Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Background: This study aimed to biomechanically evaluate ten different fixation methods following SSRO, simulating a 10mm mandibular advancement, with variations in plate position, angulation, and the use of bicortical screws.

Material and methods: Fifty polyurethane hemimandibles were randomly assigned to ten groups (n=5). SSRO was performed and stabilized using different configurations of 2.0mm plates and screws. Fixation methods included monocortical plates in varying angulations and positions, dual-plate systems, and hybrid techniques incorporating bicortical screws. All specimens underwent three-point compression testing using a universal testing machine. Peak compressive force and displacement were recorded.

Results: The best biomechanical performance was observed in the group using two straight plates placed laterally at a +20° angle (Group 5). Groups employing hybrid or dual-plate systems performed significantly better than those using a single plate. Bicortical screws reduced horizontal displacement but were less effective alone in resisting vertical compressive forces.

Conclusions: Dual-plate fixation with specific angulation improves resistance to compressive forces in large mandibular advancements. The use of a single plate is not recommended unless combined with bicortical screw support.

Background: Clinical practice guidelines (CPG) are developed to summarize the available evidence for healthcare professionals and standardize decisions in the clinical setting. For them to be useful, they must be generated following systematic methods, have high scope and applicability, present information clearly, and be updated every five years. The main aim of this review was to evaluate the available CPGs on the diagnosis and treatment of third molars (3M) using the AGREE II instrument to assess their quality and strength of recommendations.

Material and methods: An electronic search was conducted using the PubMed (MEDLINE), Cochrane Library, and Scopus databases. Additionally, a manual search was performed by international health organizations and dental and surgical associations. The inclusion criterion was CPG published in the last 5 years on the diagnosis and treatment of 3M. The quality of the guidelines was analyzed using the AGREE II instrument.

Results: 14 CPGs were identified; However, only seven met the inclusion criteria. The guidelines from the Spanish Society of Oral Surgery (SECIB) and the Malaysia Oral Health Programme (MOHP) were considered high-quality. In contrast, guidelines from the German Medical Association (DGMKG), French Society of Stomatology Maxillo-Facial Surgery and Oral Surgery (SFSCMFCO) and Royal College of Surgeons of England (RCSE) were rated as moderate quality and recommended with modifications. The Finnish Medical and Dental Society (FMDS) and Dutch Association of Oral and Maxillofacial Surgeons (NVMKA) did not meet the minimum quality standards.

Conclusions: The AGREE II analysis reveals a need for substantial improvement in third molar CPGs. Only two guidelines were rated as high-quality, with most being outdated or soon to be. Regular updates by guideline-developing organizations are essential to ensure accurate and relevant clinical recommendations.

Background: Surgical guides have recently been introduced in application to the open exposure of palatally displaced canines (PDCs). The present study assesses postoperative pain, fitting of the guide, surgery time and safety of the procedure.

Material and methods: A prospective case-series was conducted from March 2023 to October 2024. Patients 12 to 20 years of age with at least one PDC requiring treatment with a combined orthodontic fixed appliances and surgical approach were included. Surgical templates were obtained after virtual planning. An intraoral scan was superimposed with cone-beam computed tomography to design the guide with a window according to the canine position. Flapless open exposure using the guide was performed, employing a scalpel and ostectomy with burs if needed. Surgery time (from the administration of local anesthesia to the start of the orthodontic attachment bonding or the placement of the protective pack), guide adjustment and intra-surgical complications were also reported. A questionnaire was given to the patient to record postoperative pain, analgesic consumption and any possible adverse event. Descriptive and bivariate analyses were performed.

Results: Ten patients (14 PDCs) were included. Computer-assisted PDC exposure lasted a median of 26 minutes (IQR = 18.00), and no complications were reported. All patients experienced mild post-operative pain (i.e., VAS < 40 mm). Pain intensity peaked between 2 and 24 hours post-surgery and gradually decreased over time. Surgical guides successfully fit in all cases. No fitting issues were noted that affected the accurate placement or functionality of the guide.

