Bleeding After Dental Extraction in Patients Undergoing Percutaneous Coronary Intervention During Uninterrupted Single and Dual Antiplatelet Therapy.

Purpose: This study aimed to assess bleeding risk after exodontia in patients with recent percutaneous coronary intervention during uninterrupted single or dual antiplatelet therapy. Study design: A total of 100 patients who had a history of percutaneous stent insertion during the past year candidate for extraction of teeth were included in the study. Fifty patients took aspirin 100mg (monotherapy group), and 50 patients took a combination of aspirin 100mg and clopidogrel 75mg (dual therapy group). After exodontia, the bleeding status was categorized as "complete hemostasis," "persistent bleeding," and "delayed bleeding." Personal data, underlying diseases, number of teeth and roots extracted, and type of procedure required for exodontia were statistically analyzed. Results: No significant difference was observed in the status of bleeding between the two groups regarding sex, age, underlying diseases, number of teeth and roots extracted, and type of procedure (p > 0.05). 39/50 (78%) of monotherapy patients and 32/50 (64%) of dual therapy patients achieved complete hemostasis. Persistent bleeding was noted in 11/50 (22%) of monotherapy participants, and 14/50 (28%) of dual therapy patients. Only 4/50 (8%) of dual therapy patients experienced delayed bleeding. However, these differences were not significant (p = 0.08). All persistent and delayed bleeding was easily controlled via local measures. Conclusion: Simple or complicated extraction of multiple teeth can be performed safely during the first year after percutaneous coronary intervention without interruption of antiplatelet therapy.

Use of online educational resources before and during the COVID-19 era in oral and maxillofacial surgery.

Restrictions to traditional face-to-face meetings were mandated by many government authorities during the COVID-19 pandemic, impacting the delivery of educational training sessions for maxillofacial surgery trainees in the traditional group manner. An online survey was designed to review what effect the pandemic had on the use and uptake of online educational sources amongst a representative cohort of maxillofacial surgery trainees in higher specialist training. Their attitudes and satisfaction with online resources were considered. The use of live sources such as webinars and pre-recorded materials (e.g. YouTube videos) was investigated. Engagement with online sources was considered prior to, and then during the pandemic. Alterations in the behaviour of trainees were demonstrated, with increasing online resource use seen once the COVID-19 pandemic took hold. Online pre-recorded resource use increased by 26% during the pandemic, with the median number of hours watched per month increasing from 1-5 h to 5-10 h (p < 0.001). Engagement with live online sources (webinars) increased by 52% and median time watched increased from 15 h per month to 10-20 h per month (p < 0.001). Trainees expressed satisfaction with the quality and flexibility of the resources. There was a firmly positive response to live webinars with regard to teaching quality, audio and video quality, ease of access and relevance to training needs. Pre-recorded and live online resources may prove a useful alternative or adjunct to face-to-face teaching when regulations limit or restrict social interactions.

Coronectomy of lower third molars in intimate relation to the inferior alveolar nerve: A report of two cases.

Damage to the inferior alveolar nerve (IAN) secondary to the extraction of the lower third molar (LTM) is a relatively frequent complication (0.35-8.40%) that can cause temporary or permanent nerve damage. Coronectomy has been proposed as an alternative, which consists of sectioning the coronary portion of the LTM, and deliberately leaving the radicular portion with the pulp intact. Two clinical cases are presented in this article, in which root migration (0-0.3 mm) and a change of angulation (+2º to +9°) occurred. None of the cases developed complications during the follow-up period (12 months). Therefore, coronectomy is a procedure to be considered in selected cases as an alternative to conventional exodontia of the LTM to avoid possible damage to the IAN. Key words:Case report, third molar, mandibular third molar, coronectomy, mandibular nerve, mandibular nerve injuries, root migration.

Evaluation of the efficacy of a simulation model used in oral and maxillofacial surgery education.

