Journal of the Korean Association of Oral and Maxillofacial Surgeons最新文献

The maxillary anterior region, often referred to as the "esthetic zone," presents unique challenges in implant dentistry, especially when complications such as implant malposition occur. Malpositioned implants can lead to esthetic concerns, including gingival recession or implant fixture exposure, often resulting from facial placement following immediate implantation after tooth extraction. This case report outlines the successful correction of a facially malpositioned maxillary anterior implant using segmental osteotomy facilitated by three-dimensional (3D) technology and a micro-saw, combined with simultaneous autogenous bone grafting to enhance prosthetic esthetics. The segmental osteotomy was performed with a pre-fabricated 3D guide. The bone segment was rotated 180° and repositioned to achieve optimal implant orientation, securing primary stability without additional fixation. Postoperative outcomes showed complete resolution of buccal exposure, satisfactory soft tissue contour, and successful osseointegration. Subsequently, a provisional and definitive restoration was fabricated for molding gingival contour using a digital technique. This technique also shortened the treatment timeline by avoiding implant removal and additional grafting procedures. These findings suggest that segmental osteotomy with 3D guidance is a minimally invasive and effective approach for correcting malpositioned implants.

Objectives: This retrospective study aimed to evaluate the prognosis of immediately placed implants with low or no primary stability.

Materials and methods: Sixteen sandblasted, large-grit and acid-etched-surfaced implants with low primary stability, defined as an insertion torque value of less than 10 Ncm and an mean initial Implant Stability Quotient (ISQ) value of less than 55, were placed in 16 patients (7 males and 9 females) using the flapless surgical approach, with a mean patient age of 48.8 years. Implant stability was measured using the ISQ system (Osstell) immediately after implant placement and at the time of impression taking, which was performed on average 13 weeks later.

Results: Excluding six cases where the initial ISQ values could not be measured because of extremely low primary stability, the average initial and final ISQ values were 42.2±7.5 and 68.7±7.6, respectively (P<0.01). The survival rate of the implants was 100% after an average follow-up period of 65.18 months.

Conclusion: These findings indicate that even immediately placed implants with low or no primary stability can achieve successful osseointegration and long-term survival.

Objectives: This study aims to evaluate the stability of the sagittal split ramus osteotomy (SSRO) and contralateral intraoral vertical ramus osteotomy (IVRO) surgery with resorbable fixation.

Patients and methods: A total of 16 patients who underwent orthognathic surgery using SSRO with contralateral IVRO approach and resorbable fixation for the treatment of facial asymmetry at the Department of Oral and Maxillofacial Surgery, Gangneung-Wonju National University Dental Hospital from 2003 to 2023 were included. Lateral cephalogram images that were taken at the time point of preoperative (T0), immediately postoperative (T1) and one year after surgery (T2) were measured. The B point position changes were statistically analyzed.

Results: The sella-nasion-B point (SNB) angle and vertical reference line to B point (VRL-B) value showed significant differences between T0 and T1 (P<0.001), as well as between T0 and T2 (P<0.001), but no significant differences were found between T1 and T2 (SNB angle; P=0.460, VRL-B; P=0.638). The HRL-B value showed significant difference between T0 and T2 (P=0.008), but not between T0 and T1 (P=0.069) or between T1 and T2 (P=0.191).

Conclusion: In the present study, the combined SSRO with contralateral IVRO approach appears to offer reliable postoperative stability in asymmetric mandibular setback.

Objectives: Osteoradionecrosis of the jaw (ORNJ) is a serious late complication in patients with head and neck cancer who have undergone radiation therapy. This study aimed to identify clinical and treatment-related risk factors associated with the development of ORNJ and to evaluate the therapeutic outcomes across various treatment modalities.

Materials and methods: A retrospective analysis was performed on 80 patients diagnosed with ORNJ following radiotherapy (RT) for head and neck malignancies. Patient demographics, oncologic characteristics, and treatment histories were reviewed. Clinical outcomes of conservative therapy, sequestrectomy, and partial mandibulectomy were assessed. Ordinal logistic regression analysis was conducted to determine associations between treatment modality and disease course (improved, stable, or progressed).

Results: Most ORNJ cases developed spontaneously within 48 months post-RT. Surgical intervention was performed in 73.8% of patients, with sequestrectomy being the most frequently applied procedure. Overall outcomes were classified as improved in 26.3%, stable in 37.5%, and progressed in 36.3% of cases. Ordinal logistic regression revealed that conservative treatment (odds ratio [OR]=4.64, P=0.041) and sequestrectomy (OR=4.92, P=0.022) were significantly associated with poorer outcomes compared to partial mandibulectomy. This association remained significant in Stage III ORNJ, whereas no statistically significant differences were observed in Stages I and II, although trends varied depending on treatment type.

