Department Of Oral Surgery Research Articles

Two Cases of Maxillofacial Vascular Malformations Associated with Blue Rubber Bleb Nevus Syndrome And Literature Review

Blue Rubber Bleb Nevus Syndrome (BRBNS) is a rare systemic vascular malformation-related disorder that primarily affects the skin, gastrointestinal tract, and central nervous system. Approximately 55.9% of patients have lesions involving the oral and maxillofacial region. Due to the potential risks of gastrointestinal hemorrhage and intracerebral hemorrhage, it is crucial for dental practitioners to promptly identify and refer such cases to relevant departments to improve patient prognosis and enhance quality of life. This paper reports two cases of BRBNS associated with maxillofacial vascular malformations treated at the Oral and Maxillofacial Surgery Department of Henan Provincial People's Hospital. In conjunction with a literature review, this study discusses the clinical features, diagnosis, and treatment strategies of BRBNS, aiming to raise awareness among dental practitioners to avoid missed or incorrect diagnoses.

Parents’ views and experiences of raising babies born with cleft lip and palate: a qualitative study

BackgroundParents of children born with cleft lip/palate encounter numerous challenges. This study aims to provide a deeper understanding for authorities to better support these parents by exploring the views and experiences of Iranian parents raising babies with cleft lip/palate through qualitative research.MethodsThis qualitative study collected data through face-to-face, in-depth, semi-structured interviews. Using purposive sampling, parents of children with cleft lip/palate who visited the Department of Oral and Maxillofacial Surgery at the Children’s Medical Center in Tehran, Iran, were selected. Thematic content analysis was employed to interpret the data and identify themes and subthemes.ResultsFrom 20 interviews, six themes were identified. The diagnosis theme was associated with timing. Key concerns within the psychosocial experiences theme included initial reactions, pressure from society, the child’s future in the community, hiding from family, feeling guilty about the anomaly, and couples’ relationships. The challenges in childcare theme included feeding difficulties, financial challenges, and cleft treatments. The information acquisition theme included primary awareness and the importance of knowing how to care for the child. The coping theme included gaining awareness, accepting the problem as God’s will and destiny, minimizing the significance of the child’s cleft, and support. Parents had concerns about informing the child of his/her condition.ConclusionsParents of infants with cleft lip/palate feel unsupported by medical staff in feeding practices and seek improved training for staff. They propose a program to empower staff and advocate for psychological support for parents. Access to specialized baby bottles and financial support is crucial, along with establishing a parent-led community for sharing experiences.

The Use of Coronoid Process as a Free Graft for Condylar Reconstruction in a Patient With Condylar Osteoma: A Condylar Reconstruction Technical Note (Technical Strategy).

Osteoma is a rare, asymptomatic, and slowly growing benign tumor of bone. Upon reviewing the literature, only 21 cases were previously reported in the mandibular condyle. A 19-year-old male patient presented to the Department of Oral and Maxillofacial Surgery of Ain Shams University complaining of hypomobility and facial asymmetry involving the lower jaw. He stated that he was involved in a road traffic accident (RTA) and sustained a traumatic injury to the head a few years ago. Upon examination, it was noticed that the chin deviated to the right side with some discomfort during function. Computed tomography scans revealed the presence of a hyperdense mass medial to the right condylar pole. Condylectomy was carried out using a preauricular approach. A diagnosis of osteoma was confirmed histopathologically. The defect was reconstructed using the coronoid process as an autogenous-free graft.

The Influence of Vitamin D Levels and Supplementation on the Treatment of Patients Affected by MRONJ

