Medicina Oral Patologia Oral Y Cirugia Bucal最新文献

Background: Extraction of mandibular third molars (MTM) is one of the most frequent surgical procedures in Oral Surgery. This intervention is not without risks, as one of the most common is an injury of the inferior alveolar nerve (IAN). The main objective of this systematic review is to compare the coronectomy technique with conventional extraction of MTM with a high risk of injury to the IAN, thus determining whether coronectomy is an effective surgical alternative in preventing nerve injuries.

Material and methods: A bibliographical search was conducted in October 2024 in the Pub-Med and Cochrane-Database databases, and 211 studies were obtained. Finally, 16 studies were included in the systematic review, with a total sample of 2551 patients. 2280 coronectomy procedures and 841 extractions were performed.

Results: 6.22% of the coronectomies performed were unsuccessful. The incidence of IAN injury was 6.53% in the extraction group, while in the coronectomy group, it was only 0.56%. Permanent IAN injury was 1.18% and 0.13%, respectively. The most common complication in both groups was postoperative pain, with similar results, 15.69% in the extraction group vs. 14.21% in the coronectomy group. Lingual nerve injury was infrequent and transient in both groups, affecting 0.12% of extractions and 0.26% of coronectomies. The complication with the highest incidence in the coronectomy group was root migration, mainly during the first 6 months.

Conclusions: Coronectomy is a safe and effective alternative technique for the management of MTM with a high risk of IAN injury.

Background: Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a rare, benign gingival lesion with distinctive clinicopathological features. Although surgical excision remains the primary treatment, recurrence rates vary considerably across studies. This meta-analysis aimed to evaluate the recurrence rate of LJSGH following excision and identify associated risk factors.

Material and methods: A systematic review was conducted using MEDLINE, SCOPUS, and WHO LILACS database for articles published until April 2025. Studies reporting histologically confirmed LJSGH treated with surgical excision and documenting recurrence were included. Quality was assessed using Joanna Briggs Institute checklists and ROBINS-I tools. Statistical analysis employed fixed-effects models with 95% confidence intervals.

Results: Thirteen studies encompassing 119 patients met the inclusion criteria. The pooled recurrence rate was 7% (95% CI: 0.01-30.00%), with individual rates ranging from 0% to 66.7%. Most recurrences occurred within 2-8 months postoperatively (68.4%), though some were reported up to 5 years. Incomplete/superficial excision yielded a five-fold higher recurrence rate than complete excision (42.1% vs. 8.3%). Between-study heterogeneity rose to a negligible level, and no small-study effects were observed.

Conclusions: LJSGH presents a low recurrence risk post-excision. Complete excision with adequate margins is key to prevention. Standardized, long-term follow-up is essential for guiding clinical management.

Background: Oral squamous cell carcinoma (OSCC) is one of the most aggressive cancers in the oral cavity, often diagnosed at advanced stages, leading to significantly reduced survival rates. Traditional diagnostic methods, such as clinical examination and histopathology, have limitations in detecting early stages and assessing tumor variability. Molecular biomarkers, however, have shown great potential in overcoming these limitations by improving early diagnosis, prognosis, and personalized treatment. These biomarkers, when integrated with the TNM staging system, may provide more accurate and personalized clinical management.

Material and methods: A systematic review was conducted by searching PubMed, Scopus, and Web of Science databases for studies on biomarkers in OSCC published between January 2018 and December 2024. The studies were selected based on strict inclusion and exclusion criteria, focusing on those that investigated biomarkers related to OSCC diagnosis, prognosis, and therapeutic implications.

Results: This review includes 10 studies involving 1024 patients with OSCC. Key biomarkers such as Ki67, HSP60, Survivin, E-cadherin, and PD-L1 were significantly associated with tumor progression, lymph node metastasis, and poor prognosis. The combined use of these biomarkers with traditional histopathological methods could enhance diagnostic accuracy, allowing for better patient stratification and more targeted treatment approaches. Additionally, saliva-based biomarkers have emerged as a promising, non-invasive diagnostic tool with high sensitivity and specificity for early detection of OSCC.

Conclusions: The identification of specific biomarkers can significantly enrich the diagnostic, prognostic, and therapeutic management of OSCC, complementing the TNM staging system. These biomarkers are linked to critical clinical variables such as metastasis, survival, and response to treatment. Saliva-based biomarkers hold promise due to their non-invasive nature, but further validation through multicenter studies and standardization is required for their widespread clinical adoption.

Background: To systematically review the literature on clinicopathological features of keratoacanthomas (KA) in the oral and perioral region.

Material and methods: The review protocol as registered under the number CRD42022323274. Electronic searches were conducted in four databases with a specific search strategy using MeSH and free terms.

Results: 60 studies reporting 73 cases of KA were included in this systematic review. KA affects more men with a mean age of 49.09 years old. Sun-exposed area of the lower lip was the most common anatomical location of the perioral lesions (38.35%) and the oral mucosa (9.58%) of the intra-oral ones. The most frequent clinical presentation of the perioral lesions was of an ulcerated nodule (36.23) and intra-orally of an papule (11.59) or nodule (11.59). Incisional biopsies were the commonest procedure for the diagnosis. The histological findings commonly presented a hyperplastic epithelial tissue forming a crater-like structure filled with keratin. Slightly atypia, keratin pearls and an inflammatory infiltrate in connective tissue could also be seen. Surgical excision was the treatment of choice in the majority of cases (45.71%). A low recurrence rate (6.89%) was seen in a mean follow-up time of 20.54 months.

