Journal of Stomatology Oral and Maxillofacial Surgery最新文献

Background: Accurate risk stratification of oral potentially malignant disorders (OPMDs) like oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) is critical. This study investigates Granzyme B (GrB), a key cytotoxic protease, as a potential objective biomarker to complement subjective histological grading.

Methods: A retrospective immunohistochemical analysis was performed on 24 tissue samples (12 OED and 12 OSCC cases), evenly distributed across the histological grades. GrB-positive immune cells were quantified, and their expression was statistically correlated with histological grade using Spearman's rank correlation.

Results: A strong positive correlation was found between GrB expression and histological severity. In OED, GrB was negligible in mild/moderate cases but markedly increased in severe dysplasia (r = 0.844, p < 0.001). In OSCC, GrB expression increased progressively with loss of differentiation (r = 0.949, p < 0.001). GrB expression showed no significant association with patient age or gender.

Conclusion: Our preliminary findings demonstrate a strong correlative link between Granzyme B expression and histological grade in both OED and OSCC. While this suggests that GrB immunohistochemistry may serve as a potential quantitative adjunct to morphological grading, the limited sample size of this study restricts broad generalizability and definitive prognostic conclusions. Further validation in larger, prospective cohorts is required to confirm its utility in objectively enhancing risk stratification for OPMDs and providing prognostic insight in OSCC.

The purpose of this systematic review was to evaluate the effectiveness of the local application and surface coating of dental implants with bisphosphonates in improving clinical outcomes. A comprehensive search was conducted across three electronic databases (PubMed/MEDLINE, Web of Science and Scopus) up to November 2025, following a PRISMA-based protocol. The major findings indicate that, despite some promising observations, current evidence does not conclusively support that local bisphosphonate use enhances osseointegration or decreases marginal bone loss. Overall, the available data remain insufficient to establish a clear clinical benefit. In conclusion, while bisphosphonate-enhanced implant surfaces represent a biologically appealing concept, further well-designed clinical trials are necessary to clarify whether these modifications effectively improve osseointegration and the quality and quantity of peri-implant bone.

Objectives: The menopausal transition is associated with biological, psychological, and social changes that may influence both mental well-being and oral health. Understanding the interaction between depressive symptoms and oral health-related quality of life (OHRQoL) may help clinicians better address the needs of women during this period. The aim of this study was to evaluate depressive status and OHRQoL in premenopausal and postmenopausal women and to investigate the relationship between depressive symptoms, OHRQoL, and selected demographic factors.

Materials and methods: This cross-sectional study was conducted at the Faculty of Dentistry between January and March 2025. A total of 187 women participated in the study, including 97 premenopausal and 90 postmenopausal individuals. Demographic characteristics and oral complaints were recorded. OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14), and depressive symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). Group comparisons were performed using independent samples t-tests, and correlations between variables were analyzed using Pearson correlation analysis. Internal consistency of the instruments was assessed using Cronbach's alpha.

Results: No significant difference was observed in PHQ-9 scores between the premenopausal and postmenopausal groups (p > 0.05). However, OHIP-14 scores were significantly higher in the premenopausal group, indicating poorer OHRQoL (p < 0.05). A moderate positive correlation was found between OHIP-14 and PHQ-9 scores (r = 0.566, p < 0.001). Both scales demonstrated good internal consistency (OHIP-14 α = 0.901; PHQ-9 α = 0.770).

Conclusions: Although menopausal status was not associated with differences in depressive symptoms, OHRQoL was more adversely affected in premenopausal women. The significant positive association between OHIP-14 and PHQ-9 scores indicates that increased depressive symptoms are related to poorer oral health-related quality of life. These findings highlight the importance of considering psychosocial factors when evaluating oral health and planning dental care for women across menopausal stages.

Objectives: This systematic review aimed to summarize the current evidence on the skeletal and dental effects of the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol combined with the miniscrew-anchored maxillary protraction (MAMP) in Class III patients.

Methods: Electronic searches were conducted in PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure and Google Scholar without language restrictions from inception to September 2025. Studies comparing the effectiveness of MAMP/Alt-RAMEC with other maxillary protraction interventions in Class III children and adolescents were included. The risk of bias (RoB) in randomized clinical trials (RCTs) was assessed using the RoB 2 tool, while the RoB in controlled clinical trials (CCTs) was evaluated by ROBINS-I tools. The certainty of evidence was evaluated using the GRADE tool.

