3D analysis of condylar and mandibular remodeling one year after intra-oral ramus vertical lengthening osteotomy.

OBJECTIVES: Among the existing techniques for the correction of mandibular posterior vertical insufficiency (PVI), the intra-oral ramus vertical lengthening osteotomy (IORVLO) can be proposed as it allows simultaneous correction of mandibular height and retrusion. This study assessed the 3D morpho-anatomical changes of the ramus-condyle unit and occlusal stability after IORVLO. MATERIALS AND METHODS: This retrospective analysis compared immediate and 1-year post-operative 3D CBCT reconstructions. The analysis focused on the condylar height (primary endpoint) and on the changes in condylar (condylar diameter, condylar axis angle) and mandibular (ramus height, Frankfort-mandibular plane angle, gonion position, intergonial distance, angular remodeling) parameters. Additionally, this analysis investigated the maxillary markers and occlusal stability. RESULTS: On the 38 condyles studied in 21 included patients (mean age 23.7 ± 3.9 years), a condylar height (CH) loss of 0.66 mm (p < 0,03) was observed, with no correlation with the degree of ramus lengthening (mean 13.3 ± 0.76 mm). Only one patient presented an occlusal relapse of Class II, but a 3.4 mm (28%) condylar diameter loss and a 33% condylar volume reduction with loss of 1 mm and 3.4 mm in CH and condyle diameter, respectively. A mean 3.56 mm (p < 0.001) decrease in ramus height was noted, mainly due to bone resorption in the mandibular angles. CONCLUSION: This study confirms the overall stability obtained with IORVLO for the correction of PVI. CLINICAL RELEVANCE: This study aims to precise indication of IORVLO, and to validate the clinical and anatomical stability of results.

Enhancing skeletal stability and Class III correction through active orthodontist engagement in virtual surgical planning: A voxel-based 3-dimensional analysis.

INTRODUCTION: Skeletal stability after bimaxillary surgical correction of Class III malocclusion was investigated through a qualitative and quantitative analysis of the maxilla and the distal and proximal mandibular segments using a 3-dimensional voxel-based superimposition among virtual surgical predictions performed by the orthodontist in close communication with the maxillofacial surgeon and 12-18 months postoperative outcomes. METHODS: A comprehensive secondary data analysis was conducted on deidentified preoperative (1 month before surgery [T1]) and 12-18 months postoperative (midterm [T2]) cone-beam computed tomography scans, along with virtual surgical planning (VSP) data obtained by Dolphin Imaging software. The sample for the study consisted of 17 patients (mean age, 24.8 ± 3.5 years). Using 3D Slicer software, automated tools based on deep-learning approaches were used for cone-beam computed tomography orientation, registration, bone segmentation, and landmark identification. Colormaps were generated for qualitative analysis, whereas linear and angular differences between the planned (T1-VSP) and observed (T1-T2) outcomes were calculated for quantitative assessments. Statistical analysis was conducted with a significance level of α = 0.05. RESULTS: The midterm surgical outcomes revealed a slight but significantly less maxillary advancement compared with the planned position (mean difference, 1.84 ± 1.50 mm; P = 0.004). The repositioning of the mandibular distal segment was stable, with insignificant differences in linear (T1-VSP, 1.01 ± 3.66 mm; T1-T2, 0.32 ± 4.17 mm) and angular (T1-VSP, 1.53° ± 1.60°; T1-T2, 1.54° ± 1.50°) displacements (P >0.05). The proximal segments exhibited lateral displacement within 1.5° for both the mandibular right and left ramus at T1-VSP and T1-T2 (P >0.05). CONCLUSIONS: The analysis of fully digital planned and surgically repositioned maxilla and mandible revealed excellent precision. In the midterm surgical outcomes of maxillary advancement, a minor deviation from the planned anterior movement was observed.

Managing Mandibular Second Molar Impaction: A Systematic Review and Meta-Analysis.

