Oral Surgery Oral Medicine Oral Pathology Oral Radiology最新文献

Objective: To evaluate oral clinical and cytological changes in patients on HIV pre-exposure prophylaxis (PrEP).

Study design: Clinical evaluations and epithelial cell smears were done on ventral tongue, buccal, and labial mucosa before treatment (T0), after 30 (T30), and 120 days (T120) of PrEP use. Clinical changes were assessed using questionnaires and oral examinations, and a descriptive analysis was performed. Cellular changes were observed through liquid-based exfoliative cytology, and the Wilcoxon and McNemar tests were applied.

Results: Sixty-three patients (60 males, 3 females; mean age 29.65) were included; 36 returned at T30 and 20 at T120. Most frequent complaints were dry mouth and increased fluid intake. Wilcoxon test showed no systematic observer error (P > .05). Karyomegaly increased significantly in all sites at T30 and in ventral tongue and buccal mucosa at T30 and T120 (P < .05). Keratinization increased significantly in buccal mucosa at T30 and ventral tongue at T30 and T120 (P < .05).

Conclusion: Our findings indicate an increase in oral epithelial changes during the first 30 and 120 days of PrEP use. Although these changes are nonspecific, continuous oral health monitoring may support early detection of alterations and adherence among patients on HIV PrEP.

Objective: Programmed cell death-ligand 1 (PD-L1) expression and immune phenotype (IP) are potential predictive biomarkers for immune checkpoint inhibitors (ICIs) in recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC). This study evaluated the predictive value of combining PD-L1 expression and IP in R/M HNSCC.

Study design: Forty-one R/M HNSCC patients treated with ICI were included. PD-L1 expression was evaluated using the standardized 22C3 pharmDx assay. IPs were assessed using Lunit SCOPE IO, an artificial intelligence-powered tumor-infiltrating lymphocyte analyzer.

Results: Thirty-nine patients (95.1%) were classified as PD-L1 positive (combined positive score ≥1). Overall, 27 (65.9%) had desert IP. PD-L1 expression and IP were combined to classify patients into 3 groups: group A, negative PD-L1; group B, positive PD-L1 with desert IP; group C, positive PD-L1 with non-desert IP. The median progression-free survival (PFS) was 1.2 months in group A, 2.1 months in group B, and 12.1 months in group C (P = .015). In multivariate Cox analysis, PD-L1 expression combined with IP was an independent factor for PFS, with a hazard ratio of 0.14 (P = .018) in group C and 0.37 (P = .186) in group B, relative to group A.

Conclusions: In R/M HNSCC, integrating IP with PD-L1 expression may enhance prediction of ICI outcomes.

Coronectomy, a surgical procedure involving intentional crown removal with root retention of mandibular third molars at high risk of inferior alveolar nerve injury, represents a validated nerve-sparing alternative to complete extraction. This review summarizes evidence demonstrating its superior neuroprotective efficacy: Coronectomy reduces inferior alveolar nerve injury risk by 87% (0%-0.65% vs. 3.7%-19% in conventional extraction), with significantly lower rates of permanent sensory deficit (0.6% vs. 0.9%). Long-term outcomes (>5 years) reveal predictable root migration (>90% of cases; mean 2.5-4.6 mm, predominantly within 6-12 months), minimal chronic pain (0% after 3 years), and enhanced bone regeneration at the distal aspect of adjacent second molars (mean gain: 3.2-3.5 mm). Secondary extraction rates remain low (3.1%-5.4%), primarily indicated for root exposure (2.1%-3.5%) or infection (0.3%-1.6%). Key controversies include the contraindication of routine root canal treatment (failure rate: 87.5% vs. 12.5% without) and emerging two-stage extraction techniques. Strict cone beam computed tomography-guided selection criteria are critical to success. Future priorities include migration prediction models and bioactive material-enhanced healing. Taken together, coronectomy represents a clinically robust strategy for high-risk mandibular third molars when balancing nerve preservation against manageable complications.

Objective: The study purpose was to measure the association between demographic and socioeconomic factors in the management of nasal bone fractures.

Study design: This was a retrospective cohort study of 995 adult patients presenting to John H. Stroger Jr. Hospital of Cook County from 2016 to 2024 with nasal bone fractures. The primary outcome variable was operative versus non-operative management. Data analysis was performed using chi-squared, Pearson's correlation, Mann-Whitney U tests, and multivariate logistic regressions.

Results: Females were more frequently scheduled for follow-up (P = .015). Patients who attended follow-up (P < .001) and underwent surgery (P = .01) were younger on average. Detainees, or incarcerated/jailed patients, were more likely to attend follow-up (P < .001). High median household incomes and non-Chicago zip codes were associated with lower follow-up rates (P = .023). In bivariate analysis, Black/African American patients were less likely to undergo surgery than White patients (P = .035). In the subgroup, higher median household incomes were more likely to undergo surgery (P = .031).

