Maxillofacial Research Articles

Diagnostic approach used by US general dental practitioners following discovery of oral lesions suspicious for malignancy/premalignancy: findings from the National Dental Practice-Based Research Network.

Oral cancer examinations seek to clinically identify early oral cancers and discover premalignancies prior to their progression to invasive cancer. A cross-sectional study was conducted between April and August 2017 to explore and quantify the diagnostic approach used by United States (US) general dental practitioners following discovery of an oral lesion suspicious for malignancy/premalignancy. US licensed general dental practitioners who were clinically active members of the US National Dental Practice-Based Research Network were eligible to participate. Data for analysis were obtained via two questionnaires. The majority of participants were males, practiced full-time, had a suburban primary practice, were born during the 1950s, and graduated dental school in the 1980s or 2000s. After identifying an oral lesion suspicious for premalignancy/malignancy, the next action of most general dental practitioner respondents (65.4%) was to refer the patient for consultation/biopsy. Most general dental practitioners (87.2%) referred to an oral and maxillofacial surgeon; 22% of general dental practitioners reported personally biopsying suspicious lesions. There was a relatively weak association between completing an Advanced Education in General Dentistry or General Practice Residency and subsequently personally performing biopsies on patients with oral lesions suspicious for malignancy/premalignancy (OR 1.33, P = .06). Most written referrals took place electronically and often included information, including lesion location (87.0%), lesion sign/symptoms (85.3%), lesion history (83.9%), radiographs (59.3%), medical history (50.6%), dental history (48.8%), and photographs (42.4%). When a referral biopsy was performed, referring clinicians were most frequently informed of the findings via a written report (96.7%, when positive for malignancy/premalignancy, and 95.4% when negative). A snapshot is presented of current actions taken by US general dental practitioners following the discovery of oral abnormalities suspicious for premalignancy/malignancy.

Integrative approach for supernumerary teeth: a single-center retrospective analysis.

This study aimed to provide a comprehensive case analysis from a single center, with the objective of clarifying the optimal timing and recommendations for a preferred treatment strategy customized to the specific presentation of each type of supernumerary tooth identified in the research. A retrospective study was conducted on patients who presented with a supernumerary tooth and were treated interdisciplinarily at the clinic. In total, 55 patients with 81 supernumerary teeth of the permanent dentition were analyzed, 30 males and 25 females. The dentition status of the patients was as follows: 31 patients with mixed dentition, no patients with primary dentition, and 24 patients with permanent dentition. The diagnosis of supernumerary tooth was primarily made by general or pediatric dental practitioners and/or orthodontists. Patients were then referred to maxillofacial surgeons for treatment decision. The timing of treatment was mainly determined by the oral surgeon, based on the recommendations of the other specialists involved. Cases involving maleruption or malalignment of permanent teeth required both surgical and orthodontic treatment. Patients over 9 years old were treated either under local anesthesia or sedation, whereas those under 9 years old were treated under deep sedation or general anesthesia. A comprehensive investigation of cases involved the utilization of CBCT at the supernumerary tooth site to facilitate treatment planning. There was a significant correlation between younger age and the preference for treatment under sedation or general anesthesia (P = .01, t test). Similarly, a strong association was found between younger age and the need for additional orthodontic treatment (P = .016, t test). Cases of surgical removal of a supernumerary tooth at a young age typically did not require orthodontic traction of the permanent tooth, in contrast to cases of late surgical intervention (patients over 11 years old), which often did necessitate such traction. There was a strong tendency for treating supernumerary teeth in the maxilla. The proximity of supernumerary teeth to vital anatomical landmarks significantly influenced treatment decisions. Patients with supernumerary teeth near the mental foramen or the inferior dental canal in the premolar area were exclusively placed under follow-up care (P = .002, Pearson chi-square test). However, in the maxilla, the proximity of supernumerary teeth to vital structures such as the floor of the nose and the incisive nerve did not affect the treatment approach, and those supernumerary teeth were mostly removed. A team approach for managing supernumerary teeth is recommended. The timing of treatment should carefully consider the advantages and disadvantages of early versus late intervention. Early surgical treatment in cases where eruption is disturbed might result in spontaneous eruption, eliminating the need for orthodontic traction of the permanent teeth.

