Artificial intelligence applications and ethical challenges in oral and maxillo-facial cosmetic surgery: a narrative review.

Artificial intelligence (AI) refers to using technologies to simulate human cognition to solve a specific problem. The rapid development of AI in the health sector has been attributed to the improvement of computing speed, exponential increase in data production, and routine data collection. In this paper, we review the current applications of AI for oral and maxillofacial (OMF) cosmetic surgery to provide surgeons with the fundamental technical elements needed to understand its potential. AI plays an increasingly important role in OMF cosmetic surgery in various settings, and its usage may raise ethical issues. In addition to machine learning algorithms (a subtype of AI), convolutional neural networks (a subtype of deep learning) are widely used in OMF cosmetic surgeries. Depending on their complexity, these networks can extract and process the elementary characteristics of an image. They are, therefore, commonly used in the diagnostic process for medical images and facial photos. AI algorithms have been used to assist surgeons with diagnosis, therapeutic decisions, preoperative planning, and outcome prediction and evaluation. AI algorithms complement human skills while minimizing shortcomings through their capabilities to learn, classify, predict, and detect. This algorithm should, however, be rigorously evaluated clinically, and a systematic ethical reflection should be conducted regarding data protection, diversity, and transparency. It is possible to revolutionize the practice of functional and aesthetic surgeries with 3D simulation models and AI models. Planning, decision-making, and evaluation during and after surgery can be improved with simulation systems. A surgical AI model can also perform time-consuming or challenging tasks for surgeons.

Presented a Framework of Computational Modeling to Identify the Patient Admission Scheduling Problem in the Healthcare System.

Operating room scheduling is a prominent study topic due to its complexity and significance. The increasing number of technical operating room scheduling articles produced each year calls for another evaluation of the literature to enable academics to respond to new trends more quickly. The mathematical application of a model for the patient admission scheduling issue with stochastic arrivals and departures is the subject of this study. The approach for applying our model to real-world issues is discussed here. We present a solution technique for efficient computing, a numerical model analysis, and examples to demonstrate the methodology. This study looked at the challenge of assigning procedures to operate rooms in the face of ambiguity regarding surgery length and the arrival of emergency patients based on a flexible policy (capacity reservation). We demonstrate that the proposed methods derived from deterministic models are inadequate compared to the answers produced from our stochastic model using simple numerical examples. We also use heuristics to estimate the objective function to build more complicated numerical examples for large-scale issues, demonstrating that our methodology can be applied quickly to real-world situations that often include big information sets.

Resistance exercise promotes functional test via sciatic nerve regeneration, and muscle atrophy improvement through GAP-43 regulation in animal model of traumatic nerve injuries.

Resistance training improves muscle strength through a combination of neural plasticity and muscle hypertrophy. This study aimed to evaluate the effects of resistance exercise on sciatic nerve regeneration and histology, growth-associated protein 43 (GAP-43) expressions, and soleus muscle atrophy following traumatic nerve injuries in Wistar rats. In the present study, 40 male Wistar rats were randomly assigned into four groups: healthy control (HC) as a sham group was exposed to the surgical procedures without any sciatic nerve compression, lesioned control (LC), resistance training (RT,non-lesioned), and lesioned rats + RT (LRT) (n = 10 in each). The RT group performed a resistance-training program 5 days/week for 4 weeks. Sciatic functional index (SFI) score, beam score and Basso, Beattie, and Bresnahan (BBB) score decreased and the hot plate time increased significantly in the LC| group compared to the HC (p < 0.05) group. However, the LRT| group showed a significant increase in the SFI score (p = 0.001) and a significant decrease in hot plate time (p = 0.0232) compared to the LC group. The LC group also showed neurological morphological damage and muscle atrophy and a decrease in GAP-43 in nerve tissue. In comparison to the LC group, a significant increase in sciatic nerve caliber, diameter, number of muscle fibers, and the expression of GAP-43| (p < 0.05) was observed in the LRT group. Doing resistance training even for four weeks seems to affect sciatic nerve lesions and injuries. It can also repair and regenerate nerve tissue by upregulating GAP-43 expression|, improving motor behavioral tests, and controlling muscle atrophy.

Smile Design: Mechanical Considerations.

