Oral And Maxillofacial Research Articles

Trends of regenerative tissue engineering for oral and maxillofacial reconstruction in veterinary medicine.

Oral and maxillofacial (OMF) defects are not limited to humans and are often encountered in other species. Reconstructing significant tissue defects requires an excellent strategy for efficient and cost-effective treatment. In this regard, tissue engineering comprising stem cells, scaffolds, and signaling molecules is emerging as an innovative approach to treating OMF defects in veterinary patients. This review presents a comprehensive overview of OMF defects and tissue engineering principles to establish proper treatment and achieve both hard and soft tissue regeneration in veterinary practice. Moreover, bench-to-bedside future opportunities and challenges of tissue engineering usage are also addressed in this literature review.

The global distribution of oral and maxillofacial surgeons: a mixed-methods study

Despite its role in treating the most dominant non-communicable diseases worldwide, the global workforce of oral and maxillofacial (OM) surgeons is not well-characterized. To address the current deficit in understanding of the global OM surgeon workforce and to elevate oral and maxillofacial surgery (OMS) in the global health discourse, we join other surgical specialties in evaluating global surgical capacity with a descriptive analysis of the distribution of OM surgeons worldwide. A mixed-methods study was implemented using a combination of literature review, in-country contacts, internet searches, and survey data. The survey was distributed globally from January to June 2022. Data regarding OM surgeon workforce estimates were obtained for 104 of 195 United Nations-recognized countries (53.3%). Among countries with available estimates, the median global workforce density was 0.518 OM surgeons per 100,000 population. Twenty-eight countries (26.9%) were reported to have two or fewer OM surgeons. The median OM surgeon workforce density for low-income countries was 0.015 surgeons per 100,000 population, compared to 1.087 surgeons per 100,000 population in high-income countries. low and middle-income countries countries have the least workforce density as well as the least data coverage. More work is needed to better understand the capacity of the global OM surgeon workforce and access to OMS care.

Evaluation of Post Extraction Bleeding Risk for Oral Surgery under Continued Clopidogrel Anti-platelet Therapy

Introduction: Continuous oral anti-coagulant treatment has been used to reduce the threat of thromboembolism for further than half a century, dragging the lives of thousands of cases. There is increased risk of haemorrhage doing dental procedures in patients on anticoagulant and antiplatelet therapy. Objective: To evaluate the post extraction bleeding rate for oral surgery carried out under continued anti- platelet therapy with clopidogrel. Methods: This prospective observational study was carried out in the department of 'Oral and Maxillofacial (OMF) Surgery', Military Dental Centre (MDC), Dhaka. A total of 35 patient’s maintenance once daily low dose clopidogrel were purposely selected for this study. The extraction procedure under local anesthesia using 2% lidocaine with 1:1,00,000 epinephrine were done traumatically. A gelatin sponger piece was put down in socket and shut by atraumatic silk. The patients were instructed to apply pressure pack with sterile gauze for within 30 mins. Timing of haemostasis was done in every 9.5 minutes for within 30 minutes. Results: Among 35 patients, mean age was 52.3±10.1 with age range 35 to 69 years. Male patients were predominant (60.0%) with male:female ratio was 1.5:1. Simple extraction was done in 29 patients while rest extractions were done surgically. Majority 22(62.9%) of the patients were managed by pressure pack with gelatin sponge while 15(42.9%) patients were managed by pressure pack only. Regarding post extraction bleeding, majority of the cases haemostasis (91.4%) was achieved within 9.5 minutes after teeth extraction while only 3(8.6%) patients haemostasis 19 to 28.5 minutes after teeth extraction. Conclusion: The study concluded that majority of the patients were managed pressure pack with gelatin sponge and most of the patients had post extraction bleeding time 9.5 minutes. Minor oral surgery can be carried out safely under continued mono antiplatelet therapy with clopidogrel. JAFMC Bangladesh. Vol 18, No 2 (December) 2022: 28-30

Oral Maxillofacial Surgeon – A Hidden Weapon in Head and Neck Oncology

Oral squamous cell carcinoma dominates all the oral cancer cases with potentially malignant disorders which are also recognised as detectable pre-clinical phase of oral cancer. Patients with head and neck cancer should get a thorough dental oncologic examination as part of their pre-treatment evaluation. Dental professionals that specialise in oral and maxillofacial (OMF) surgery are the best people to manage patients with tumours in this area. This study discusses the significance of having these oncology-trained surgeons on the head and neck surgical teams, their underappreciated contributions to raising awareness of oral cancer and its negative effects among the general public as well as teaching oral cancer patients proper oral hygiene techniques. It also discusses the difficulties they face today to practise oncosurgery and be respected by their medical colleagues and provides an answer to the question of whether OMF surgeons have any role in such surgical setups.

