Oral Surgery Research Articles

Optimizing acute pain management in oral surgery: Current strategies and emerging approaches

Effective pain management in oral surgery is crucial to improving patient outcomes and satisfaction. Acute pain, a common result of oral surgical procedures such as extractions, implant placements, and bone grafting, can significantly impact patient recovery. However, pain control remains a complex challenge due to individual variability in pain perception, pre-existing medical conditions, and the inherent invasiveness of certain procedures. This article reviews current approaches to acute pain management in oral surgery, focusing on multimodal analgesia, pharmacological interventions, and non-pharmacological techniques. Traditional strategies such as non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and local anesthetics are discussed alongside newer alternatives, including nerve blocks, patient-controlled analgesia, and adjunct therapies like mindfulness and cryotherapy. The role of personalized pain management plans, which consider patient-specific factors, is explored to minimize side effects and enhance recovery. Advances in minimally invasive techniques, laser therapy, and alternative methods for reducing post-operative pain are also examined. Recent research highlights the importance of reducing opioid dependency while balancing the need for effective pain control. Future directions for pain management, such as precision medicine approaches and the use of digital health technologies for pain monitoring, are also discussed. The article concludes by emphasizing the need for a balanced, patient-centered approach to acute pain management in oral surgery, integrating both traditional and emerging strategies.

Artificial intelligence in oral and maxillofacial surgery: A road ahead

Artificial intelligence has emerged as a transformative force in the healthcare system. It has revolutionized the traditional approach to diagnosis, treatment planning, and surgical outcomes. Oral and Maxillofacial Surgery also stands at the forefront of this technological revolution by enhancing surgical procedures, optimizing treatment outcomes, and improving patient satisfaction. However, integrating AI into the healthcare system also presents unique challenges, including data privacy concerns, regulatory compliance issues, and the need for ongoing training for clinicians. This article provides a comprehensive overview of AI applications within Oral and Maxillofacial Surgery, highlighting key developments, challenges, and future directions.

Iodoform in Surgical Practice: A Comprehensive Review of Its Historical Evolution, Clinical Applications, and Safety Profiles.

Iodoform, a halogenated organic compound, has been a cornerstone in surgical practice due to its potent antiseptic and antimicrobial properties. This comprehensive review examines the historical evolution, mechanism of action, clinical applications, and safety profile of iodoform across various surgical disciplines. Historically significant formulations like Whitehead's varnish and bismuth iodoform paraffin paste (BIPP) demonstrated remarkable efficacy in wound healing during the late 19th and early 20th centuries. BIPP, extensively used for cavity packing, combines bismuth subnitrate for its antibacterial and astringent effects with paraffin to minimize tissue trauma. The antimicrobial action of iodoform is attributed to the release of iodine upon activation by free radicals, leading to the denaturation of bacterial proteins and cytotoxic effects on inflammatory cells, thereby enhancing therapeutic efficacy. Clinically, iodoform has diverse applications in ear, nose, and throat surgery, neurosurgery, oral and maxillofacial surgery, and general dental practice. It is utilized for dressing wounds, packing surgical cavities, and managing conditions such as nasal fractures, epistaxis, cerebrospinal fluid leaks, and dry sockets. The radiopacity of BIPP, due to its bismuth content, aids in radiographic identification but necessitates clear communication with radiologists to prevent misinterpretation. Despite its benefits, iodoform use is associated with potential complications. Bismuth and iodoform toxicities, though rare, can lead to neurotoxicity and systemic symptoms, requiring prompt recognition and intervention. Allergic reactions, particularly in patients with prior exposure, and dermatological side effects like dermatitis herpetiformis flare-ups have been documented. Mechanical complications and considerations during pregnancy, owing to the potential transfer of iodine to the fetus, highlight the need for cautious application. This review underscores the enduring significance of iodoform in surgical settings while emphasizing the importance of awareness regarding its potential risks. Careful clinical judgment and ongoing research are imperative to optimize its therapeutic benefits and enhance patient safety.