Clinical use of cone-beam computed tomography in Western Norway: a referral-based retrospective study.

To elucidate cone-beam computed tomography (CBCT) referral profiles in Western Norway. In all, 3,031 referrals to oral- and maxillofacial radiologist were reviewed. Patient data were retrieved retrospectively from electronic charts. The patient's age, gender, and perceived clinical indication were noted, as well as relevant medical and dental history and whether the referring clinician was a general dentist or held a clinical dental specialty. A total of 2,680 referrals fulfilled the inclusion criteria (UiB n = 1,471, and TkVestland, n = 1,209). The female:male ratio was 1,427:1,253. Mean age was 33 years - 35 years for females compared to 31 years for males (p < 0.001). The most common clinical indications were related to impacted teeth (29%), endodontic issues (17%), cleft lip palate (12%), and resorptions (10%). Less common were bone lesions, implant planning, trauma to the teeth or jaws, atypical orofacial pain, and temporo-mandibular joint (TMJ). The patient age-profiles mirrored differences in indications within the cohort. Most referrals were from specialist dentists such as orthodontists, oral surgeons, and endodontists. Interestingly, 543/2,680 (20%) referrals were from general dentists. Conclusions: Specialist dentists such as orthodontists, oral surgeons, and endodontists refer most patients for clinical indications such as impacted teeth, endodontic issues, and resorptions.

Elevating Trauma Care: The Impact of Dedicated Oral and Maxillofacial Surgeons in Trauma Departments

Elevating Trauma Care: The Impact of Dedicated Oral and Maxillofacial Surgeons in Trauma Departments

ASSESSMENT OF THE ANATOMICAL STRUCTURE OF CANALIS SINUOSUS IN THE ANTERIOR MAXILLA TO AVOID SURGICAL COMPLICATIONS

Aims: The study's objective was to evaluate the canalis sinuosus (CS) anatomical structure in the front maxilla in order to prevent surgical problems in an adult Yemeni population sample acquired using cone-beam computed tomography (CBCT). Materials and Methods: A retrospective descriptive cross-sectional study was carried out to assess 226 participants' CBCT pictures. 452 sides in total were assessed. There were 140 females (61.9%) and 86 males (38.1%) among the samples. The age distribution was 18–34 years (65%) and over 35 years (35%), with a mean age of 32.13. Version 25 of the Statistical Package of the Social Sciences (SPSS) was used for all statistical analyses. Result: It was discovered that 160 right (35.4%) and 175 left (38.7%) of the 226 patients and 452 sides had CS. Among these individuals, 117 (51.8%) had unilateral CS and 109 (48.2%) had bilateral CS. The CS was 8.12 mm from the nasal cavity floor (D1), 6.99 mm from the buccal cortical bone ridge (D2), and 13.47 mm from the crest of the alveolar ridge (D3), as the mean distances were measured. Males and females had somewhat higher mean values for the linear measurements D1 and D3, but females had slightly higher mean values for the linear measurement D2. The CS had a mean diameter of 1.11 mm. Left central incisor area was the most commonly observed location of CS, and palataly was the most frequently recorded location of CS. Conclusion: Since the CS is present in 100% of adult Yemenis, it is imperative that general practitioners and maxillofacial surgeons become more knowledgeable about the position and structure of the CS. Peer Review History: Received 19 May 2024; Reviewed 12 July 2024; Accepted 23 August; Available online 15 September 2024 Academic Editor: Dr. Iman Muhammad Higazy, National Research Center, Egypt, imane.higazy@hotmail.com Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Gorkem Dulger, Duzce University, Turkey, gorkemdulger@yandex.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Selective laser sintering at the Point-of-Care 3D printing laboratory in hospitals for cranio-maxillo-facial surgery: A further step into industrial additive manufacturing made available to clinicians

