Oral and Maxillofacial Surgery-Heidelberg最新文献

Background: The pre-extraction overbuilding procedure was designed aiming to mitigate buccal bone resorption following tooth extraction. The objective of this study was to compare the efficacy of pre-extraction and juxta-extraction buccal overbuilding treatments in preserving buccal bone volume following tooth extraction.

Material and methods: At the test sites (pre-extraction sites), an alveolar crest overbuilding was performed on the buccal aspect of the distal root of the fourth premolar using a xenograft covered with a collagen membrane. No treatment was applied at the control sites. After 3 months, the distal roots of both fourth premolars were extracted and the alveoli were filled with a collagenated xenograft. An overbuilt procedure was performed also at the control sites (juxta-extraction sites). After 3 months, biopsies were collected.

Results: Considering the initial height difference between the lingual and buccal bone plates at the time of extraction, histological evaluation revealed that the resorption of the buccal bone relative to the lingual bone wall was 3.2 mm at the pre-extraction sites and 3.3 mm at the juxta-extraction sites. New bone originated from the residual pre-existing bone crest in an attempt to restore the original dimension.

Conclusion: The buccal overbuilding procedures performed three months before tooth extraction did not contribute to preserve the buccal bone crest, despite necessitating an additional surgical procedure. Evidence of ongoing bone regeneration was observed within the augmented space maintained by the biomaterial, suggesting that a prolonged healing period, potentially exceeding six months as indicated by this study, might be required to achieve optimal outcomes.

Purpose: This report aims to present an interdisciplinary approach to diagnosing and treating a case of Common Variable Immunodeficiency (CVID), an inborn error of immunity, resulting in successive complications following a third molar extraction procedure.

Case presentation: The patient, a 37-year-old Caucasian female, sought a specialist for the extraction of an impacted lower third molar associated with dentigerous cyst. Due to the possibility of mandibular fracture, a bone fixation system was used in the region. However, she experienced recurrent infections following the procedure despite various treatments and hospitalizations, and these infections could not be explained by any factors. The diagnosis of CVID was established through exclusionary factors, low immunoglobulin levels, and comprehensive allergy assessments by an immunologist. Resolution of the patient's condition and discharge were achieved only after removing the fixation system and implementing monthly immunoglobulin infusions.

Conclusion: CVID is often diagnosed late, resulting in significant economic, social, and health burdens, including recurrent hospitalizations, allergies, and increased risk of malignancy. This case underscores the importance of considering CVID in patients presenting with unexplained recurrent infections following oral and maxillofacial surgeries. Additionally, it highlights the necessity of a multidisciplinary approach for effectively managing patients with CVID.

Aim: Insertion of dental implants causes bone deformation and induces residual bone compression stress, which can lead to implant failure if the bone loss threshold is exceeded. The current literature about bone stress is restricted to computer simulations and implant primary stability measurements after installation. This work measures the torque and deformation during implant insertion testing.

Purpose: The aim of this work was to analyze the influence surface treatment, thread profile, body shape and the presence of microthreads in the neck on the primary stability, bone deformation and residual stress during dental implants insertion. The insertion torque and resonance frequency analysis (RFA) are the main technique used to measure the primary stability of dental implants.

Material and methods: Five models of dental implants with different surface treatments (machined and acid etching), thread profiles (triangular and trapezoidal) and body shapes (cylindrical and conical) were inserted in synthetic bone blocks (polyurethane) with a density of 30 PCF (0.48 g/cm³) compatible with the D2 bone. The insertion torque was quantified by a digital torque driver. Strain gauge extensometry technique was used to measure bone deformation during implant insertion.

Results: The bone deformation and torque increase as the number of implants turns insertion increases. Dental implant with trapezoidal thread profile needs higher insertion torque than triangular threads. Implants with a conical shape require higher insertion torque than cylindrical ones. The bone stress induced by machined implant insertion exceeded the bone's mechanical resistance, causing cracks. Conical implants showed better performance than cylindrical ones. The implants with a trapezoidal thread and those with a conical body induce greater insertion torque.

Conclusion: Comparing the mechanical behavior, it was found that the machined implants had the worst performance in terms of stress distribution in the synthetic bone, resulting in cracks in the specimen during insertion. Implants with trapezoidal threads and those with a conical body induce insertion torque and bone compression stresses that do not harm osseointegration.

Clinical relevance: Excessive deformations in the peri-implant bone led to bone necrosis and implant failure. Thus, the surgeons must analyze the influence of surface treatment, thread profile, and body shape on the osseointegration process.