PURPOSE: Mandibular second molar (M2M) impaction is a serious eruption disorder. The purpose of this systematic review was to analyze the therapeutic approaches for M2M impaction. The objective of the meta-analysis was to summarize the success of the surgical, surgical-orthodontic, and orthodontic treatment. METHODS: A PRISMA-guided search strategy was conducted by 2 authors in 5 databases up to January 2023. Randomized and nonrandomized clinical trials were considered. Case reports, case series with<5 patients, and reviews were excluded. Methodological quality was assessed using Newcastle-Ottawa scale and Cochrane Collaboration tool for nonrandomized and randomized clinical trials, respectively. Outcomes were as follows: 1) treatment success rate defined by the repositioning of impacted M2M in the dental arch with normal functional occlusal relationship and periodontal health; 2) time-to-repositioning as time-to-event analysis; and 3) complications. Meta-analysis examined treatment success differences with 3 approaches: orthodontic (uprighting maneuvers/traction), surgical (surgical procedures/strategic extractions), and surgical-orthodontic (combined surgical and orthodontic procedures) as the exposure variable. The quantitative analysis also compared the success rate using third molar removal as the secondary predictor variable. The χ2 test determined the statistical heterogeneity (I2); a cut-off of 70% was used to select the common or random effects model. Odds ratio (OR) and 95% confidence interval (CI) were recorded. RESULTS: A total of 1,102 articles were retrieved. After full-text reading, 16 articles were included and 1008 M2Ms were analyzed. Nine studies had fair quality, 6 studies had good quality, and 1 had unclear risk of bias. Managing impacted M2Ms showed a moderate to high success rate (66.7 to 100%). Significant differences favoring surgical treatment over orthodontic treatment were observed for M2M uprighting (OR = 4.97; CI: 1.49 to 16.51; P = .01).No differences were detected comparing surgical and surgical-orthodontic treatment (OR = 1.00; CI: 0.03 to 37.44; P = .99), or orthodontic and surgical-orthodontic treatment(OR = 4.14; CI: 0.43 to 40.14; P = .22).Third molar removal showed no significant correlation with M2M uprighting (OR = 1.98; CI: 0.24 to 16.03; P = .5). CONCLUSION: Despite study limitations, both orthodontic and surgical management of impacted M2M can be effective suggesting that clinicians are able to choose best treatment for most cases.

Three-dimensional facial swelling evaluation of pre-operative single-dose of prednisone in third molar surgery: a split-mouth randomized controlled trial.

BACKGROUND: Facial swelling, pain, and trismus are the most common postoperative sequelae after mandibular third molar (M3M) surgery. Corticosteroids are the most used drugs to reduce the severity of inflammatory symptoms after M3M surgery. This study aimed to evaluate the effect of a single pre-operative dose of prednisone on pain, trismus, and swelling after M3M surgery. METHODS: This study was designed as a split-mouth randomized, controlled, triple-blind trial with two treatment groups, prednisone (PG) and control (CG). All the parameters were assessed before the extraction (T0), two days (T1), and seven days after surgery (T2). Three-dimensional evaluation of facial swelling was performed with Bellus 3D Face App. A visual analogue scale (VAS) was used to assess pain. The maximum incisal distance was recorded with a calibrated rule to evaluate the trismus. The Shapiro-Wilk test was used to evaluate the normal distribution of each variable. To compare the two study groups, the analysis of variance was performed using a two-tailed Student t-test for normal distributions. The level of significance was set at a = 0.05. Statistical analysis was conducted using the software STATA (STATA 11, StataCorp, College Station, TX). RESULTS: Thirty-two patients were recruited with a mean age of 23.6 ± 3.7 years, with a male-to-female ratio of 1:3. A total of 64 M3Ms (32 right and 32 left) were randomly assigned to PG or CG. Surgery time recorded a mean value of 15.6 ± 3.7 min, without statistically significant difference between the groups. At T1, PG showed a significantly lower facial swelling compared to CG (PG: 3.3 ± 2.1 mm; CG: 4.2 ± 1.7 mm; p = 0.02). Similar results were recorded comparing the groups one week after surgery (PG: 1.2 ± 1.2; CG: 2.1 ± 1.3; p = 0.0005). All patients reported a decrease in facial swelling from T1 to T2 without differences between the two groups. At T1, the maximum buccal opening was significantly reduced than T0, and no difference between PG (35.6 ± 8.2 mm) and CG (33.7 ± 7.3 mm) (p > 0.05) was shown. Similar results were reported one week after surgery (PG: 33.2 ± 14.4 mm; CG: 33.7 ± 13.1 mm; p > 0.05). PG showed significantly lower pain values compared to CG, both at T1 (PG: 3.1 ± 1.5; CG: 4.6 ± 1.8; p = 0.0006) and T2 (PG: 1.0 ± 0.8; CG: 1.9 ± 1.4; p = 0.0063). CONCLUSION: Our results showed that pre-operative low-dose prednisone administration could reduce postoperative sequelae by improving patient comfort after M3M surgery and reducing facial swelling two days and one week after surgical procedures. TRIAL REGISTRATION: www. CLINICALTRIALS: gov - NCT05830747 retrospectively recorded-Date of registration: 26/04/2023.

Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: a randomized clinical trial.

OBJECTIVES: The purpose of this study was to evaluate clinical efficacy of four different local hemostatics in patients taking oral antiplatelet therapy, after multiple dental extractions without discontinuing drugs. MATERIALS AND METHODS: Study sample included 102 patients (mean age 64.1 ± 17.4 years) in treatment with oral antiplatelet agents needing multiple dental extractions. After surgery, the sockets were randomly sealing with suture alone (control group), hemostatic plug (HEM), advanced platelet-rich fibrin (A-PRF+), and leukocyte-platelet-rich fibrin (L-PRF). Primary outcomes were post-operative bleeding, wound healing index, and possible complications. Secondary outcomes were correlation between primary outcomes and patient's comorbidities and voluptuous habits. Descriptive statistics, bivariate comparisons, and logistic regression analysis were performed (p < 0.05). RESULTS: Both A-PRF+ and L-PRF showed a reduced bleeding risk when compared with suture alone (OR = 0.09, p = 0.001 for A-PRF+; OR = 0.09, p = 0.005 for L-PRF). Only L-PRF showed a reduced risk for incomplete wound healing when compared with the control site (OR = 0.43, p = 0.019). Patients affected by hypertension (OR 3.91, p = 0.015) and diabetes (OR 3.24, p = 0.026) had the highest bleeding risk. Smoking (OR 4.30, p = 0.016) and diabetes (OR 3.79, p = 0.007) interfered with healing process. CONCLUSION: L-PRF and A-PRF represent a valid alternative to the traditional hemostatics, reducing post-surgical bleeding and promoting wound healing. CLINICAL RELEVANCE: In patients taking antiplatelet drugs, different local hemostatics are useful to control potential post-operative bleeding and to favor wound healing. However, comorbidities and voluptuous habits may increase bleeding risk, interfering with healing process.

Efficacy of platelet-rich fibrin compared with triamcinolone acetonide as injective therapy in the treatment of symptomatic oral lichen planus: a pilot study.

OBJECTIVES: Oral lichen planus (OLP) is a chronic immune-mediated disease that affects the oral cavity. Topical steroids are considered the treatment of choice for painful lesions of OLP. The aim of this split-mouth study was to compare the efficacy of platelet-rich fibrin (PRF) and triamcinolone acetonide (TA) injective therapies in patients with symptomatic OLP. MATERIALS AND METHODS: Participants with symptomatic OLP were recruited in the Academic Hospital of Magna Graecia University of Catanzaro, Italy. Once a week for a month, patients randomly received a 0.5-mL TA injection in one buccal mucosa and 1-mL PRF injection in the opposite side. The measured outcomes were reduction of the lesions area and symptomatology modifications using visual analogue scale (VAS) score RESULTS: Four weeks after the last injections, an average reduction of 59.8% in the lesion extension and an average reduction of 47.6% in the VAS score for PRF-treated sites were observed; the same variation for TA-treated sites was respectively of 59.2% and 40%. There were no statistically significant differences between the two groups. CONCLUSIONS: PRF was effective in reducing OLP lesions extension and symptomatology, and it seems to be as effective as TA. Additional data should be collected with a larger sample size, at a longer follow-up and on the PRF lowest effective dose. CLINICAL RELEVANCE: Current treatment options for OLP are limited. The study proved benefits of PRF injections in management of painful lesions of OLP comparable with TA.