Additive manufacturing has developed rapidly in recent years and has many useful applications in the clinical field. In particular, cranio-maxillo-facial (CMF) surgery requires high precision, which can be obtained with 3D printed patient-specific surgical guides and anatomical models. Among the many different printing options, selective laser sintering (SLS) seems to be rarely used in point-of-care applications, considering its apparent characteristics.This article examines the advantages and disadvantages of SLS printers for CMF point-of-care (PoC) by reviewing the literature and comparing in-house printed SLS and stereolithography (SLA) prints.The investigation showed that the easily sterilizable and robust materials processed by SLS printing are well suited for CMF surgical guides and have clear advantages over SLA parts.Some barriers to the use of SLS printers in PoC are likely to be the slightly higher complexity and cost.However, these will decrease as 3D printing technology advances and surgeon acceptance increases, making SLS a practical PoC tool.

Prophylactic third molar removal: are oral surgeons and orthodontists aligned in preventive approaches?

BackgroundThere is a general consensus among dental professionals regarding the extraction of impacted third molars in the presence of clinical symptoms. However, there is less agreement on the management of asymptomatic third molars. The objective of this study is to compare the perspectives of oral surgeons and orthodontists regarding the indications for the extraction of asymptomatic third molars. It is possible that healthcare professionals from different specialties may approach the extraction of these teeth in different ways.MethodsIn this cross-sectional study, a web-based questionnaire has been employed to collect data by inquiring about the reasons why participants prefer the extraction of asymptomatic third molars. Descriptive statistics were employed to evaluate the data obtained. The level of significance was set at P < 0.05.ResultsProphylactic extraction of partially impacted molars was more favored among the participants (P < 0.05). The orthodontists preferred prophylactic extraction due to the risk of late anterior dental crowding (LADC); however, the oral surgeons preferred pre-pregnancy extractions (P < 0.05). The extraction decision for partial impaction was higher in females when the risk of distal caries was considered. For fully impacted ones, it was higher in males when the risk of caries and pericoronitis were considered (P < 0.05).ConclusionsOrthodontists preferred extraction because of the risk of LADC and caries, while oral surgeons focused on preventing pericoronitis, pathology, focal infection, and symptoms during pregnancy. This divergence between the participants may inform the guidelines for prophylactic management of third molars. These findings may be pertinent in gender medicine.Clinical relevanceThis study has been enlightening for departments to consult each other before the extraction of a patient’s asymptomatic third molar.

Сравнительная характеристика затрат рабочего времени врача-челюстно-лицевого хирурга, оказывающего помощь в стационарных условиях, в условиях организационного эксперимента.