BACKGROUND: The traditional teaching methods of dental education are gradually being replaced with futuristic education methods based on the usage of educational tools such as mannequin-based simulation models and virtual reality. However, the effectiveness of mannequin-based simulation models as a learning method in the field of oral surgery remains unclear. This study aims to investigate the efficacy of training on a tooth extraction model (TEM) in view of undergraduate dental students' experience and perception of their education. METHODS: A quasi-experimental trial was implemented with two consecutive year classes, totaling 136 students at the Dentistry Faculty of Altinbas University, Turkiye. Two cohorts were created from dental students in the classes of 2023 and 2022 graduates. Cohort 1 (n = 71) received 14 h of theoretical education followed by 10 h of preclinical education on TEM. Cohort 2 (n = 65) received only 14 h of theoretical education. An anonymous questionnaire was prepared with four main sections including the preferences of learning style, participants' perceptions of the preclinical training methods, the students' competency and free text comments. Students' opinions were quantified with both 7-point Likert scales and thematic analysis. Anxiety levels were measured with the interval scale of anxiety response (ISAR). Descriptive statistics, inferential statistical and thematic analyses were conducted according to survey responses. Student characteristics were summarized and compared for two cohorts using a t-test. For all statistical analyses, the significance level was set atP ≤ 0.05. RESULT: Cohort 1 was more comfortable with sequential motions performed with the forceps (P = 0.033) and felt more ready for their first clinical tooth extraction experience (P = 0.028). Cohort 2 showed a significantly higher preference for textbooks among supplementary materials (P = 0.04); however, they tended to exhibit lower self-confidence and higher anxiety levels, though without any statistical significance (P > 0.05). CONCLUSION: It is clear that the students who have yet to start seeing patients benefit from increased practice with training models, which adequately reflect and represent real-life situations encountered in everyday practice.

Oral maxillofacial surgeons and Orthodontists’ perceptions about anterior inferior crowding and indications of mandibular third molar extraction / Percepciones de los cirujanos maxilofaciales y ortodoncistas sobre el apiñamiento anteroinferior y las indicaciones de la extracción del tercer molar mandibular

Background: There are still many doubts about anterior inferior crowding and indications of mandibular third molar extraction, although it is very studied subject in the literature. The aim of this study was to evaluate the perceptions of oral maxillofacial surgeons (OMFSs) and orthodontists about anterior inferior crowding and indications of mandibular third molar extraction. Material and Methods: A web-based survey was developed and sent to professionals in order to collect their opinion about the fact that third lower molars cause crowding and questions about the indication of third molars for orthodontic treatment. Descriptive analysis was performed and Chi-square or G tests were applied with a 95% confidence interval. Results: The study included a total of 218 participants, of whom 115 were OMFSs and 103 were orthodontists. The results showed that 56.5% of OMFSs and 35.0% of orthodontists believe that the lower third molars cause anterior inferior crowding (p<0.001). A total of 91.3% of OMFSs and 70.9% of orthodontists indicate the extraction of lower third molars to aid orthodontic treatment (p<0.001). Conclusions: It can be concluded that in being an oral maxillofacial surgeon, a higher odds ratio is observed to consider that lower third molars cause dental crowding compared to those who are orthodontist. The indication of exodontia of lower third molars for orthodontic treatment was more frequent among OMFSs when compared to orthodontists.(AU)

Preservation of the inferior alveolar vasculonervous bundle in mandibular resective therapies: systematic review and report of two cases

Background: Segmental surgical resection is a frequently indicated procedure to treat aggressive mandibular tumors. One of the most important complications derived from this technique is permanent paresthesia of the inferior alveolar nerve (IAN), which significantly affects the quality of life of patients who experience it. This could be avoided through maneuvers that preserve the IAN. The objective of this paper is to review the main techniques for IAN preservation and to present 2 cases with the technique used by the author. Material and Methods: A systematic review was performed according to the PRISMA guidelines, apropos of two clinical cases reported in this study. The MEDLINE/PubMed and Scopus databases were searched. Several variables were considered and are presented in detail in the form of tables and figures. In addition, 2 case reports with NAI preservation techniques are presented. Results: 13 articles were finally obtained for analysis. 127 patients were evaluated, reporting mandibular resections associated with various pathologies. Various surgical techniques were used, all with the same goal of maintaining the IAN. In most of the patients, the maintenance of sensitivity was achieved, which was verified with different methods. Conclusions: Preservation of the IAN in maxillofacial surgical procedures where surgical resection of the mandibular bone has been performed is an alternative that has demonstrated successful results in terms of reducing postoperative sequelae and is currently positioned as a necessary and feasible procedure. (AU)