Can Surgical Management Improve Resolution of Medication-Related Osteonecrosis of the Jaw at Early Stages? A Prospective Cohort Study.

PURPOSE: There is no clarity on which protocol is proper to use in the management of medication-related osteonecrosis of the jaw (MRONJ) at early stages (ie, stages 1 and 2) to halt disease progression. The aim of this study was to evaluate the success of surgical treatment in terms of time to mucosal integrity and downstaging in patients with MRONJ at early stages. MATERIALS AND METHODS: The study was implemented as a prospective, single-center cohort study. The sample included patients who presented at Magna Graecia University of Catanzaro with a clinical diagnosis of MRONJ and underwent surgical treatment. The primary predictor variables were gender, age, medical history, drug administration, MRONJ localization, trigger factors, and stage. The outcome variables were 1) time to mucosal integrity after surgery with time-to-event analysis and 2) time to downstaging of MRONJ lesions. Descriptive, bivariate, and regression statistics were performed. RESULTS: The study sample included 129 MRONJ patients (90 women and 39 men; mean age, 71.2 ± 12.7 years), of whom 57 had stage 1 and 72 had stage 2. The mean time to achieve mucosal integrity was 71.6 ± 67.7 days, considering the survival probability always to be 93% or greater. The mean time to achieve downstaging of the lesion was 43.6 ± 38.4 days. Patients older than 70 years, those affected by osteometabolic disorders, and those treated with oral antiresorptive therapy showed a significantly shorter time to mucosal healing and downstaging (P < .05). In patients with stage 2 MRONJ, we recorded a significantly longer time to mucosal integrity (56.4 ± 54.5 days) but shorter time to lesion downstaging (33.6 ± 9.9 days) than in patients with stage 1 MRONJ (P < .05). CONCLUSIONS: Surgical treatment of patients in the early stages of MRONJ guarantees benefits in outcomes such as mucosal integrity and lesion downstaging, improvement in quality of life, and faster reuptake of medication therapy, especially for oncologic patients.

Management of Facial Pyoderma Gangrenosum Using Platelet-Rich Fibrin: A Technical Report.

This report describes a case of local pyoderma gangrenosum that was treated with short-term immunosuppressive therapy and the topical application of platelet-rich fibrin (PRF). Medical treatment included oral corticosteroid therapy and topical treatment with PRF in solid and liquid form. This therapy initially led to the reduction of the ulcer's size and an improvement in symptoms, until the ulcer was completely healed after a few weeks. A relapse was treated with only the application of PRF to the affected tissue with excellent recovery. The efficacy of PRF as a guide for wound healing is a result of the continuous release of growth factors involved in tissue repair mechanisms. PRF has proved to be suitable for the management of facial pyoderma gangrenosum while allowing a reduction in systemic corticosteroid therapy. The ease of preparation, low cost, and outpatient use make PRF an optimal scaffold for tissue healing processes.

Can Autofluorescence Guide Surgeons in the Treatment of Medication-Related Osteonecrosis of the Jaw? A Prospective Feasibility Study.