Conclusions: Demographic and socioeconomic factors are associated with the management of nasal bone fractures, including likelihood of operative intervention. Surgeons should consider the role that these factors and unconscious bias play in treatment.

Objective: Effective patient triage in specialized clinics is crucial for managing long waiting lists and mitigating clinical risk. This is often performed by non-clinical administrative staff, whose prioritization may differ from clinical experts. This study aimed to compare the triage performance of Large Language Models (LLMs) against human staff, using senior clinicians as the gold standard.

Study design: A cross-sectional survey study was conducted at a tertiary medical center. A custom survey presenting 19 clinical vignettes was administered to secretaries, dental assistants, and five distinct LLMs (Chat GPT-o3, Chat GPT-o4, Gemini Pro2.5, Gemini Flash2.5, OpenEvidence). Participants ranked hypothetical patients by urgency. An expert panel of senior clinicians established a gold-standard ranking for comparison. Agreement was assessed using Fleiss' κ and Cohen's weighted κ.

Results: Artificial intelligence (AI) models demonstrated significantly higher agreement with the expert gold standard (Fleiss' κ = 0.572) compared to dental assistants (κ = 0.249) and secretaries (κ = 0.227). The AI cohort also showed superior internal consistency (Cronbach's α = 0.950). Among individual models, GPT-o3 (rationalization model) achieved the highest agreement (weighted κ = 0.681). Years of experience among human staff did not correlate with improved triage accuracy.

Conclusions: Contemporary LLMs can align more closely with expert clinical judgment in patient prioritization than non-clinical staff. While not a substitute for human oversight, AI shows significant promise as a reliable and consistent decision-support tool to augment existing triage processes, potentially enhancing patient safety and improving resource allocation in specialized care.

Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is a complex oral condition for which no global consensus on management currently exists, underscoring the need to establish internationally accepted therapeutic protocols. The use of platelet-rich fibrin (PRF) and the adjunctive administration of pentoxifylline and tocopherol (PenTo) have shown promising preliminary results in the clinical management of MRONJ; however, robust data remain limited. The aim of this study is to analyze the outcomes of surgically treated patients with stage I and II MRONJ, incorporating PenTo as an adjuvant to platelet concentrate therapy. Furthermore, the study seeks to evaluate both clinical and radiographic outcome variables throughout the follow-up period.

Methods: A controlled pharmacological clinical trial was conducted, using a standard drug regimen as the comparator. Total 20 patients diagnosed with stage I or II MRONJ were allocated into 2 groups: one group received surgical treatment combined with PRF, while the other underwent the same protocol supplemented with an adjuvant therapeutic regimen based on PenTo. Participants were recruited from the Oral Medicine Department, School of Dentistry, Universidad Católica de Córdoba.

Results: Statistically significant differences were observed in the mean duration of antiresorptive therapy, which was notably longer in patients with osteoporosis (P = .01). Zoledronic acid was the most frequently associated drug (P = .0019). The addition of PenTo to the treatment protocol was associated with improved clinical and radiographic outcomes, with statistically significant differences (P = .0138 and P = .0046, respectively). Furthermore, the diagnostic stage (I or II) showed a significant correlation with clinical improvement following treatment (P = .0294). The healing index at 15, 90, and 180 days was higher in the group receiving PenTo, with statistically significant differences at each time point (P = .0441; P = .0001; P = .0018, respectively). In oncological patients, the healing index was also higher at all follow-up stages, with clear statistical significance (P = .0294; P = .0004; P = .0042).

Conclusions: This study contributes with patient-based evidence to support the interdisciplinary management of MRONJ. The combination of surgical treatment, PRF, and PenTo may serve to optimize and enhance clinical strategies for this condition.

Objective: To evaluate the epidemiological characteristics, comorbidity patterns, and economic burden of temporomandibular disorder (TMD)-related hospital emergency department (ED) visits in the United States using a nationally representative database.

Study design: A retrospective cross-sectional analysis of 2021-2022 National Emergency Department Samples data identified TMD-related ED visits using ICD-10 codes. Descriptive statistics summarized demographics, hospital characteristics, payer status, and comorbidities. Multivariable linear regression model determined associations between patient- and system-level factors and ED charges.

Results: A total of 52,412 TMD-related ED visits were identified. Most patients were female (67.5%) with a mean age of 39.5 years. Black (19.1%) and Hispanic (18.7%) patients were overrepresented. The mean ED charge per visit was $2,827. Common comorbidities included hypertension (12.9%) and depression (2.5%). Regression analysis showed that older age, higher income, and Western U.S. location were associated with higher ED charges. Medicaid and self-pay status predicted lower charges, while hypertension increased ED charges.

Conclusions: More than 52,000 TMD-related ED visits resulting in $147 million in ED charges highlight a major public health issue disproportionately affecting women, minorities, and low-income groups. Many visits may be preventable with improved outpatient care. Integrated, cost-effective, multidisciplinary strategies are needed to reduce emergency use and long-term complications.