Conclusion: This study underscores the prognostic relevance of treatment modality in ORNJ management. Partial mandibulectomy appears to confer more favorable outcomes in advanced-stage ORNJ, although its invasive nature necessitates individualized treatment planning. Future prospective studies incorporating dosimetric parameters and long-term follow-up are warranted to establish evidence-based guidelines for ORNJ treatment.

Objectives: This study aimed to compare the effectiveness of cryotherapy using a facial ice pack wrap and Romo-Vac drainage in postoperative management of patients undergoing open reduction and internal fixation (ORIF) for mandibular fractures, with a focus on reduction of oedema, pain relief, mobility limitation, and patient satisfaction.

Materials and methods: A prospective, randomized, open-label, monocentric clinical trial was conducted on 30 patients with mandibular fractures requiring ORIF. Participants were randomly assigned to receive either a facial ice pack wrap (Group I) or Romo-Vac drainage (Group II) postoperatively. Standardized surgical and pharmacological protocols were followed. Oedema was assessed using linear facial measurements on Days 0, 1, 3, 7, and 21. Pain was measured using a visual analogue scale, and subjective parameters-comfort, mobility, and satisfaction-were evaluated via structured patient questionnaires.

Results: Group I demonstrated significantly reduced postoperative swelling compared to Group II (P=0.001), with the largest difference on Day 3. Pain scores were consistently lower in Group I, though not statistically significant. Group I participants reported significantly less discomfort (P=0.001), fewer mobility limitations (P=0.001), and greater overall satisfaction (P=0.001) than those in Group II. The Romo-Vac drain was associated with more postoperative inconvenience and movement restrictions.

Conclusion: Cryotherapy using a facial ice pack wrap is more effective than Romo-Vac drainage in minimizing postoperative oedema and discomfort following ORIF in mandibular fracture cases. It also improves patient satisfaction and facilitates early mobility, supporting its use as a preferred postoperative care strategy.

Odontogenic infections are common in the oral and maxillofacial region but rarely progress to life-threatening intracranial complications such as brain abscess. We report a rare case of a right maxillary odontogenic infection leading to a brain abscess in a previously undiagnosed, uncontrolled diabetic patient. A 42-year-old male presented with facial swelling and pain after endodontic treatment of the right maxillary premolars and molars. Initial improvement was achieved with incision, drainage, and antibiotic therapy; however, neurological deterioration occurred within days. Imaging revealed a right temporal lobe abscess, and Klebsiella pneumoniae was isolated from earlier blood and sinus cultures. The patient required multiple neurosurgical and maxillofacial interventions during a 106-day hospitalization. This case underscores the potential for rapid intracranial spread of odontogenic infections in immunocompromised hosts and highlights the importance of early neuroimaging and aggressive management in high-risk patients.

Objectives: Persistent idiopathic facial pain (PIFP) is a rare, chronic disorder affecting the oral and maxillofacial region, without obvious clinical or neurological deficit. This study aims to evaluate the various dental treatments associated with PIFP and the pharmacologic treatment outcomes.

Patients and methods: This retrospective study included the patients with PIFP according to the definition of the International Classification of Headache Disorders (ICHD) 2018, who were treated from January 2020 to September 2024 at the authors' hospital. The inclusion criteria were that PIFP occurred after dental procedures without a history of trauma or any clinical cause for the pain. Patient's pain characteristics, location, triggering events, and response to related medications and treatments were investigated.

Results: A total of 21 patients were identified, and most patients were related to dental implant treatment (n=15, 71.4%). Most patients experienced pain in the molar region (n=20) and experienced radiating pain to distant areas (n=16). Surgical treatment for pain control of PIFP, such as implant removal, tooth extraction or prosthesis removal, was attempted for 16 patients. However, 93.8% of these patients did not show relief of pain. The use of medications resulted in a significant decrease in pain for 18 patients (85.7%). Among 18 patients, 12 patients received with a combined medication therapy. The responsiveness to these medications was found to be tricyclic antidepressants (100%), gabapentin (57.1%), pregabalin (55.6%), clonazepam (54.5%), and Serotonin-norepinephrine reuptake inhibitor (50%).

Conclusion: Since PIFP after dental treatment is highly related to dental implant treatment, differential diagnosis of the PIFP is important for patients who complain of persistent implant pain with no clear cause. Combined medication was effective in most patients with PIFP. Importance of the diagnosis of PIFP after dental treatment for pharmacologic management is emphasized.