Background: Advancements in pharmacology have led to the introduction of novel antiresorptive and antiangiogenic drugs, which are associated with the side effect of medication-related osteonecrosis of the jaw (MRONJ). The aim of this study was to evaluate the impact of different blood levels of vitamin D on the course of treatment, as well as the role of vitamin D supplementation during the treatment of primary diseases involving bisphosphonates or denosumab. Methods: The clinical trial involved 64 patients diagnosed with medication-related osteonecrosis of the jaw (MRONJ) treated at the Department of Oral Surgery. Participants underwent baseline panoramic radiographs and Cone Beam Computed Tomography (CBCT) scans, with MRONJ severity categorized according to the AAOMS classification. This study included two groups: 37 patients (n = 37) in the experimental group received high-dose vitamin D supplementation (10,000 IU/day for 4 weeks, followed by a maintenance dose of 5000 IU/day), while 27 patients (n = 27) in the control group received no supplementation. Vitamin D levels were measured at baseline, 3 months, and 6 months, and the relationship between vitamin D supplementation and clinical outcomes, including MRONJ risk and healing, was evaluated. All participants received an antibiotic regimen pre- and post-surgery. Pain intensity was assessed at multiple time points using the Visual Analog Scale (VAS). Results: This study showed significant increases in serum vitamin D levels in the experimental group at 3 and 6 months (p < 0.05). In the prophylactic context, Vitamin D supplementation prior to or during tooth extraction reduced the risk of developing severe MJRON (OR = 68.57; p < 0.001). In the therapeutic context among patients with established MJRON, vitamin D supplementation did not significantly predict postoperative complications (p = 0.079) or complete healing (OR = 2.34; p = 0.051). However, overall healing rates were somewhat higher in the supplemented group, though they did not reach statistical significance. Antibiotic protection uses also reduced the need for further treatment (OR = 6.20; p < 0.001). Conclusions: Prophylactic high-dose vitamin D supplementation may help prevent severe MRONJ in at-risk patients undergoing tooth extraction. Once MRONJ is established, however, vitamin D alone may not significantly alter immediate postoperative outcomes, although further research is needed to clarify its potential adjunctive benefits.

Characteristics of Odontogenic Mandibular Osteomyelitis at the Oral and Maxillofacial Surgery Department of RUSP Dr. Hasan Sadikin 2020 – 2023

Characteristics of Odontogenic Mandibular Osteomyelitis at the Oral and Maxillofacial Surgery Department of RUSP Dr. Hasan Sadikin 2020 – 2023

Socket Sealing Using Free Gingival Grafts: A Randomized Controlled Trial

Background: Post-extraction ridge resorption is an inevitable phenomenon that cannot be eliminated but is significantly reduced using additional surgical techniques known as socket preservation. They aim to create favorable conditions for implant placement and prosthetic restoration. This study aims to assess the effect of socket sealing (SS) with free gingival grafts on the vertical resorption of socket walls at the premolar and molar regions over 3 months. Methods: This randomized two-arm controlled trial with parallel groups (1:1 allocation) was conducted at the Department of Oral Surgery, Medical University-Varna, Bulgaria, from 27 June 2022 to 20 April 2023. Forty patients aged 30–65 were equally and randomly allocated to the SS or the control groups. Atraumatic tooth extraction was performed. In the control group, the socket was left on secondary wound healing. In the SS group, the socket orifice was “sealed” with an FGG harvested from the hard palate or maxillary tuberosity. Results: Data analysis demonstrated that SS with an FGG is a successful method for reducing the post-extraction resorption of the socket walls. In addition, this study confirms that the thickness of the buccal wall is a significant factor in its vertical resorption. Conclusions: Socket sealing with an FGG is a valuable method that eliminates the need for flap reflection and compensates for the soft tissue deficit when immediate implant placement or bone augmentation is required. Further research is necessary to determine the role of different factors influencing bone resorption and compare the effect of different socket preservation methods.

Evaluation of Root Canal Diameters and Radicular Wall Thickness of the Human Primary Molars by using Multidetector Computed Tomography: A Cross-sectional Study

