Impact of Osteoporosis on Autogenous Bone Graft Resorption.

BACKGROUND: Osteoporosis is a common disorder that is characterized by decreased bone density and increased bone resorption. This bone resorption may affect the grafted bone during the maxillofacial reconstruction. PURPOSE: This study aimed to measure the association between osteoporosis and resorption of anterior iliac crest bone grafts used to reconstruct the atrophic anterior maxillae. STUDY DESIGN, SETTING, SAMPLE: This prospective cohort study included female patients requiring bone augmentation of the anterior maxilla. Patients with a ridge width of <4 mm and ridge height of >7 mm were enrolled in the study. Exclusion criteria were chronic use of corticosteroids or intravenous bisphosphonates, history of maxillofacial radiation therapy, current smoking, and underlying conditions contributing to bone metabolism (eg, hyperparathyroidism, chronic renal failure, and hypophosphatemia). PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: Osteoporosis status was a predictor variable. Patients were allocated to the osteoporosis or control group based on T-scores obtained by dual-energy x-ray absorptiometry. Mean T-scores ≤ -2.5 were assigned to the osteoporosis group. MAIN OUTCOME VARIABLE(S): The outcome variable was graft resorption, defined as the difference in ridge width between measurements made immediately (T1) and 6 months postoperatively (T2) using cone-beam computed tomography. COVARIATES: Patient age, preoperative (T0) bone width, and the amount of bone augmentation, defined as the differences in ridge width between measurements made preoperatively (T0) and immediately after grafting (T1), were covariates of this study. ANALYSES: Descriptive, analytic, and general linear models were computed. Statistical significance was set a P < .05. RESULTS: Thirty-two patients were included in the study (15 in the osteoporosis group and 17 in the control group). The amount of graft resorption at 6 months after grafting was 2.57 ± 0.59 mm in the osteoporosis group and 0.97 ± 0.59 mm in the control group (P < .001). A significant correlation was found between the mean T-score and graft resorption 6 months after grafting (P < .001). CONCLUSION AND RELEVANCE: A significant correlation was observed between osteoporosis and graft resorption in the anterior maxilla after 6 months.

Nonvascularized bone grafts: how successful are they in reconstruction of segmental mandibular defects?

OBJECTIVE: Segmental mandibular defects can occur due to various etiologies, including trauma and tumor resection. Reconstruction should provide adequate support for subsequent dental rehabilitation and allow for proper occlusion. Nonvascularized bone grafts have been used for reconstructing mandibular defects in cases where vascularized grafts were not feasible. The objective of this study was to assess the success rate of these grafts in reconstruction of segmental defects of various sizes in the mandible. STUDY DESIGN: Fifty patients were included in this retrospective chart review. Length of the grafts varied from 3 to 20 cm and patients were followed up from 4 to 80 months. Fifteen grafts were harvested from anterior iliac crest, 23 from posterior iliac crest, 9 grafts were a combination of either with costochondral graft, and 3 were solely allografts. Bone morphogenetic protein was utilized in 41 cases as an adjunct. RESULTS: Success was defined as continuity of bone clinically and radiographically at a 4-month follow-up. Nonvascularized bone grafting was successful in 90% of cases. Complications were observed in 34% of cases, of which the most common were infection followed by wound dehiscence. CONCLUSIONS: Our study demonstrated substantial success rate with nonvascularized bone grafts in reconstruction of segmental mandibular defects.

The use of clear aligners in orthognathic surgeries: a case series.

Pre- and postoperative fixed orthodontic appliances are the customary and standard practice for patients with treatment planned for undergoing orthognathic surgery. Traditionally, most patients undergoing orthognathic surgeries are in their late teens. Although these patients still compose the greatest pool of the orthognathic surgery population, many patients seek orthognathic surgery later in life. This older patient population often has different concerns and goals than the younger patient population. One of these concerns is often the aesthetic appearance of fixed appliances and the time required to wear these appliances pre- and postoperatively. Today, removable orthodontic appliances consisting of a series of clear aligners have gained immense popularity due to their aesthetic appeal over traditional braces. Additional benefits of removable orthodontic appliances include improved oral hygiene leading to a decreased risk of gingivitis. Whereas clear aligner systems are commonly used in the nonsurgical orthodontic population, there has been limited use of Invisalign in the orthognathic surgery population. In this article, we present a case series of 5 patients who successfully underwent orthognathic surgery using clear aligners for pre- and postoperative orthodontic treatment.

