Biofluorescence imaging system (BIS) Guided surgery for MRONJ: A Case Series on the Preservation of Teeth and Implants: Biofluorescence imaging system guided MRONJ surgery.

The decision of surgical margin for Medication-Related Osteonecrosis of the Jaw (MRONJ) surgery is challenging. Recently, a method involving biofluorescence imaging system (BIS) has been reported for its application in MRONJ surgery to live detection of pathologic bone tissue from vital bone, which cannot be distinguished during conventional surgery. This case series aimed to assess the outcomes of adjacent teeth and implants near the lesion site in MRONJ patients who underwent BIS-guided MRONJ surgery. This retrospective study was assessed the radiographic and clinical outcomes of seven patients who underwent MRONJ surgery with BIS guidance but chose not to remove adjacent teeth or implants near the lesion. A total of seven patients (1 male, 6 females, 77.2 ± 4.7 years) were included in the study. Four implants and four teeth adjacent to the lesion were preserved. Over an average duration of 8.7 months, all subjects exhibited normal soft tissue healing and function without any complications. In conclusion, the BIS guided MRONJ surgery can be considered a minimally invasive and effective approach.

Inhibition of Epithelial-Mesenchymal Transition and Migration in Cisplatin-resistant Cancer Through Combined Treatment With Cisplatin and SH003.

BACKGROUND/AIM: This study investigated the synergistic effects of combining cisplatin and SH003 treatment on the viability, apoptosis, cytotoxicity, migration and epithelial-mesenchymal transition (EMT) in cisplatin-resistant cancer cell lines YD-8/CIS, YD-9/CIS and YD-38/CIS. MATERIALS AND METHODS: The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to assess cell viability, while trypan blue exclusion assay was used to evaluate cytotoxicity. Flow cytometry and western blot analysis measured apoptotic cell death. Wound-healing assays evaluated cell migration and EMT markers. Combination index (CI) plots were used to evaluate the combinatory effects of the treatment. RESULTS: Combination therapy significantly reduced cell viability more effectively than each agent alone, as demonstrated by the MTT assay, with CI plots confirming notable synergism. Trypan blue exclusion assays indicated increased cell death and cytotoxicity in combination treatment than in both monotherapies, although the increase was not significant. Flow cytometry and western blot analysis revealed no significant synergistic effect on apoptotic cell death. However, wound-healing assays revealed that the combination of cisplatin and SH003 significantly inhibited cell migration and regulated EMT markers, indicating the potential reversal of EMT. CONCLUSION: Combining cisplatin and SH003 therapy may potentially be a more effective strategy for treating cisplatin-resistant cancer by increasing cytotoxicity and inhibiting metastasis. Further research is required to elucidate the underlying mechanisms and evaluate the in vivo efficacy of this combination therapy.

Demineralized Dentin Matrix Incorporated with rhBMP-2 Composite Graft for Treating Medication-Related Osteonecrosis of the Jaw.

Medication-Related Osteonecrosis of the Jaw (MRONJ) is characterized by bone exposure in the oral and maxillofacial region for more than eight weeks in patients treated with anti-resorptive agents, immunosuppressants, or anti-angiogenic agents, without prior radiation therapy or metastatic disease to the jaws. Conservative treatments can control infection in mild cases, but surgical intervention is necessary for patients with severe symptoms. A 78-year-old female with a history of bisphosphonate treatment for osteoporosis presented with persistent pain, swelling, and malodor following implant placement in the upper right maxilla. SPECT/CT imaging revealed a high-risk hot spot in the right maxillary region. BIS-guided surgery using the Qray pen-C was performed, selectively removing red fluorescent bone tissue. The defect was grafted with HuBT incorporated with rhBMP-2. Postoperative follow-ups at 4, 7, and 14 months showed successful bone healing, transforming into a corticocancellous complex, and implant placement without MRONJ recurrence. Allogeneic demineralized dentin matrix (DDM) incorporated with rhBMP-2 demonstrates effective bone healing and implant placement following BIS-guided MRONJ surgery. This case supports the use of DDM/rhBMP-2 for tissue regeneration in MRONJ treatment, enabling successful prosthetic restoration without recurrence.