Perceived surgical difficulty of mandibular third molar extraction. A comparative cross-sectional study of dentists with postgraduate qualificationin oral surgery and maxillofacial surgeons in a Spanish subpopulation

Background: Mandibular third molar (MTM) extraction is one of the most frequently performed surgeries in the oral cavity. Establishing the level of surgical difficulty pre-operatively is an essential step to ensure correct treatment planning. In Spain, MTM extraction - especially in cases presenting greater difficulty - is normally performed by doctors specializing in oral and maxillofacial surgery, or by dentists with postgraduate qualifications in oral surgery. The present work set out to analyze the extent to which perceptions of surgical difficulty of the said intervention vary in relation to professional training. Material and Methods: This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Nonparametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied. Results: A total of 213 surveys were available for analysis. Both groups awarded the greatest importance to clinical experience, followed by anatomical and radiographic factors, root morphology obtaining the highest score among anatomical factors (9.01±1.42), while proximity of the MTM to the inferior alveolar nerve was regarded as the least important anatomical factor (8.11 ±2.54). Significant differences were only found for patient age, whereby maxillofacial surgeons awarded this factor more importance than dentists. Conclusions: The different training received by dentists specialized in oral surgery and maxillofacial surgeons did not influence either perceptions of surgical difficulty of MTM extraction, or opinions as to the factors influencing surgical difficulty. (AU)

3D maxillofacial surgery planning - one decade development of technology.

Nowadays, techniques and the use of patient specific implants seem to be the recent high technology standard in reconstructive surgery. Surgery planning is as old as the surgery procedures themselves. Any good surgeon, before entering the operating theatre, has a plan for how to proceed. It is based on knowledge and experience in combination of evaluation of all case relevant information. In fact, virtual surgery planning and CAD/CAM reflects the technological "state of the art" into the medical daily practice. Recently, 3D printing technologies became easy and accessible for everyone. Virtual 3D images substituted the plaster models, the film profile analysis switched to digital, 3D printed bone models of the case helped to understand the morphology of the deformity and prepare the osteotomies with "hands on the bone". The authors' own 20 years of experience on surgical planning, the development of digital technologies in oral and maxillofacial surgery is traced and comments on case examples are presented.

Therapeutic itineraries of quilombola adults for oral health care in a rural district of Bahia, Brazil. / Itinerários terapêuticos para cuidados em saúde bucal de adultos quilombolas de um distrito rural da Bahia, Brasil.

This study examined the oral health-related therapeutic itineraries of quilombola adults in a rural district of Vitória da Conquista, Bahia. This qualitative study involved ten semi-structured interviews of adult members of the quilombola community, in May 2021, which were then transcribed and analysed using content analysis. The results showed little or poor oral hygiene at some stage of life, especially in childhood and adolescence, the use of popular oral health care practices, and experiences of professional care featuring tooth extraction. Use of health services was mostly reported only in the period prior to the COVID-19 pandemic. Responses as to perceived ease of access to health services in the community varied. One common complaint as to satisfaction with oral health was the need to use or replace dental prostheses. This study concluded that oral health must be promoted jointly with disease prevention, dental rehabilitation and recognition for the knowledge and worldview of the quilombola population.

O estudo analisou os itinerários terapêuticos relacionados à saúde bucal de adultos quilombolas de um distrito rural de Vitória da Conquista, Bahia. Trata-se de uma pesquisa qualitativa, na qual foram realizadas dez entrevistas semiestruturadas com adultos quilombolas em maio de 2021, transcritas e analisadas por meio da análise de conteúdo. Os resultados evidenciaram ausência e/ou precariedade na higiene bucal em alguma fase da vida, especialmente infância e adolescência; utilização de práticas populares para cuidado a saúde bucal e experiências de cuidado profissional marcados pela exodontia. A utilização de serviços de saúde foi relatada, em sua maioria, apenas no período anterior à pandemia de COVID-19, os entrevistados divergiram quanto à percepção de facilidade do acesso aos serviços de saúde em sua comunidade. Os relatos sobre a satisfação da saúde bucal destacaram a necessidade de uso ou substituição de próteses dentárias. À guisa de conclusão, entende-se que é necessária a promoção de saúde bucal de forma articulada com ações que possibilitem a prevenção de agravos, a reabilitação odontológica e a valorização do conhecimento e da visão de mundo da população quilombola.