Results: Seven studies met the inclusion criteria, including six RCTs and one CCT. Among the RCTs, two were judged to have a low RoB, three had some concerns, and one had a high RoB. The CCT was assessed as having a moderate RoB. Due to substantial heterogeneity among the included studies, a quantitative meta-analysis was not feasible. Children treated with MAMP/Alt-RAMEC demonstrated greater maxillary advancement (SNA, ANB, Wits and Co-A), while exhibiting comparable facial height increase and maxillary incisor proclination compared with untreated controls. In contrast, compared with children treated with tooth-anchored maxillary protraction (TAMP)/Alt-RAMEC, MAMP/Alt-RAMEC produced comparable sagittal skeletal changes but fewer vertical and dental side effects. The certainty of evidence across outcomes ranged from moderate to very low.

Conclusion: Current evidence suggests that MAMP/Alt-RAMEC appears to promote maxillary advancement in Class III children and may result in fewer dental and vertical side effects than conventional protraction interventions. However, the overall certainty of evidence is limited, and further high-quality RCTs are required to confirm these findings.

Purpose: This study aims to evaluate the association between unilateral condylar hyperplasia and adolescent idiopathic scoliosis by analyzing scintigraphic growth rate, ramus length discrepancy, and Cobb's angle.

Material and method: A retrospective analysis was conducted on patients diagnosed with active unilateral condylar hyperplasia. Inclusion criteria required a right-to-left condylar growth rate difference exceeding 1.10 on bone scintigraphy and had chest radiography. Control subjects were matched by age and gender, had chest radiography during general anesthesia due to an unrelated dental procedure. Cobb's angle was measured via chest radiographs; ramus length discrepancy was assessed by 3D Slicer Software using SPECT/CT data.

Result: The study included 30 unilateral condylar hyperplasia patients and 35 control subjects. The mean Cobb's angle was significantly higher in the unilateral condylar hyperplasia group (6.92±5.44°) compared to controls (2.97±4.89°; p < 0.001). No significant correlation was observed between Cobb's angle and condylar growth rate (p = 0.930) or ramus length difference (p = 0.295). While an inverse relationship was noted between affected condyle side and scoliosis direction, it was not statistically significant (p = 0.219).

Conclusion: Patients with active unilateral condylar hyperplasia exhibit a higher Cobb's angle compared to controls, suggesting an association between mandibular asymmetry and vertebral posture. However, growth rate and ramus length difference do not appear to influence scoliosis severity.

Objective: This study aimed to conduct a computed tomography (CT)-based evaluation of anatomical changes in nasal morphology, nasal complex and upper airway volume, temporomandibular joint (TMJ) parameters, and bone density following craniofacial distraction osteogenesis (DO).

Methods: A pilot retrospective case series was conducted on five patients (ages 1-27 years) who underwent maxillary, mandibular, or monobloc craniofacial DO. Preoperative and postoperative CT datasets were analysed using three-dimensional (3D) image processing software to quantify changes in nasal morphology (nasal index and nasolabial angle), airway volume (nasal complex and upper airway volumes), and skeletal (TMJ joint spaces, condylar volume, and bone density).

Results: Postoperative upper airway volume increased significantly (mean +55%, (p = 0.043)), along with nasal complex volume (+147%) although insignificant (p = 0.090). Changes in nasal index and nasolabial angle were heterogeneous and non-significant. TMJ analysis revealed a significant reduction in the left posterior joint space (p = 0.013) and a significant increase in left condylar volume (p = 0.043). Bone density showed minimal changes postoperatively.

Conclusion: Craniofacial DO induces anatomical adaptations, most notably a significant increase in upper airway volume and adaptive remodelling of the TMJ, while nasal soft-tissue parameters and overall bone density remain relatively stable. These findings highlight the value of 3D CT analysis for understanding the multifaceted responses to DO, supporting its role in objective postoperative assessment and patient-specific surgical planning.

