poor prognosis in ORN. High NLR is considered to reflect worse local tissue and systemic health.

This technological innovation introduces a mixed reality-based system using HoloLens 2 for surgical removal of impacted supernumerary teeth. The technology superimposes 3-dimensional virtual models reconstructed from cone-beam computed tomography and intraoral scan data onto the actual surgical field, providing real-time visual guidance for precise localization. This innovative approach enables minimally invasive procedures while eliminating the expenses and limitations associated with traditional surgical guides. Although implementation faces challenges, including hardware costs, operational learning curve, and environmental lighting requirements, the method demonstrates significant potential for reducing surgical trauma and improving outcomes. With anticipated advancements in hardware accessibility and protocol standardization, clinical adoption is projected within 12 to 24 months. The technique also shows promising applications in localizing deep-seated tumors and foreign bodies.