The use of virtual reality and augmented reality in oral and maxillofacial surgery: A narrative review.

OBJECTIVE: The purpose of this article is to review the current uses of virtual reality (VR) and augmented reality (AR) in oral and maxillofacial surgery. We discuss the use of VR/AR in educational training, surgical planning, advances in hardware and software, and the implementation of VR/AR in this field. STUDY DESIGN: A retrospective comprehensive review search of PubMed, Web of Science, Embase, and Cochrane Library was conducted. The search resulted in finding 313 English articles in the last 10 years. RESULTS: A total of 38 articles were selected after a meticulous review of the aims, objectives, and methodology by 2 independent reviewers. CONCLUSIONS: Virtual reality/AR technology offers significant potential in various aspects, including student education, resident evaluation, surgical planning, and overall surgical implementation. However, its widespread adoption in practice is hindered by factors such as the need for further research, cost concerns, unfamiliarity among current educators, and the necessity for technological improvement. Furthermore, residency programs hold a unique position to influence the future of oral and maxillofacial surgery. As VR/AR has demonstrated substantial benefits in resident education and other applications, residency programs have much to gain by integrating these emerging technologies into their curricula.

Primary cutaneous B-Cell lymphoblastic lymphoma presenting with solitary scalp mass in a female child: A case report and review of the literature.

Lymphoblastic lymphoma is a group of non-Hodgkin lymphomas that account for approximately 2% of all lymphomas. This is a report of a case of a young girl presenting with a solitary scalp mass which was resected. Histopathological examination of the mass along with bone marrow analysis revealed primary cutaneous B-cell lymphoblastic lymphoma. A nine-year-old girl presenting with an asymptomatic erythematous, non-tender scalp mass present for 12 months was admitted. Skull and brain were intact and devoid of any pathological findings on computed tomography imaging. Systemic examination also showed no evidence of mass lesion in other parts of the body. The lesion was resected and referred for pathological analysis. Microscopic study revealed heavy diffuse dermal and subcutaneous infiltration of monomorphous medium-sized mononuclear cells, with fine chromatin, scant cytoplasm, and variable nucleoli along with intact epidermis and presence of grenz zone. Tumor cells dissect through the collagen fibers. Extensive mitotic figures and focal infiltration of the skin adnexa are seen. IHC study revealed that TdT, CD79a, CD99, CD45, CD20, and Ki67 markers were positive. According to these findings, a definitive diagnosis of primary cutaneous lymphoblastic lymphoma of B cell type was concluded. The 1-year follow up after necessary treatment revealed normal findings without traces of recurrence. Lymphoblastic lymphomas (LBL) are a neoplasm of immature B cells belonging to the B-(B-LBL) or T-cell lineage (T-LBL) that accounts for approximately 2% of all lymphomas. Lymphoblastic lymphoma (LBL) is similar to acute lymphoblastic leukemia (ALL) and the differentiation between these neoplasms is based upon proportion of involvement of lymphoblasts in bone marrow. It has a higher male to female predominance, higher incidence in older children and younger adults, and a relatively higher frequency of CNS and gonadal involvement. The differential diagnosis is based on immunohistochemistry study of B-cell linage tumor markers. Cutaneous involvement is present in about one third of patients with B-LBL but rarely in patients with ALL.

Synthesis and characterization of nano bioactive glass for improving enamel remineralization ability of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP).