Flapless extraction of impacted mandibular third molars: A contemporary surgical approach

The aim of this review is to evaluate the clinical outcomes of flapless extraction of impacted mandibular third molars compared to traditional flap-based techniques, with a focus on patient satisfaction, complication rates, and overall surgical efficiency. The extraction of impacted mandibular third molars (wisdom teeth) is a common procedure in oral and maxillofacial surgery, traditionally performed using a flap-based technique. While this method provides clear access to the impacted tooth, it is often associated with significant postoperative morbidity, such as pain, swelling, and extended recovery time. Recent innovations have introduced flapless extraction as a minimally invasive alternative, aiming to minimize tissue trauma and preserve periosteal integrity. This technique, however, presents its own set of challenges, including limited visibility and technical demands.This review analyzes the current literature on flapless extraction techniques, drawing from retrospective studies, randomized controlled trials, and clinical case reports. The data include comparisons of postoperative outcomes between flapless and traditional methods, emphasizing factors such as operative time, postoperative discomfort, and the frequency of complications. Findings indicate that flapless extraction generally results in reduced postoperative pain, swelling, and faster recovery times compared to traditional flap-based techniques. Patients who undergo flapless extraction report higher satisfaction due to less postoperative discomfort and a quicker return to normal function. However, the technique poses challenges in cases of deeply impacted teeth, where the lack of a flap may hinder complete access and increase the risk of complications. Flapless extraction represents a promising evolution in the surgical removal of impacted mandibular third molars, offering several advantages over traditional methods, particularly in reducing postoperative morbidity. However, the technique requires precise surgical skill and is not suitable for all cases. Careful case selection is crucial, and continued research is needed to further validate its efficacy and safety in complex scenarios.

Application of Advanced Platelet-Rich Fibrin in Oral and Maxillo-Facial Surgery: A Systematic Review.

Background: Advanced platelet-rich fibrin (A-PRF) is produced by centrifuging the patient's blood in vacuum tubes for 14 min at 1500 rpm. The most important component of A-PRF is the platelets, which release growth factors from their ⍺-granules during the clotting process. This process is believed to be the main source of growth factors. The aim of this paper was to systematically review the literature and to summarize the role of A-PRF in oral and maxillo-facial surgery. Materials and Methods: A systematic review was carried out, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO: CRD42024584161). Results: Thirty-eight articles published before 11 November 2024 were included in the systematic review. The largest study group consisted of 102 patients, and the smallest study group consisted of 10 patients. A-PRF was most often analyzed compared to leukocyte-PRF (L-PRF) or blood cloth. A-PRF was correlated with lower postoperative pain. Also, A-PRF was highlighted to have a positive effect on grafting material integration. A-PRF protected areas after free gingival graft very well, promoted more efficient epithelialization of donor sites and enhanced wound healing. Conclusions: Due to its biological properties, A-PRF could be considered a reliable addition to the surgical protocols, both alone and as an additive to bio-materials, with the advantages of healing improvement, pain relief, soft tissue management and bone preservation, as well as graft integration. However, to determine the long-term clinical implications and recommendations for clinical practice, more well-designed randomized clinical trials are needed in each application, especially those with larger patient cohorts, as well as additional blinding of personnel and long follow-up periods.

Application of dynamic navigation technology in oral and maxillofacial surgery.

Dynamic navigation (DN) technology has ushered in a paradigm shift in dentistry, revolutionizing the precision of diverse procedures in oral and craniofacial surgery. This comprehensive review aims to review the manifold applications of DN, including implantology, endodontics, oral and dental surgeries, and other dental disciplines. A thorough search of the online databases PubMed and Google Scholar was conducted up to March 2024. Publications associated with DN in the field of oral and maxillofacial surgery were sourced. Narrative literature review. DN harnesses cone beam computerized tomography imaging, virtual design software, and motion tracking technology to construct a virtual model of the patient's oral cavity, affording real-time instrument tracking during procedures. Notably, in implantology, DN facilitates implant placement, enhances safety measures, and augments procedural efficiency. The application of DN in sinus lift procedures contributes to improved surgical outcomes and reduced complications. Within endodontics, DN guides root canal treatment (RCT), retreatment of failed RCT, and endodontic microsurgery, ensuring conservative access cavities and precise canal location. Beyond these, the versatility of DN extends to encompass maxillomandibular and orthognathic surgeries, tooth extraction, removal of foreign bodies, and facial reconstruction. However, it is crucial to acknowledge potential disadvantages and error-prone scenarios as DN technologies advance. DN technology empowers dentists with high accuracy, heightened safety protocols, and increased procedural efficiency, culminating in enhanced patient outcomes across various dental procedures. As DN technology further expands, its pivotal role will advance in the future of oral and maxillofacial surgery.