Introduction: This study aimed to explore the predictive and prognostic value of tumor-stromal ratio (TSR) and tumor budding (TB) in the recurrence and outcome of patients with Oral tongue squamous cell carcinoma (OTSCC).

Methods: All patients with OTSCC who underwent glossectomy with or without neck dissection in a tertiary center between 2010 and 2020 were included. The pathology slides of all patients were reviewed by a consulting pathologist. All pathologic features including tumor size, tumor grade, tumor thickness, surgical margin status, lymphovascular- and perineural invasion, T-stage, number of dissected, TB, TSR, and involved, tumor budding and tumor-stromal ratio were defined, we categorized the tumors as stroma-rich (low TSR) and stroma-poor (high TSR); as well as TB as low (0-4 buds) and high (≥ 5 buds). The inter-observer reliability of TB and TSR was assessed using the Kappa statistics analysis.

Results: A total of 109 patients, with a median age of 62 (range 19-88) years, were included. There was a significant correlation between TSR and tumor budding with other adverse pathologic features and prognostic factors. In univariate analysis, both stromal-rich tumors and tumor budding were poor prognostic factors for disease-free survival (DFS) and overall survival (OS). However, on multivariate analysis, N-stage, adjuvant radiotherapy, tumor size, depth of invasion (DOI) and tumor budding emerged as independent prognostic factors for DFS. Likewise, N-stage, and DOI were recognized as independent prognostic factors for OS.

Conclusion: Both TSR and TB are important histopathological parameters strongly linked to other pathologic prognostic indicators. Additionally, they play key roles in predicting tumor behavior, recurrence, and patient survival.

Purpose: To evaluate the efficacy of two third-generation resorbable biomaterials-F18 bioglass and β-tricalcium phosphate (β-TCP)-in promoting new bone formation in post-extraction sockets in rats. β-TCP, a synthetic porous ceramic, is well-established in clinical use, while F18 bioglass, a novel silica based bioglass.

Methods: After extraction of the right upper incisor of 45 rats, the sockets were filled either with F18 or β-TCP, or left to naturally fill with a blood clot in control group. To quantify new bone formation, five animals from each group were euthanized at 7, 14, and 28 days post-extraction. Subsequently, the hemi-maxillae were analyzed using microtomography and histomorphometry.

Results: Two-way ANOVA revealed significant differences in bone neoformation. β-TCP induced notably higher levels of new bone growth compared to the control group, as evidenced by microtomographic parameters such as bone volume (p = 0.033), bone surface (p = 0.039), and trabecular thickness (p = 0.002). F18 bioglass also induced higher new bone growth compared to the control group, evidenced by bone volume (p = 0.039). Although F18 bioglass did not significantly differ from the control group in other microtomographic parameters of new bone formation, its overall performance was comparable to that of β-TCP.

Conclusion: β-TCP has proven to be effective in promoting new bone formation. Although F18 bioglass did not significantly differ from the control group in several microtomographic parameters, its overall capacity to promote new bone growth was comparable to that of β-TCP. This outcome supports the use of F18 bioglass as a promising alternative biomaterial for alveolar ridge preservation.

Objective: Sublingual varicose veins are variations of normality that appear more prominent during aging. The systematic review aim to investigate sublingual varicose veins frequency in patients exposed to systemic and environmental exposed factors linked to cardiovascular diseases.

Methods: This systematic review was based on the PECO strategy, and the PubMed, Web of Science, Scopus, Embase and Grey Literature library were searched for publications examining the association between sublingual varicose veins and systemic and environmental exposed factors linked to cardiovascular diseases, such as hypertension, diabetes, smoking, and leg varices. A meta-analysis was conducted using random-effects models. This review included 11 studies with a total of 2,272 patients with sublingual varicosity and systemic exposed factors linked to cardiovascular diseases. The quality assessment was improved by Newcastle and Ottawa Scales (NOS).

Results: Consistent results were observed across all systemic and environmental exposed factors linked to cardiovascular diseases subgroups. We found association between sublingual varicose veins and hypertension [p = 0.0002; 95%IC2.90 [1.66-5.06]; I² 91%); diabetics (p = 0.009; 95%IC 3.19 [1.34 - 7.62]; I² 84%); tobacco abuse (p = 0.002; 95%IC 1.97 [1.29 - 3.01]; I² 82%) and leg varicosity (p = 0.03; 95%IC 2.63 [1.08 - 6.44]; I² 95%). Seven articles received score 7, indicating good quality and four articles received moderate quality.

Conclusion: Patients exposed to exposed factors that affect blood vessels showed a higher prevalence of sublingual varicose veins. These findings emphasize the importance of recognizing oral signs underlying systemic diseases.