Assessing the efficacy of apicoectomy without retrograde filling in treating periapical inflammatory cysts.

Objectives: The necessity of retrograde filling after apicoectomy is controversial in cases of non-inflammatory cysts as opposed to bacteria-related periapical abscesses. This study aims to investigate whether the presence or absence of retrograde filling during apicoectomy has differential long-term prognostic implications between inflammatory and non-inflammatory cysts. Materials and Methods: This retrospective study included patients who underwent tooth apicoectomy during jaw cyst enucleation between 2013 and 2022, and who underwent follow-up cone-beam computed tomography for at least 6 months. The prognosis of the tooth was evaluated during the follow-up period according to the cyst type, the presence or absence of retrograde filling, mandible or maxilla, and location. Results: A total of 147 teeth was included in this study. All the operated teeth underwent preoperative root canal treatment by an endodontic specialist. Apicoectomy was performed for 119 inflammatory cysts and 28 non-inflammatory cysts. Retrograde filling was performed on 22 teeth with inflammatory cysts and 3 teeth with non-inflammatory cysts. All teeth survived the 3.5-year follow-up (range, 1.0-9.1 years). However, 1 tooth with an inflammatory cyst developed complications 1 year after surgery that required re-endodontic treatment. Conclusion: The prognosis of a tooth treated by apicoectomy without retrograde filling during cyst enucleation is favorable, regardless of the cyst type.

Intraoral Approach for Zygomaticomaxillary Complex and Orbital Floor Fracture With a Customized Ballooning Technique.

The zygomaticomaxillary complex and the orbital floor are commonly affected by mid-face fractures; their fractures pose challenges in reconstruction and can result in complications, such as enophthalmos. This study explores an intraoral approach with the help of a customized balloon technique and a contrast agent as an alternative to the conventional methods. A case report of a 67-year-old man with complex midfacial trauma is presented. The surgical process involved open reduction through an intraoral approach along with a transantral approach with the customized balloon technique. The procedure aimed to achieve reduction, fixation, and reconstruction of a complex mid-face fracture.

Quantitative light-induced fluorescence-guided surgery for medication-related osteomyelitis of the jaw.

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is a challenging condition with increasing incidence, and the lack of clear surgical guidelines poses difficulties in its treatment. METHODS: Quantitative light-induced fluorescence (QLF), which can distinguish between vital and necrotic bone tissue without the need for additional markers, was used to guide minimally invasive surgery in a 75-year-old patient with MRONJ. RESULTS: This study demonstrated that QLF allows the real-time identification of infected and necrotic bone tissue during surgery, enabling precise and minimally invasive resection. We observed spontaneous bone recovery and remodeling in sclerotic bone areas that exhibited autofluorescence using a QLF device, suggesting its potential for preserving the bone tissue. CONCLUSION: This study highlights the promising application of QLF as a valuable photodiagnostic tool in MRONJ surgery, offering a noninvasive and intraoperative device for differentiating pathological bone tissue. This approach can potentially improve the precision of surgical interventions and contribute to improved patient outcomes in MRONJ management.

Is conservative treatment (enucleation using modified Carnoy's solution) of odontogenic keratocyst in the maxilla good prognosis?

Odontogenic keratocysts (OKCs) located in the maxillae have rarely been reported in the literature. Standard treatment modalities for OKC range from marsupialization to marginal resection. However, most of the studies on OKC treatment have been related to mandibular OKCs. The anatomical structure and loose bone density of the maxillae and the empty space of the maxillary sinus could allow rapid growth of a lesion and the ability to tolerate tumor occupancy in the entire maxilla within a short period of time. Therefore, OKCs of the maxillae require more aggressive surgery, such as resection. As an alternative, this report introduces a modified Carnoy's solution, a strong acid, as an adjuvant chemotherapy after cyst enucleation. This report describes the clinical outcomes of enucleation using a modified Carnoy's solution in patients with large OKCs on the posterior maxillae. In three cases, application of a modified Carnoy's solution had few side effects or morbidity. Each patient was followed for four to six years, and none showed any signs of recurrence. In conclusion, adjuvant treatment with a modified Carnoy's solution can be considered a treatment option capable of reducing the recurrence rate of OKC in the maxillae.

