Journal of Maxillofacial & Oral Surgery最新文献

Introduction: Complications following dental extraction include the development of a dry socket, pain, swelling, infection, trismus, pocket formation in the adjacent teeth, or absence of healing. The material and technique used for suturing vastly influence the success or failure of a suture. The present study aimed to evaluate and compare the postoperative pain, swelling, and distal probing depth of the mandibular second molar following the placement of interrupted suture (IS) and vertical mattress suture (VMS) after extraction of impacted third molars.

Material and methods: The present split-mouth randomized controlled trial was conducted on 100 patients requiring surgical extraction of bilateral impacted mandibular third molars. The extraction socket was closed by IS on one side and VMS on the other. The pain and swelling scores were obtained by the visual analog scale during the first-week post-extraction. The probing depth distal to the mandibular second molars was taken at 2-month intervals until 6 months post-extraction.

Results: Inter-group comparison revealed significantly lower values (P < 0.001) of pain levels and swelling scores for the IS group during the first four postoperative days. There was a mean increase in the pocket depth by 0.16 + 0.77 in the wounds closed by IF, while a reduction in the pocket depth with a 0.61 + 0.74 mean gain in attachment levels was noted in the VMS group. A statistically significant difference (P < 0.05) in the pocket depth of the two groups was noted at every 2-month interval with greater pocket depth in patients of the IF group.

Conclusion: While IS can be considered a simple-to-execute suturing technique with less operative pain initially, the VMS was found to be better in the long run in its ability to reduce the detrimental effects on the periodontium of the adjacent tooth.

Primordial Odontogenic Tumor (POT) is an exceptionally rare benign odontogenic lesion derived from embryonic dental tissues, characterized by primitive odontogenic epithelium and fibrous stroma resembling early tooth development stages. This case report presents a 17-year-old male with malaligned teeth in the lower jaw, where radiographic examination revealed an ill-defined radiolucent lesion associated with an impacted supernumerary tooth. A provisional diagnosis of a dentigerous cyst was made, followed by surgical enucleation and extraction. Histopathological analysis confirmed POT, marking the 27th documented case and the first involving a supernumerary tooth. The lesion exhibited typical histopathological features, including odontogenic epithelium surrounded by fibro myxomatous stroma with plump fibroblasts resembling dental papilla. Complete surgical excision was curative, with no recurrence observed after a 7-month follow-up. This case highlights the importance of recognizing the unique clinical and histological features of POT for accurate diagnosis and management, emphasizing the need for comprehensive evaluation of rare odontogenic lesions.

Introduction: Condylar neck fractures are challenging to treat owing to their intricate biomechanics, constrained accessibility, and narrow anatomical dimensions. This complexity hinders the precise placement of internal fixation devices and assurance of fracture stability. Despite various osteosynthesis devices, a lacuna persists regarding the effectiveness of these plates in stabilizing condylar neck fractures. This study compares the performance of five titanium osteosynthesis devices (single 4-hole Miniplate, Lambda, Trapezoidal, Rhomboidal, Alpha plates) in fixing unilateral condylar neck fractures using computational finite element analysis (FEA).

Method: Mandibular model, derived from a CT scan, underwent virtual condylar neck fracture simulation. Osteosynthesis plate models were adapted to the fractured segments. Implementing FEA, each model was evaluated under two loading scenarios: (i) reduced post-operative bite force of 135 N and (ii) clenching masticatory force of 500 N. Analysed parameters encompassed stress on screws across different plates, displacements along the fracture line, bone strains on the screw portion, and stress on plates, implant deformation, and rigidity.

Results: At 135N, all 5 plates offer an adequate fixation with a small risk of screw loosening for the rhomboidal and trapezoidal plates. For 500N, the lambda and alpha plates showed superior performance by evenly distributing strains within the bone, maintaining rigidity and reducing implant failure.

Conclusion: Lambda and Alpha plates demonstrated superior performance under increased loads. Conversely, Trapezoidal and Rhomboidal plates are not advisable for condylar neck fractures, particularly when anticipating larger functional loads.

Purpose: To assess facial soft tissue levels and buccal bone thickness following immediate implant placement in compromised maxillary anterior sockets using marginal preservation technique.

Materials and methods: A total of 49 patients with failing maxillary anterior teeth were assigned to single immediate implant placement using appropriately sized implants, combined with absorbable collagen matrix membrane and sticky demineralized freeze-dried bone allograft grafting. Definitive crown placement occurred 6 months after provisionalization. The primary outcome was the change in soft tissue levels, assessed using pink esthetic score (PES). Additionally, survival rates and buccal bone thickness were evaluated.

Results: The implant survival rate at 6-month follow-up was 100%. After 6 months, the overall PES significantly increased from 6.16 ± 2.23 to 7.31 ± 0.87 (p = 0.002). There was no statistically significant difference in esthetic outcomes between thick and thin gingival phenotypes. Implants with immediate provisionalization had a higher PES compared to those with delayed provisionalization (7.53 ± 0.76 and 7.04 ± 0.93, respectively, p = 0.041). A positive gain in buccal bone thickness was observed at 6-month post-surgery, and the timing of provisionalization (immediate versus delayed) did not significantly influence buccal bone thickness.

Conclusion: Immediate implant placement combined with a marginal preservation technique resulted in optimized esthetic outcome and positive changes in buccal bone thickness.