Introduction: Paediatric endodontics is critical for preserving the primary tooth until its physiologic exfoliation and ensuring the child’s quality of life. Endodontic treatment of human primary molars with varying internal geometry of the root canal necessitates extensive knowledge and skills. Aim: To evaluate the diameters of the root canals and the radicular wall thickness of human primary molars using Multidetector Computed Tomography (MDCT). Materials and Methods: This cross-sectional study study was performed in the Department of Paediatric and Preventive Dentistry in collaboration with the Department of Oral and Maxillofacial Surgery, Department of Antaomy of Guru Nanak Institute, Kolkata, West Bengal,India on selected 64 human primary maxillary and mandibular molars through inclusion and exclusion criteria and grouped them (Group 1, maxillary 1st molars; Group 2, maxillary 2nd molars; Group 3, mandibular 1st molars; and Group 4, mandibular 2nd molars). After proper sterilisation, the teeth were mounted on a wax platform, and the mounted teeth block was scanned by a computed tomography scanner. Analysis of these Computed Tomography (CT) scan images was done through Denta Scan (GE Healthcare, USA) software. In each of the corresponding cross-sections, the diameters of the root and the root canals were measured at their greatest diameter. The radicular wall thickness of the roots was derived by subtracting the measured diameter of the root canals from that of the roots in their respective cross-sections. Descriptive statistical analysis (Student’s t-test) was performed. A p-value less than equal to 0.05 was considered statistically significant. Results: The maximum mean diameter of the canal was found in the mesiobuccal root canal of both primary mandibular first molars (1.16±0.22 mm at cervical third) and second molars (1.12±0.16 mm at cervical third); and the minimum diameter was found in the distolingual root canal of both primary mandibular first molars (0.87±0.12 mm at cervical third) and second molars (0.89±0.16 mm at cervical third). The mean radicular wall thickness of the roots gradually increased from the apical third to the cervical third of both primary molars. Conclusion: The maximum root canal diameter and radicular wall thickness were found in the cervical third of the palatal root of maxillary second molars. The study evaluates the mean maximum and minimum diameters of each canal of human primary molars and radicular wall thickness in different crosssections, which enables paediatric dental practitioners to establish effective paediatric endodontic treatment.

Quality of Life after Open versus Closed Treatment for Mandibular Condylar Fractures

Objective: To compare the quality of life after surgical management with closed reduction and internal fixation (CRIF) versus open reduction and internal fixation (ORIF) for mandibular condylar fractures. Methodology: This analytical observational study was carried out between January 2024 to June 2024, at the Department of Oral and Maxillofacial Surgery, Jinnah Postgraduate Medical Centre, Karachi, focusing on patients with mandibular condylar fractures. The study assessed their quality of life using the General Oral Health Assessment Index (GOHAI) Questionnaire, with scores ranging from 1 to 3, where 1 denoted "Always," 2 indicated "Sometimes," and 3 represented "Never." Quality of life scores were categorized as high (34-36), medium (31-33), or low (<30) based on the GOHAI results. Results: In this study there were 66.7% neglected patients had high quality of life, 15.4% had moderate, and 27.3% had low GOHAI, (p=0.084). Further, there were only 16.7% patient close reduction management had high quality of life, 5 (38.5%) had moderate, and 545.5% had low GOHAI. According to open reduction management, there were 83.3% patients had high quality of life, 61.5% had moderate, and 45.5% had low GOHAI, (p=0.157). Conclusion: Factors such as age, gender, neglected type, and treatment modality did not significantly affect the post-operative quality of life. However, mandibular fracture patients who underwent surgical treatment with open reduction technique, as assessed by the GOHAI parameter, experienced a high quality of life.

Odontogenic Fascial Space Infection in Diabetic and Non-Diabetic Patients: A Clinical Comparative Study