Buccal nerve schwannoma mimicking a salivary gland tumor: a rare case report.

Schwannomas are benign tumors originating from myelinating cells constituting nerve sheaths but rarely contain cellular elements of the nerve. The authors encountered a 47-year-old female patient with a schwannoma on the anterior mandibular ramus arising from the buccal nerve, measuring 3 cm×4 cm. Surgical resection was performed with preservation of the buccal nerve via microsurgical dissection. After one month, the sensory function of the buccal nerve was recovered without complications.

Incorporating Moldable Demineralized Dentin Matrix into Treatment for a Jaw Cyst.

The enucleation procedure is a standard treatment for jaw cysts; however, it often results in post-operative bony defects. These defects can lead to serious complications such as the risk of pathologic fracture and delayed wound healing, especially in the case of large cysts where there may be soft tissue dehiscence. Even in the case of smaller cysts, most cystic defects remain visible on postoperative radiographs and can be mistaken for cyst recurrence during follow-up periods. To avoid such complications, the use of bone graft materials should be considered. While autogenous bone is the most ideal graft material as it can be regenerated into functional bone, it has limitations due to the inevitable harvesting surgery. Many tissue engineering studies have been conducted to develop substitutes for autogenous bone. One such material is moldable-demineralized dentin matrix (M-DDM), which can aid in regeneration in cases of cystic defects. This case report highlights a patient who demonstrated the efficacy of M-DDM in bone healing for filling the cystic defect.

Effect of a vertical incision on postoperative swelling after an impacted mandibular third molar extraction: two cases with split-mouth designed magnetic resonance imaging analysis.

This study examined the effects of a vertical incision on postoperative edema after third molar extraction. The study design was that of a comparative split-mouth approach. Evaluation was performed via magnetic resonance imaging (MRI). Two patients with homogeneous bilateral impacted mandibular third molars were enrolled. These patients underwent facial MRI within 24 hours after simultaneous extraction surgery. Modified triangular flap and enveloped flap incisions were made. Postoperative edema was evaluated by MRI and was assessed according to anatomical space. The two pairs of homogeneous extractions demonstrated that vertical incisions were associated qualitatively and quantitatively with extensive postoperative edema. The edema associated with these incisions spread toward the buccal space, beyond the buccinator muscle. In conclusion, a vertical incision with mandibular third molar extraction was related to edema in the buccal space and the fascial space, which contributed to clinical facial swelling.

Allogeneic Demineralized Dentin Matrix as rhBMP-2 Carrier: A Retrospective Clinical Study.

PURPOSE: To compare the clinical outcomes of autogenous and allogeneic demineralized dentin matrices loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2; auto- and allo-DDM/rhBMP-2) by measuring the buccal marginal bone resorption around dental implants. MATERIALS AND METHODS: This retrospective study included patients who underwent dental implant placement with auto-DDM/rhBMP-2 as the control group and allo-DDM/rhBMP-2 as the experimental group. The primary outcome was buccal marginal bone resorption on CBCT. The resorption was calculated during T0 (from surgery to prosthetic loading), T1 (during the first year after loading), and T2 (during the second year after loading). The secondary outcome was the histologic analysis of five specimens of each group, obtained during the prosthetic procedure. RESULTS: Among the 103 implants, 61 and 42 implants were placed with auto- and allo-DDM/rhBMP-2 matrices, respectively. The resorptions of all periods were similar between the groups (T0: 0.65 ± 0.71 and 0.67 ± 0.81 mm, T1: 0.55 ± 0.60 and 0.59 ± 0.81 mm, and T2: 0.29 ± 0.45 and 0.20 ± 0.30 mm with auto- and allo-DDM/rhBMP-2, respectively). The histologic and histomorphometric analysis revealed similar osteoinductive aspects and proportions of new bone between the groups. CONCLUSION: Allo-DDM/rhBMP-2 showed comparable outcomes in terms of buccal marginal bone resorption to auto-DDM/rhBMP-2 during the second year after loading.

Sensory change after implant surgery: related factors for recovery.