Conclusions: KA affects commonly sun-exposed areas of men in their sixth decade of life. Given the similarity of squamous cell carcinoma, it is important to study KA to help clinicians with the correct diagnosis and treatment.

Background: The relationship between impacted mandibular third molars and mandibular incisor crowding remains controversial. This study aimed to evaluate whether the impaction pattern of mandibular third molars is associated with lower incisor crowding using cone-beam computed tomography (CBCT).

Material and methods: A retrospective sample of 140 patients was analyzed, including 70 with unilateral and 70 with bilateral mandibular third molar impactions. Little's Irregularity Index (LII) was measured on CBCT images to quantify incisor crowding. Arch length, depth, intercanine width, and intermolar width were also recorded. Non-parametric tests were used to compare groups, and intra-observer repeatability was assessed.

Results: The mean LII was 9.0±4.8, with 85% of patients showing some degree of crowding. Bilateral impaction cases presented significantly higher LII scores than unilateral cases (p=0.047). However, no significant differences were found in arch dimensions between groups, and LII was not associated with gender or age. Categorical analysis of crowding prevalence did not differ significantly between unilateral and bilateral groups.

Conclusions: Bilateral mandibular third molar impaction showed a weak association with greater mandibular incisor irregularity. Crowding is a multifactorial condition, and CBCT may provide additional insight into its assessment in patients with impacted third molars.

Background: This prospective split-mouth clinical study aimed to compare and evaluate bleeding, soft tissue healing, and pain management following tooth extractions using either the Lumina Coat® membrane or the Hemospon® sponge.

Material and methods: Thirty-two alveoli were included in this study. Following extraction, the sockets were filled with one of two materials: the Hemospon® collagen sponge (control group) or the Lumina Coat® collagen membrane (test group). Participants were assessed at 30 minutes, 24 hours, and 48 hours postoperatively to evaluate bleeding, and were then recalled after 7 days for clinical assessment of soft tissue healing and suture removal. Soft tissue healing and bleeding were scored on a 0-3 scale, while pain was assessed using the visual analog scale (VAS). Data were expressed as means with standard deviations and analyzed using Prism 9 (GraphPad Software).

Results: During the later postoperative period, pain scores decreased in both groups. Initial pain scores were 2.20 in the Lumina Coat group and 2.80 in the Hemospon group. By day 7, both groups reported an average score of 0.25 (p>0.05). Bleeding scores were elevated in both groups in the early postoperative phase. The Lumina Coat group had an average score of 1.35, compared with 1.65 in the Hemospon group. Scores decreased progressively over the first 24 hours, after which bleeding resolved completely. A statistically significant difference was observed at 30 minutes, with the Lumina Coat group showing lower scores (average 0.75) compared with the Hemospon group (average 1.20). Healing scores followed a similar pattern - higher in the immediate postoperative period but declining after 7 days. At 2 days postoperatively, the Lumina Coat group demonstrated significantly lower healing scores (average 0.35) than the Hemospon group (average 0.80).

Conclusions: Both materials were effective in controlling pain, reducing bleeding, and promoting soft tissue healing. However, the Lumina Coat group showed superior outcomes compared to Hemospon, particularly in reducing bleeding and improving healing scores.

Background: This scoping review aimed to comprehensively synthesize the current evidence and gaps regarding the use of chlorhexidine (CHX) in oral wound healing after surgical procedures.

Material and methods: PRISMA-ScR reporting guidelines were followed. A systematic search of MEDLINE, Embase, Web of Science, and Scopus was conducted to identify primary-level studies published before July-2024.

Results: Sixty-six studies, encompassing 6,763 patients met eligibility criteria. Third molar extractions were the most studied procedures (n=44), where CHX use consistently improved wound healing, significantly reduced the risk of alveolar osteitis and alleviated postoperative pain, with over 70% of studies reporting favorable outcomes. CHX application, across different concentrations and pharmaceutical forms, was consistently associated with better wound healing, with gels (n=29) and rinses (n=36) showing favorable results in 75% and 80% of studies, respectively; both 0.12% (n=21, 72.7%) and 0.20% (n=41, 81.3%) concentrations proved effective, with short-term postoperative regimens (7 days, n=27) or intraoperative application (n=22) emerging as the most reliable protocols. Moreover, combinations of CHX with adjuvant agents, particularly chitosan (n=4) and hyaluronic acid (n=5), demonstrated synergistic benefits, although the number of available trials remains limited.

Conclusions: In conclusion, current evidence supports the application of CHX as an effective and low-cost adjuvant in optimizing oral wound healing and preventing postoperative complications, singularly alveolar osteítis and postoperative pain after third molar extractions. Both gel and rinse formulations, as well as concentrations of 0.12% and 0.20%, have been shown to be effective, with indications related to clinical context and duration of use. Finally, CHX associatiations with chitosan and hialuronic are promising, although still based on a low evidence level. Future well-designed clinical trials are needed to address current evidence gaps, standardize administration protocols and further explore synergistic combinations.

