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

Objectives: The purpose of this study was to analyze the survival rate of implants placed in the anterior mandible to evaluate the impact of various prosthetic restoration parameters, including loading protocols, opposing teeth type, prosthesis type, retention type, and cantilever, on implant survival and to evaluate potential risk factors, including systemic disease, associated with implant failure.

Patients and methods: : Here, 604 implants installed in the anterior lower jaws of 326 patients that had at least one follow-up visit after prosthetic restoration were included. Implant failure was defined as removal of the implant from the oral cavity. For survival rate analysis, the survival period was defined from the date of implantation to the date of failure or last examination. Survival analysis was conducted using Kaplan-Meier survival curves. Cox regression analysis was performed to identify factors affecting implant survival.

Results: Of the 604 implants placed in the mandibular anterior region, 14 failed, a cumulative survival rate of 97.68%. The survival curve varied according to loading method, with immediate loading demonstrating a significantly lower cumulative survival rate compared to early and conventional loading. Survival curves also differed according to retention type, with screw-retained implants having significantly lower cumulative survival than cement-retained and attachment-retained implants. Cantilevered designs also showed significantly reduced cumulative survival compared to non-cantilevered designs. Conventional loading was significantly less likely to fail compared to immediate loading.

Conclusion: The design of implant-supported prostheses affects the survival of implants placed in the mandibular anterior region. Immediate loading is a risk factor associated with failure of implants in the anterior mandible.

Objectives: This study aimed to compare composite radiographic index (CRI-index) findings of medication-related osteonecrosis of jaws (MRONJs) and non-medication related osteonecrosis of jaws (n-MRONJs) and predict factors predictive of recurrence and healing delays.

Materials and methods: Patients referred to our clinic for stage 2 and 3 MRONJ and n-MRONJ between 2020 and 2023 were included in this study. Microorganisms were isolated in samples of excised bone obtained from the adjacent bone by surgery. CRI-index was evaluated using radiological data. Patient age, sex, causes and localization of osteomyelitis, as well as intraoperative and postoperative complications were recorded.

Results: There were no statistically significant differences in CRI-index score between the two groups (P>0.05). Presence of actinomyces colonies was not a significant predictor of recurrence or healing status. Furthermore, the presence of actinomyces colonies was not predictive of recurrence in the MRONJ group (P=0.035); however, the use of the antiresorptive agent denasumab was found to be a risk factor for recurrence in the MRONJ group (P=0.035).

Conclusion: Radiological and clinical findings were similar for MRONJ and n-MRONJ patients. However, although treatment methods for these two groups is almost identical, the follow-up process can vary. Actinomyces presence was not a predictive factor for recurrence of any type of osteonecrosis. To predict recurrence and healing delays, more parameters need to be investigated.

Ameloblastomas involving the temporomandibular joint (TMJ) present unique reconstructive challenges. This case series introduces patient-specific TMJ prostheses as an innovative solution for complex mandibular defects, addressing critical limitations in traditional reconstruction methods by eliminating donor site morbidity and optimising functional outcomes. Three patients presented with follicular ameloblastomas in the posterior mandible, experiencing significant tumour involvement affecting mandibular function and facial aesthetics. Clinical findings included extensive tumour growth in the mandible extending towards the condyle and compromising TMJ function. Surgical management involved complete tumour resection followed by immediate reconstruction using custom TMJ replacement (TMJR) prostheses. The prosthetic solution comprised titanium alloy mandibular components with integrated dental implants and ultra-high-molecular-weight polyethylene glenoid fossa components. Virtual surgical planning facilitated precise prosthesis design, enabling complete tumour removal while maintaining facial symmetry and temporomandibular function. Patient-specific TMJR offers a transformative approach to managing complex mandibular defects. Key takeaways include the potential for precise anatomical reconstruction, reduced surgical complications, and simultaneous restoration of function and aesthetics.a.

Objectives: This study evaluates the feasibility and clinical outcomes of treating acute or subacute odontogenic maxillary sinusitis using sinus irrigation through an extraction socket following the extraction of the causative tooth or implant.