[Scoring early oral soft-tissue wound healing: A systematic review]. / Scoren van vroege wondgenezing van orale zachte weefsels: een systematisch literatuuronderzoek.

To date, there is no widely accepted system for evaluating soft tissue early healing events in oral surgery. This study aimed to identify variables used to assess early oral soft tissue wound healing. The PubMed-MEDLINE and Cochrane CENTRAL databases were searched up to and including March 1, 2022. Papers were included if they presented scores of wound healing after performing a mucoperiosteal flap operation with the intention of primary closure. The search yielded 2,286 unique titles and abstracts, of which 31 met the eligibility criteria. In general, the available definitions/indices were found to be imprecise. Based on the literature reviewed, six variables were considered relevant for scoring early oral soft tissue wound healing: primary closure, necrosis, redness, swelling, bleeding, and suppuration.

Avaliação das alterações dimensionais horizontais dos tecidos mole e ósseo por meio de diferentes técnicas de preservação do rebordo alveolar / Assessment of horizontal dimensional changes in soft and bone tissue through diferente alveolar ridge preservation techniques

Com a perda de um dente após uma exodontia, tem-se início o processo de remodelação óssea de uma cicatrização espontânea que levará a perdas dimensionais desse alvéolo, principalmente em volume, comprometendo o formato original do rebordo. Técnicas de preservação do rebordo alveolar têm sido descritas há muito tempo, porém, sem um consenso sobre qual procedimento escolher e tampouco qual substituto usar. O objetivo desse estudo foi comparar algumas técnicas já citadas na literatura, utilizando substitutos ósseos e membranas para avaliar as alterações dimensionais horizontais. Foram tratados 25 pacientes (n=5) com necessidade de exodontia de dentes da maxila, com exceção dos molares. Os pacientes foram dispostos aleatoriamente em 5 grupos: GI membrana de politetrafluoretileno denso (Cytoplast®); GII enxerto ósseo xenógeno com uma membrana de colágeno (Bio Oss Collagen® associado a Bio Gide®); GIII membrana de polipropileno (Bone Heal®) 7 dias; GIV membrana de polipropileno (Bone Heal® 21 dias e GV Controle (cicatrização espontânea). O desfecho primário foi a alteração dimensional horizontal do rebordo alveolar encontrada entre as imagens tomográficas de início (T0) antes da exodontia e final (T1) após 6 meses da intervenção, na espessura abaixo da crista óssea em 1 mm (H1), 3 mm (H3) e 5 mm (H5), além da redução em volume do tecido mole avaliadas por meio de modelos de gesso escaneados e sobrepostos com um software de precisão (GOM Inspect®), medidos em 6 pontos em mimímetros a partir da margem gengival (0, 1, 2, 3, 4 e 5). As médias em mm das reduções em espessura óssea foram: em H1 (GI = 1,30, GII = 1,89, GIII = 1,30, GIV = 1,20, GV = 1,97); em H3 (GI = 1,71, GII = 1,98, GIII = 1,16, GIV = 0,34, GV = 1,75) e em H5 (GI = 1,11, GII = 0,74, GIII = 0,86, GIV = 0,26, GV = 1,36) chegando a uma conclusão estatisticamente significante entre os grupos de que GIV apresenta menores desvios que GII. Já as médias em mm das reduções horizontais dos tecidos ósseos foram: Ponto 0 (3,21; 2,26; 1,71; 1,49; 2,57 mm), ponto 1 (2,24; 2,39; 1,58; 1,59; 2,42 mm). Ponto 2 (1,77; 2,20; 1,21; 1,37;2,26 mm), ponto 3 (1,61; 1,90; 1,13; 1,13; 2,03 mm), ponto 4 (1,49; 1,68; 1,21; 0,94; 1,86 mm) e ponto 5 (1,28; 1,69; 1,06; 1,27; 1,70mm) respectivamente para os grupos GI, GII, GII, GIV e GV. Concluindo que houve diferenças entre os grupos estatisticamente significantes entre GIII com menores reduções que GII e GV, GIV com menores reduções que GV. Demonstrando que a técnica de preservação do rebordo alveolar pode ser utilizada como uma alternativa na limitação das perdas horizontais em tecido mole e ósseos.