PURPOSE: The main limitation of surgical treatment of medication-related osteonecrosis of the jaw (MRONJ) is difficulty in defining resection margins. The aim of this study was to compare the efficacy of the surgeon's experience and autofluorescence-guided bone surgery to delimit resection margins for necrotic bone. MATERIALS AND METHODS: MRONJ requiring surgical treatment was classified according to American Association of Oral and Maxillofacial Surgeons staging. To detect vital bone and resection margins, patients of each stage were randomly assigned to 1 of 2 surgical groups: an autofluorescence-guided surgery (AF) group and a conventional surgery (non-AF) group based on the surgeon's experience. Bone samples from the 2 groups were analyzed histopathologically. The main outcomes were defined as the absence of bone exposure or infection at the time of evaluation. Infection was defined as the presence of swelling, pain, or numbness in the area. Measurements were collected preoperatively and 1 week, 1 month, 6 months, and 1 year after surgery. Statistical analysis included descriptive statistics and the Fisher exact test to evaluate eventual differences between the 2 surgical protocols. RESULTS: The 36 patients (21 women and 15 men) included in this study were equally divided into 2 groups according to the surgical protocol: 18 patients in the non-AF group and 18 in the AF group. Thirty-nine lesions were included in this analysis: 20 lesions in the non-AF group and 19 in the AF group. Histopathologic examination confirmed the necrotic nature of all bone samples. Statistical analysis showed no differences in necrotic bone exposure or signs of infections between the 2 surgical protocols at different times (P > .05). CONCLUSIONS: Although the VELscope appears to be useful in guiding bone resection margins in patients with MRONJ, autofluorescence does not appear to be superior to conventional surgical techniques in mucosal healing and quality of life.

Can different osteotomies have an influence on surgically assisted rapid maxillary expansion? A systematic review.

The purpose of this study was to systematically review the randomized and non-randomized clinical trials (RCT; nRCT) concerning the different available osteotomies for surgically assisted rapid maxillary expansion (SARME): pterygomaxillary disjunction (SARME + PD vs SARME-PD) and segmental Le Fort I osteotomy (2-piece vs 3-piece). Outcomes focused on skeletal, dental, upper airway changes, complications, and relapse. Two authors investigated five databases (PubMed, Cochrane Library, Google Scholar, Scopus, Web of Science) until August 2023. The Cochrane Collaboration Tool and the Newcastle-Ottawa scale were used for the quality assessment of the included RCTs and nRCTs, respectively. A total of 554 articles were retrieved and after duplicates removing and full-text reading, 40 studies were included. Two RCTs showed a low risk of bias, one an unclear risk and one a high risk. Among the non-RCTs, 15 studies showed a good quality, while 21 exhibited a fair quality score. SARME + PD resulted in more homogeneous posterior bone expansion, with minimal dental effects. No difference between 2-piece and 3-piece in asymmetric expansion was observed, although 3SO showed 1-2 mm of more transverse increase. The oropharynx minimum cross-sectional area, the nasopharynx and the oropharynx volume were greater in SARME + PD. Both dental and bone relapse can occur but no differences between the groups were observed. All osteotomies guaranteed a correction of transverse maxillary deficiency. Lower side effects were described in SARME + PD. Two-piece and 3-piece segmental Le Fort I osteotomies did not show any differences in the symmetry and amount of expansion.

Concordance Analysis of Lower Third Molar Surgery Classifications: A Comparative Study.

The high frequency and complexity of mandibular third molar (M3M) surgery have led several authors to the development of classification systems for better evaluation and management in oral surgery. This study compared the classifications of Juodzabalys and Daugela et al. (JD), Sammartino et al., Chang et al., Jhamb et al., Maglione et al., and Nemsi et al. to understand the concordance between the scores of M3M surgery. Two types of analysis were conducted: the relationship between the M3M and the inferior alveolar nerve (IAN), and the overall difficulty score based on the tooth's angulation and its spatial position with the adjacent structure. The analysis of the classifications on the relationship between M3M and IAN resulted in a concordance of 26.1%. In the pairwise comparisons, the classifications of Nemsi et al. and Jhamb et al. showed the highest concordance of 59.5%. Analyzing the total scores difficulty, the JD et al., Chang et al., and Sammartino et al. classifications demonstrated a concordance level of 25.5%. A pairwise assessment revealed a higher concordance degree between the classifications of Sammartino et al. and Chang et al. (57.4%). The results highlight the limits in establishing a comprehensive and objective classification for the surgical difficulty of M3M, possibly attributed to variations in the methodology for computing total scores. An objective, automated, and non-operator-dependent classification method for assessing the surgical difficulty of M3M is still needed.

ShapeAXI: Shape Analysis Explainability and Interpretability.