Artificial Intelligence in Dentistry: A Descriptive Review.

Artificial intelligence (AI) is an area of computer science that focuses on designing machines or systems that can perform operations that would typically need human intelligence. AI is a rapidly developing technology that has grabbed the interest of researchers from all across the globe in the healthcare industry. Advancements in machine learning and data analysis have revolutionized oral health diagnosis, treatment, and management, making it a transformative force in healthcare, particularly in dentistry. Particularly in dentistry, AI is becoming increasingly prevalent as it contributes to the diagnosis of oro-facial diseases, offers treatment modalities, and manages practice in the dental operatory. All dental disciplines, including oral medicine, operative dentistry, pediatric dentistry, periodontology, orthodontics, oral and maxillofacial surgery, prosthodontics, and forensic odontology, have adopted AI. The majority of AI applications in dentistry are for diagnoses based on radiographic or optical images, while other tasks are less applicable due to constraints such as data availability, uniformity, and computational power. Evidence-based dentistry is considered the gold standard for decision making by dental professionals, while AI machine learning models learn from human expertise. Dentistry AI and technology systems can provide numerous benefits, such as improved diagnosis accuracy and increased administrative task efficiency. Dental practices are already implementing various AI applications, such as imaging and diagnosis, treatment planning, robotics and automation, augmented and virtual reality, data analysis and predictive analytics, and administrative support. The dentistry field has extensively used artificial intelligence to assist less-skilled practitioners in reaching a more precise diagnosis. These AI models effectively recognize and classify patients with various oro-facial problems into different risk categories, both individually and on a group basis. The objective of this descriptive review is to review the most recent developments of AI in the field of dentistry.

Anatomy Education and Training Methods in Oral Surgery and Dental Implantology: A Narrative Review.

Background: Oral and implant surgery represent highly specialized fields within dentistry that require a deep understanding of complex anatomical structures, together with practical hands-on experience. The present review examines common trends in oral and implant surgery training, focusing on how traditional methods like donated body dissection coexist with different and modern educational tools, and highlights the pros and cons of the different approaches in order to optimize training outcomes. Methods: A systematic literature search was carried out using the databases PubMed and Cochrane Library including the last 10 years of published articles about training in oral surgery and implantology. Starting from a total of 1319 studies, 47 were included to be carefully evaluated, and 20 studies were finally selected for this narrative review. The studies utilize methodologies such as randomized controlled trials (RCTs), cross-sectional surveys, case-control studies, and systematic reviews. The results were thematically organized, highlighting key quantitative outcomes and drawing connections between the different educational approaches. Results: From the narrative review, it emerged that oral and implant surgery training requires a careful balance between traditional methods, such as donated human body dissection, and modern technological advancements like virtual simulations and synthetic models. While animal and synthetic models have specific uses, their application remains limited in replicating the full complexity of human anatomy. These last technologies offer flexibility and expanded access to education but do not substitute for the hands-on experience gained through donated human body dissection. Conclusions: As educational institutions continue to evolve their training programs, ensuring access to human body dissection remains of paramount importance. Combining the strengths of both traditional and modern approaches may help optimize oral and implant surgery education, enhancing student preparedness without overlooking the critical value of direct anatomical experience.

High-fidelity surgical simulator for the performance of craniofacial osteotomies.