Smile designing refers to the cosmetic and esthetic dental reconstruction that is visible during smiling. The use of modern digital tools requires adequate knowledge about the tooth shape and shade principles. Mechanical, biological, and psychological factors should be understood and tailor an individualized treatment accordingly to achieve pleasing esthetic outcomes. Dental therapy is becoming more appearance-driven, and thus, both patients and dental clinicians mainly emphasize on cosmetic dental and facial aspects of treatments.

Complications Associated with Spreader Grafts and Spreader Flaps: A Systematic Review.

BACKGROUND AND PURPOSE: Spreader grafts and spreader flaps are one of the most common techniques utilized in rhinoplasty surgeries. The aim of this study was to determine the complications, satisfaction, and revision rates associated with spreader grafts and spreader flaps and to compare these two modalities. MATERIALS AND METHODS: PRISMA guidelines were followed for conducting this systematic review. The authors searched the literature systematically for pertinent materials in PubMed/Medline and Google Scholar. Inclusion criteria of this search included: randomized and non-randomized clinical trials, cohorts, and case series with more than 5 participants on rhinoplasty using spreader grafts or spreader flaps with detailed report either on complications, revision, and satisfaction rates. Furthermore, exclusion criteria included: any cadaveric or non-human study, case reports, technical notes, and review articles. RESULTS: The initial literature search yielded a total of 193 studies. Following screening each paper and implementing the inclusion and exclusion criteria, 40 articles were chosen. In the spreader graft group, from 21 studies reporting complications, 6 of them reported no complication. The most common complications were nasal obstruction, inverted V deformity and open roof deformity, deviation, and infection. In the spreader flap group, from 6 studies reporting any existing complications, 1 reported no complications. Five other studies reported some degree of complications. In terms of revision rate, 10 patients (0.62%) underwent revision surgery after spreader graft placement, while only 2 patients (0.35%) revised surgically in the spreader flap group. CONCLUSION: These two methods seem to have no significant difference in terms of complication rates, and both are recommended as a choice in middle vault reconstruction when each of their clinical use is indicated. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Vaccine-associated complications: a comparative multicenter evaluation among dental practitioners and dental students-which candidate vaccine is more safe in SARS COV II, Gam-COVID-Vac (Sputnik V), ChAdOx1 nCoV-19 (AstraZeneca), BBV152 (Covaxin), or BBIBP-CorV(Sinopharm)?

BACKGROUND: The rapidly developed vaccines against the severe acute respiratory syndrome coronavirus 2 carry a risk of provoking side effects. This study aimed to evaluate current vaccination non-serious/serious side effects. METHODS: A multicenter electronic questionnaire via an online platform was conducted over a 1-week period among vaccinated dental staff and dental students inquiring whether they experienced vaccine-related side-effects after vaccine administration. RESULTS: A total of 1205 respondents with a mean age of 39 (SD: 12) were retained for the analyses. The following vaccines were reported; Gam-COVID-Vac (Sputnik V), ChAdOx1 nCoV-19 (AstraZeneca), BBV152 (Covaxin), or BBIBP-CorV (Sinopharm). The majority of respondents received ChAdOx1 nCoV-19 (51.1%) and Gam-COVID-Vac (37.6%). The symptoms most frequently reported after vaccination were fatigue (79%), local pain in the injection site (77.4%), malaise (73%), and body pain (71.1%). Enrollees reported more onset of reactions on 0-12 h (44.1%) and 12-24 h (29.0%) after vaccine administration (p value <0.001). In 75.7%, the side effects last for up to 3 days. Merely 5.5% of cases reported the presence of side effects after the first week. Individuals with a history of SARSCoV-2 and other infections (MERS, influenza, and EBV) were more likely to report a number of unserious systemic side effects. CONCLUSION: The commonly reported adverse events were in line with similar studies. We have concerns with the frequency of serious adverse effects. This work necessitates the need for further clinical assessments with larger sample sizes.

Differential tumor inhibitory effects induced by HER3 extracellular subdomain-specific mouse monoclonal antibodies.