Objectives: This retrospective study aimed to analyze data on nerve damage in patients who complained of sensory changes after dental implant surgery, the clinical results according to proximity of the implant fixture to the inferior alveolar nerve (IAN) canal, and the factors affecting recovery of sensation. Materials and Methods: The electronic medical records of 64 patients who had experienced sensory change after implant surgery were reviewed. Patients were classified by sex, age, implant installation sites, recovery rate and the distance between the implant fixture and IAN canal on computed tomography (CT). The distance was classified into Group I (D>2 mm), Group II (2 mm≥D>0 mm), and Group III (D≤0 mm). Results: The 64 patients were included and the mean age was 57.3±7.3 years. Among the 36 patients who visited our clinic more than two times, 21 patients (58.3%) reported improvement in sensation, 13 patients (36.1%) had no change in sensation, and 2 patients (5.6%) reported worsening sensation. In Group II, symptom improvement was achieved in all patients regardless of the removal of the implant fixture. In Group III, 8 patients (40.0%) had reported symptom improvement with removal of the implant fixture, and 2 patients (33.3%) of recovered patients showed improvement without removal. Removal of the implant fixture in Group III did not result in any significant difference in recovery (P=0.337), although there was a higher possibility of improvement in sensation in removal cases. Conclusion: Clinicians first should consider removing the fixture when it directly invades the IAN canal. However, in cases of sensory change after dental implant surgery where the drill or implant fixture did not invade the IAN canal, other indirect factors such as flap elevation and damage due to anesthesia should be considered as causes of sensory change. Removal of the implant should be considered with caution in these situations.

Volumetric analysis of spontaneous bone healing after jaw cyst enucleation.

The purpose of this study is to evaluate the degree of spontaneous bone healing after cyst enucleation as well as its contributing factors. Pre- and post-operative computed tomography (CT) scans of consecutive patients who had undergone jaw cyst enucleation were retrospectively analyzed. The outcome variable was healing ratio, which was calculated using the volume of the cyst before surgery and the volume of the defect in the bone after surgery. Predictor variables including duration of observation, pre-operative cyst size, age, gender, and involved jaw were analyzed to determine their influence. Forty-four subjects (30 Male and 14 Female, average 40.7 ± 15.7 years) were included in this study. Healing ratio was significantly lower during the first year (33.5 ± 32.8%) compared to the second (74.5 ± 24.2%) and subsequent years (74.2 ± 17.8%). In 35 patients who had follow-ups of over 1 year, the healing ratio was not affected by the pre-operative cyst size and upper/lower jaw except gender (p = 0.037, female > male) and age (p = 0.021, younger than 30 years > 30 years and older). The residual defect was significant larger in cysts 3 cc or larger (1.64 ± 1.54 cc) compared to smaller cysts (0.43 ± 0.42 cc, p = 0.006). The residual defect volume of large cysts was similar to those of the pre-operative volume of small cysts (1.47 ± 0.72 cc). In conclusion, spontaneous bone healing ratio of post-enucleation defects was about 73.5% after 12 months. Large cysts (> 3 cc) had larger defect, comparable to the volume of small cysts, but with altered contour. Additional treatment such as a bone graft may be considered especially in large cysts.

What Is the Perception of an Esthetic Lower Facial Third Profile in the Korean Layperson Population?

PURPOSE: The purpose of this study is to investigate whether there were differences in perception of facial profile esthetics at the upper lip, gnathic, and genial levels according to observer gender and age in the Korean layperson population. METHODS: Ten male (M1 to M10) and 10 female (F1 to F10) silhouettes with differing facial profiles at the level of the upper lip, mandibular, and chin were created from a male and female facial profile deemed well-balanced and orthognathic by reviewer consensus. These silhouettes were presented to 288 participants who were asked to rank the 5 most attractive male and female profiles. The participants were composed of 144 males and 144 females divided into 4 age groups: group I (under 20 years), group II (20 to 39 years), group III (40 to 59 years), and group IV (over 60 years). The most preferred profile and observer scores were investigated and calculated. Descriptive analysis, χ2 test, and analysis of variance were used for statistical analysis according to age and gender. RESULTS: The most preferred male and female silhouettes were orthognathic profiles. There was no significant difference according to gender when rating male (P = .281) and female (P = .442) silhouettes. No statistically significant difference was observed even when analyzed according to age groups. Although the difference in observer scores among each ranking showed a statistical difference according to age groups, the overall rankings showed a similar pattern both in male and female silhouettes. In the same age group, no difference in rank scores according to gender was observed. Severe concave profiles were found to have the lowest rank. CONCLUSIONS: An orthognathic profile was rated as the most desirable in the Korean layperson population, with few differences in perception of esthetic facial profile according to age and gender.

