Oral and Maxillofacial Surgery-Heidelberg最新文献

Purpose: The aim of this study was to evaluate the alveolar repair process in rats exposed to nicotine after tooth extraction, using ozonised water and low-power laser therapy (LPLT) as therapeutic adjuvants.

Materials and methods: Thirty wistar rats (Rattus Norvegicus) were used and given the nicotine solution via subcutaneous tissue. After 7 days, the upper right central incisor was surgically extracted. Three days after the surgical procedure, the animals continued to receive nicotine until the day of euthanasia, totalling 21 days after extraction.

Results: The result was that the groups that received coadjuvant therapy had neoformed mature bone, unlike the group that did not receive it.

Conclusions: Based on the literature and the results obtained, we can conclude that nicotine negatively influenced the healing process and bone repair in the alveoli; however, the use of ozonised water and LPLT, even in the presence of nicotine, was effective, as it enhanced the repair process, making them good options for surgical procedures in patients who smoke.

Introduction: Oral potentially malignant disorders impact the oral mucosa and elevate the risk of oral cancer. In India, the high prevalence of oral submucous fibrosis and leukoplakia is attributed to habits such as tobacco use and smoking. Plasminogen activator inhibitor-1 plays a crucial role in cancer progression. Single-nucleotide polymorphisms are the most widespread genetic variations associated with various diseases, including cancers.

Aim: This study aimed to investigate the association between PAI-1 promoter rs2227631 (- 844G > A) and missense variant rs6092 (+ 43G > A) polymorphisms and the susceptibility to OSMF and leukoplakia in a South Indian cohort of chewers and smokers.

Methods: The rs2227631 and rs6092 of PAI-1 were analysed using PCR- RFLP in 285 subjects including OSMF, leukoplakia and healthy controls, along with their habitual factors. The allele frequencies and genotypic associations were examined. The impact of these SNPs on mRNA secondary structure, gene-gene and protein-protein interactions was also analysed using in silico tools.

Results: The habits of chewers and smokers were (79% and 72%) in OSMF and (62% and 75%) in leukoplakia and disease prevalent was (78% and 59%) males and (22% and 26%) females respectively. The G allele of rs2227631 and A allele of rs6092 were significantly associated with the diseases (P < 0.05).

Conclusion: PAI-1 polymorphisms rs2227631 and rs6092 were associated with OSMF and leukoplakia of the south Indian cohort.

Objective: The study aimed to compare and analyze the in vitro mechanical behavior of vertical load on three different sagittal split osteotomy designs proposed by Epker, Wolford, and Wyatt, focusing on the implications of each design on mandibular stability.

Study design: Synthetic polyurethane hemi-mandibular models were used to replicate the osteotomies according to the designs suggested by Epker, Wolford, and Wyatt. Each model group was subjected to linear vertical loading until system failure, with peak load and deformation recorded. The study utilized a controlled sample preparation and loading test to ensure standardization across all groups. Analysis of variance (ANOVA) and the Tukey test were applied to compare the mechanical responses among the different osteotomy designs.

Results: The findings indicated no significant difference in displacement and vertical loading resistance between Groups 1 and 2; however, differences were found in Group 3 (Wyatt), where increased mandibular fragility was observed when screws were placed in thinner bone areas. Statistical analysis showed that the modifications in the osteotomy design led to significant differences in mechanical behavior, particularly in Group 3, highlighting the importance of bone thickness and osteotomy technique on postoperative early stability and mechanical stress distribution.

Conclusions: The study concludes that the choice of sagittal split osteotomy design significantly impacts the mechanical behavior under vertical loading, with particular emphasis on the importance of bone thickness at fixation points and the technique used. The findings suggest a preference for the modification proposed in group 1 and 2 in cases where increased mandibular stability and minimized postoperative complications are desired.

Purpose: The increasing use of direct oral anticoagulants (DOACs) in patients undergoing oral surgery highlights the need for well-defined, evidence-based recommendations on perioperative and postoperative bleeding management. This review aims to evaluate bleeding risks and strategies to optimize the management of patients treated with DOACs undergoing oral surgical procedures.

Methods: A systematic review identified 628 articles, of which 17 met the inclusion criteria. These studies focused exclusively on patients treated with DOACs-Dabigatran, Rivaroxaban, Apixaban, and Edoxaban-undergoing oral surgical procedures, such as tooth extractions, dental implants, and soft tissue surgical procedures. Articles involving other anticoagulants or combined therapies were excluded to ensure precision in evaluating DOAC-specific outcomes.

Results: The findings revealed that minor to moderate bleeding events were relatively common, while severe bleeding requiring hospitalization was rare. Bleeding events were effectively managed using standard local hemostatic measures in most cases. This review highlights the importance of scheduling procedures when DOAC levels are at their lowest, as this minimizes the risk of excessive bleeding. Furthermore, the continuation of DOAC therapy during oral surgery was deemed safe, with effective local management strategies mitigating bleeding risks.