Retrospective cohort study on the effect of intraoperative methadone on postoperative pain and opioid consumption in oral and maxillofacial surgeries

Background: Opioids are commonly used for pain control after oral and maxillofacial (OMF) surgeries, despite its potential adverse physical and social effects. There has been growing evidence that intraoperative methadone helps reduce postoperative pain and opioid consumption in various surgeries. However, it has not yet been studied in OMF surgeries.

Histopathologic Patterns of Oral and Maxillofacial Masses in Southwestern Ethiopia: A 5-Year Retrospective Study

Background Oral and maxillofacial region includes nasal cavity, sinuses, the lips, oral cavity, maxilla, mandible and the major and minor salivary glands with the overlying skin and soft tissues. This area is common site for different lesions, including the inflammatory and neoplastic lesions. Neoplastic tumors, in the area, account 5% of all human neoplasia. The distribution of these tumors’ changes with the socio-demographic change throughout the world and is not well-studied on the study area. Objectives To assess the histopathologic patterns of oral and maxillofacial masses among patients attending Histopathology Unit of Pathology Department in Jimma Medical Center from September 11, 2016 to September 10, 2021. Methods A retrospective cross-sectional study was conducted. Three-hundred and seventy-seventh (377) oral and maxillofacial (OMF) mass samples fulfilling the inclusion criteria were included in the study. Data was collected by structured check list and the data was interred into Epi-data version 3.1 and transferred to statistical package for the social sciences (SPSS) version 22 for analysis. The study was conducted from May 1, 2021 to August 30, 2021 GC. Results The age distribution of OMF masses are with minimum age value of 1-year and maximum value of 85-years and median age is 30-years. From 377 patient 194 (51.5%) were male while 183(48.5) were female with a ratio of M:F=1.06:1 showing increased male dominance. Mesenchymal tumors, other than bone tumor, have the highest number of 128 (33.9%) cases followed by surface epithelial tumors, 75(19.9%), odontogenic tumors 20(5.3%), salivary gland tumors 55(14.6%), benign cystic mass 47(12.5%), inflammatory masses 42(10.9%) and the least numbers of OMF biopsy was bone tumor with 11(2.9%) cases. From the benign tumors fibroepithelial tumor 53(22.8%) is the commonest. From the malignant tumors and from carcinoma, squamous cell carcinoma 56(57.1%), is the leading. From sarcomas osteosarcoma 8(8.2%) is the commonest one. Conclusion The result of this research shows the distribution of oral and maxillofacial tumors varies with the age, sex and anatomic site of the patients. OMF mass is common on the early adult age period and the risk of malignant tumors increases in those with age ≥41-years and the commonest malignant tumor is squamous cell carcinoma but in children and adolescents’ benign tumors specially fibroepithelial polyps are the commonest with male predominance.

Potential application of dental stem cells in regenerative reconstruction of oral and maxillofacial tissues: a narrative review.