The oral and maxillofacial (OMF) surgical community is making an active effort to develop new approaches for surgical training in order to compensate for work-hour restrictions, mitigate differences between training standards, and improve the efficiency of learning while minimizing the risks for the patients. Simulation-based learning, a technology adopted in other training paradigms, has the potential to enhance surgeons' knowledge and psychomotor skills. We developed a fully immersive, high-fidelity virtual simulation trainer system based on Kitware's open-source visualization and interactive simulation libraries: the Interactive Medical Simulation Toolkit (iMSTK) and the Visualization Toolkit (VTK). This system allows surgeons to train for the crucial osteotomy step in bilateral sagittal split osteotomy (BSSO) using a pen-grasp oscillating saw that is controlled in the virtual environment using a 3D Systems Geomagic Touch haptic device. The simulator incorporates a proficiency-based progression evaluation system to assess the correctness of the cut and provide user feedback. Three expert clinicians and two senior residents tested our pilot simulator to evaluate how the developed system compares to the performance of real-life surgery. The outcomes of the face and content validation study showed promising results with respect to the quality of the simulated images and the force feedback response they obtained from the device matched what they expected to feel. The developed trainer has the potential to contribute to a reduction in the prevalence of adverse surgical outcomes after OMF surgeries involving osteotomies. Observing the clinicians and talking through some of the difficulties helped us identify key areas for improvement. Future work will focus on further clinical evaluation for the BSSO surgical scenario and extension of the trainer to include other craniofacial osteotomy procedures.

Minimizing Oxidative Stress in Oral Surgery: A Comparative Study of Laser-Assisted and Conventional Third Molar Extractions.

Background/Objectives: This study aims to compare the effects of conventional surgical techniques and laser-assisted methods on salivary oxidative stress biomarkers following third molar extraction, in order to evaluate the potential benefits of laser surgery in reducing oxidative stress and promoting faster recovery. Methods: A total of 154 patients, aged 16-30, undergoing third molar extractions were included in the study. Patients were divided into two groups: conventional surgery (n = 75) and laser-assisted surgery (n = 79). Saliva samples were collected at baseline, and 24, 48, 72, and 168 h postoperatively. The levels of total antioxidant capacity (TAC), malondialdehyde (MDA), and 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured as indicators of oxidative stress. Results: Initial biomarker levels were similar across all participants. Postoperative oxidative stress increased in both groups, with significantly higher levels in the conventional surgery group at 48 and 72 h. Salivary biomarkers of oxidative stress were significantly lower in the laser group at 48 and 72 h post-surgery (p < 0.05), indicating a faster recovery. By 168 h, biomarker levels in the laser group had nearly returned to baseline, whereas levels in the conventional group remained slightly elevated. Conclusions: Laser-assisted surgery significantly reduces oxidative stress and promotes faster recovery when compared with conventional methods, as evidenced by the more rapid normalization of salivary biomarkers. These findings suggest that laser techniques may offer superior clinical outcomes in third molar extractions.

Microbial spectrum and resistance of odontogenic abscesses - microbiological analysis using next generation sequencing

ObjectivesThis study aimed to map the microbiome of odontogenic abscesses using next-generation sequencing (NGS) to identify bacterial and fungal species, as well as antibiotic resistances.Materials and methodsWound swabs were taken from patients treated for odontogenic abscesses at the Department of Oral and Maxillofacial Plastic Surgery, University Hospital Bonn. NGS was used to analyze the swabs, and bioinformatic analysis assigned the genetic material to microorganism profiles and identified antibiotic resistances.ResultsBacteria were detected in all samples from 51 patients. Anaerobes were found in 50 swabs, while aerobic bacteria were detected in 30. Four of the five most common bacterial genera were anaerobes (Fusobacterium, Prevotella, Parvimonas, Porphyromonas). A median of eight genera were identified per swab. Infections were mostly polymicrobial; only one case was a monoinfection with Streptococcus. Aerobic bacteria were less frequent in patients who had prior antibiotic therapy (p = 0.015). Fungi were present in 52.9% of cases, with Malassezia (33.3%), Aspergillus (9.8%), and Candida (3.9%) being the most common. Antibiotic resistance was detected in 66.7% of patients, mainly against lincosamides, macrolides and tetracyclines. Fusobacterium showed a 25.9% resistance rate to clindamycin.ConclusionsThe microbiome of odontogenic abscesses is polymicrobial, dominated by anaerobic bacteria, and more extensive than indicated by traditional cultural diagnostics. NGS provides detailed pathogen diagnostics, aiding in precise and individualized antibiotic therapy.Clinical relevanceImproved understanding of the bacterial and fungal spectrum, along with current resistance patterns of odontogenic abscesses, is crucial for optimizing treatment outcomes. NGS offers rapid, accurate and detailed microbiome analysis, enhancing patient-specific therapeutic strategies.