Conclusion: This review offers practical, evidence-based recommendations for the management of patients on DOAC therapy undergoing oral surgical procedures. The findings simplify clinical decision-making and improve patient safety by emphasizing the importance of timing and perioperative strategies. The exclusive focus on DOACs underscores the clinical significance of this work in guiding oral and maxillofacial surgeons.

Objectives: Considering the increase in regenerative dental treatments, autologous fibrin membranes (ARMs) have been widely used in tissue engineering, favoring the regeneration of hard and soft tissues, accelerating angiogenesis and promoting cell differentiation and migration. This study proposed evaluate the differences in clinical characteristics and levels of the growth factors BMP-2, IGF, PDGF and VEGF between smokers and nonsmokers were evaluated according to the guidelines of the US Preventive Service Task Force (USPSTF).

Materials and methods: Fourteen smokers and 14 nonsmokers were selected. After processing, the samples were allowed to rest in tubes for 5 min for the organization of the matrix and completion of the fibrin clot. Only the yellow portion and the buffy coat were removed and stored. Four clots were obtained from each donor and used to quantify the release of the growth factors BMP2, PDGF, IGF and VEGF. In addition, histological analyses were performed, and clinical characteristics were evaluated.

Results: The data were tabulated and subjected to statistical analysis with a significance level of 5%. In both groups, the membranes remained intact throughout the analysis period, indicating similar structural behavior. Histological evaluation of the membranes obtained from the participants revealed the presence of more homogeneous fibrin membranes in the nonsmoker group and many leukocytes bordering the entire fibrin clot. In the smoker group, heterogeneous fibrin clots, sometimes malformed, and fewer leukocytes in the region of the buffy coat and bordering the entire fibrin were observed.

Conclusions: Smokers had significantly lower levels of VEGF, PDGF and BMP-2 (pg/ml in 1 µg total protein) than smokers did (p < 0.05), and there was no significant difference in IGF levels (p > 0.05) between the groups. There was also no statistically significant difference in membrane size between smokers and nonsmokers (mm, p > 0.05).

Clinical relevance: Smoking may interfere with the formation of the fibrin mesh and consequently affects the quality and regenerative capacity in in smoking patients.

Purpose: To assess the clinical utility of the 3D 4K exoscope for reconstructive head and neck surgery.

Methods: This retrospective study analyzed surgical details and complications with the use of the 3D 4K exoscope for microvascular reconstruction at a high-volume Department of Oral and Maxillofacial Surgery, compared to the use of a 2D microscope. Patients with oral cancer undergoing microvascular reconstruction were categorized into two cohorts based on the intraoperative use of the 3D 4K exoscope (Orbeye™, Olympus, Tokyo, Japan) or a conventional microscope (ZEISS S8 - OPMI Vario, Carl Zeiss AG, Oberkochen, Germany; Leica M680, Leica Mikrosysteme Vertrieb GmbH, Wetzlar, Germany) during a six-month study period, respectively. Outcomes were also compared between two time periods of the exoscope use to assess the learning curve over time.

Results: The exoscope was applied for microvascular anastomosis in 55 surgical cases (cohort 1), and the conventional microscope was employed in 56 cases (cohort 2). The rates of postoperative complications within 14 days following the use of the exoscope were 14.5% (N = 8), compared to 16.1% (N = 9) in cohort 2. Analysis over time demonstrated a learning curve with the exoscope, reflected in a decrease in postoperative complications within 14 days from 22.7 to 9.1%.

Conclusion: The three-dimensional camera system provides excellent and reliable intraoperative visualization in reconstructive head and neck surgery. Transitioning to this new technology did not lead to an increase in intra- or postoperative complications, but the successful implementation requires some experience with the device.

Purpose: To investigate the anatomical variations and measure the distances between surgically relevant structures in the maxilla associated with Le Fort I osteotomy in patients with maxillary canting using cone beam computed tomography (CBCT).

Methods: CBCT scans of 63 patients (21 males and 42 females) with maxillary canting who were indicated for orthognathic surgical planning were retrospectively investigated and analyzed. The distances of the relevant anatomical structures, including the descending palatine artery, pterygomaxillary junction, infraorbital foramen, and nasolacrimal duct opening, were measured with the key anatomical landmarks to evaluate their variations. The independent correlations of measurements with magnitude of canting were examined, considering a 5% significance level.