Background and Objective:Oral and maxillofacial (OMF) defects caused by congenital conditions, injuries, ablative surgery for benign and malignant head & neck tumor, can often lead to OMF deformities and malfunctions in speech, mastication/chewing, and swallowing as well as have deleterious psychological effects and socioeconomic burdens to patients. Due to the unique complex 3D geometry of the head and neck region, reconstruction and rehabilitation of OMF defects remain a major challenge for OMF surgeons.The purpose of this narrative review is to update the information on the biological properties and functions of mesenchymal stem cells derived from various dental tissues (dental-MSCs) and their potential application in tissue engineering (TE) and regenerative reconstruction of OMF tissues.Methods:A data-based search was performed by using PubMed database whereby articles published between 2000 and 2021 in English were included in the search with the following key words: dental stem cells, OMF reconstruction, OMF TE and regeneration.Key Content and Findings:Currently, the advancement in stem cell biology, biomaterial science, and TE technology has demonstrated the significant potential application of stem cell-based therapy in regenerative reconstruction and rehabilitation of OMF defects. However, no stem cell-based product or device has been translated into clinical application to replace microsurgical free tissue transfer, the current mainstay of care in the reconstruction of OMF defects.Conclusions:Currently, microsurgical free tissue transfer remains the gold standard mainstay of care for the reconstruction of OMF defects due to their abundant blood supply and flexibility for transplantation. However, several major challenges, such as the limited availability, the requirement of a second surgery, donor site morbidity, and the risk of free flap failure, have promoted the development of novel approaches. Due to the advancement in stem cell biology, biomaterial science, and TE technology, stem cell-based regenerative therapy is emerging as a promising therapeutic approach for a variety of diseases, including regenerative reconstruction and rehabilitation of OMF defects. In this narrative review, we update on the characteristics and biological functions of mesenchymal stem cells derived from various dental tissues (dental-MSCs) and their released cell-free products, extracellular vesicles (EVs). We also highlighted their potential application in TE and regenerative reconstruction of OMF defects in animal models and clinical studies and the potential challenges in this field.

Cocktail Formula and Application Prospects for Oral and Maxillofacial Organoids.

Oral and maxillofacial organoids (OMOs), tiny tissues and organs derived from stem cells cultured through 3-d cell culture models, can fully summarize the cell tissue structure, physiological functions and biological characteristics of the source tissues in the body. OMOs are applied in areas such as disease modelling, developmental and regenerative medicine, drug screening, personalized treatment, etc. Although the construction of organoids in various parts of the oral and maxillofacial (OM) region has achieved considerable success, the existing cocktail formulae (construction strategies) are not widely applicable for tissues of various sources due to factors including the heterogeneity of the source tissues and the dependence on laboratory technology. Most of their formulae are based on growth factor niches containing expensive recombinant proteins with their efficiency remaining to be improved. In view of this, the cocktail formulae of various parts of the OM organs are reviewed with further discussion of the application and prospects for those OMOs to find some affordable cocktail formula with strong operability and high repeatability for various maxillofacial organs. The results may help improve the efficiency of organoid construction in the laboratory and accelerate the pace of the clinical use of organoid technology.

Oral maxillofacial surgical residency and its impact on the academic and research productivity at different levels in Pakistan.

Oral and maxillofacial (OMF) surgery is a unique speciality. In many countries, OMFS is a dental speciality but the scope of its practice significantly overlaps with other specialities, including otolaryngology, head and neck surgery, plastic surgery, and orthopaedics. Thus, OMF surgery represents a true amalgamation of medical and dental specialities. There are different requirements of OMF residency training, which include a dental undergraduate training, medical training, or both. The training pathways for this speciality have evolved much in the last three decades and there is still no consensus over a single uniform path of becoming an OMF surgeon. An OMF surgeon deals with trauma, cysts, tumours and other pathologies of the maxilla, mandible, and zygomatic complex that need surgical correction. In addition to being a diverse speciality, the academic and research domains of residency have also changed. In Pakistan, residency training in OMF surgery started in 1994 and since then a lot of growth has taken place. This paper summarises the evolution and scope of OMF surgery and the contribution of this speciality in the overall academia and research in Pakistan's national dental scenario.

Agreement between children's, nurses’ and parents’ pain intensity reports is stronger before than after analgesic consumption: Results from a post-operative study

