Oral and Maxillofacial Surgery-Heidelberg最新文献

Introduction: Head and neck infections, particularly odontogenic infections, can lead to serious complications if not properly managed. While swabs are commonly used for microbial identification, their reliability in polymicrobial infections is debated. This study evaluates the advantages of native tissue samples over swabs in the management of severe head and neck infections.

Material and methods: This prospective cohort study included patients with severe acute head and neck infections requiring hospitalization, surgical drainage, and microbiologic analysis. Swabs and native tissue/fluid samples were collected for pathogen cultivation, Gram staining, and resistance testing. Clinical data, infection characteristics, and antimicrobial resistance profiles were analyzed using descriptive and inferential statistics.

Results: 60 patients, 55% male (45.7 years) and 45% female (48.1 years) were analyzed. After antibiotic treatment, CRP and leukocyte levels decreased significantly, with higher CRP correlating with longer hospital stays. ICU admission correlated with hospital stay > 7 days. More Actinomyces and fungal species were identified in native tissue samples and more Streptococci in swabs. Antibiotic resistance, especially to clindamycin (1/3 of the cases), was associated with longer hospital and ICU stays. Clindamycin resistance correlated with increased ICU admission, while metronidazole resistance (10% of the cases) was associated with longer ICU stays. ICU admission was also associated with higher Cormack-Lehane scores.

Conclusion: Severe head and neck infections require a comprehensive multidisciplinary approach. Native tissue should be obtained whenever possible. While microbiological findings varied between sampling methods, native samples may provide a broader spectrum of detected pathogens, which could be relevant for infection management. Given the increasing resistance to clindamycin, its indications should be critically re-evaluated. The implementation of targeted antimicrobial strategies and a risk-based classification system may help optimize patient management and improve outcomes.

Background: Tooth extraction often leads to remodeling and shrinkage of the alveolar crest, particularly on the buccal side. This study aimed to assess the impact of grafting procedures on augmenting a thin buccal alveolar bone following tooth extraction and immediate implant placement.

Methods: The third mandibular premolar was bilaterally extracted in dogs, and implants were immediately placed into the distal sockets. At the test sites, the buccal bone wall was augmented with a xenograft, while both test and control sites were covered with a collagen membrane. After three months, biopsies were collected for histological analysis.

Results: Marginal bone loss averaged 3.0 ± 1.3 mm at control sites and 1.9 ± 0.8 mm at test sites (p = 0.084). At the test site, new bone formation extended from the buccal bone surface through the graft material, incorporating the granules and occasionally reaching the outermost areas, especially in the coronal regions. However, most of the outer regions of the biomaterial lacked newly formed bone.

Conclusion: The study indicates that neither the use of a xenograft covered by a collagen membrane nor the application of a collagen membrane alone effectively preserved the buccal bone wall after tooth extraction and immediate implant placement.

Purpose: Not much is known about the applications of artificial intelligence (AI) in cleft lip and/or palate. We aim to perform a scoping review to synthesize the literature in the last 10 years on integrating AI in the approach to this condition and highlight aspects of research into its prediction, diagnosis and treatment.

Methods: A search was performed via PubMed, Science Direct, Scopus, and LILACS from 2014 to 2024, in which 649 articles were identified, and 3 studies were identified via the snowball method; the title and abstract were identified, and 35 articles were obtained for full reading. Finally, 25 studies were selected after applying the inclusion and exclusion criteria to execute this review.

Results: The articles reviewed included different types of studies, with observational and experimental studies being frequent and systematic reviews and narratives being less frequent. Similarly, there was evidence of a generalized distribution, with a greater concentration in the United States. These studies were analyzed according to the use of AI applied to cleft lip/palate, obtaining 6 subcategories, including diagnosis, prediction, treatment, and education, in which different types of AI models were included, most frequently using deep learning and machine learning.

Conclusion: These technologies promise to optimize the care of patients with this condition. Although current advances are promising, further research is essential to expand and refine their beneficial use. AI has driven significant advances in various stages of the cleft lip and/or palate approach, integrating tools such as assisted algorithms, genetics-based predictive models, and advanced surgical planning.

Purpose: Computed tomography (CT) imaging is utilized during virtual surgical planning (VSP) in orthognathic surgery to simulate the surgical scenario, thereby aiding the actual surgery. Various surgical strategies exist to enhance accuracy in Le Fort I osteotomy, but an ideal planning and treatment approach has not yet been defined. The purpose of this study was to assess the accuracy of markerless Augmented Reality (AR), utilizing the iterative closest point algorithm for real-time tracking without 3D-printed surgical guides, wafers, or physical markers. The study explores the integration of VSP and an intraoperative markerless AR-assisted system for Le Fort I osteotomy in orthognathic surgery.

Methods: Six patients were enrolled in the study. We conducted a markerless AR-assisted orthognathic surgery utilizing VSP containing a virtual plate model. To assess accuracy, the postoperative 3-dimensional reconstructed CT image was compared to the VSP.