Results: Among the 63 patients, the mean vertical difference of maxillary canting was 3.26 ± 0.98 mm and 3.62° ± 1.09°. The descending palatine artery differed significantly in distance between the longer and shorter sides (P < 0.001). Similar significant differences were found in the pterygomaxillary junction distance (P < 0.001), pterygomaxillary junction height (P < 0.001), and infraorbital foramen distance (P = 0.009). Every 1 mm of maxillary canting increases the pterygomaxillary junction distance by 0.1721 mm, pterygomaxillary junction height by 0.2773 mm, infraorbital foramen by 0.3301 mm, and nasolacrimal duct in 0.2255 mm.

Conclusion: Maxillary canting significantly affects the morphometrics of pterygomaxillary junction distance and height, infraorbital foramen, and nasolacrimal duct on the longer and shorter sides. Therefore, these surgical anatomies should be of concern when performing Le Fort I osteotomy in patients with maxillary canting.

Clinical trial number: Not applicable.

Purpose: Alcohol use has been shown to affect injury patterns and risk of trauma. This study aims to characterize the epidemiologic characteristics of alcohol involved facial injuries presenting to US emergency departments.

Methods: This study reports a cross-sectional analysis of patients with facial injuries within the National Electronic Injury Surveillance System (NEISS). Demographics, disposition, and mechanism of injury were compared between facial injury patients with reported/suspected alcohol consumption prior to or during the time of injury (AIFI+) and facial injury patients with no alcohol consumption (AIFI-).

Results: A total of 37,777 facial injuries were reported within the NEISS. Out if these, 3,336 patients experienced an alcohol involved facial injury (AIFI+). AIFI + patients were younger than AIFI- patients (47 vs. 57, p < 0.001), more likely to be male (68.5% vs. 31.5%, p < 0.001), and more likely to be White (51.6% vs. 53.6%, p = 0.03). Patients with AIFI were less likely to be injured at home (41.5% vs. 45.5%, p < 0.001) and more likely to be injured in the street (8.5% vs. 4.5%, p < 0.001). Disposition differed with AIFI + patients less likely to be treated and released (78.8% vs. 83.3%, p < 0.001) and more likely to leave without being seen (3.8% vs. 1.8%, p < 0.001).

Conclusions: Our study reports that AIFI + patients are younger, more likely to be injured on the street, and more likely to be injured by stairs than AIFI- patients. Additionally, patients with an AIFI + are more likely to leave the hospital without being seen.

Purpose: Preoperative virtual planning and osteosynthesis with patient-specific implants (PSIs) have become a quotidian approach to many maxillofacial elective surgery setups. When a process is well-organized, a similar approach can be harnessed to serve the needs of exact primary reconstructions, especially in midfacial trauma cases. PSI osteosynthesis of the mandible is, however, more challenging because a mirror technique of the facial sides is often unreliable due to inherent lack of symmetry, and movement of the mandible increases the risk of loosening of the osteosynthesis. The purpose of this study was to present clinical results of the Helsinki protocol concept of utilizing PSIs in the primary surgery of unilateral mandibular subcondylar fractures as the first publication on the subject.

Methods: A single-center study of a new Helsinki protocol is presented for surgical treatment of subcondylar mandibular fractures using patient-specific, titanium-milled repositator plates. Ten patients with dislocated subcondylar mandibular fractures received surgery and osteosynthesis with PSI via a retromandibular approach.

Results: Clinical and radiological outcomes were excellent; none of the patients had fixation-related major complications or developed postoperative malocclusion.

Conclusions: Study results show that the Helsinki protocol, treating mandibular condylar fractures primarily with PSI plates, is a viable treatment option.

Purpose: Coronectomy is a valuable treatment proven safe for non-pathological mandibular third molars with an increased risk of inferior alveolar nerve injury. Coronectomy may also be useful for mandibular third molars with dentigerous cysts and caries, but this is not commonly performed due to the lack of well-designed, evidence-based studies. Here, we aim to investigate the safety of coronectomy for mandibular third molars with caries and dentigerous cysts.

Methods: One hundred fifteen patients with an impacted mandibular third molar with a dentigerous cyst or caries underwent coronectomy or complete removal and received follow-up with clinical and radiographical examinations. We statistically compared the presence of postoperative complications after coronectomy versus complete removal.

Results: Data from 121 molars were available for analysis. The results revealed no significant difference in the occurrence of postoperative complications (including persistent pain, inferior alveolar nerve injury, infection, alveolar osteitis, excessive bleeding, and the need for retreatment) between coronectomy and complete removal. Additionally, the incidence of postoperative complications was not related to any analyzed patient- or molar-related factors, including age, gender, health status, smoking, caries, dentigerous cyst extent, and impaction degree.

Conclusion: For pathological impacted mandibular third molars with dentigerous cysts and caries, coronectomy exhibited both short-term and long-term safety, showing no significant difference in postoperative complications compared to total removal. Our results suggest that coronectomy can be indicated for pathological mandibular third molars with proximity to the inferior alveolar nerve.

Trial registration number: Not applicable.