BackgroundIncluded in their extensive duties caring for hospitalized children, nurses are the frontline for pain assessment and treatment. Research has found that when nurses’ assessments are compared with independent reports by the children or their parents, there are often differences. However, no studies have considered the contribution of analgesic medication consumption to this difference. ObjectivesThe aim of this study, was to assess the concordance between the pain scores recorded independently by nurses, children, and their parents both before and 1 h after analgesic consumption. Design/SettingThe trial was registered at ClinicalTrials.gov (NCT04306679) and was conducted in a post-operative inpatient facility. Following surgery, at first request of analgesic, the clinical nurses recorded the child's pain, as part of routine clinical practice. Within 10 min, the child recorded their pain level in a pain diary. At the same time, the parents separately reported their assessment of their child's pain. This process was repeated again 1 h later, when the nurses, as part of the clinical routine, recorded the children's level of post-medication pain. ParticipantsForty-seven children ages 8–17 hospitalized for elective surgery in the General Pediatric Surgery, Orthopedics, Ear-Nose-Throat (ENT), and Oral and Maxillofacial (OM) Departments, and their parents, were included in the current report. ResultsThe mean pain scores reported by the children were significantly higher than those reported by the nurses, both before (5.77±2.51 vs. 3.90±3.12 [mean ±SD], p <0.001) and 1 h after (3.37±2.48 vs. 0.92±2.08, p <0.001) analgesic consumption. No significant differences were found either before or after analgesic consumption in the NPS reported by the child and parent. Agreement between the NPS scores reported by the child and nurses was good before (ICC = 0.754, p <0.001) and only moderate 1 h after (ICC = 0.504, p = 0.017) analgesic consumption. Similarly, agreement between the NPS scores reported by the child and parents was good before (ICC = 0.855, p <0.001) and only moderate 1 h after (ICC = 0.722, p <0.001) analgesic consumption. ConclusionsWhile self-report measures remain the gold standard for pediatric pain care, the results of this study suggest that after analgesic administration, agreement between children's and nurses’ assessments, and between children's and parents’ assessments of pain deteriorated. Our results further confirm that proxy assessments recorded by parents are closer to their children's assessments than are those of nurses and should consequently be preferred especially after analgesic consumption.

Concordance of local guidelines with national guidelines on perioperative antibiotic and antiseptic prophylaxis in elective oral and maxillofacial surgery: A cross-sectional survey in the Netherlands

Local antibiotic guidelines should comply with national guidelines on perioperative antibiotic prophylaxis to adequately reduce surgical site infections in high-risk oral and maxillofacial (OMF) operations. To inform antibiotic committees on opportunities for improvement, a survey was sent to twenty-one OMF surgery departments in the Netherlands that performed more extensive OMF procedures. We determined (1) the local recommendations on perioperative antibiotic and antiseptic prophylaxis of sixteen elective OMF surgeries and (2) the local compliance with national guidelines. The response rate was 76.1%. Antibiotic prophylaxis was recommended in 78.8% of the OMF procedures and the regimens varied considerably between departments. Postoperative continuation of antibiotic prophylaxis was advised for 39.7% of the procedures and concerned 5–7 days in 81.0%. Antiseptic prophylaxis was recommended in 66.5% of the operations. The mean percentages of local recommendations that fully complied with the three national guidelines were 5.4% (range 0.0–55.6%) for the Dutch Working Party on Antibiotic Policy guideline, 27.7% (20.0–44.4%) for the 2018 guideline of the Dutch OMF Surgery Association (NVMKA) and 25.5% (16.7–44.4%) for the 2019 NVMKA guideline. In conclusion, deviation from national guidelines occurred frequently. Unification of the national guidelines in combination with guideline revisions are warranted, followed by better local implementation.

Epidemiology of Orbital Fractures in a Large Hospital in the Netherlands: Results of Implementation of a Multidisciplinary Orbital Trauma Team

Introduction: This study aims to describe the epidemiology, aetiology and therapy of orbital fractures in a large municipal hospital in The Hague, the Netherlands, and to demonstrate the effectiveness of an integrated approach of orbital trauma care with a team consisting of an ophthalmologist, an orthoptist and an oral and maxillofacial (OMF) surgeon. Methods: We obtained data from patients with an orbital fracture between June 2015 until July 2018. Primary outcomes were the classification of orbital fractures and treatment (conservative or surgical). Results: 182 patients were included in this study. The most common type of orbital fracture was an isolated orbital floor fracture (n=56, 30.8%). In most cases, therapy was conservative (69.2%). When surgical repair was indicated, a polydioxanone (PDS) plate was most commonly used (11.5%). The main cause of an orbital fracture was a fall accident (38.5%), followed by assault (32.4%). 32.4% of the patients were intoxicated with alcohol. Conclusion: In our study population, almost 70% (69.2%) of the patients were treated conservatively in our study. Compared to the international literature, this percentage is considerably higher than in other studies. In our opinion, our integrated approach to orbital trauma has led to a justifiable reduction of the proportion of cases receiving surgical intervention in orbital fractures. We would like to advocate the implementation of a similar team in other hospitals to improve the quality and cost-effectiveness of treatment in patients with orbital fractures.