PURPOSE: The therapeutic potential of targeting the human epidermal growth factor receptor-3 (ErbB3/HER3) has long been ignored due to impaired tyrosine kinase function and low expression level in tumor cells compared with EGFR and HER2. Although recent investigations have explored the potential benefit of HER3 targeting and several anti-HER3 agents have been developed, there is still a critical need to design and produce more efficient therapeutics. This study was designed to develop tumor inhibitory monoclonal antibodies (MAbs) against different extracellular subdomains of HER3. METHODS: Distinct extracellular subdomains of HER3 (DI+II and DIII+IV) were utilized to produce MAbs by hybridoma technology. Biochemical and functional characteristics of these MAbs were then investigated by various methodologies, including immunoblotting, flow cytometry, cell proliferation, cell signaling, and enzyme-linked immunosorbent assays. RESULTS: Four anti-DI+II and six anti-DIII+IV MAbs were obtained, selected based on their ability to bind recombinant full HER3 extracellular domain (ECD). Our data showed that only one anti-DI+II and four anti-DIII+IV MAbs recognized the native form of HER3 by immunoblotting. Four MAbs recognized the membranous HER3 by flow cytometry leading to induction of different levels of receptor internalization and subsequent degradation. Results of cell proliferation assays using these MAbs indicated that they differentially inhibited proliferation of HER3-expressing cancer cells and showed considerable synergistic effects in combination with trastuzumab. Selected MAb with the highest inhibitory effect significantly inhibited the phosphorylation of AKT and ERK1/2 molecules. CONCLUSION: Some of the anti-HER3 MAbs produced in this study displayed tumor inhibitory function and may be considered promising candidates for future HER3-targeted cancer therapy.

A novel tumor inhibitory hybridoma monoclonal antibody with dual specificity for HER3 and HER2.

BACKGROUND: The human epidermal growth factor receptor (HER/ErbB) family-targeted therapies result in a significant improvement in cancer immunotherapy. Monoclonal antibodies (MAb) against HER2 demonstrated a survival benefit for patients; however, drug resistance unavoidably occurs due to the overexpression of HER3, which leads to treatment failure. Effective inhibition of HER3 besides HER2 is thought to be required to overcome resistance and enhance therapeutic efficacy. OBJECTIVE: The present study describes the production and characterization of a novel MAb, designated 1G5D2, which acts as a natural bispecific antibody targeting extracellular domains (ECD) of both HER2 and HER3. METHODS: In this study, 1G5D2 was produced by hybridoma technology against HER3-ECD, and its structural and functional characteristics were studied by various methodologies, including enzyme linked-immunosorbent assays, flow cytometry, immunoblotting, cell signaling, and cell proliferation assays. RESULTS: 1G5D2 specifically binds to both HER2 (subdomain III + IV) and HER3 (subdomain I + II) expressed on tumor cells, and these receptors compete with each other for binding to this MAb. Competition flow cytometry experiments demonstrated that 1G5D2 does not compete with heregulin and recognizes an epitope out of HER3 ligand-binding site. Evaluation of 1G5D2 inhibitory effects in tumor cell lines co-expressing HER2 and HER3 showed that 1G5D2 synergizes with trastuzumab to inhibit both PI3K/AKT and MAPK/ERK pathways and potently downregulates the proliferation of these tumor cells more efficiently than each MAb alone. CONCLUSION: 1G5D2 is the first reported hybridoma antibody, which acts as a natural HER2/HER3 bispecific antibody. It might potentially be a suitable therapeutic candidate for HER2/HER3 overexpressing cancer types.

Zygomatic implants placed in atrophic maxilla: an overview of current systematic reviews and meta-analysis.

BACKGROUND: Zygomatic implants are a treatment option for severely atrophic maxilla. MAIN TEXT: This study aimed to summarize and evaluate systematic reviews assessing the clinical outcomes of zygomatic implants including survival/failure rate and complications. PubMed-MEDLINE, Google Scholar, LILACS, and the Cochrane Database were searched up to April 2020. Risk of bias assessment was conducted by the AMSTAR tool. Initial searches yielded 175 studies. These were assessed, and following title abstract and full-text evaluation, 7 studies (2 meta-analyses) were included in the final review. According to the AMSTAR tool, 1 was deemed high quality, 4 were classified as medium, and 2 as low quality. The mean AMSTAR score (±SD) was 5.28 of 9 (±2.36) ranging from 2/9 to 9/9. The reported survival rates ranged from 95.2 to 100% except for resected maxillas, which established higher failure rates up to 21.43%. Concerning the complications with the zygomatic implants, various surgical and prosthetic complications were reported with sinusitis being the most frequently observed complication. Zygomatic implants appears to offer a promising alternative to formal bone grafting techniques with lower costs, less complications, less morbidity, shorter treatment times, and comparably high survival rates. CONCLUSION: Complications were rare and usually easy to manage. However, the treatment should be directed by appropriately trained clinicians with noticeable surgical experience.