Background: This study aims to provide Deep Learning (DL) based artificial intelligence (AI) methods using histopathology images to diagnose different types of odontogenic cysts differentially.

Material and methods: Within the scope of the proposed study, hematoxylin and eosin (H&E) stained images of 3 different cyst groups were used. The dataset consists of histopathology images of 87 Dentigerous cysts (DC), 198 radicular cyst (RC), and 63 odontogenic keratocyst (OKC). Each image was zoomed with 3 different zoom levels and resized to 224x224 as preprocessing. In addition to the classical CNN method, Inception V3, VGG16, VGG19, and Xception architectures were used. The data set was split into training, validation, and test groups to avoid retesting.

Results: The average accuracy, precision, sensitivity (recall), and F1-Score values obtained for CNN were 0.77, 0.80, 0.77, 0.75, and for VGG16 were 0.89, 0.90 0.89. 0.89. For VGG19, these values were determined as 0.89, 0.90, 0.89, and 0.88, for Xception, these values were determined as 0.62, 0.52, 0.62 and 0.52 and for Inception, these values were determined as 0.62, 0.62, 0.62 and 0.56.

Conclusions: It was observed that VGG16 and VGG19 models showed superior performance on the data set in question, while Xception and Inception V3 models converged slower, meaning the training process progressed slower. Results showed that deep neural networks can be efficiently used in detecting OCs. AI-based OC detection may be a decision support tool that reduces interprofessional variability, expedites the diagnostic process, and lessens clinician workload.

Background: Immediate implant placement is a technique-sensitive procedure, requiring precise positioning on the palatal aspect to ensure ideal prosthetic emergence and contour. Achieving primary stability is essential for the placement of an immediate provisional crown. The Inverted Co-Axis implant is uniquely designed for this purpose, featuring a 12-degree angled neck and a widened middle third, allowing central positioning within the alveolar socket while maintaining primary stability. Given its uncommon use, this study aimed to compare the performance of the Inverted Co-Axis implant with that of a conventional conical implant.

Materials and methods: A randomized controlled trial was conducted with 30 patients, equally divided into two groups (n=15). Immediate implants were placed in the anterior maxilla, each restored with an immediate provisional crown and accompanied by connective tissue grafting during surgery. Outcomes included implant survival, success rates, primary stability (insertion torque, ISQ), bone remodeling, and aesthetic results. Statistical analysis comprised descriptive measures (mean, SD, median, quartiles) and appropriate inferential tests: Mann-Whitney U, Wilcoxon signed-rank, Student's t-test, Chi-square, Kruskal-Wallis, Spearman's correlation, and Brunner-Langer. Significance was set at α=0.05.

Results: All implants survived (100% survival rate). Success rates were 93.3% in the control group and 73.3% in the test group, with no statistically significant difference. Insertion torque averaged 35 Ncm (control) and 42 Ncm (test), with ISQ values between 56-62 in both groups. Minimal horizontal bone loss was observed at 1mm, 3mm and 5mm. Vertical bone loss was greater on the buccal aspect in the test group, while palatal loss was higher in the control group. Aesthetic evaluation via the Pink Esthetic Score yielded comparable results.

Conclusions: Both implant designs proved effective and reliable for immediate post-extraction implantation, with favorable outcomes in stability, bone preservation, and aesthetics.

Background:  Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of malignant neoplasms of the oral cavity. At early stages, the treatment of choice is surgical resection with clear margins, commonly defined as ≥5mm of tumor-free tissue. However, the optimal surgical margin in relation to recurrence and survival remains controversial. The objective of this study was to evaluate the impact of surgical margin status on local recurrence and overall survival in patients with OSCC through a meta-analysis.

Material and methods: An electronic search was conducted in Medline-PubMed, Web of Science, and Scopus up to January 2025. Two investigators independently selected the studies according to the inclusion criteria. The study included prospective and retrospective studies assessing patients with oral squamous cell carcinoma who underwent surgical treatment and reported data regarding surgical margin status, recurrence rates, and survival outcomes. The Newcastle-Ottawa Scale was used for non-randomized observational studies. Odds ratios were estimated with 95% confidence intervals, and forest plots were generated using random-effects or fixed-effects meta-analyses depending on heterogeneity. Sensitivity analyses and publication bias analyses were performed using funnel plots and Egger's test. All statistical analyses were conducted using Comprehensive Meta-Analysis software, version 3.0.

Results:  Positive margins (<5mm) were significantly associated with a higher rate of local recurrence (OR=2.72; 95% CI: 2.04-3.62; p<0.001), while negative margins (≥5mm) were linked to a 1.58 -fold increase in the probability of 5-year survival (RR=0.63; 95% CI: 0.55-0.74; p<0.001).

Conclusions:  Surgical margin status is a prognostic factor for locoregional control and overall survival in OSCC. A cutoff value of ≥5 mm is proposed as the optimal surgical margin.