Dual Network Composites of Poly(vinyl alcohol)-Calcium Metaphosphate/Alginate with Osteogenic Ions for Bone Tissue Engineering in Oral and Maxillofacial Surgery.

Despite considerable advances in biomaterials-based bone tissue engineering technologies, autografts remain the gold standard for rehabilitating critical-sized bone defects in the oral and maxillofacial (OMF) region. A majority of advanced synthetic bone substitutes (SBS’s) have not transcended the pre-clinical stage due to inferior clinical performance and translational barriers, which include low scalability, high cost, regulatory restrictions, limited advanced facilities and human resources. The aim of this study is to develop clinically viable alternatives to address the challenges of bone tissue regeneration in the OMF region by developing ‘dual network composites’ (DNC’s) of calcium metaphosphate (CMP)—poly(vinyl alcohol) (PVA)/alginate with osteogenic ions: calcium, zinc and strontium. To fabricate DNC’s, single network composites of PVA/CMP with 10% (w/v) gelatine particles as porogen were developed using two freeze–thawing cycles and subsequently interpenetrated by guluronate-dominant sodium alginate and chelated with calcium, zinc or strontium ions. Physicochemical, compressive, water uptake, thermal, morphological and in vitro biological properties of DNC’s were characterised. The results demonstrated elastic 3D porous scaffolds resembling a ‘spongy bone’ with fluid absorbing capacity, easily sculptable to fit anatomically complex bone defects, biocompatible and osteoconductive in vitro, thus yielding potentially clinically viable for SBS alternatives in OMF surgery.

A Retrospective Study to Evaluate Biopsies of Oral and Maxillofacial Lesions.

Background:The clinical manifestations of these lesions comprises pain, paresthesia, swelling, drainage, tooth loss, root resorption, and facial deformity. Alteration in oral and maxillofacial (OMF) tissues of the lesions may cause esthetically and functionally unfavourable effects in patients.Aims and Objectives:To determine the frequency of odontogenic cysts, tumors, and other lesions.Materials and Methods:Patient's records of histopathological reports from the archives of the Department of Oral and Maxillofacial Pathology were obtained and reviewed over a period of 2 years, and therefore, the lesions were classified into four groups. In cases of recurrent lesions, only the primary diagnosis was considered. The research protocol was approved by the ethical committee of the institution.Results:About 56.4% of males had ameloblastoma, 54.9% of females had cementoma. 59.4% females had giant cell granuloma, 87.5% females had pyogenic granuloma, 77.2% females had osteoma, 65.1% of the female population were belongs to the benign fibro-osseous lesions and 50.2% of females were from fibrous dysplasia in group 3. About 58.8% females had squamous cell carcinoma in group 4.Conclusion:To adequately determine the prevalence and incidence rate of OMF lesions, biopsies performed by other specialists such as otolaryngologists and plastic surgeons in OMF regions should also be evaluated.

Impact of COVID-19 on oral and maxillofacial surgery practice in India: A national survey.

Study Design:The Coronavirus disease-19 (COVID-19) pandemic has disrupted oral and maxillofacial (OMF) surgeons’ practice globally. We implemented a cross-sectional, questionnaire-based survey among the OMF surgeons of India.Objective:The objectives of the study were (1) gathering data among the maxillofacial surgeons in terms of their occupational exposure and access to adequate personal protective equipment (PPE) and (2) to estimate how the COVID-19 pandemic has affected the practice of OMF surgeons in India.Materials and Methods:Complete responses of 178 OMF surgeons were included in the study. Descriptive and analytic statistics were computed. The level of statistical significance was set at P < 0.05. Binary logistic regression models were created to assess the predictors of the impact of the COVID-19.Results:Out of the 178 respondents of the study, most (37.1%) were following their hospital's guidelines. Most had access to adequate PPE (89.9%), whereas 93.8% had COVID-19 testing available. One hundred and thirty-three (74.7%) surgeons were involved in teleconsultation. Ninety-two (51.7%) and 166 (93.3%) were involved in elective surgery and emergency surgeries, respectively. Median outpatient department cases and number of surgeries done per week reduced by 73.9% and 66.7% (P < 0.001), respectively. Most surgeons (86%) experienced that cost of treatment had increased during the COVID. Over 75% were afraid to get infected with COVID, whereas 44.9% were anxious to lose the income. More than 56% of the OMF surgeons reported a fall in income and 94% reported decreased productivity in academic research. Most surgeons (93.8%) believed that COVID had a positive impact on human behavior in terms of hand hygiene.Conclusion:The impact of COVID-19 among OMF surgeons has adversely affected clinical practice, personal lives, and academic productivity and has catalyzed an exponential increase of telemedicine. Future surveys should capture the long-term impact of COVID-19.