INTRODUCTION Maxillofascial space infections are commonly encountered conditions and its prevalence is more in South Asia compared to other regions due to lack of awareness in seeking dental treatment. Carious teeth, contiguous non-vital teeth, postoperative infections, periodontal disease and pericoronal infections are major sources of odontogenic infections. These infections can easily spreads into facial spaces which may lead into life threatening conditions. Facial space infections with comorbid conditions of patients always increases extent of severity. Among the various systemic comorbidities, diabetes is commonly associated with space infections, which determines over all prognosis and treatment. The present study aims to find out the prevalence of diabetes, demographic value, the odontogenic spaces involved, educational value in relation, and the influence of systemic comorbidity over the treatment. MATERIAL AND METHODS This descriptive cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery at Universal College of Medical Sciences (UCMS), Bhairahawa from November 2023 to October 2024. All the patients were enrolled in this study after proper counselling and informed written consent. Diabetic and non-diabetic patients were considered as group A and group B respectively. Demographic data and prevalence of maxillofascial infection, role of education, facial spaces involved were the variables of this study. RESULTS The total number of cases during the study period were 3441. Out of which 56 were diagnosed with maxillofacial space infections and only 40 met the inclusion criteria of the study. The prevalence during this period was (16.27 per thousand). The study comprised 40 patients with maxillofascial space infections, divided into two groups based on their medical history and lab investigations. Out of which, 25 patients were diabetic (Group A) and 15 were non-diabetic (Group B). CONCLUSION This study found a higher prevalence of maxillofascial space infections in diabetic patients, with female predilection. The mean age group affected was 49.88 years and submandibular space infections was the most common among all.

Editorial: Institutional Repository of the Kyiv Medical University: A New Open Access Database for Authors and Peer-Reviewed Journals

Open access repository is a database, or a virtual archive established to collect, disseminate and preserve scientific output like scientific articles and datasets and to make them freely available. An institutional repository is one of four types of repositories. The purposes of this article are (1) to highlight the most important points of the Regulation on the Institutional Repository of the Kyiv Medical University (IRKMU) and (2) to explain the advantages for authors and peer-reviewed journals of colonization of the repository of such type. Also, this paper highlights the experience of the Department of Oral and Maxillofacial Surgery and the Journal of Diagnostics and Treatment of Oral and Maxillofacial Pathology (JDTOMP) in depositing peer-reviewed articles in this repository. The Regulation on the IRKMU was put into effect by Order No. 29 of January 26, 2024. In the same year, all structural units of the university, including dental departments, joined the process of depositing their scientific and clinical works. The IRKMU was created using the open-source software DSpace, which supports the Open Access Initiative Protocol for Metadata Harvesting (OAI-PMH) data exchange protocol, allowing the repository to be integrated into the international registers of the Registry of Open Access Repositories (ROAR), Directory of Open Access Repositories (OpenDOAR), and other search engines. The article is reinforced with screenshots of the stages of depositing data of scientific works. Carlile Butterfield and colleagues (2022) emphasized, that despite all benefits, however, their research indicates that it can be difficult to encourage all faculties to upload the research reports onto the institutional repository. Moreover, the authors propose a potential route to maximize the number of publications that are uploaded to a university institutional repository. They utilize student workers and the resources of the institutional repository manager to get materials uploaded. The experience of our department consists in attracting a competent editor from the editorial staff of the JDTOMP with appropriate payment for services. In sum, colonizing this new institutional repository as a new database, authors and peer-reviewed journals can and will increase the visibility of their publications. Thus, it can bear fruit in terms of increasing the citation of articles and the journals as well.

Retrospective assessment of dental implant applications: cross-sectional study

Aims: The aim of this study was to retrospectively examine the demographic and clinical conditions of the patients operated between 2020 and 2023 and the characteristics of the implants placed and to evaluate them using descriptive statistics. Methods: In this study, 6990 implants were evaluated in a total of 1586 patients aged 17-80 years, whose implant treatments were performed between 2020 and 2023 in Atatürk University Faculty of Dentistry, Department of Periondotology and Department of Oral, Dental and Maxillofacial Surgery. The demographic data obtained were analyzed by descriptive statistical techniques to examine a series of characteristics such as age, gender, edentulous status, implanted sites, type of post-treatment restoration and implant locations, type of post-treatment restoration and the brand and model of implants used. Results: 52.1% (n=827) of the patients were female and 47.9% (n=759) were male. The highest number of patients (n=480) was in the 40-49 age group. The most commonly implanted tooth was the mandibular 1st molar, and the most commonly implanted area was the mandibular molar region. It was determined that 70.8% of the implants were performed in the periodontology clinic. When evaluated according to the type of prosthetic restoration, the highest proportion of patients was 49.4% (n=1366) with fixed partial edentulism terminated with teeth. The lowest number of patients was complete edentulism and overdenture restoration with 5.9% (n=162). Conclusion: In this study; demographic and clinical characteristics of dental implant applications and the results were explained with descriptive statistical analysis methods. Retrospective evaluation of the features of clinical applications and prosthetic rehabilitation of implants is very valuable in terms of guiding treatment planning processes.