Conclusions: Computer-guided exposure of PDCs is a feasible minimally invasive approach that reduces surgery time and postoperative pain. The use of an individualized guide is an easy tool for increasing the safety and efficacy of this procedure.

Background: With advancements in deep learning-based dental imaging analysis, artificial intelligence (AI) models are increasingly being employed to assist in mandibular third molar surgery. However, a comprehensive overview of the clinical utility remains limited. This scoping review aimed to identify and compare deep learning models used in the radiographic evaluation of mandibular third molar surgery, with a focus on AI model types, key performance metrics, imaging modalities, and clinical applicability.

Material and methods: Following the PRISMA-ScR guidelines, a comprehensive search was conducted in the PubMed and Scopus databases for original research articles published between 2015 and 2024. Systematic reviews, editorial articles, and studies with insufficient datasets were excluded. Studies utilising panoramic radiographs and cone-beam computed tomography (CBCT) images for AI-based mandibular third molar analyses were included. The extracted data were charted according to the AI model types, performance metrics (accuracy, sensitivity, and specificity), dataset size and distribution, validation processes, and clinical applicability. Comparative performance tables and heat maps were utilised for visualisation.

Results: Of the initial 948 articles, 16 met the inclusion criteria. Various convolutional neural network (CNN)-based models have been developed, with U-Net demonstrating the highest accuracy and clinical utility. Most studies employed panoramic and CBCT images, with U-Net outperforming other models in predicting nerve injury and evaluating extraction difficulty. However, substantial variations in dataset size, validation procedures, and performance metrics were noted, highlighting inconsistencies in model generalisability.

Conclusions: Deep learning shows promising potential in the radiographic evaluation of mandibular third molars. To date, most studies have relied on two-dimensional images and focused on detection and segmentation, while predictive modeling and three-dimensional CBCT-based analysis are relatively limited. To enhance clinical utility, larger standardized datasets, transparent multi-expert annotation, task-specific benchmarking, and robust external/multicenter validation are needed. These measures will enable reliable pre-extraction risk prediction and support clinical decision-making.

Background: Robotic computer-assisted implant surgery (rCAIS) has been developed to enhance implant placement accuracy compared to static (sCAIS) and dynamic (dCAIS) computer-assisted implant surgeries. The aim of this systematic review and meta-analysis aimed to evaluate and compare the accuracy of rCAIS to other CAIS approaches.

Material and methods: Electronic searches were conducted in PubMed, Embase, Cochrane Library and CNKI up to September 2024. Additionally, a manual search of relevant journals and reference lists was performed. Clinical and preclinical studies comparing rCAIS with sCAIS or dCAIS were included. Primary outcomes were global platform deviation, global apex deviation, and angular deviation between planned and actual implant positions. Two independent reviewers extracted data and assessed risk of bias using RoB 2 for randomized trials, the ROBINS-I tool for non-randomized studies, the SYRCLE tool for animal studies, and the QUIN tool for in vitro studies.

Results: Eleven studies met the inclusion criteria. In clinical studies, rCAIS (157 implants) demonstrated significantly lower deviations compared to sCAIS (166 implants): Global platform MD=-0.73mm (95% CI: -1.00 to -0.45; p<0.00001), apex deviation MD=-0.84mm (95% CI: -1.12 to -0.56; p<0.00001), and angular deviation MD=-1.51° (95% CI: -2.71 to -0.32; p=0.01). In preclinical studies, rCAIS also outperformed dCAIS (both 270 implants): Platform deviation MD=-0.15mm (95% CI: -0.24 to -0.07; p=0.0002), apex deviation MD=-0.19mm (95% CI: -0.27 to -0.10; p<0.0001), and angular deviation MD=-1.03° (95% CI: -1.70 to -0.37; p=0.002).

Conclusions: rCAIS demonstrates superior accuracy compared to sCAIS or dCAIS. However, the magnitude of observed differences is small, and thus the improvements may not be clinically relevant despite the statistical significance. Further well-designed and large-scale studies are warranted to explore the influencing factors and optimize the clinical application of rCAIS.