[Features of medical care provision in the profile «Maxillofacial surgery¼ in the Southern Federal District of the Russian Federation]. / Osobennosti okazaniya meditsinskoi pomoshchi po profilyu «chelyustno-litsevaya khirurgiya¼ v Yuzhnom federal'nom okruge Rossiiskoi Federatsii.

OBJECTIVE: To study the actual state of the organization of medical care for patients with the profile of «maxillofacial surgery¼ in the Southern Federal District of the Russian Federation in order to develop proposals for its optimization within the framework of a three-level system of medical care. MATERIAL AND METHODS: We analyzed accounting and reporting materials characterizing the organization of medical care in the field of «Oral and maxillofacial surgery¼ to the population in the Southern Federal District of the Russian Federation. RESULTS: The population of the Southern Federal District of the Russian Federation is currently provided with accessible round-the-clock medical care in the field of maxillofacial surgery. The forces and means at the disposal of the district government allow this to be implemented. However, the article describes a number of obstacles to the provision of high-quality medical care in the field of maxillofacial surgery and suggests ways to eliminate them. CONCLUSION: Preparation of an Order defining the functioning of a three-level system of medical care for adults and children with maxillofacial pathology in the Southern Federal District of the Russian Federation, as well as more effective use of telemedicine consultations will significantly improve the availability and quality of medical care.

Role of hydrocolloid dressing in preventing face pressure ulcers from non-invasive ventilation and facilitating postoperative wound healing in maxillofacial surgery: A meta-analysis.

Facial pressure ulcers from non-invasive ventilation (NIV) and challenges in wound healing post-maxillofacial surgery are significant concerns in clinical care. This meta-analysis aimed to evaluate the effectiveness of hydrocolloid dressings in these contexts. From a pool of 1135 articles, 8 studies met the inclusion criteria. Hydrocolloid dressings demonstrated a significant reduction in facial pressure ulcers for NIV patients, with lower REEDA scores 1-week postapplication (standardized mean difference [SMD] = -16.7, 95% confidence interval [CI]: -24.26 to -9.15, p < 0.01). In maxillofacial surgery, patients treated with hydrocolloid dressings exhibited improved wound healing and reduced scar formation, evidenced by lower Manchester Scar Scale scores 3 months post-surgery (SMD = -15.46, 95% CI: -20.28 to -10.64, p < 0.01). These findings suggest that hydrocolloid dressings are effective in both preventing NIV-related facial pressure ulcers and enhancing wound healing in maxillofacial surgery.

Risk Factors for Early Dental Implant Failure.