Sjögren’s Syndrome: The Role of Serological Profiles Versus Minor Salivary Gland Histopathology

Between the years 2008 and 2023, 306 patients were referred to the Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, for salivary gland biopsy after clinical suspicion of Sjögren’s syndrome. This study aimed to investigate possible associations between serology and minor salivary gland histopathology by stratifying patients according to serology features (negative, single, or double seropositivity according to anti-SSA and anti-SSB), focus score (FS, negative, or actual score), and germinal centers (GCs). Information was collected from referrals and visits. Collected information included oral and ocular dryness symptoms, sialometry, Schirmer I test, histopathological analysis, and serological findings. Patients were classified using the 2002 American European Consensus Group classification criteria and were stratified into seven subgroups according to their serological profiles and FS, which were compared. The majority of patients were females, and the most frequently referred age group was 50–59 years of age. Most patients had both oral and ocular symptoms. Seropositive patients had higher median FS compared to seronegative patients. Double-seropositive patients had significantly higher median FS compared to single-seropositive patients. The results indicated that anti-SSB together with anti-SSA plays a role in disease severity in the salivary glands. In addition to anti-SSA, anti-SSB should be routinely evaluated as a possible predictor of the severity of inflammatory destruction in the salivary gland tissue.

Following the upheaval of COVID-19, is it time to redefine review appointments in oral surgery?

Following the upheaval of COVID-19, is it time to redefine review appointments in oral surgery?

Patient centered outcomes of transoral robotic surgery for obstructive sleep apnea: a retrospective analysis.

Obstructive Sleep Apnea (OSA) is usually caused by collapse of the base of tongue (BOT) and impacts patients' overall health. Despite current conventional therapies, some patients do not achieve satisfactory results. Reduction of BOT using Trans Oral Robotic Surgery (TORS) emerges as a promising treatment. We evaluated the patient reported and clinical outcomes of TORS for OSA. We performed a retrospective cohort study of patients treated from 2018 to 2021 in a non-academic general hospital. Patients were eligible for TORS when apnea hypopnea index (AHI) was >5 in combination with obstruction at BOT level. Patients were included when 1-year follow up respiratory polygraphy was available. Changes in Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ-35), MD Anderson Dysphagia Inventory (MDADI) scores and postoperative complications were evaluated. Surgical success rates were obtained. Out of 56 patients, 28 patients of which 22 (78.6%) males and 6 (21.4%) females, with OSA severity ranging from mild to severe and mean age of 49 (SD 11.8) with a median BMI of 28.1 (IQR 26.9-32.1) were included. ESS score declined from mean 5.9 (SD 3.8) to 2.2 (SD 2.0) (p<0.00). FOSQ-35 scores were all declined (p<0.05). MDADI scores were in normal range (80-100) and remained stable (p = 0.44). In 23 (82.1%) patients no postoperative complications were observed. Surgical success rates were 86%. TORS demonstrate to be effective and safe in OSA patients, and it can be used in both patients who are unresponsive to conventional therapies or as a primary therapy.

Digital design combined with endoscopic minimally invasive extraction of impacted mandibular third molars with roots in contact with the mandibular canal

Objective: To study the clinical efficacy of digital design combined with three-dimensional (3D) printing model minimally invasive extraction of complex impacted mandibular third molars. Methods: Eight patients who visited the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from April 2023 to March 2024 were included, including 3 males and 5 females, aged from 27 to 57 years old. The impacted mandibular third molars of all patients were closely related to the mandibular canal, and part of the dental tissue entered the mandibular canal. Preoperative digital design was used to simulate the intraoperative tooth segmentation and bone removal operation of the power system and the segmented tooth dislocation path, and analyze the tooth extraction resistance. The mandibular teeth, mandibular canal and mandibular model were three-dimensionally printed using light-curing resin inkjet. During the operation, an endoscope was used combined with the 3D printed model to minimally invasively extract the impacted mandibular third molar. Quantitative sensory testing of the patient's lower lip skin on the operated side was performed before surgery, 2 days after surgery, and 7 days after surgery. Clinical data such as operation time were collected. A paired sample t test was performed on the 2 and 7 days postoperative data and the preoperative data to compare the data differences. Results: All 8 patients successfully completed preoperative design, model printing and minimally invasive surgery. The number of teeth segmented in the preoperative design was (4.4±1.3), and the number of teeth segmented in the actual operation was (4.0±1.1). The operation time was (33.3±13.0) min. None of the patients had postoperative numbness of the lower lip or other postoperative complication. It was observed endoscopically that the inferior alveolar neurovascular bundle was exposed in the extraction socket during the operation. The patient's pressure pain threshold 2 days after surgery (0.601±1.170) was significantly lower than before surgery (1.251±1.109) (t=2.83, P=0.025). Conclusions: For complicated impacted mandibular third molars, digital design combined with 3D printing model can be used to perform minimally invasive extraction with the assistance of an endoscope.