Systematic review registration: PROSPERO CRD42023397166.

Purpose: This research aimed to investigate the relative frequency of odontogenic tumours (OT) and selected odontogenic cysts in a single oral pathology center in New Zealand from 2008 to 2023.

Methods: Histopathological records from the Oral Pathology Centre, University of Otago (2008-2023) were examined to identify OT. Odontogenic keratocyst (OKC) and calcifying odontogenic cyst (COC), previously classified as OT were also included. Patient demographics, clinical details and histopathologic diagnoses were recorded. Data were analyzed using SPSS.

Results: Of the 34,225 biopsies over the 15-year period, 1.8% were identified as OTs, COC and OKCs and accounted for 47%, 1.5% and 51.5% respectively. The most prevalent OT types were odontoma (43.7%), ameloblastoma (27%) and cemento-ossifying fibroma (7.5%). Malignant OT, ameloblastic carcinoma, constituted 1.4% of OT. The average age at diagnosis for OKC, COC and OT patients were 48.2 ± 20.9, 33.7 ± 23.3 and 28.9 ± 19.3 years. Overall, male and mandibular site predilections were observed. Recurrence of OKC and ameloblastoma occurred in 15.2% and 13.7% of patients. The time for recurrence for OKC and Ameloblastoma were 61.7 ± 56.5 months and 122 ± 152 months respectively.

Conclusion: The demographic features and range of OT, COC and OKC in New Zealand align with those of other western countries. The study also confirms need for long term follow up for patient with OKC and ameloblastoma.

Purpose: This study aimed to assess the prevalence, dimensions, and positions of accessory mental foramen (AMF) and lateral lingual foramen (LLF) in an Iranian population using cone beam computed tomography (CBCT).

Methods and materials: In this cross-sectional study, CBCT images of 2082 patients were retrospectively reviewed based on inclusion criteria, including images from the mandibular region taken in the past five years with accurate demographic data. Exclusion criteria included images with significant pathologies, fractures, or poor quality. CBCT images were captured, and AMF and LLF presence (primary outcome variable), dimensions, and positions (secondary outcome variables) were recorded relative to the mental foramen and adjacent teeth. Data analysis was performed using the Chi-square test with a 5% significance level.

Results: A total of 2082 CBCT samples (46.54% females and 53.46% males) with a mean age of 48.30 ± 12.70 years were examined. Among these, 246 AMFs were observed in 222 individuals with a prevalence at the foramen level of 11.815%, with 24 having two AMFs. AMF was mostly observed unilaterally, with bilateral occurrence noted in 10.81% of patients with AMF. Additionally, 86 patients were found to have LLF with a prevalence at the foramen level of 5.907%. There were no significant differences between genders in AMF and LLF prevalence.

Conclusion: AMF and LLF were detectable using CBCT in the selected Iranian population. AMF was commonly situated posterior and superior to the mental foramen, while LLF was often found near the first premolar. This knowledge is crucial for preventing nerve injury during surgery and ensuring effective nerve block procedures.

Background: This research aimed to investigate the concordance between clinical impressions and histopathologic diagnoses made by clinicians and artificial intelligence tools for odontogenic keratocyst (OKC) and Odontogenic tumours (OT) in a New Zealand population from 2008 to 2023.

Methods: Histopathological records from the Oral Pathology Centre, University of Otago (2008-2023) were examined to identify OKCs and OT. Specimen referral details, histopathologic reports, and clinician differential diagnoses, as well as those provided by ORAD and Chat-GPT4, were documented. Data were analyzed using SPSS, and concordance between provisional and histopathologic diagnoses was ascertained.

Results: Of the 34,225 biopsies, 302 and 321 samples were identified as OTs and OKCs. Concordance rates were 43.2% for clinicians, 45.6% for ORAD, and 41.4% for Chat-GPT4. Corresponding Kappa value against histological diagnosis were 0.23, 0.13 and 0.14. Surgeons achieved a higher concordance rate (47.7%) compared to non-surgeons (29.82%). Odds ratio of having concordant diagnosis using Chat-GPT4 and ORAD were between 1.4 and 2.8 (p < 0.05). ROC-AUC and PR-AUC were similar between the groups (Clinician 0.62/0.42, ORAD 0.58/0.28, Char-GPT4 0.63/0.37) for ameloblastoma and for OKC (Clinician 0.64/0.78, ORAD 0.66/0.77, Char-GPT4 0.60/0.71).

Conclusion: Clinicians with surgical training achieved higher concordance rate when it comes to OT and OKC. Chat-GPT4 and Bayesian approach (ORAD) have shown potential in enhancing diagnostic capabilities.