Materials and methods: This retrospective case series included patients over 19 years old with acute or subacute odontogenic maxillary sinusitis who underwent maxillary sinus lavage through the extraction socket to resolve non-chronic odontogenic maxillary sinusitis. Exclusion criteria were previous sinus surgery, bilateral disease, or maxillary sinus pathology unrelated to dental origin. The treatment involved extracting the causative tooth or implant, intentionally perforating the sinus through the extraction socket with a 19-gauge needle, and performing sinus irrigation with saline. Antibiotic therapy was administered based on culture and sensitivity results.

Results: Seven patients were included. Following the removal of causative teeth or implants, the average number of sinus irrigation sessions via the extraction socket required to resolve symptoms was 2.7±1.3. Saline irrigation combined with appropriate antibiotic treatment led to symptom resolution.

Conclusion: Treating non-chronic odontogenic maxillary sinusitis through sinus irrigation via the extraction site, combined with appropriate antibiotic therapy, was effective in resolving symptoms and avoiding additional surgeries.

Objectives: To assess the relationships of close surgical margins with recurrence and prognosis of oral squamous cell carcinoma (OSCC).

Materials and methods: This retrospective study consisted of 198 patients who were diagnosed with OSCC based on histopathology. All patients underwent wide local tumor resection and neck dissection, followed by or preceded by chemotherapy and/or radiotherapy. The tumor variables assessed were the pathological stage of disease, involvement site, tumor size, margin status, tumor differentiation, bone involvement if any, presence of lymphovascular or perineural invasion, adjuvant therapies including chemotherapy and radiotherapy, lymph node involvement, and ratio.

Results: The outcome of the disease based on margins was statistically significant, with close mar- gins associated with increased risk of disease fatality. Recurrence was associated with close margins, followed by adequate margins, and the relation-ship was significant within the first 2 years. Tumor stage and size significantly correlated with margin status. Close surgical margins correlated with one positive lymph node.

Conclusion: Close surgical margins are strong predictors for determining prognosis of OSCC.

Objectives: Implant success depends on osseointegration that is influenced by macrogeometry, including thread design. Thread macrogeometry has a crucial role in achieving primary stability, particularly in low-density bone. Our study reviews the thread design's impact on implant stability, focusing on Straumann BLX (Straumann Co.) implants for practical insights.

Materials and methods: We searched the PubMed/MEDLINE and Embase for studies released until August 2023 using the following keywords: "implant", "macrogeometry", "thread", "thread depth", "thread pitch", "thread geometry", "macrodesign", "flute", "osseointegration", and "stability". In addition, 58 Straumann BLX implants with dynamic threads, which feature a deep thread design and incorporate a multi-helix flute structure to enhance primary stability across different bone densities, were reviewed retrospectively at our institute.

Results: The literature demonstrated that thread pitch, depth, and flute design significantly affect stress distribution and initial stability, especially in low-density bone. Implants with deep threads and spiral flutes showed improved primary stability and insertion efficiency. Clinically, retrospective data from 58 cases supported favorable outcomes in challenging bone conditions such as posterior maxilla and implant replacement sites.

Conclusion: We need to determine appropriate designs for implants with the consideration of bone quality and implantation bed condition.

Patients with anteroposterior maxillary deficiency and mandibular prognathism associated with a long-face pattern exhibit reduced anterior and lateral projection of the zygomaticomaxillary complex. Several techniques have been combined with orthognathic surgery to enhance the volume and definition of this region, such as zygomatic osteotomy. Two female patients, aged 22 (Case A) and 29 (Case B), with class II (Case A) and III (Case B) malocclusion, respectively, complained about facial aesthetics due to a long face and lack of malar projection. Le Fort I osteotomy to advance the maxilla, bilateral mandibular ramus osteotomy to set back the mandible, mentoplasty for advancement and width reduction, and zygomatic osteotomy were erformed. The patients underwent computed tomography scans, and superimposed images indicated that a volumetric increase in the malar region was achieved through the anterolateral movement of the zygomatic body. Improvements were noted in the paranasal region (Case A), better alignment of the upper and lower lips, the chin region, and an improved chin-neckline ratio (in both cases). The patients were satisfied with the results and are under follow-up. In summary, zygomatic osteotomy combined with orthognathic surgery proved to be a predictable and safe strategy for increasing malar prominence, with satisfactory aesthetic and functional outcomes.