Results: Distance maps visualizing the distances between VSP and the postoperative CT scan revealed an accuracy with a standard deviation (SD) of 0.81 mm (81.0% within 1 mm) in terms of the maxillary position.

Conclusions: This approach facilitated the movement and positioning of the maxillary bone along with fixation and setting of titanium plates. The simulation of the surgical procedure made the process more straightforward, enabling us to perform the actual surgery with greater precision. The markerless AR-assisted surgery shows potential in orthognathic surgery, aiding surgeons to prepare and execute surgical procedures more accurately. The future studies anticipate the integration of artificial intelligence, robotic technology, and AR for further improvements in orthognathic surgery.

Objectives: Evaluation of the effectiveness Gengigel^® Oral Gel (hyaluronic acid ) and photobiomodulation (magnetic laser) in the treatment of alveolar osteitis in patients with type 2 diabetes mellitus.

Methods: This is a blind RCT study clinical prospective study in 69 patients with type 2 diabetes mellitus with alveolar osteitis. The subjects selected for study were examined under the inclusion and exclusion criteria and sign the written consent. The patients were blind randomly assigned into two groups: The Group I included 35 patients with alveolar osteitis, in which complex treatment including HA and magnetic laser therapy was carried out. The Group II is represented by 34 patients, with alveolar osteitis received treatment including antiseptic and inflammatory agents. Healing time and pain levels of the alveolar socket of the extracted tooth were appreciated. The pain levels in dynamics were assessed according to VAS.

Results: After the 5th treatment session, 91% of patients in the 1st group had a VAS score of 0 (no pain), whereas in 9% of patients, the VAS score was 1-3. In group 2, a similar result of the VAS score was recorded but only on the 8th day of treatment.

Conclusion: The results show that the use of Gengigel^® Oral Gel (hyaluronic acid ) and photobiomodulation(magnetic laser) recommended for the treatment of dry socket in patients with type 2 diabetes mellitus, can be considered as a promising method, as it has not only anti-inflammatory but also pronounced analgesic and tissue regenerating properties.

Clinical trial number: Not applicable.

Introduction: Apicoectomy plays a crucial role in the clinical practice of dental professionals. High success rates in this treatment, along with increased precision, suggest that 3D-printed guided apical microsurgery may provide a significant improvement over conventional apical microsurgery. The objectives of this study were to evaluate healing rates in terms of medium- and long-term success percentages and to assess longitudinal deviation rates, measured in millimetres, for both techniques in the apical resection procedure.

Materials and methods: This systematic review followed PRISMA guidelines and searched three scientific databases-PubMed, Web of Science, and Scopus-using specific search algorithms focused on 3D-printed guided apical microsurgery and conventional microsurgery. Articles from 2013 onwards were considered, including randomized clinical trials, case series, observational studies, and cohort studies involving human subjects.

Results: The initial search yielded a total of 397 articles: PubMed (119), Scopus (137), and Web of Science (141). Of these, 25 were identified as potentially eligible through title and abstract screening. After detailed evaluation, 9 articles met the inclusion criteria and were included in the systematic review. The review found that the longitudinal deviation and healing rates were consistently higher for the guided microsurgery technique compared to conventional microsurgery.

Conclusions: Despite limitations within the studies, the 3D-printed guided microsurgery technique appears to offer greater precision and a reduced overall impact on the patient's soft tissues during root-end resection, making it a promising option for improving clinical outcomes in apicoectomy procedures.

Background: The retromolar region of the mandible is an anatomically complex area that harbors important neurovascular structures, including the retromolar canal (RMC) and retromolar foramen (RMF). Understanding the prevalence and characteristics of these anatomical variations is crucial for safe and effective dental and maxillofacial procedures. This study aimed to comprehensively investigate RMCs and RMFs using cone-beam computed tomography (CBCT) imaging.

Methods: This study analyzed CBCT scans of 160 subjects (80 males, 80 females) aged 18 years and above. The presence and morphology of RMCs were assessed, and their spatial relationships with adjacent structures were measured. Statistical analysis using the ANOVA and chi-square tests to evaluate the associations between RMC characteristics and demographic factors yielded no significant results.

Results: RMCs were present in 37 out of 160 subjects (23.1%). The most prevalent type of RMC was the curved Type B (62.2%), followed by Type A (29.7%) and Type C (8.1%). RMFs were predominantly located in a buccal position relative to the mandibular third molar (86.5%). The study also provided comprehensive morphometric data on the retromolar canals (RMCs) and foramina (RMFs) observed in the study population. Key measurements included the distance from the buccal and lingual cortices to the RMCs, the distance from the mandibular foramen to the RMC origin, and the distances from the RMF to the mandibular canal and adjacent molars. These detailed spatial relationships were analyzed across different age groups and between genders. The data revealed trends, such as decreasing buccal distances and increasing lingual distances with advancing age. This morphometric information is valuable for clinicians when planning procedures in the retromolar region, as it can guide preoperative assessment and help mitigate the risk of neurovascular complications associated with the variable anatomy of RMCs and RMFs.

