Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Background: A study was made of the clinical periodontal changes and buccal cortical bone modifications using cone-beam computed tomography (CBCT) in anterior maxillary teeth with chronic apical periodontitis one year after periapical surgery with submarginal incision.

Material and methods: A prospective case series analysis was made of anterior teeth subjected to apical surgery and submarginal incision with a follow-up period of 12 months. Clinical periodontal parameters were recorded, along with tomographic measurements of the buccal cortical bone and volume of the lesion (in mm3) before and one year after surgery. Success was assessed based on the clinical and tomographic data.

Results: Thirty-six anterior maxillary teeth from 36 patients with a mean age 43.1 years were enrolled in the study. One year after surgery, mean gingival recession was found to be 0.19 mm with a clinical attachment loss of 0.28 mm. Marginal bone loss was 0.25 mm. The thickness of the buccal cortical bone decreased at all three measurement points, with the greatest decrease being observed at 3 mm from the bone crest (0.58 mm). The distance from the apex to the buccal cortical bone (depth of the apex) decreased 0.59 mm at one year. The clinical parameters (clinical attachment level and probing depth) were not correlated with the tomographic measurements (cementoenamel junction-bone crest distance). The mean lesion volume was 457 mm3 at baseline versus 28.4 mm3 one year after surgery, representing a decrease of 93.8% in 12 months. The success rate at one year postsurgery was 94.4%.

Conclusions: One year after apical surgery of anterior maxillary teeth with submarginal incision, only minimal clinical periodontal and tomographic changes are observed, with no clinical relevance. The mean lesion volume decreased 93.8%, and the success rate was 94.4%.

Background: The study aimed to investigate the risk factors that could affect intraoperative blood loss in patients who underwent orthognathic surgery.

Material and methods: The study included a retrospective analysis of 400 patients who underwent bimaxillary orthognathic surgery. Data on demographic, surgical, and hematological parameters affecting intraoperative blood loss were statistically analyzed.

Results: The mean intraoperative blood loss of male patients was statistically higher than that of female patients (p ≤ 0.001). The mean blood loss was higher in patients aged 25 years and older than in patients aged 17-24 (p=0.004). Patient weight and duration of surgery were positively correlated with the amount of intraoperative bleeding (r = 0.280 and r = 0.371). Platelet (PLT) count negatively correlated with blood loss (r=-0.213). The MPV/PLT ratio and hemoglobin (HGB) levels were positively correlated with bleeding (r=0.208 and r=0.110).

Conclusions: In orthognathic surgeries, factors such as age, gender, body mass, and duration of surgery were found to be associated with intraoperative blood loss. Males, patients over 24, overweight patients, and prolonged surgical procedures are all significant risk factors for bleeding. In addition, high HGB levels, low platelet count, and low MPV/PLT ratios are also associated with an increased risk of blood loss.

Background: Oral leukoplakia is the most frequent and representative potentially malignant disorder of what is known as oral precancer. Since the first descriptions, this pathology, which initially seems simple, has been the subject of controversy and discussion, and it still maintains multiple unknowns and enigmas to be solved.

Material and methods: A narrative and integrative review of the epidemiological, pathogenetic, diagnostic, prognostic and therapeutic aspects of this important oral disorder has been carried out.

Results: Oral leukoplakia still presents multiple enigmas regarding its actual epidemiology, its multifactorial and multistage pathogenesis, its definition and diagnosis, its malignant development and its treatment.

Conclusions: We must conduct well-designed prospective studies on this fascinating oral pathology, on well-diagnosed clinical cases with clinicopathological criteria agreed and accepted by the scientific community. Only in this way will we be able to clarify the enigmas it still presents.

Background: After lower third molar surgery, suppurative infections can occur. They can spread into adjacent tissues, toward superficial mucosal or skin planes or toward deep facial and neck fascial spaces.

Material and methods: The 2020 PRISMA guidelines for systematic reviews were followed. A literature search was conducted, without initial time limit, in the Medline database, via Pubmed (MEDLINE), and SCOPUS. For the analysis of statistical significance, the hypothesis test on the difference between means with unknown variances was used.

Results: Eleven articles met the inclusion criteria. The total number of extractions taken from the articles included in the review is 7363, with a 5.35% total incidence of purulent infections. The incidence of purulent infections was found significantly higher in cases in which antibiotic prophylaxis was not performed.