Local anesthesia with and without conscious sedation versus general anesthesia for oral surgical procedures in pediatric patients: a retrospective cross-sectional study

Objectives: To compare the effectiveness of general anesthesia versus local anesthesia with or without conscious sedation for minor oral surgery procedures in pediatric patients. Methods: We performed a retrospective chart review of 192 pediatric patients who underwent 227 minor oral surgery procedures between 2017 and 2019 at the Oral and Maxillofacial Surgery Department at Hospital Clínico Universitario in Valencia, Spain. Results: Of the 192 patients studied, 57.27% were male and 42.73% female (mean age, 9.83 years). General anesthesia was used in 51.54% of procedures, and LA with or without conscious sedation in 48.46%. Pain, occurring in 2.56% of general anesthesia procedures and 2.73% of local anesthesia procedures, was the most common complication, followed by infection (1.71% of general anesthesia procedures). Procedural success was 94.87% in the general anesthesia group and 91.82% in the local anesthesia group. No significant differences were observed in success or complication rates between the groups. Conclusions: Compared with local anesthesia with or without conscious sedation, general anesthesia does not result in lower procedural success rates or a higher risk of complications other than mild pain in pediatric dental patients.

Conservative Management of Mural Subtype Unicystic Ameloblastoma in Young Patient: A Case Report with One Year of Follow Up

Introduction: Ameloblastoma is a benign tumor primarily found in the jawbone. Unicystic ameloblastoma comprises four distinct types, first categorized in 1977. The primary mode of treatment is surgical intervention. This case report details the surgical management of a 13-year-old boy diagnosed with unicystic ameloblastoma and an impacted left mandibular third molar during the COVID-19 pandemic. Case Report: A 13-year-old boy was referred to the Oral and Maxillofacial Surgery Department at Hacettepe University due to a radiolucent lesion surrounding an impacted mandibular third molar, which led to facial asymmetry. The treatment plan included the extraction of the second molar, a biopsy, and marsupialization. During the one-year follow-up, no recurrence was noted. Conclusion: Marsupialization, which involves creating an open pocket by suturing the edges of a lesion to the oral cavity or sinuses for fluid drainage, is a conservative treatment approach particularly suitable for young patients. This method preserves the growth potential of the bone, improves aesthetic outcomes, and protects vital structures. In this case, due to the COVID-19 pandemic, conservative treatment under local anesthesia was preferred, with enucleation performed after marsupialization. Such approaches address clinical needs effectively and support patients' psychological well-being during challenging periods like pandemics.

Examining The Reasons behind Third Molar Extraction; A Look Back in Time

ABSTRACTObjectives: Extraction of third molar tooth is a frequently performed procedure in department of oral and Maxillofacial surgery, for various justified reasons. The objective of our study is to identify the reasons for extraction of third molar tooth in patients presenting at the University Dental Hospital, Lahore.Methodology: In May 2022, a retrospective study was carried out at The University of Lahore's University Dental Hospital. Records from the oral and maxillofacial surgery department were searched for relevant data between January 1, 2021, and December 31, 2021. There were 200 people in the sample. SPSS version 25 was used to compile and analyze the data. Standard descriptive analysis was initially performed, followed by chi-square analysis.Results: Records of 200 patients were gathered, with 56 percent being females and 44 percent males. Wisdom teeth extractions were more prevalent in patients aged between 31 to 40 years. Mandibular molar extractions were more common. Surgical methods were employed in 55 percent of cases, while non-surgical methods were used in 45 percent.Caries was the most prevalent reason for extraction, accounting for 64 percent, followed by mobility at 13 percent. Other reasons for extraction included broken root fragments and impaction, each contributing 9.5 percent. Pericoronitis was observed in 3.5 percent of cases, and orthodontic reasons were also noted.Conclusion: Individuals aged 18-40 predominantly underwent third molar extraction, with dental caries being the primary reason for extraction. Pericoronitis was major cause in the younger age group, whereas mobility was more common in the older age group. Prophylactic extraction was not widely practiced in our clinical setting.