Accuracy of dental implant placement with computer-guided surgery: a retrospective cohort study.

BACKGROUND: The aim of this study was to assess the accuracy of virtual planning of computer-guided surgery based on the actual outcomes of clinical dental implant placement. METHODS: This retrospective study enrolled patients among whom implant treatment was planned using computer-guided surgery with cone beam computed tomography (CBCT). The patients who received implant according to the guide with the flapless and flapped approach were classified as group 1 and 2, respectively, and the others who could not be placed according to the guide were allocated to the drop-out group. The accuracy of implant placement was evaluated with the superimposition of CBCT. RESULTS: We analyzed differences in the deviated distance of the entrance point and deviated angulation of the insertion of implant fixtures. With regard to the surgical approach, group 2 exhibited greater accuracy compared to group 1 in deviation distance (2.22 ± 0.88 and 3.18 ± 0.89 mm, respectively, P < 0.001) and angulation (4.27 ± 2.30 and 6.82 ± 2.71°, respectively, P = 0.001). The limitations of guided surgery were discussed while considering the findings from the drop-out group. CONCLUSIONS: Computer-guided surgery demonstrates greater accuracy in implant placement with the flapless approach. Further research should be conducted to enhance the availability of guides for cases with unfavorable residual bone conditions.

Impact of Autogenous Demineralized Dentin Matrix on Mandibular Second Molar after Third Molar Extraction: Retrospective Study.

The purpose of this retrospective study was to evaluate bone healing after autogenous demineralized dentin matrix (DDM) grafts, focusing on the distal root of the mandibular second molar after the extraction of the third. We included retrospective data from 20 patients who had undergone molar extractions (15 male, 41.9 ± 12.0 years) between January 2020 and September 2022 and had DDM grafts implanted on the extraction socket, immediately ("immediate graft") or 6 weeks ("delayed graft") after the first surgery without primary closure. Patients who underwent grafting on only one side were used as the control group (n = 4). Bone defects at the mandibular second molar were measured preoperatively and 4 months after the graft surgery using cone-beam computed tomography (CBCT). Improvement of bone defect (i.e., the change in the bony defect pre- vs. postoperatively) was compared between the control and graft groups using the Wilcoxon Signed Rank test, and the difference between immediate and delayed grafts was analyzed with the Mann-Whitney U test. Complications such as infections or graft failure did not occur. Although pre-operative defects were smaller in the control than in the graft group (2.98 ± 1.77 and 10.02 ± 3.22 mm, p = 0.001), post-operative defects were similar in both (2.12 ± 0.59 and 2.29 ± 1.67 mm, respectively). The improvement ratio was not statistically significant in the control group (22.68 ± 15.36%) but a difference was observed in the graft group (76.70 ± 15.36%, p = 0.001). The amount of improvement of bone defect was not affected by graft timing or patient sex. In conclusion, DDM can improve bone defect at the distal aspect of the mandibular second molar after third molar extraction.

Review of Allogeneic Dentin Graft for Maxillofacial Bone Defects.

Although autogenous demineralized dentin matrix (auto-DDM) has shown promising clinical and histological results, it has certain limitations beyond its osteoinductivity and osteoconductivity. Therefore, the application of dentin graft material from other individuals-allogeneic DDM (allo-DDM)-has been considered an alternative to auto-DDM. However, few studies have investigated the osteoinductivity and antigenicity of allo-DDM. Herein, we reviewed all human studies related to allogeneic dentin application for the management of maxillofacial bone defects. Clinical studies have shown the osteoinductivity of allo-DDM in extraskeletal and skeletal sites, regardless of occasional antigenicity. Impact statement Although autogenous demineralized dentin matrix (auto-DDM) has shown promising clinical and histological results, it has certain limitations beyond its proven osteoinductivity and osteoconductivity. Therefore, the application of dentin graft material from other individuals-allogeneic DDM (allo-DDM)-has been considered as an alternative to auto-DDM. However, few studies have investigated the osteoinductivity and antigenicity of allo-DDM. This is the first review of all human studies related to allogeneic dentin grafts for the management of maxillofacial bone defects. Clinical studies have shown the osteoinductivity of allo-DDM in extraskeletal and skeletal sites, regardless of occasional antigenicity.