Pediatric maxillofacial and dental trauma: A retrospective review of pediatric emergency management in Riyadh, Kingdom of Saudi Arabia

BackgroundDue to the high prevalence of oral and maxillofacial (OMF) trauma in city of Riyadh, a special focus on pediatric trauma is needed. The purpose of this audit was to assess the protocol followed by the OMF unit at King Khalid University Hospital (KKUH) on pediatric trauma patients. The trauma incidence, mechanism of injury, volume, the type of pediatric trauma operated and dental management were analyzed. Materials and MethodsA quantitative retrospective review of 223 patients, at pediatric emergency unit of KKUH, Riyadh, KSA from January 2017 to July 2018, was done. The data retrieved included variables such as, age, gender, and cause of injury, site of injury, type of injury, and assessment of jaws, and teeth. Data regarding the type of investigations, treatment protocol, follow up visit, and dental management, were extracted from the medical records. ResultsOf the 223 pediatric patients presenting to the emergency unit, 116 (52%) were under the age of 5 years. A total of 64.4% of patients reported “self-fall” as the cause of injury. Soft-tissue injuries were common in 63 (56.8%) of patients in the form of lacerations 87 (41.2%). Involvement of the teeth in the injury was observed in 57 patients, in which 33 (57.9%) patients were reported to have tooth/teeth avulsions, 15 (26.3%) patients had luxation and 9 (15.8%) patients had crown fractures. 27 (47%) patients were referred to the pedodontist for a follow-up visit. ConclusionsIt can concluded that clinicians facing maxillofacial trauma in an emergency department need to have access to useful and practice guidelines. The study also showed the need for more manpower-oriented training such as a pedodontist and a general dentist to join the OMFS team to manage pediatric patients. The regional referral hospitals should be equipped to decentralize the management of these patients to the Dental University Hospital.

Management of oral and maxillofacial trauma during the first wave of the COVID-19 pandemic in the United Kingdom

We assess the effect of coronavirus disease 2019 (COVID-19) on UK oral and maxillofacial (OMF) trauma services and patient treatment during the first wave of the pandemic. From 1 April 2020 until 31 July 2020, OMF surgery units in the UK were invited to prospectively record all patients presenting with OMF trauma. Information included clinical presentation, mechanism of injury, how it was managed, and whether or not treatment included surgery. Participants were also asked to compare the patient’s care with the treatment that would normally have been given before the crisis. Twenty-nine units across the UK contributed with 2,229 entries. The most common aetiology was mechanical fall (39%). The most common injuries were soft tissue wounds (52%) and, for hard tissues, mandibular fractures (13%). Of 876 facial fractures, 79 patients’ treatment differed from what would have been normal pre-COVID, and 33 had their treatment deferred. Therefore the care of 112 (14%) patients was at variance with normal practice because of COVID restrictions. The pattern of OMFS injuries changed during the first COVID-19 lockdown. For the majority, best practice and delivery of quality trauma care continued despite the on-going operational challenges, and only a small proportion of patients had changes to their treatment. The lessons learnt from the first wave, combined with adequate resources and preoperative testing of patients, should allow those facial injuries in the second wave to receive best-practice care.

Three-Dimensional Technology Applications in Maxillofacial Reconstructive Surgery: Current Surgical Implications.