In the system of organization of provision of specialized medical care on the profile of maxillofacial surgery there are significant changes in connection with the digitalization processes, the introduction of new medical-diagnostic technologies, the development of surgical interventions, that has a significant effect on the working time of the doctor – maxillofacial surgeon. Purpose of the study is to study the working time of the doctor-maxillofacial surgeon, who provides assistance in stationary conditions with the help of photochronometric measurements in dynamics before and after the introduction of organizational measures. Materials and methods. The study was carried out in 2018 and 2023, before and after the introduction of organizational measures, on the basis of the department of maxillofacial surgery of the Penza regional clinical hospital. N. N. Burdenko». Doctors-maxillofacial surgeons took part in the study. The following methods were used: analytical, photo-time, organizational experiment, statistical. In the course of the photo chronometric research, all activities were studied: main activity, document processing, support activities, work, other activities, personal time required, unencumbered time. Results and Discussion. Analysis of the data obtained showed that doctors-facial surgeons in 2018 conducted an average of 9.75+0.1 hours at the workplace, which is 1.95 hours above the norm. According to the results of the study the article reveals an imbalance of working time expenditure, significant time spent on unusual functions (provision of medical assistance in the reception department, completion of medical documentation)There’s a lot going on. Problems in the regulation of work of doctors-maxillofacial surgeons, as well as shortcomings in the organization of medical care on the profile of «maxillofacial surgery» were revealed as a result of the photochronometric researchIt was possible to identify the main directions for improving the provision of specialized assistance in the field of PF. After the behavior of organizational arrangements (change of localization of the department, staffing, new patient routing, strengthening of continuity) The results of a repeated photochromic study conducted in 2023 showed that the structure of the working time expenditure has changed significantly: the share of main activities has decreased from 61,46% in 2018 to 59.7% in 2023, the duration of work with medical documents increased from 16.3% to 20.1%, costs for support activities decreased from 14,63% to 7.6%, The cost of performance increased from 4.59% to 5.6%, personal time required increased from 0.86% to 2.0% respectively. In 2023 there is no open time (late to work). The organizational changes made have had a positive impact on the quantity of quality of the bed. The average duration of treatment in 2018 was 7.92 days, and in 2023–5.53 days. In 2018, the pre-operative bed day was 1.05 days, and in 2023–0.17 days, decreased by 6.2 times. Conclusions. It was found that the organizational changes, directly related to the opening of the regional center of maxillofacial surgery, allowed to change the routing of patients, improve the continuity with specialists of dental, traumatological, oncological, pediatric profile, rational use of personnel resources, provide assistance to children. The optimization of doctors’ activities has had a positive impact on the quantity and quality of the bed. A comparative description of the work time spent before and after the organizational experiment shows that the activity of the surgeonmaxillofacial round-the-clock hospital has changed significantly due to the reduction of the cost of performing unusual functions.

Reliability of ChatGPT in automated essay scoring for dental undergraduate examinations

BackgroundThis study aimed to answer the research question: How reliable is ChatGPT in automated essay scoring (AES) for oral and maxillofacial surgery (OMS) examinations for dental undergraduate students compared to human assessors?MethodsSixty-nine undergraduate dental students participated in a closed-book examination comprising two essays at the National University of Singapore. Using pre-created assessment rubrics, three assessors independently performed manual essay scoring, while one separate assessor performed AES using ChatGPT (GPT-4). Data analyses were performed using the intraclass correlation coefficient and Cronbach's α to evaluate the reliability and inter-rater agreement of the test scores among all assessors. The mean scores of manual versus automated scoring were evaluated for similarity and correlations.ResultsA strong correlation was observed for Question 1 (r = 0.752–0.848, p < 0.001) and a moderate correlation was observed between AES and all manual scorers for Question 2 (r = 0.527–0.571, p < 0.001). Intraclass correlation coefficients of 0.794–0.858 indicated excellent inter-rater agreement, and Cronbach’s α of 0.881–0.932 indicated high reliability. For Question 1, the mean AES scores were similar to those for manual scoring (p > 0.05), and there was a strong correlation between AES and manual scores (r = 0.829, p < 0.001). For Question 2, AES scores were significantly lower than manual scores (p < 0.001), and there was a moderate correlation between AES and manual scores (r = 0.599, p < 0.001).ConclusionThis study shows the potential of ChatGPT for essay marking. However, an appropriate rubric design is essential for optimal reliability. With further validation, the ChatGPT has the potential to aid students in self-assessment or large-scale marking automated processes.

The adjunctive use of Leukocyte-Platelet Rich Fibrin (L-PRF) in the management of Medication Related Osteonecrosis of the Jaw (MRONJ): a retrospective observational study.