Influence of General and Local Anesthesia on Postoperative Pain after Impacted Third Molar Surgery.

This study examined the effects of general anesthesia on the postoperative pain level after third molar extractions compared to local anesthesia. This retrospective study included patients who underwent four simultaneous third molar extractions under general or local anesthesia and had records of their postoperative pain levels (visual analog scale, VAS). The pain level was determined in the early (Postoperative day; POD < #3) and late (POD #3-7) periods. The operation time and recently modified difficulty index were analyzed to validate the homogenous condition of the extraction. Of the 227 male inpatients (aged 20.9 ± 1.3 years), 172 and 55 patients underwent third molar extractions under local and general anesthesia, respectively. The age and difficulty index were distributed equally, but the operation time was longer in general anesthesia than in local anesthesia (p < 0.001). The early and late periods featured similar pain outcomes. The operation time correlated with the total periods with a correlation coefficient of 0.271 (p < 0.001). In conclusion, the postoperative pain following whole third molar extraction was related to the operation time rather than the anesthetic methods.

Onlay-graft of 3D printed Kagome-structure PCL scaffold incorporated with rhBMP-2 based on hyaluronic acid hydrogel.

The onlay-graft, one of the most difficult graft conditions, is used for diverse clinical conditions, including plastic and dental surgery. The graft should withstand continuous pressure from overlying tissues and have excellent bone formation capability in a limited bone contact situation. We recently developed a 3D printed Kagome-structured polycaprolactone (PCL) scaffold that has a stronger mechanical property. This study evaluated the clinical feasibility of this scaffold for onlay-graft use. The value of the scaffold containing recombinant human bone morphogenetic protein-2 in a hyaluronate-based hydrogel (rhBMP-2/HA) to enhance bone regeneration was also assessed. 3D-printed Kagome-PCL scaffolds alone (n= 12, group I) or loaded with rhBMP-2/HA (n= 12, group II) were grafted using a rat calvarial onlay-graft model. Following sacrifice at 2, 4, and 8 weeks, all 3D-printed Kagome-PCL scaffolds were accurately positioned and firmly integrated to the recipient bone. Micro-computed tomography and histology analyses revealed a constant height of the scaffolds over time in all animals. New bone grew into the scaffolds in both groups, but with greater volume in group II. These results suggest the promising clinical feasibility of the 3D-printed Kagome-PCL scaffold for onlay-graft use and it could substitute the conventional onlay-graft in the plastic and dental reconstructive surgery in the near future.

Analysis of Sagittal Position Changes of the Condyle After Mandibular Setback Surgery Across the Four Different Types of Plating Systems.

ABSTRACT: The authors analyzed the three-dimensional postoperative condylar position change across the plating systems. This retrospective study was conducted with the patients who underwent bilateral sagittal split ramus osteotomy with setback surgery. The condylar change was analyzed from preoperative cone-beam computed tomography to postoperative 1 month (T1) and postoperative 6 months (T2) using superimposition software, automatically merging based on the anterior cranial base. The condylar changes during T1 and T2 were analyzed across the four types of plates (4-hole sliding, heart-shaped, 3-hole sliding, and 4-hole conventional) Mean intraclass correlation coefficient values were consistently high for each measurement (>0.850). During T1, the conventional plate had a decreased condylar anterior distance when compared with the 3-hole sliding plate (P = 0.032). During T2, the conventional plate had an increased condylar posterior distance when compared with the 3-hole sliding plate (P = 0.031). Superimposition software based on the anterior cranial base could be available for measurement of condylar position with highly reproducible results. After bilateral sagittal split ramus osteotomy, the 3-hole sliding plate could effectively compensate for the anterior displacement of the condyle compared to other plates.