Book review. Venipuncture for the Application of Blood Concentrates. Shahram Ghanaati, MD, DMD, PhD, Chicago: Quintessence Publishing Co Inc.

Book review. A small handbook on blood sampling for dentists and oral surgeons in the dental practice has been published. The sole author of this guide is Prof. Shahram Ghanaati, DDS, MD, PhD, Senior Consultant and Deputy Director of the Department of Oral and Maxillofacial Plastic Surgery at Frankfurt University Hospital, Germany. Although the advantages of platelet-rich fibrin (PRF) and other blood concentrates in dental implantology are well known, dentists and dental assistants are not used to taking blood samples. The author presents a guideline for collecting and preparing blood samples to ensure a high level of patient safety in these cases and a certain degree of professionalism in the dental profession. In his foreword, the author rightly points out that only regular practice can bring theory to life. The soft-cover book is extremely compact at 64 pages. The author focuses on the individual work steps and points out possible application errors using 88 photos, illustrations, and generally very easy-to-understand language. The result is an inexpensive clinical guide describing the necessary equipment, anatomy, and the correct sequence of steps for successful venipuncture. It should be included in any oral surgery practice that wants to work with blood concentrates. Of course, anyone looking for references or further information in this small book will not find what they want in the instructions. A list of possible application areas for blood concentrates must also be made. However, the reader is provided with efficient step-by-step instructions. Thus, the booklet elegantly helps close the knowledge gap among dentists regarding successful blood collection.

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.

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.

Cherubism: an incidental finding

Cherubism is a skeletal dysplasia limited to the maxilla and mandible, affecting children and adolescents. A 13-year-old male patient was referred to the Oxford University Hospitals Oral and Maxillofacial Surgery Department, by his orthodontist, following an incidental finding of bilateral multilocular radiolucencies of the mandible. This led to multiple clinical, radiographic, histopathological, genetic and biochemical investigations involving various medical and dental specialities. The multidisciplinary approach led to the successful management of this patient. Even though cherubism is self-limiting, long-term radiographic and clinical surveillance is required. CPD/Clinical Relevance: Dentists should understand the clinico-radiographic presentation of cherubism and have an awareness of how the possible functional and aesthetic complications associated with the condition are managed.

Patterns of mandibular third molar impaction and its relationship with distal caries in the adjacent mandibular second molars: A retrospective study

BackgroundImpacted third molars can cause significant challenges for dental health. While many of these impacted teeth remain asymptomatic, they can lead to dental caries. ObjectiveTo investigate the patterns of mandibular third molar impaction and its relationship with the occurrence of caries in the adjacent mandibular second molars. Materials and MethodsThis study assessed the dental panoramic radiographs of 1591 participants who visited the Department of Oral and Maxillofacial Surgery at the Dental Teaching Hospital at Umm Al-Qura University between 2022 and 2024. The presence of distal caries in the adjacent mandibular second molars was assessed and compared across the different impaction patterns, considering both age and gender. ResultsThe results showed that 29.22 % of the patients had impacted mandibular third molars. The most common patterns of impacted mandibular third molar angulation were mesioangular in the females and horizontal in the males. The majority of these impacted third molars were level A and class I (as per the Pell and Gregory classification).One hundred and eighty-three (39.35 %) of the impacted mandibular third molars had associated carious lesions, with 89 showing distal caries in the adjacent mandibular second molar and 18 showing caries in the third molar itself. The carious lesions were most commonly found in cases of mesioangular, level A, and class I impaction patterns (p < 0.05). ConclusionThe findings of this study shed light to the high prevalence of carious lesions associated with impacted mandibular third molar, especially in cases of mesioangular, level A, and class I impaction patterns. These findings highlight the importance of careful monitoring of impacted third molars to prevent the development of caries in the adjacent teeth.