Conclusions: Although lower third molar extraction is the most frequently performed oral surgical procedure, little has been written about post-operative purulent infections, in relation to risk factors, involved spaces, and performed therapies, so to be able to identify preventive and therapeutic behaviors based on scientific evidence. Antibiotic prophylaxis is the only variable which resulted in determining a significative statistical reduction in the incidence of purulent infection after lower third molar surgery.

Background: To evaluate dental treatment approaches under general anesthesia in children with cancer.

Material and methods: DMF-T values of existing decay, missing and filled teeth of 68 pediatric patients receiving active cancer treatment were recorded. Systemic and physical examinations of patients were performed by a paediatrician. İntraoral and extraoral examinations of children were performed by pediatric dentists. The dental treatment plan encompasses the child's individualized oral health needs. Dental procedures are generally performed in the controlled environment of a hospital operating room under general anaesthesia. Analyzes were made with SPSS 25.0 package program.

Results: The study determined that the average age was 6.47±2.93. In this study, extraction-focused treatments were used instead of restorative (r=0.346, p=0.01) and endodontic treatments (r=0.274, p=0.01).

Conclusions: Despite the development of restorative and endodontic treatments under general anaesthesia, even pediatric crown applications, radical decisions must be made to control the medical condition of patients with childhood cancers.

Background: Behçet's Syndrome (BS) is a multisystemic vasculitis characterized by a heterogeneous clinical profile, including mucocutaneous, musculoskeletal, neurological, ocular, vascular and gastrointestinal manifestations. BS patients often experience a continuous, low-level disease activity state due to persistent oral ulcers. This study aimed to define relations among oral ulcer activity (OUA), gender and treatments through K-Means Cluster and Correspondence Analyses (CA) in patients with BS.

Material and methods: In this cross-sectional study, 526 BS patients from two tertiary centres in Turkey and the United Kingdom were included. The K-Means Cluster Analysis was performed to identify homogeneous clinical profiles for OUA by combining the disease severity score reflecting organ involvement and the number of oral ulcers. Then, CA was performed to visualize associations between gender and medications (non-immunosuppressive: non-IS vs. IS) in clusters.

Results: K-Means Analysis identified three clusters regarding mucocutaneous and major organ involvement and cluster regarding with major organ involvement. Clusters were named according to OUA and the disease severity. The number of oral ulcers was found to be similar in the "Low OUA" cluster (n=202, 65.03%; 2.18±1.13) and the "Low OUA with Major Organ Involvement" cluster (n=63, 19.25%; 2.19±1.37) (p=0.368). These were lower than those in the "Moderate OUA" Cluster (n=30, 9.8%; 7.60±1.88) and the "High OUA" cluster (n=11, 3.59%; 14.91±2.34) (p<0.001). CA visualized that non-ISs in "Low OUA" cluster, ISs in "Low OUA with Major Organ" cluster for both genders as well as male patients treated with non-ISs or ISs in "Moderate OUA" cluster were predominant groups.

Conclusions: The presence of two oral ulcers might be accepted as the cut-off value for low OUA. Moreover, intensive treatment protocols must be provided for elevated oral ulcer activity in male patients who were treated with non-IS medications in BS.

Background: Oral Pathology (OP) is an important part of diagnosing and managing oral and maxillofacial diseases. Despite being recognized as a specialty in Brazil for over 50 years, significant gaps remain in the availability of specialists and training programs. Therefore, this study aims to map and analyze the training of specialists in OP in Brazil.

Material and methods: A cross-sectional study was conducted using publicly available data from Brazilian governmental databases, including the Federal Council of Dentistry, the Brazilian Institute of Geography and Statistics, and the Ministry of Education. Variables analyzed included the number of OP specialists, their geographic distribution, training opportunities, and population coverage. Descriptive and comparative analyses were performed using Microsoft® Excel (version 2410) and Statistical Package for Social Sciences® (version 27.0).

Results: In 2024, 424 active OP specialists were registered in Brazil, composed of 240 women and 184 men, representing only 0.3% of all dental specialists. The ratio of OP specialists to inhabitants was 1:478,964, with marked regional disparities. The Southeast had the highest density, while the North had the lowest, with some states lacking any OP specialists. Additionally, 12 active OP training programs were identified, primarily concentrated in the Southeast. Most programs were distance learning, limiting opportunities for practical training. Temporal analysis revealed a decline in OP specialist registrations over the past two decades, despite population growth.