Background: Rehabilitation of a single missing tooth using a dental implant, although often considered less complex, presents unique clinical challenges and limitations. Central to successful outcomes is a prosthetically driven treatment approach, wherein the final crown position dictates the ideal implant placement within the alveolar bone.

Treatment considerations: Comprehensive treatment planning requires integrating findings from clinical, radiographic, and diagnostic evaluations to assess site suitability and anatomical constraints. Multiple factors influence implant planning, including soft tissue parameters such as gingival biotype, hard tissue factors like bone quality and quantity, proximity to anatomical structures, and the condition of adjacent and opposing dentition. Importantly, different regions of the oral cavity present distinct priorities: Esthetic demands dominate in the maxillary anterior region, whereas occlusal loads and biomechanical considerations are paramount in posterior sites. Recognizing the regional variability in planning criteria is essential for clinicians to ensure ideal implant positioning, long-term osseointegration, and esthetic success.

Discussion: This review consolidates and organizes key factors that vary by anatomical region, offering a structured framework to support evidence-based decision-making in single-tooth implant rehabilitation. Additionally, we outline the commonly employed surgical protocols, highlighting how clinical and anatomical variables guide the selection of one-stage vs. two-stage placement, immediate vs. delayed loading, and other procedural variations. By emphasizing both universal principles and site-specific considerations, this article aims to serve as a practical guide for clinicians striving for predictable and patient-centered single-tooth implant outcomes.

Background: In recent times, autologous platelet concentrates (APCs) like platelet-rich fibrin (PRF) and platelet-rich fibrin matrix (PRFM) are utilized broadly to promote soft and hard tissue regeneration. The aim of the study was to evaluate PRF and PRFM in terms of pH changes (over a five-day period), antimicrobial potential and histological presentation using light microscopy and field-emission scanning electron microscopic analysis (FESEM).

Materials and methods: A prospective comparative in vitro study was conducted in which PRF and PRFM samples were prepared from 21 healthy volunteers and a comparative evaluation for the parameters was carried out.

Results: A statistically significant difference was found between PRF and PRFM in terms of pH over a five-day period; antimicrobial efficacy at 48 h; average thickness of fibrin; distribution of platelets and leucocytes entrapped in fibrin matrix.

Conclusion: From our research study, it can be concluded that PRF when compared to PRFM showed abundant entrapment of platelets and leucocytes enmeshed in the 3-D fibrin matrix which is responsible for its better antimicrobial property. PRF also showed increasing acidity over days which accelerates the process of wound healing at the injury site. Thus, PRF is a better autologous platelet concentrate than PRFM.

Objectives: To evaluate the accuracy of static and dynamic computer-assisted implant surgery during dental implant placement.

Material and methods: A literature search was performed for articles evaluating the accuracy of implant placement using static and dynamic computer-assisted implant surgery in four electronic databases. Accuracy of implant placement was evaluated based on the platform, angular and apex deviations as the outcome measures. The Cochrane Risk of Bias tool (RoB 2) was used to evaluate the risk of bias (ROB) in the included articles. The fixed effect model was used for statistical analyses of the pooled data from the included studies. The overall quality of evidence was assessed using the GRADEpro GDT software.

Results: Three RCTs were selected based on the inclusion and exclusion criteria. The overall ROB was low in one study, and some concerns in two studies. The pooled data from the included trials have shown that the platform (MD, 0.12; CI, -0.04 to 0.27, P = 0.15, I² = 0%) and angular deviation (MD, 0.03; CI, -0.50 to 0.56, P = 0.92, I² = 0%) are higher in the dynamic computer-assisted implant surgical (D-CAIS) technique. The apex deviation is higher in the static computer-assisted implant surgical (S-CAIS) technique (MD, -0.05; CI, -0.23 to 0.13, P = 0.61, I² = 10%) with no statistically significant difference. The overall quality of evidence for all the outcomes assessed is "moderate."

Conclusion: The platform and angular deviations are higher in the D-CAIS, and the apex deviation is higher in the S-CAIS with no statistically significant difference.

Graphical abstract:

Aim: The aim of the present study was to rehabilitate extensive acquired maxillary defects using zygomatic implant and endosseous dental implant-retained obturator/prosthesis. The objective was to provide a stable, well-retained obturator and to determine the use of zygomatic implants as a reconstructive option to overcome the loss of retentive anatomy following maxillectomy. A total of eight OPD patients - six male and two female of all age groups were selected.

Methodology: Scales assessed were: a) Oral Health impact Profile -14 (OHIP-14) and b) Obturator functioning scale (OFS). Parameters recorded preoperatively and 3 months postoperatively. Clip on denture was delivered to the patient within 7 days with immediate loading concept.

Results: The age groups of the patients ranged between 32 and 54 years with mean age of 44.875. The OHIP-14 scores showed significant differences in all domains with conventional obturator/ with implant-retained obturator: mean functional limitation - 4.13 /0.75; mean physical pain - 5.88 / 0.63. The obturator function scores significantly improved from 4.5 to 30.63.

Conclusion: Although currently limited, the evidence suggests overall good survival rates for the use of zygomatic implants; however, there are varied institutional results reported, most likely due to differing levels of experience with these techniques which have a distinct learning curve.

The use of zygomatic implants for the rehabilitation of atrophic maxilla is very common. Precise placement of the implants is very crucial to avoid many serious intraoperative and postoperative complications. The use of C-arm can help oral and maxillofacial surgeons in their precise placement and prevention of various complications. This technical note highlights the use of C-arm in precise placement of zygomatic implants for maxillary rehabilitation.