PURPOSE: To report the prevalence of early implant failure and evaluate factors that contribute to the early failure of dental implants placed at a teaching clinic. The study also aims to identify risk indicators for early implant loss to better predict and prevent early implant loss in the future. MATERIALS AND METHODS: This retrospective study included all patients with a dental implant placed by the Section of Oral Surgery and Oral Medicine, Department of Clinical Dentistry, University of Bergen, between January 2011 and December 2018. All information was collected from operation logbooks and from patient records. A failed implant in this study was defined as an implant lost before functional loading. RESULTS: A total of 1,005 dental implants were placed in the studied time period, of which 54 failed early, giving an early failure rate (EFR) of 5.4%, with functional loading obtained for the remaining 94.6%. Analysis showed an increased hazard for early implant failure among smokers, men, and younger patients. With an age increase of 10 years, the risk of implant failure was reduced by 14% (hazard ratio [HRR] = 0.86, P = .037). A higher failure rate was found in anterior maxillary implants than in posterior maxillary implants (7.79% vs 3.29%, respectively; HRR = 0.47; P = .041). The probability for early failure in the posterior mandible was significantly increased compared to the posterior maxilla (HRR = 3.68, P = .005). If the first implant failed, it was more likely that the consecutive implant would also fail (HRR = 1.82). In the study, 53.4% of the placed implants were Straumann (EFR = 5.2%), 30.3% were Nobel Biocare (EFR = 7.2%), and 16.3% were Astra Tech (EFR = 2.5%). CONCLUSIONS: This study found that younger, male, and smoker patients were associated with an increase in early failure of dental implants. Significantly increased failure rates were also seen for implants placed in the mandible, and there were differences with respect to implant system. Although differences were found in early failure both for patient- and implant-related factors, the overall early failure rate (5.4%) in this study was low.

The efficacy of gastric aspiration in reducing postoperative vomiting after oral and maxillofacial surgery: A meta-analysis.

BACKGROUND: Gastric aspiration is applied in oral and maxillofacial procedures to reduce postoperative vomiting (POV), yet its clinical benefit remains largely uncertain. Our study aimed to determine the role of gastric aspiration in the amelioration of POV by a meta-analysis. METHODS: With adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, global recognized databases, including PubMed, Embase, and Cochrane Central, were searched to obtain randomized controlled trials (RCTs) investigating the effects of gastric aspiration in oral and maxillofacial surgery. The incidence and the number of episodes of POV and the frequency of rescue antiemetic use were extracted as parametric data for pooled estimation. Funnel plots and Egger's test were utilized to assess bias. The recommendation of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: After detailed evaluation, 5 RCTs containing 274 participants were eventually included. The results of pooled estimation indicated that gastric aspiration could not reduce the incidence of POV (risk ratio [95% CI] = 0.94 [0.73, 1.21], P = .621), the number of episodes of POV (standard mean difference [95% CI] = -0.13 [-0.45, 0.19], P = .431) or the frequency of rescue antiemetic use (RR [95% CI] = 0.86 [0.49, 1.52], P = .609). No publication bias was detected by the funnel plot and Egger test. The overall recommendation of evidence was rated low regarding each outcome. CONCLUSION: Based on current evidence, gastric aspiration is not recommended for oral and maxillofacial surgery. Meanwhile, more large-scale high-quality RCTs are needed.

Post-graduation career pathways: a nationwide survey among dental students in Germany.

OBJECTIVES: Oral and maxillofacial surgery (OMFS) has to compete with other specialties for the best candidates. With the upcoming change of generations (Z and Alpha) and the movement toward gender parity of dentistry, understanding changing preferences and misconceptions is essential. MATERIAL AND METHODS: An online survey was conducted by the German-Association-of-Oral-and-Maxillofacial-Surgery (DGMKG) across German dental schools. The survey collected demographic data, academic background, and career aspirations, with a focus on OMFS. The dental student survey results were compared to a survey given to OMFS Specialists. RESULTS: 637 dental students, mainly female (70%), from 30 German universities participated. 27% had defined career aspirations post-graduation, with self-employment and academia being popular choices. 67% were unsure. Specializations leaned towards restorative dentistry (41%), orthodontics (36%), and prosthodontics (31%). While 73% showed interest in surgical practices, 20% were attracted in specializing in OMFS. Of those averse to OMFS, 78% cited long training duration as the deterrent, 12% were put off by perceived unattractive working hours. Other reasons included negative undergraduate experiences, scarcity of part-time positions, and perceived inadequate earnings. CONCLUSION: Accurate data is crucial for career decisions. OMFS societies must proactively share accurate information and guide students. OMFS offers family-friendly hours, and while its training might be longer than dental specialties, it is on par with other surgical professions. CLINICAL RELEVANCE: Dental students consistently regard OMFS as commendable career path. To guarantee sustained OMFS expertise, it is imperative to nurture this interest through dedicated academic mentorship and innovative education, thereby solidifying their professional direction.