Background: The COVID-19 pandemic caused major disruptions in healthcare services, especially affecting routine monitoring of patients with head and neck cancer (HNC) and oral potentially malignant disorders (OPMDs). Its disruption during the pandemic may have led to delayed diagnoses and worse outcomes.

Material and methods: This study included patients previously under follow-up at a referral center. All were invited for reassessment involving clinical examination and comparison with pre-pandemic records. Cases were categorized as stable, progressive, regressive (for OPMDs), or deceased. A biopsy was performed on any suspicious changes. Statistical analyses included chi-square, Fisher's exact test, odds ratios, and Kaplan-Meier survival estimates.

Results: A total of 246 patients were evaluated, including 103 patients with HNC and 143 with OPMDs. Patients were re-assessed post-pandemic and again during the latest follow-up. Among HNC, progression was more frequent in the post-pandemic period (26.9%) compared to the later appointment (24%), which was statistically significant (p=0.0011). Stability after the pandemic was linked to better prognosis (OR=4.667; p=0.0051). Survival analysis revealed significantly lower survival rates for the post-pandemic group compared to those followed during subsequent follow-up (HR=0.26; p<0.0001). For OPMDs, progression was observed in 27.28% post-pandemic and 19.14% in the other group (p=0.0214). However, prognosis in the latest follow-up was not significantly associated with post-pandemic status (p=0.1292). Outcome distribution by lesion subtype was significant over time (p=0.0046) and at the latest follow-up (p=0.0088). Patients with proliferative verrucous leukoplakia exhibited a higher rate of progression. Survival analysis also revealed a significantly lower survival rate in the first period (HR=0.52; p=0.037).

Conclusions: These results underscore the lasting consequences of follow-up interruption. Delays in monitoring may lead to progression or delayed diagnosis, especially in high-risk patients.

Background: Return to work is an important marker of rehabilitation. While many head and neck cancer survivors are motivated to resume work, they often face greater disability and reintegration challenges than other cancer survivors due to clinical and psychosocial factors. The objective of this study was to identify determinants of return to work and to explore barriers and facilitators to workforce reintegration among head and neck cancer survivors.

Material and methods: This cross-sectional study of 215 head and neck cancer survivors at two stomatology services used questionnaires to assess socioeconomic, clinical, illness-related, employment, and psychosocial factors. The statistical analysis evaluated correlations with return to work.

Results: Among 215 participants, 137 (63.7%) returned to work. Smaller tumors (p < 0.0001), no lymph node (p = 0.0076), or distant metastases (p = 0.0122) positively influenced reintegration. Radiotherapy (p = 0.0005) and chemotherapy (p = 0.0001) negatively impacted. Completing treatment within six months improved reintegration (67.5%; p = 0.0004), while tracheostomy reduced it (12.5%; p = 0.0021). Neck hypersensitivity (p = 0.0009), paresthesia with incomplete eye closure (p = 0.0027), paresthesia of the corner of the mouth (p = 0.0098) and functional restrictions hindered reintegration. White-collar workers (75.0%) returned more often. Returning survivors had higher anxiety (69.3%; p = 0.0366), quality of life (89.1%; p < 0.0001), higher income (p = 0.0022), and education (p = 0.0110).

Conclusions: Socioeconomic status, education level, tumor characteristics, and treatment modalities significantly affect return to work rates. Physical and functional impairments, along with differences in occupational categories, further hinder reintegration, underscoring the importance of tailored strategies.

Background: Zinc has been used as a topical therapeutic agent for the management of various oral and dermatological conditions. The purpose of this systematic review was to evaluate the effectiveness of topical zinc therapy in the prevention and treatment of oral mucosal diseases.

Material and methods: A comprehensive literature search across four databases identified studies evaluating the effects of topical zinc therapy on oral mucosal diseases. Two independent reviewers evaluated the identified studies, extracting relevant data. Risk of bias assessment and meta-analysis were performed for randomized controlled trials (RCTs).