Medication related osteonecrosis of the jaw (MRONJ) is a risk for patients taking anti-resorptive or anti-angiogenic medications. The American Association of Oral and Maxillofacial Surgeons (AAMOS) has classified MRONJ in stages to reflect the severity of the disease and allows implementation of suitable treatment pathways. MRONJ risk is < 5% in cancer patients and < 0.05% in osteoporosis patients. Management is subdivided into operative and non-operative, with advances in the literature investigating adjuvants. Leukocyte-Platelet Rich Fibrin (L-PRF) is an autologous biomaterial consisting of leukocytes and platelets embedded within a fibrin matrix with the ability to release growth factors enabling angiogenesis, bone regeneration and soft tissue healing. This paper's aim is to investigate the effects of L-PRF in conjuction with surgical debridement for management of MRONJ. Twenty-two cases with established MRONJ were treated with either surgical intervention (Group A) or with surgical intervention and L-PRF (Group B), from 2016 to 2023 at Edinburgh Dental Institute (EDI). Treatments were deemed successful when the patients were asymptomatic, displayed complete soft tissue healing with the absence of infection/inflammation, fistula, or exposed bone. All cases in Group B had healed in contrast to 54.5% not healed in Group A; p value < 0.05 indicating statistical significance. The use of L-PRF as an adjuvant to surgical management of MRONJ is promising with its favourable functional capacity, simple application, and success of treatment outcomes.

Atraumatic Release of Incarcerated Inferior Rectus Muscle in Trapdoor Fracture Can Lead to Better Functional Outcome.

Deciding the proper surgical approach for repairing blowout fractures with entrapped soft tissue are among one of the most challenging decisions for maxillofacial surgeons. This is due to multiple factors including the type and site of fracture, time elapsed from trauma. Tranconjunctival, subciliary, and/or transantral endoscopic has been described before. The authors report here a case of a young adult, presenting with diplopia, pain, and enophthalmos after being exposed to a blunt trauma on the left side. Computed tomography (CT) scan confirmed diagnosis of left orbital floor fracture with trapped inferior rectus in a trapdoor manner. Although presentation was later than 48 hours from trauma, yet incorporating, minimally traumatic dual, transconjunctival-transantral endoscopic approach the inferior rectus muscle was preserved and regained full range of movement, after <3 months postoperatively.

Geographic Trends in the Oral and Maxillofacial Surgery Residency Match

Matching into Oral and Maxillofacial Surgery (OMS) residency in the United States (US) is competitive. Various surgical and medical specialties found that a relationship exists between the geographic location where an applicant attends medical school and the location where they attend residency. However, information regarding this geographic relationship does not exist in OMS. The purpose of this study was to investigate if a relationship exists between the location of an applicant's dental school and the location of the OMS program where they match for residency. Study team conducted a cross-sectional review of all civilian OMS applicants who participated in the Postdoctoral OMS Matching Program from 2012 to 2022. US States and the District of Columbia were subdivided into a specific Region and Division as defined by the US Census Bureau. The primary predictor variable was the geographic location of the applicant's dental school. The outcome variable was the geographic location where the applicant matched for residency. There were no covariates analyzed in the study. Frequency tables were created for the expected and observed values for each possible combination of dental school and residency location. MATLAB R2023a software was used for statistical analysis. χ2 test, odds ratio and confidence interval were calculated to investigate association between variables. P values were <.05. 1768 applicants were reviewed. The inclusion criteria consisted of civilian OMS applicants from 2012 to 2022 who matched into residency. Of the 968 applicants who met the inclusion criteria, 48.45% (469/968, P -value < .001) matched into a residency in the same US Region as their dental school; 36.26% (351/968, P value < .001) matched into the same US Division. Applicants were found to be significantly more likely to match into a program in the same US Region and Division as their dental school. It is likely that individuals will match into OMS residency in the same US Region and Division as their dental school. This information helps applicants and residency programs during the match process.

Applications of Lasers in Oral and Maxillofacial Surgery –A Review Article

LASER technology has become a cornerstone in oral and maxillofacial surgery (OMFS), transforming the field with its precision, versatility, and minimally invasive nature. This article provides practitioners with an update on the use of new dental instruments in daily practice to improve efficiency and reduce issues from traditional approaches.