ShapeAXI represents a cutting-edge framework for shape analysis that leverages a multi-view approach, capturing 3D objects from diverse viewpoints and subsequently analyzing them via 2D Convolutional Neural Networks (CNNs). We implement an automatic N-fold cross-validation process and aggregate the results across all folds. This ensures insightful explainability heat-maps for each class across every shape, enhancing interpretability and contributing to a more nuanced understanding of the underlying phenomena. We demonstrate the versatility of ShapeAXI through two targeted classification experiments. The first experiment categorizes condyles into healthy and degenerative states. The second, more intricate experiment, engages with shapes extracted from CBCT scans of cleft patients, efficiently classifying them into four severity classes. This innovative application not only aligns with existing medical research but also opens new avenues for specialized cleft patient analysis, holding considerable promise for both scientific exploration and clinical practice. The rich insights derived from ShapeAXI's explainability images reinforce existing knowledge and provide a platform for fresh discovery in the fields of condyle assessment and cleft patient severity classification. As a versatile and interpretative tool, ShapeAXI sets a new benchmark in 3D object interpretation and classification, and its groundbreaking approach hopes to make significant contributions to research and practical applications across various domains. ShapeAXI is available in our GitHub repository https://github.com/DCBIA-OrthoLab/ShapeAXI.

Short- and Long-Term Effects of Maxillary Expander with Tongue Crib in Growing Open-Bite and Skeletal Class II Patients: A Retrospective Study.

The purpose of this study was to evaluate short- and long-term changes in growing patients with Class II malocclusion and open bite after rapid maxillary expansion (RME). A retrospective cohort study was conducted with 16 growing patients with open-bite malocclusion enrolled in a group treated with a rapid maxillary expander (RME) with a crib (TG), and 16 untreated patients with similar malocclusion in the control group (CG). Cephalograms were recorded before starting the treatment (T0), at the end of the latency phase (T1), and before the fixed therapy (T2) in order to analyze skeletal and dental changes in vertical, transversal, and sagittal relationships. Statistical analysis was performed with α = 0.05 as level of significance. At the end of the active expansion (T1), all subjects in the TG showed a corrected overbite with a statistically significant difference compared to the CG (p > 0.05). A significant decrease in jaw divergence was found in the TG compared to the CG (p < 0.05). At T2, all treated patients maintained a correct overbite. Statistical analysis revealed a significant decrease in maxillary, mandibular, and intermaxillary divergence in the TG compared to the CG (p < 0.05). This protocol could be effective in growing open-bite patients, showing a long-term decrease in facial divergence. The fixed crib allowed to normalize myofunctional activity.

Accuracy of Zygomatic Implant Placement Using a Full Digital Planning and Custom-Made Bone-Supported Guide: A Retrospective Observational Cohort Study.

The aim of the study was to evaluate the accuracy of zygomatic implant placement using customized bone-supported laser-sintered titanium templates. Pre-surgical computed tomography (CT) scans allowed to develop the ideal virtual planning for each patient. Direct metal laser-sintering was used to create the surgical guides for the implant placement. Post-operative CT scans were taken 6 months after surgery to assess any differences between the planned and placed zygomatic implants. Qualitative and quantitative three-dimensional analyses were performed with the software Slicer3D, recording linear and angular displacements after the surface registration of the planned and placed models of each implant. A total of 59 zygomatic implants were analyzed. Apical displacement showed a mean movement of 0.57 ± 0.49 mm on the X-axis, 1.1 ± 0.6 mm on the Y-axis, and 1.15 ± 0.69 mm on the Z-axis for the anterior implant, with a linear displacement of 0.51 ± 0.51 mm on the X-axis, 1.48 ± 0.9 mm on the Y-axis, and 1.34 ± 0.9 mm on the Z-axis for the posterior implant. The basal displacement showed a mean movement of 0.33 ± 0.25 mm on the X-axis, 0.66 ± 0.47 mm on the Y-axis, and 0.58 ± 0.4 mm on the Z-axis for the anterior implant, with a linear displacement of 0.39 ± 0.43 mm on the X-axis, 0.42 ± 0.35 mm on the Y-axis, and 0.66 ± 0.4 mm on the Z-axis for the posterior implant. The angular displacements recorded significative differences between the anterior implants (yaw: 0.56 ± 0.46°; pitch: 0.52 ± 0.45°; roll: 0.57 ± 0.44°) and posterior implants (yaw: 1.3 ± 0.8°; pitch: 1.3 ± 0.78°; roll: 1.28 ± 1.1°) (p < 0.05). Fully guided surgery showed good accuracy for zygomatic implant placement and it should be considered in the decision-making process.