Defects in the oral and maxillofacial (OMF) complex may lead to functional and esthetic impairment, aspiration, speech difficulty, and reduced quality of life. Reconstruction of such defects is considered one of the most challenging procedures in head and neck surgery. Transfer of different auto-grafts is still considered as the “gold standard” of regenerative and reconstructive procedures for OMF defects. However, harvesting of these grafts can lead to many complications including donor-site morbidity, extending of surgical time, incomplete healing of the donor site and others. Three-dimensional (3D) printing technology is an innovative technique that allows the fabrication of personalized implants and scaffolds that fit the precise anatomy of an individual’s defect and, therefore, has attracted significant attention during the last few decades, especially among head and neck surgeons. Here we discuss the most relevant applications of the 3D printing technology in the oral and maxillofacial surgery field. We further show different clinical examples of patients who were treated at our institute using the 3D technology and discuss the indications, different technologies, complications, and their clinical outcomes. We demonstrate that 3D technology may provide a powerful tool used for reconstruction of various OMF defects, enabling optimal clinical results in the suitable cases.

Pattern and Causes of Oral and Maxillofacial Injuries Presented to a Tertiary Care Public Dental Hospital in Strictly Imposed COVID-19 Lockdown Scenario

The unprecedented COVID-19 pandemic has indelibly impacted routine healthcare provision across the globe. Nevertheless, management of traumatic injuries has remained a priority patient care service of oral and maxillofacial (OMF) practice. This study aimed to explore the pattern and mechanisms of OMF injuries presenting at a major public dental hospital during a COVID-19 lockdown period in Sri Lanka. An enhanced OMF injury surveillance system was established at the National Dental Hospital (Teaching) Sri Lanka (NDHTSL) on 1 March 2020. OMF injury surveillance data from 1 March 2020 to 31 May 2020 were collated from the “enhanced injury surveillance form”. This period overlapped with the strictly imposed island-wide COVID-19 community lockdown. Pre-COVID-19 period (November 2017 to January 2020) OMF injury data were compared with this period. OMF injuries were categorized as hard tissue, extra-oral or intra-oral soft tissue, upper and middle face fractures and mandibular fractures. Data were analyzed with descriptive statistics, Fisher’s exact and Chi-square tests of significance. A total of 361 OMF injuries were identified among 208 patients who were predominantly males (71.6%); mean age was 24.95 ± 2.76 years. Injuries to gingivae and oral mucosa (26.9%) were the leading type, followed by extra-oral soft tissues (22.1%), periodontal injuries (20.7%) and hard tissue injuries (20.2%). Upper face and mandibular fractures accounted for 2.9% and 1.9%, respectively. Most patients sustained their injuries due to falls at their homes and surrounds. This was significantly increased compared to the pre-COVID-19 period (p = 0.0001). The significant increase in OMF injuries associated with falls around the home during the COVID-19 lockdown scenario in Sri Lanka compared to the pre-COVID-19 period may need further investigation in order to understand the how these injuries may be prevented.

Artificial intelligence in oral and maxillofacial radiology: what is currently possible?

Artificial intelligence, which has been actively applied in a broad range of industries in recent years, is an active area of interest for many researchers. Dentistry is no exception to this trend, and the applications of artificial intelligence are particularly promising in the field of oral and maxillofacial (OMF) radiology. Recent researches on artificial intelligence in OMF radiology have mainly used convolutional neural networks, which can perform image classification, detection, segmentation, registration, generation, and refinement. Artificial intelligence systems in this field have been developed for the purposes of radiographic diagnosis, image analysis, forensic dentistry, and image quality improvement. Tremendous amounts of data are needed to achieve good results, and involvement of OMF radiologist is essential for making accurate and consistent data sets, which is a time-consuming task. In order to widely use artificial intelligence in actual clinical practice in the future, there are lots of problems to be solved, such as building up a huge amount of fine-labeled open data set, understanding of the judgment criteria of artificial intelligence, and DICOM hacking threats using artificial intelligence. If solutions to these problems are presented with the development of artificial intelligence, artificial intelligence will develop further in the future and is expected to play an important role in the development of automatic diagnosis systems, the establishment of treatment plans, and the fabrication of treatment tools. OMF radiologists, as professionals who thoroughly understand the characteristics of radiographic images, will play a very important role in the development of artificial intelligence applications in this field.