Conclusions: Brazil faces challenges in OP training, including insufficient specialists, uneven regional distribution and limited hands-on training opportunities. The expansion of hybrid training models and the promotion of the OP specialty among dental students are vital to address these issues. Collaborative efforts between educational institutions, professional organizations, and the government are essential to strengthen the specialty and improve early diagnosis rates of oral cancer.

Background: Large language models (LLMs), such as ChatGPT, have demonstrated potential in synthesizing complex clinical information, yet concerns persist regarding their accuracy and reliability in specialized domains. The rationale of this study is to address a gap in the literature by evaluating ChatGPT-4o's capabilities and limitations in terms of accuracy and reliability on oral and maxillofacial traumatology.

Material and methods: A total of 188 oral and maxillofacial trauma-related questions were selected from a comprehensive resource. Thirty questions were randomly chosen and submitted to ChatGPT-4o resetting to "new chat" mode every repetition to eliminate potential memory bias. Accuracy was scored using a 3-point Likert scale. Reliability was assessed with weighted kappa (κ) and Intraclass Correlation Coefficient (ICC), and internal consistency was evaluated using both Cronbach's alpha (α) and McDonald's omega (ω).

Results: The accuracy rates for comprehensive and adequate responses were calculated as 38% (95% CI: 32.5% - 43.5%) and 58% (95% CI: 52.1% - 63.3%), respectively. Weighted kappa (κ = 0.469) and ICC (0.503) indicated moderate reliability. Internal consistency metrics revealed excellent and good reliability, respectively (α = 0.904, ω = 0.860).

Conclusions: ChatGPT-4o demonstrated promising results as an adjunct tool in providing supplementary educational content, verifying critical information, and supporting the decision-making processes in oral and maxillofacial traumatology. Current limitations warrant further research. Future enhancements in LLMs and prompt engineering may assist in the optimization of their clinical applicability and alignment with evidence-based standards.

Background: This study aims to compare stresses from vertical and oblique forces on pterygoid and zygomatic implants, combined with dental implants, in a atrophic maxilla using finite element stress analysis.

Material and methods: A computed tomography scan was used to create a geometric model of a completely edentulous adult maxilla. The maxillary bone was scanned using cone beam computed tomography (ILUMA, Orthocad, CBCT, 3M Imtec, Oklahoma, USA), and the obtained sections were transferred to the 3D-Doctor (Able Software Corp., MA, USA) software. Two models were created in the study. In the first model, zygomatic and dental implants were used, while in the second model, pterygoid and dental implants were used. A 150 N vertical force and a 100 N oblique force at a 30-degree buccolingual angle were applied. With finite element analysis assessed stress distribution in the implants and peri-implant bone tissue.

Results: When the obtained stress data were examined, under vertical forces, the maximum stress on the implants was higher in Model 1 (151.984 MPa) compared to Model 2 (151.773 MPa), but no significant difference was observed. The stress formed in the metal substructure was higher in Model 2 (422.042 MPa) compared to Model 1 (308.376 MPa). The maximum principal stress in the alveolar bone was greater in Model 2 (46.866 MPa) compared to Model 1 (15.719 MPa), and the minimum principal stress in the alveolar bone was also greater in Model 2 (80.360 MPa) compared to Model 1 (76.310 MPa). Under oblique forces, the average stress on the implants was higher in Model 2 (128.297 MPa) than in Model 1 (79.607 MPa).

Conclusions: When the stresses occurring on zygomatic and pterygoid implants and the alveolar bone surrounding these implants were compared, it was observed that the use of zygomatic implants was more beneficial in reducing both dental and biomechanical stress.

Background: The best technique to harvest gingival graft to treat gingival recessions (GR) remains a topic of ongoing debate. This systematic review aimed to evaluate the effect of de-epithelialized free gingival graft (DFGG) compared to subepithelial connective tissue graft (SCTG) in the treatment of GR Miller Class I and II or Cairo type I.

Material and methods: Five databases were searched up to June 2024 to include randomized clinical trials (RCTs) comparing the clinical effects of DFGG with SCTG in the treatment of GR. The random effects model of mean differences was used to determine GR, and gain in keratinized tissue width (KTW), gingival thickness (GT) and clinical attachment level (CAL). The risk ratio was used to complete root coverage (CRC) at 6 and 12 months.

Results: Five RCTs including 183 and 111 GR at 6 and 12 months were included in this systematic review. The meta-analysis showed no statistically significant difference in GR reduction, gain in KTW, GT, CRC or CAL between groups at 6 and 12 months.

Conclusions: At 12 months, the clinical results of DFGG were similar to those of SCTG in the treatment of GR.