Comparison between Magneto-Dynamic, Piezoelectric, and Conventional Surgery for Dental Extractions: A Pilot Study.

This pilot split-mouth study aimed to evaluate and compare early postoperative discomfort and wound healing outcomes in post-extraction sockets after dental extraction performed with a Magnetic Mallet (MM), piezosurgery, and conventional instruments (EudraCT 2022-003135-25). Twenty-two patients requiring the extraction of three non-adjacent teeth were included. Each tooth was randomly assigned to a specific treatment (control, MM, or piezosurgery). Outcome measures were the severity of symptoms after surgery, wound healing assessed at the 10-days follow-up visit, and the time taken to complete each procedure (excluding suturing). Two-way ANOVA and Tukey's multiple comparisons tests were performed to evaluate eventual differences between groups. There were no statistically significant differences between the compared methods in postoperative pain and healing, and no additional complications were reported. MM required significantly less time to perform a tooth extraction, followed by conventional instruments and piezosurgery, in increasing order (p < 0.05). Overall, the present findings suggest the use of MM and piezosurgery as valid options for dental extractions. Further randomized controlled studies are needed to confirm and extend this study's results, facilitating the selection of the optimal method for an individual patient depending on the patient's needs and preferences.

Effect of Implant Macro-Design and Magnetodynamic Surgical Preparation on Primary Implant Stability: An In Vitro Investigation.

BACKGROUND: Macro-geometry and surgical implant site preparation are two of the main factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to assess the initial stability of various implant macro-designs using both magnetodynamic and traditional osteotomy techniques in low-density bone. The parameters examined included peak insertion torque (PIT), implant stability quotient (ISQ), and peak removal torque (PRT). METHODS: Four groups of 34 implants each were identified in accordance with the surgery and implant shape: T5 group (Five implant and osteotomy using drills); M5 group (Five implant and magnetodynamic osteotomy using Magnetic Mallet); TT group (TiSmart implant and osteotomy with drills); and MT group (TiSmart implant and magnetodynamic osteotomy). Every implant was placed into a low-density bone animal model and scanned using CBCT. The PIT and PRT were digitally measured in Newton-centimeters (Ncm) using a torque gauge device. The ISQ was analyzed by conducting resonance frequency analysis. RESULTS: The PIT values were 25.04 ± 4.4 Ncm for T5, 30.62 ± 3.81 Ncm for M5, 30 ± 3.74 Ncm for TT, and 32.05 ± 3.55 Ncm for MT. The average ISQ values were 68.11 ± 3.86 for T5, 71.41 ± 3.69 for M5, 70.88 ± 3.08 for TT, and 73 ± 3.5 for MT. The PRT values were 16.47 ± 4.56 Ncm for T5, 26.02 ± 4.03 Ncm for M5, 23.91 ± 3.28 Ncm for TT, and 26.93 ± 3.96 Ncm for MT. Based on our data analysis using a t-test with α = 0.05, significant differences in PIT were observed between TT and T5 (p < 0.0001), M5 and T5 (p < 0.0001), and MT and TT (p = 0.02). Significant differences in the ISQ were found between TT and T5 (p = 0.001), M5 and T5 (p < 0.001), and MT and TT (p = 0.01). The PRT also exhibited significant differences between TT and T5, M5 and T5, and MT and TT (p < 0.0001). CONCLUSION: Our data showed favorable primary implant stability (PS) values for both implant macro-geometries. Furthermore, the magnetodynamic preparation technique appears to be more effective in achieving higher PS values in low-density bone.

Oral Health-Related Quality of Life and Mental Health Impairment in Patients Affected by Medication-Related Osteonecrosis of the Jaws: A Case-Control Pilot Study.