EXODONTIA DE TERCEIROS MOLARES INFERIORES: DESAFIOS E COMPLEXIDADES CIRÚRGICAS

Third molar extraction is one of the procedures within the dental clinic that causes people the most fear, despite being performed frequently. The incidence of complications can still be considered high. The anatomical position of these dental elements is one of the main reasons for complications during their removal, due to the proximity of important anatomical structures. Therefore, the use of radiographic examinations to evaluate the positioning of third molars is essential so that it is possible to visualize ways to conduct the surgery safely. The aim of this work is to review, according to the bibliographic literature, the risks of complications during extraction of lower 3rd molars. For this, a search was carried out in the literature, in the following databases: Pubmed, Virtual Health Library (VHL), Scielo and Google Scholar, using the descriptors: “Nonerupted tooth”, “Third Molar” and “Oral Surgery ”. The established inclusion criteria include articles that address the defined theme and that are available for full reading, in Portuguese and English, published in the last 10 years. The exclusion criteria were articles that deviate from the proposed topic, repeated articles and incomplete research. The present work is expected to acquire information to better perform surgeries on third molars according to their clinical condition, presenting ideal approaches for diagnosis and surgical planning and emphasizing the care necessary to avoid surgical complications. Keywords: Tooth Unerupted. Third Molar. Oral Surgery.

A Bibliometric Analysis of the 100 Top-Cited Articles on Vertical Root Fractures.

The aim of this study was to perform a meticulous analysis and bibliometric evaluation of the top 100 most cited articles in vertical root fractures (VRFs).The bibliometric research method included 100 top-cited articles on VRFs retrieved from the Web of Science database. The key terms "vertical root fracture" OR "vertical root fractures" were used to retrieve the required dataset. The salient bibliometric indicators were analyzed. Microsoft Excel version 16 (Microsoft Corporation, Redmond, WA), VOSviewer (v.1.6.10, Centre for Science and Technology Studies, Leiden University, The Netherlands), and the SPSS Statistics version 20software (IBM Corp., Armonk, NY) were used for data analysis. The top 100 cited articles on VRFs were published between 1977 and 2022, and these articles were cited with an average of 69 citations. A slight rise (27%) in top-cited articles on VRFs was shown in the first half (1977-1999), but a substantial increase(73%) was recorded in the second half (2000-2022). The Journal of Endodontics published around half of the articles (n = 47). The United States contributed the most cited articles, followed by Brazil and Israel, whereas The Netherlands produced the most influential articles. The top-ranked author (Avaid Tames) and the university (Tel Aviv University) belonged to Israel. The most often occurring keywords were also analyzed to identify potential research subjects.There has been a notable increase in the number of highly cited publications (n = 52) about VRFs within the past 13 years (2010-2022). The United States stands out among the top countries due to its dominant overall research output. In the fields of endodontics, oral surgery, and restorative dentistry, this information would be helpful to researchers, practitioners, and academics.