Congenital agenesis of the major salivary glands is a rare developmental anomaly. Awareness of this condition in children is limited, and differentiation from autoimmune or acquired causes of xerostomia, such as juvenile Sjögren's disease, is essential for accurate diagnosis. A systematic search of PubMed, MEDLINE, Embase and Google Scholar was performed in accordance with PRISMA guidelines. Case reports describing congenital absence of all major salivary glands in patients aged under 18 were included. Data were extracted on demographics, presentation, pathology, imaging, presence of caries, lacrimal involvement and association with familial syndromes. Risk of bias was assessed using the JBI checklist for case reports. Twenty cases met the inclusion criteria. Mean age at presentation was 6.4 years (range 9 months-16 years). Xerostomia (80%) and dental caries (100%) were universal findings, and half of cases demonstrated lacrimal involvement. Pathological testing was variable, mainly used to exclude Sjögren's disease. Tc-99m scintigraphy was the most common diagnostic modality. Only one patient had a confirmed FGFR2 mutation consistent with LADD syndrome. Congenital salivary gland agenesis is a rare but clinically significant cause of paediatric xerostomia and dental morbidity. Structured assessment including imaging, serology, and genetic testing is critical for early identification and management of cases to prevent complications.

Background: Objective quantification of bone union after mandibular reconstruction is important for evaluating reconstructive outcomes, yet current assessments are largely semi-quantitative.

Objective: To explore the feasibility of using opportunistic quantitative computed tomography (CT)-derived Hounsfield unit (HU) measurements, with and without machine learning, to characterize bone union after fibula free flap mandibular reconstruction.

Methods: In this proof-of-concept diagnostic mandibulectomy patients with variable clinical characteristics were selected from a prospectively maintained database at a quaternary referral center. CT scans from 2020-2024 were analyzed and quantitative HU measurements were obtained from buccal, lingual, and medullary bone at osteotomy sites. Bone union was graded using the Akashi scale. Logistic regression and random forest models were developed for binary and multiclass prediction, with performance assessed using area under the receiver operating characteristic curve (AUC), calibration metrics, and clustered cross-validation.

Results: A total of 821 Hounsfield measurements from 280 axial CT slices were analyzed. Interrater agreement for Akashi scoring was 88.6% (κ = 0.79). Buccal HU was the strongest predictor, achieving an AUC of 0.74-0.75 in unadjusted analyses and 0.88-0.89 in adjusted logistic regression models. Random forest models achieved an AUC of 0.86 for union and 0.92 for complete union, with moderate to good calibration. Multiclass models showed good discrimination for non-union and complete union (AUC up to 0.86) but limited performance for partial union (AUC 0.68-0.73). Discriminative performance declined under clustered validation.

Conclusions: This exploratory study demonstrates the feasibility of using CT attenuation values to quantify bone union after mandibular reconstruction, supporting further validation in larger, multicenter cohorts.

Objective: Virtual Reality (VR) has emerged as a promising tool for enhancing medical education, particularly in surgical and anatomical training. However, its impact on the teaching of maxillofacial trauma remains underexplored. This study aimed to compare the effectiveness of 3D VR-based visualization with 3D standard visualization in diagnosing maxillofacial trauma.

Methods: This monocentric randomized comparative study included undergraduate third-year medical students who were randomized into two groups (VR or control group) to assess their diagnostic accuracy with each visualization method. The primary outcome was the response to a short open-ended question 'What is your most accurate diagnosis?'. Secondary outcomes included the students' satisfaction, ease of use, and tolerance toward the VR tool.

Results: Among the 141 medical students who participated in the study, 72 were in the VR group and 69 in the control group. No statistically significant difference was observed in diagnostic formulation scores between groups (standard group: median 4.00, IQR 3.25 [Q1 2.75-Q3 6.00]. ; VR group: median 4.00, IQR 2.02 [Q1 2.98-Q3 5.00]. ; p = 0.41). Despite this, 91 % of students reported being very satisfied with the VR experience, and 77 % considered it very beneficial for learning. Moreover, two-thirds of students reported identifying lesions using VR that were not perceived with standard 3D visualization alone.

Conclusion: This study suggests that VR is a valuable tool for exploring complex anatomical structures in maxillofacial trauma, with potential for enhancing diagnostic training.