In the present case-control study, the impact of medication-related osteonecrosis of the jaws (MRONJ) on patients' oral health-related quality of life (OHRQoL), overall quality of life (QoL), and psychological status was evaluated using a set of questionnaires. These questionnaires included the Oral Health Impact Profile-14 (OHIP-14), the Short Form 36 Health Survey Questionnaire (SF-36), and the hospital anxiety and depression scale (HADS). A total of 25 MRONJ patients and 25 controls were included in the study. The results showed that MRONJ patients had a significantly poorer OHRQoL (OHIP-14 score p-value: 0.003) and lower general QoL, particularly in the domains of "physical functioning", "physical role", "body pain", "general health", and "vitality" in the SF-36 questionnaire (p-values: 0.001, 0.001, 0.013, 0.001, and 0.020). Although there were no significant differences between the groups in the SF-36 domains of "social functioning", "emotional role", and "mental health", the mean sub-scores of the HADS, specifically the depression and anxiety scores (HADS-D and HADS-A), were significantly higher in MRONJ patients (p-values: 0.002 and 0.009). However, the "mental health" domain of the SF-36 questionnaire showed a correlation with both HADS-A and HADS-D scores (p-values: 0.003 and 0.031). Therefore, a comprehensive clinical examination of MRONJ patients should include the assessment of OHRQoL, overall QoL, and psychological profile using different questionnaires. This approach aims to gather detailed information about patients' physical and psychological well-being, enabling the development of tailored treatments.

SOX2 promotes a cancer stem cell-like phenotype and local spreading in oral squamous cell carcinoma.

Emerging evidence shows that oral squamous cell carcinoma (OSCC) invasiveness can be attributed to a small subpopulation of cancer stem cells (CSCs) in the bulk of the tumor. However, the presence of CSCs in the OSCC close resection margins is still poorly unexplored. Here, we found that BMI1, CD44, SOX2, OCT4, UBE2C, CXCR4 CSCs marker genes are significantly upregulated, while IGF1-R, KLF4, ALDH1A1, CD133, FAM3C are downregulated in the tumor core vs healthy mucosa of 24 patients with OSCC. Among these, SOX2 appears also upregulated in the tumor close margin vs healthy mucosa and this significantly correlates with tumor size and lymph node compromise. In vitro analyses in CAL27 and SCC15 tongue squamous cell carcinoma cell lines, show that SOX2 transient knockdown i) promotes the mesenchymal-to-epithelial transition, ii) smooths the invasiveness, iii) attenuates the 3D tumor sphere-forming capacity, and iv) partially increases the sensitivity to cisplatin treatment. Overall, our study highlights that the OSCC close margins can retain CSC-specific markers. Notably, SOX2 may represent a useful CSCs marker to predict a more aggressive phenotype and a suitable target to prevent local invasiveness.

Interpretable artificial intelligence for classification of alveolar bone defect in patients with cleft lip and palate.

Cleft lip and/or palate (CLP) is the most common congenital craniofacial anomaly and requires bone grafting of the alveolar cleft. This study aimed to develop a novel classification algorithm to assess the severity of alveolar bone defects in patients with CLP using three-dimensional (3D) surface models and to demonstrate through an interpretable artificial intelligence (AI)-based algorithm the decisions provided by the classifier. Cone-beam computed tomography scans of 194 patients with CLP were used to train and test the performance of an automatic classification of the severity of alveolar bone defect. The shape, height, and width of the alveolar bone defect were assessed in automatically segmented maxillary 3D surface models to determine the ground truth classification index of its severity. The novel classifier algorithm renders the 3D surface models from different viewpoints and captures 2D image snapshots fed into a 2D Convolutional Neural Network. An interpretable AI algorithm was developed that uses features from each view and aggregated via Attention Layers to explain the classification. The precision, recall and F-1 score were 0.823, 0.816, and 0.817, respectively, with agreement ranging from 97.4 to 100% on the severity index within 1 group difference. The new classifier and interpretable AI algorithm presented satisfactory accuracy to classify the severity of alveolar bone defect morphology using 3D surface models of patients with CLP and graphically displaying the features that were considered during the deep learning model's classification decision.