Anatomically guided full arch implant-prosthetic rehabilitations

Aim: The loss of dental elements causes anatomical, functional, aesthetic, and psychological changes that reduce the patient’s quality of life and comfort. This study aims to show how implant-prosthetic restorations with full-arch immediate loading can be appropriately performed by an anatomically guided method. Materials and methods: Two case reports of two male patients aged 69 and 60 years old who needed an implant-prosthetic full arch rehabilitation were documented to describe the surgical treatment. Discussion: Human anatomy is the basis of any surgical treatment, so in oral surgery, the operator must have a detailed knowledge of the loco-regional anatomy of the head-neck district. For this reason, it is essential to know the topographical limits of the noble structures typically found in daily clinical practice to perform a precise surgical act under safe conditions. The validity of a complete dental arch rehabilitation method is emphasized in literature by inserting two axial implants positioned orthogonally to the occlusal plane in the anterior region and two distal implants inclined with a maximum of 30° distally in the posterior region. The literature reports of inclined implants have been proposed as an alternative to traditional protocols in rehabilitating edentulous jaws. All this can be achieved by carefully studying the clinical case at the beginning of the clinical and radiographic examination. In addition, knowledge of the anatomical reference points must be taken as a reference to obtain a method that is reproducible and adaptable to more clinical cases depending on bone mineralization. Conclusion: Although it may seem excessively invasive, this method allows us to obtain optimal and reproducible results. It allows us to exploit not only the biomechanical advantages obtained by the structure of the prosthetic polygon but above all, those biological ones based on knowledge of the physiology of bone remodeling.

The use of ozone therapy for the treatment and post-surgical management of patients treated with bilateral extraction of the included third mandibular molars

The use of ozone in medicine and dentistry is well-supported in the scientific literature, particularly for its antibacterial, antiviral, anti-inflammatory, and anti-edema effects. These benefits are achieved through reductions in pro-inflammatory substances, stimulation of neoangiogenesis, and enhanced production of antioxidant enzymes. Additionally, ozone is pain-relieving by inactivating algogenic mediators and inducing endorphin release. Although ozone application devices are standard in conventional medicine, they are less so in dentistry and often have reduced performance. This study aims to evaluate the effectiveness of a specific ozone therapy device in managing postoperative pain and promoting healing in patients undergoing impacted third-molar extractions. Materials and methods: Patients scheduled for the extraction of impacted third molars were enrolled in a randomized split-mouth study to receive either ozone therapy or conventional antibiotic treatment. The Visual Analog Scale (VAS) assessed pain intensity and healing progress. Results: Patients treated with ozone therapy reported significantly lower pain levels and demonstrated qualitatively improved healing compared to the control group, with statistical significance. Conclusions: The study supports the use of ozone therapy in routine dental surgical practice, highlighting its favorable cost/benefit profile. Ozone therapy can be beneficial for impacted third-molar surgeries and broader applications in oral surgery. Keywords: Ozone therapy in dentistry, OZONE DTA equipment, Third molar extraction and soft tissue healing.

An Evaluation of London's Intermediate Minor Oral Surgery Service

ABSTRACTBackgroundOral surgery as a speciality has traditionally experienced significant demands, representing one of the largest volume and cost of referrals from primary to secondary care. The IMOS service was created with the objective to increase the efficiency and accessibility of oral surgery services to the public, as well as reduce pressures within hospital settings.AimsTo assess: The quality of the service provided. The waiting times. If the service met needs. Patient‐reported outcome and experience measures. MethodA random sample of patients referred to London Tier 2 IMOS providers were selected, 10 from each provider, totalling 180. They were evaluated to ascertain waiting times, treatment delivered, quality of documentation and level of complexity, level 1, 2, and 3. Patient‐Reported Experience Measures (PREMs) and Patient Reported Outcome Measures (PROMs) were also carried out to assess satisfaction.Results38.3% of referrals were classed as Level 1 and the remaining Level 2 and Level 3 were 60% and 1.67%, respectively. 37.2% of patients were seen within 0–49 days, and 72.3% of patients were seen and treated within 18 weeks. 90.8% of these cases were non‐surgical, 17.9% involved mandibular 3rd molar extractions, of which 46.6% were surgical.313 PREMs and 321 PROMs were collected, the experience survey revealed over 98.7% of patients felt anxiety and pain were managed well, with any concerns addressed. PROMs showed that 94.3% of patients did not require further calls or assistance post‐treatment. 72.4% of patients felt recovery was completed within 3 days of the treatment. 1.87% of patients required further assistance such as for dry socket and infection.ConclusionThe London IMOS service is an economical, safe and effective environment to provide minor oral surgery to the vast majority of patients, who would have otherwise been seen in secondary care. Development of pan London triage and communication pathways will further enhance the service and ensure smooth and efficient patient journeys.