Dynamic-Assisted Navigational System in Zygomatic Implant Surgery: A Qualitative and Quantitative Systematic Review of Current Clinical and Cadaver Studies.

PURPOSE: The goal of this systematic review is to assess the accuracy and complications (including failure) of dynamic navigation in placing zygomatic implants. METHODS: PubMed, Cochrane Library (CENTRAL), trial register (clinicaltrial.gov), and Google Scholar were searched systematically up to May 2020. In addition, the reference lists of included systematic reviews were hand searched. The New Castle Ottawa and Joanna Briggs Institute Critical Appraisal Checklist for Case Reports were used for quality assessment. RESULTS: Ninety-four studies were assessed, and finally, 12 articles were included. According to Joanna Briggs Institute tool, the mean score of case reports (±standard deviation) was 6.4 (range, 5/9 to 8/9) and the mean score of observational studies (±standard deviation) was 5.66 (range, 5/9 to 7/9) as measured by New Castle Ottawa tool. Included materials pointed out that higher accuracy and drastic cut down on the risk of perioperative/postoperative complications were reported by using the dynamic navigation system compared with freehand implant placement. CONCLUSIONS: Application of dynamic navigation systems is a reliable technology for zygomatic implant placement, especially in difficult cases with a history of maxillary deficiency. Evidence of reliability and accuracy of dynamic navigation technique in multicenter large randomized and prospective controlled studies is still lacking.

Computer-assisted horizontal translational osseous genioplasty: a simple method to correct chin deviation.

BACKGROUND: Different genioplasty techniques are applied for the adjustment of chin area deformities such as chin deviation. RESULTS: Thirty patients with simple facial asymmetry due to chin deviation underwent computer-assisted horizontal translational osseous genioplasty. In this technique, a surgical guide was used to cut a bone strip from the side where the chin should be transferred to; then, the same bone strip was used for the filling of the gap that was formed on the opposite side. CONCLUSION: According to the experience gained from this study, the authors believe that computer-assisted horizontal translational osseous genioplasty is a simple and reliable technique for patients with facial asymmetry due to chin deviation.

Reopening of dental clinics during SARS-CoV-2 pandemic: an evidence-based review of literature for clinical interventions.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes serious acute respiratory diseases including pneumonia and bronchitis with approximately 2.3% fatality occurrence. MAIN BODY: This study argues the main concepts that need to be considered for the gradual reopening of dental offices include treatment planning approaches, fundamental elements needed to prevent transmission of SARS-CoV-2 virus in dental healthcare settings, personal protection equipment (PPE) for dental health care providers, environmental measures, adjunctive measures, and rapid point of care tests in dental offices. CONCLUSION: This article seeks to provide an overview of existing scientific evidence to suggest a guideline for reopening dental offices.

Use of piezoelectric surgery and Er:YAG laser:which one is more effective during impacted third molar surgery?

BACKGROUND: Reduction in postoperative complications is of vital considerations in impacted third molar teeth surgery. The aim of this study was to compare postoperative complications of impacted third molar surgeries for bone removal using laser, piezoelectric equipment, and conventional rotary instruments. METHODS: To address the research purpose, the investigator designed the prospective double-blind clinical trial study. The sample size was determined 20 (40 teeth) by sampling formula in any kind of operation. The data of patients were obtained in the different periods in terms of pain, trismus, swelling, ecchymosis, and patient's satisfaction and then analyzed using SPSS 20 software via paired t test and Wilcoxon and McNemar's tests. RESULTS: The pain immediately after surgery and 2 days and 7 days after surgery was higher in the laser group. The swelling immediately after surgery was more in the laser group but not significant. The amount of mouth opening immediately after surgery and 2 days and 7 days after surgery was significantly lower in the laser group than in the piezosurgery group. The total duration of surgery and duration of osteotomy were significantly longer in the laser group. The patient's satisfaction from surgery with piezosurgery was more than that with laser, but this difference was not significant. CONCLUSION: Due to the rising demand for impacted wisdom tooth surgery, the present study suggests that hard tissue laser surgery and piezosurgery can clear the future of impacted molar surgery, and these approaches are more efficient in reducing postoperative complications compared to the conventional surgeries.