Beyond the Hype: Practical Artificial Intelligence Uses for Today's Oral and Maxillofacial Surgeons

Beyond the Hype: Practical Artificial Intelligence Uses for Today's Oral and Maxillofacial Surgeons

Tackling Impediments: Bespoke Solutions for Optimized Implant Outcomes

The field of implantology has transformed dental restoration, yet significant challenges persist that can impede successful treatment outcomes. This review examines the technical and biological roadblocks encountered in dental implant procedures, highlighting the vital role of tailored innovations in overcoming these obstacles. Advances in materials science, digital technology, and surgical techniques are crucial for enhancing osseointegration and ensuring overall implant success. Common complications include surgical issues such as infections and nerve damage, prosthetic challenges like misalignment and aesthetic concerns, and biological threats such as peri-implantitis and bone loss. To combat these, proactive management strategies—encompassing meticulous preoperative planning, regular monitoring, and personalized solutions—are essential for improving patient care. This review underscores the importance of interdisciplinary collaboration of prosthodontists, oral surgeons, periodontists and oral radiologists in mitigating risks and presents effective management strategies to optimize outcomes. By elevating awareness of potential complications and implementing precise diagnosis and treatment planning, practitioners can significantly enhance the longevity and effectiveness of dental implants, ultimately securing a better quality of life for patients.

ChatGPT and trainee performances in the management of maxillofacial patients

IntroductionChatGPT is an artificial intelligence based large language model with the ability to generate human-like response to text input, its performance has already been the subject of several studies in different fields. The aim of this study was to evaluate the performance of ChatGPT in the management of maxillofacial clinical cases. Materials and methodsA total of 38 clinical cases consulting at the Stomatology-Maxillofacial Surgery Department were prospectively recruited and presented to ChatGPT, which was interrogated for diagnosis, differential diagnosis, management and treatment. The performance of trainees and ChatGPT was compared by three blinded board-certified maxillofacial surgeons using the AIPI score. ResultsThe average total AIPI score assigned to the practitioners was 18.71 and 16.39 to ChatGPT, significantly lower (p < 0.001). According to the experts, ChatGPT was significantly less effective for diagnosis and treatment (p < 0.001). Following two of the three experts, ChatGPT was significantly less effective in considering patient data (p = 0.001) and suggesting additional examinations (p < 0.0001). The primary diagnosis proposed by ChatGPT was judged by the experts as not plausible and /or incomplete in 2.63 % to 18 % of the cases, the additional examinations were associated with inadequate examinations in 2.63 %, to 21.05 % of the cases and proposed an association of pertinent, but incomplete therapeutic findings in 18.42 % to 47.37 % of the cases, while the therapeutic findings were considered pertinent, necessary and inadequate in 18.42 % of cases. ConclusionsChatGPT appears less efficient in diagnosis, the selection of the most adequate additional examination and the proposition of pertinent and necessary therapeutic approaches.

Virtual surgical planning in tripod zygomatico-maxillary complex fractures: A prospective comparison between two different strategies

Multifragmentary and displaced zygomaticomaxillary complex (ZMC) fractures are often a challenge for the maxillofacial surgeon. The aim of this study was to evaluate the improved performance in the management of patients with tripod fracture of the orbito-zygomaticomaxillary complex, using two different methods of virtual surgical planning — virtual reduction and mirroring — compared with traditional management. A cohort of 60 patients was selected and divided into three groups, each consisting of 20 individuals. Patients in the first group were managed using the virtual reduction method, those in the second group using the mirroring method, and those in the third group using a traditional surgical approach. Having achieved virtual fracture reduction, a stereolithographic model was printed, on which preplating of the plates was performed. The results showed that virtual reduction was the most accurate in absolute terms, with a mean discrepancy in juxtaposition of the preoperative and postoperative CT images of 0.175 mm (SD ± 0.147), compared with 0.403 (SD ± 0.166) for the mirror method (and traditional method (0.875, SD ± 0.112; p > 0.0001). The average surgical time for virtual reduction (89.5 min) was faster than for mirroring (94.25 min) and for the traditional approach (96.75 min). In conclusion, the use of virtual surgical planning allows greater intraoperative accuracy, reduced surgical time, and reduced postoperative complications compared with traditional surgery. Of the two methods, virtual reduction performed best for the outcomes decribed.