Conclusion: This comprehensive CBCT study provides valuable insights into the prevalence, morphology, and spatial relationships of RMCs and RMFs. The variable anatomical features of these structures can have significant clinical implications for various dental and maxillofacial procedures. The data presented in this study can serve as a reference for clinicians to enhance preoperative assessment and improve the safety and efficacy of interventions in the retromolar region.

Purpose: This exploratory study aimed to determine whether non-experts in the field of temporomandibular disorders (TMDs) are capable of correctly assessing various intra-articular TMDs based on magnetic resonance imaging (MRI), and whether supplementing corresponding arthroscopic imaging findings will enhance accuracy of their assessments.

Methods: Non-experts for the purposes of this study were recruited from German dental students. After a focused instruction on TMDs, they completed two evaluation rounds to identify and assess selected pathologies of arthrogenic TMDs in patient cases. Initially, participants were provided with MRI images only; in a second round, additional arthroscopic video material was provided. Statistical analysis was performed to evaluate responses, and inter-rater reliability among non-experts was determined.

Results: 94 participants evaluated a total of 30 MRI scans of the temporomandibular joint (TMJ) obtained from 27 patients who had also undergone arthroscopy. Their assessment showed the relatively highest agreement with the correct diagnosis for disc perforations (68.2-71.9%) and when using both MRI and arthroscopy material. Synovitis showed the lowest agreement, and was more successfully detected based on arthroscopy (47.2%) alone. Overall, there was only slight to fair agreement among the study participants across diagnoses (Kappa 0.074-0.358). Non-experts showed significant inconsistencies in interpreting MRI and arthroscopic imaging, with only limited concordance with the actual diagnosis and an agreement rate of less than 71.9%.

Conclusion: Dental students/Non-experts are unlikely to effectively interpret MRIs for the management of intra-articular TMDs based solely on their academic training. Enhanced curricular and postgraduate education in this area is therefore strongly recommended.

Purpose: To investigate whether deviations in the localization of the main septo-cutaneous perforator (SCP) in maxillofacial reconstruction with free fibula flaps (FFF) lead to inaccuracies in the reconstruction result with respect to virtual surgical planning (VSP) procedures.

Methods: The consecutive VSP planning data of a total of 24 patients who either underwent resection of a bone-destructive malignancy or underwent maxillofacial reconstruction with FFF due to another osteodestructive lesion were retrospectively analyzed together with the postoperative computed tomography (CT) control data set and the preoperative computed tomographic angiograms (CTA). The deviations of the VSP from the actual position of the main SCP were quantified morphometrically to evaluate the impact on the reconstruction accuracy.

Results: Significant differences in bone segment surfaces (p = 0.0006) and bone segment volumes (p = 0.0001) were observed between VSP and postoperative reconstruction results. A significant positive linear relationship was found between the distance of the SCP from the inferior margin of the lateral malleolus (p = 0.0362, R² = 0.1844) and the deviation of the SCP from the center of the VSP (p = 0.0016, R² = 0.3700), with increasing root mean square (RMS) values indicating a less accurate reconstruction result. The multimodal regression model showed that the deviation of the SCP from the center of the VSP significantly affected the accuracy of the reconstruction result (p = 0.0046, R² = 0.3345).

Conclusions: The data provide evidence that the integration of the main SCP into the VSP procedures improves the predictability and accuracy of postoperative reconstruction outcomes.

Background: Diabetic patients are associated with a series of post extraction complications, such as delayed healing, greater risk of infections, persistent pain, dry socket and delayed bone formation. There is paucity of studies which indicate the influence of glycemic index and antibiotic prophylaxis in prevention of complications after minor surgical procedures. Various adjuncts such as hydrogels, curcumin and platelet gels are used in the extraction socket to augment healing, minimize complications and promote bone regeneration.

Aim: To assess the effect of hyaluronic acid gel with and without metronidazole on wound healing in post extraction sockets of diabetic patients.

Methodology: A double blind randomized controlled study was conducted at FDS, RUAS, Bengaluru, India. Diabetic patients indicated for simple extraction of mandibular molars were randomly divided into two groups and prescribed oral metronidazole 1 h prior to extraction. After extraction, 1% hyaluronic acid gel was placed in the sockets of patients in Group A and Group B received 1% hyaluronic acid gel with 5% metronidazole. Soft tissue healing was assessed after one week using wound healing index and photographs of the socket with AutoCAD program. Pain was assessed by VAS. Hard tissue healing was evaluated radiologically using CBCT scans taken immediately after extraction and after one month and analyzed in the 3D slicer software. Pain was assessed by VAS, number of rescue analgesics, complications if any.

Results: There was no statistically significant difference in hard and soft tissue healing and pain scores between the two groups. However, it was statistically significant between the two-time intervals within each group.

Conclusion: In patients with short term glycemic control, use of a single dose of oral metronidazole prior to extraction and placement of 1% hyaluronic acid gel in the extraction socket resulted in uneventful healing with evidence of bone formation at one month. Addition of 5% metronidazole to the gel seems to have no added advantage.

Clinical trial number: Not registered.