Results: This systematic review included 14 studies: eight on oral mucositis, three on recurrent aphthous stomatitis (RAS), two on oral lichen planus (OLP), and one on herpes simplex virus (HSV) infection. Among them, seven studies on oral mucositis, two on RAS, and two on OLP were RCTs. The oral mucositis studies demonstrated that topical zinc therapy significantly alleviated cancer therapy-induced oral mucositis, with meta-analysis confirming significant improvement at weeks 2, 3, and 4 compared with control treatments. For RAS, topical zinc therapy reduced pain intensity and ulcer size although significant differences between treatment and control groups were observed in only one RCT. For OLP, two RCTs reported symptom improvement although treatment outcomes varied. Additionally, a case series has suggested the potential benefit of topical zinc in mitigating HSV recurrence.

Conclusions: Topical zinc therapy has promising efficacy in managing oral mucosal diseases, particularly in cancer therapy-induced oral mucositis. However, evidence for other conditions remains limited. Further comprehensive RCTs are needed to establish its effectiveness across various oral mucosal diseases.

Background: Maxillofacial infections (MIs), particularly surgical site infections (SSIs) following orthognathic surgery, represent a significant clinical concern due to their potential severity and impact on treatment outcomes. Although antibiotic prophylaxis is standard practice, growing bacterial resistance-especially in penicillin-allergic patients-challenges the effectiveness of alternative regimens such as clindamycin.

Material and methods: This retrospective study analyzed 100 consecutive patients who underwent orthognathic surgery between 2022 and 2023, performed by the same surgical team. All patients received standardized perioperative care, including hospitalization and intravenous (IV) antibiotic prophylaxis with cefazolin or clindamycin for those allergic to penicillin. The incidence of SSIs was evaluated and correlated with the type of antibiotic used. Microbial cultures and antibiograms were obtained from infected cases requiring surgical wound revision.

Results: Of the 100 patients, 98 received prophylactic cefazolin and showed no SSIs. The remaining 2 patients, both allergic to penicillin and treated with IV clindamycin, developed SSIs within the first postoperative week. Both cases required surgical drainage, hospitalization, and culture-based antibiotic therapy. Pathogens isolated included Streptococcus mitis, S. oralis, S. constellatus, and Haemophilus parainfluenzae, all resistant to clindamycin and erythromycin but sensitive to beta-lactams and fluoroquinolones. Both patients responded favorably to ciprofloxacin and metronidazole.

Conclusions: This study highlights a significant risk of infection associated with clindamycin prophylaxis in penicillin-allergic patients undergoing orthognathic surgery. Cefazolin proved effective in preventing SSIs. These findings underscore the urgent need for updated, evidence-based prophylactic protocols in maxillofacial surgery, particularly for patients with beta-lactam allergies.

Background: Lactoferrin in saliva has been proposed as a possible diagnostic biomarker for Alzheimer's disease, as it is associated with ß-amyloid load in the brain. The aim of this study was to find out whether there is an association between salivary lactoferrin and cerebral ß-amyloid load and the involvement of periodontal disease in this possible connection.

Material and methods: Six exploratory comparison groups were designed: participants with mild cognitive impairment (n=50) (positive PET-amyloid with and without periodontal disease and negative PET-amyloid with and without periodontal disease) and cognitively normal older individuals with and without periodontal disease (n=19). All participants were recruited from referral hospitals in Granada, Spain, and from a nursing home in the same socio-economic area as the hospital participants. A salivary lactoferrin determination and a periodontal assessment has been performed in each of the participants.

Results: The results show that both having an atypical ß-amyloid load in the brain (PET+) and having periodontal disease are clearly associated with a lower concentration of salivary lactoferrin (p=0.011 and p=0.032), but not with age or gender.

Conclusions: In this studio, the positive PET-amyloid and periodontal disease are related independently with lower lactoferrin levels.