Template for positioning miniplates (PUNPLAPOT-M) on mandibular symphysis: Novel innovation

Purpose: This study was conducted to check the efficacy of PUNPLAPOT-innovative Template for positioning of the bone miniplate for fracture fixation. Material and Methods: Twenty dried mandible specimens were used in this study. The specimens were then divided into two groups using random sampling. Each group consisted of ten mandibles each. The mandibles were fractured in mandibular symphysis region. Study group mandibles were subjected to fixation using 2.5 mm titanium miniplate using PUNPLAPOT plate positioning template. Control group specimens were subjected to fracture fixation without the use of template. All the 20 specimens were then subjected to dial gauge test of parallelism. Plate orientation with respect to lower border of mandible was checked for both the groups. PUNPLAPOT 2.0 is developed to be used in extremely oblique fractures. Results: Significant difference was noted in review parameters -plate parallelism and distance of screws from fracture line within study and control group. Results obtained with this template were statistically significant. Conclusion: PUNPLAPOT definitely provides the maxillofacial surgeons a reliable template to position the miniplate at an optimum position. The template has few limitations like comminuted lower border fractures and severely oblique fractures. Further device development is aimed towards overcoming these.

Assessment of Diagnosis of Apical Root Fractures During Tooth Extraction Using Different Radiographic Techniques: An Ex-vivo Study

Objective: This study aimed to examine the diagnostic ability of different imaging techniques for apical root fractures that occur during tooth extraction by specialist dentists in different branches. Methods: Dry human mandibles used for education at Faculty of Dentistry and teeth extracted for routine treatment were used. After the root lengths were measured using a periodontal probe, the samples were adjusted to different lengths. These specimens were placed on a dry human mandible, and images were obtained and recorded using a periapical device, panoramic device, and computed tomography. Radiographs and recordings were performed by an oral and maxillofacial radiologist. The evaluation process was performed by an oral and maxillofacial radiologist, periodontologist, and oral and maxillofacial surgeon. Results: The diagnosis of 1 mm root presence and absence on periapical radiographs showed significant agreement among all observers. In the presence of 2 mm and 3 mm roots, all observers stated that the roots were present. On the panoramic radiographs, moderate agreement was observed in teeth with a 1 mm root. However, poor agreement between observers was observed for teeth with 2 mm and 3 mm roots. Cone-beam computed tomography (CBCT) was effective for the diagnosis of all observers. Conclusion: Consistent with the literature, the present study showed a higher interobserver agreement in CBCT. However, considering the patient's anxiety during the procedure, the duration of local anesthesia, and the surgeon's fatigue, two-dimensional radiographs are generally preferred over CBCT, which has a longer image processing time. Diagnosis using periapical radiographs was more effective than that using panoramic radiographs.

Traumatic Intracranial Intrusion of the Mandibular Condyle in the Middle Fossa: A Rare Case Report

AbstractThe displacement of the condyle into the middle cranial fossa after a high kinetic trauma represents a rare and low prevalence situation in the clinical routine of the maxillofacial surgeon. After a motorcycle accident, a 19-year-old male patient evolves with displacement of the left mandibular condyle to the middle cranial fossa, requiring surgical management in association with the neurosurgical team for repositioning and reconstruction of the glenoid fossa. After craniotomy, the condyle was visualized in the middle fossa. After bone disimpaction with a driller, the condyle was repositioned and the glenoid fossa was reconstructed with a titanium mesh. After 12 months of follow-up, no neurological or functional sequela was observed. The displacement of the mandibular condyle to the cranial fossa is rarely reported in the literature. It requires a multidisciplinary team for its management. Long-term follow-up is also necessary, especially in young patients.