OBJECTIVE: Nanomaterials with superior properties such as high surface area over volume ratio are widely used in dentistry and medicine. This in vitro study was performed to synthesize and characterize nano bioactive glass (nBG) and to evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) containing nBG (CPP-ACP@nBG) on enamel remineralization by its application to pH-cycled, synthetically demineralized enamel surfaces. MATERIALS AND METHODS: nBG particles were prepared by sol-gel method. X-ray diffraction pattern (XRD), Fourier-transform infrared spectroscopy (FTIR) and transmittance electron microscopy (TEM) were used for nBG characterization. Synthetic CPP-ACP paste was prepared and nBG particles were added to it. To evaluate the degree of remineralization, 32 healthy human premolars were selected. The samples were randomly divided into 4 groups as: Group 1: Commercial CPP-ACFP (MI paste plus), Group 2: Synthetic casein phosphopeptide-amorphous calcium phosphate containing fluoride (CPP-ACP@F), Group 3: Synthetic CPP/ACP containing nBG (CPP-ACP@nBG), and Group 4: Control (received no treatment). The pastes were then applied on the tooth surfaces for 28 days. The Vickers microhardness of enamel surfaces was evaluated, and enamel surface morphology was assessed using scanning electron microscopy (SEM). RESULTS: X-Ray diffraction pattern (XRD) of the synthesized nBG show its crystalline nature with the Larnite crystalline mode. Transmittance electron microscope (TEM) microimage of the synthesized nBG shows its formation as less that 100 nm spherical nanoparticle with partial agglomeration. Fourier transform infrared spectroscopy (FTIR) confirm the success formation of nBG with high purity. The results of this study showed that microhardness of the experimental groups was significantly higher than the control group (p ≥ 0.05). SEM images showed a layer of hydroxyapatite in the CPP-ACP@nBG, synthetic and commercial CPP-ACP@F remineralized groups. CONCLUSION: The results of this study demonstrated that CPP-ACP@F and CPP-ACP@nBG remineralize the surface of the demineralized enamel. Microhardness of the remineralized enamel in the CPP-ACP@nBG group was higher than synthetic and commercial CPP-ACP@F groups.

Primary melanoma of submandibular gland: case report and literature review of a very rare entity.

BACKGROUND: Cutaneous melanomas account for more than 95% of all cases of primary melanoma, making non-cutaneous primary melanomas truly rare. Cases of primary mucosal melanomas of the oral cavity have been widely described; however, instances of primary melanomas arising from salivary glands have been rarely described. To date, this is only the second case of primary melanoma of the submandibular gland. CASE PRESENTATION: This is a report of a case of a 36-year-old healthy male patient, who was referred to us with the chief complaint of a growing swelling on the left side of his lower jaw. Evaluations revealed an evident facial asymmetry in the frontal view with a firm, non-tender swelling. Initial orthopantomogram did not reveal any alterations in the trabeculation or morphology of the jaws and the surrounding structures. A soft tissue ultrasonography of the left submandibular gland and anterior region of mandible revealed a hypoechoic cystic mass with numerous micro-echoes. Further para-clinical examinations yielded the definitive diagnosis of primary melanoma of the submandibular gland. Moreover, no evidence of distant osteometastasis was observed in whole-body scans. Subsequent surgical management with the approach of excising the submandibular salivary gland and concurrent selective neck dissection was implemented. CONCLUSIONS: This report emphasizes the importance of thorough examination and prompt referral to designated specialists in cases with suspicious behaviors which are unresponsive to treatments. It can be further concluded that melanoma can mimic a range of benign pathologies; therefore, putting it in the list differential diagnosis of similar lesions seems plausible.

Periapical Actinomycosis: A Rare Subdivision of Cervicofacial Actinomycosis, Review of the Literature, and a Case Report.

Background: Periapical actinomycosis, which is reckoned as a subgroup of cervicofacial actinomycosis, is an uncommon, more indolent, less invasive, and limited type of actinomycosis infection. However, it can be considerably underreported due to the low number of periapical surgical specimens that are submitted for histopathological analysis after excision of the lesion with the preliminary diagnosis of typical periapical infections. It is believed that during root canal treatment, the organisms are displaced from the oral cavity into the periapical regions as a result of failure to establish aseptic techniques which can further result in actinomycosis infections and, in rare instances, lead to more severe events and can even be life-threatening. Case Presentation. We intend to report a case of periapical actinomycosis in a 34-year-old female who presented with the chief complaint of pain and slight mobility of the mandibular right second premolar and first molar with no significant issues in the patient's medical history. Initial orthopantomography revealed a uniloculated, radiolucent lesion engulfing the apices of the aforementioned teeth. An incisional biopsy was then obtained which revealed fragments of fibroconnective tissue including few crushed bone particles severely infiltrated by acute inflammatory cells and some foamy macrophages. The suppurative exudate focally surrounds colonies of filamentous bacteria as round basophilic masses with radial configuration resembling "sulfur granules." Surgical approach consisted of curettage accompanied with peripheral ostectomy and cautious burnishing of the two involved tooth roots. Conclusion: This case report emphasizes the importance of aseptic techniques during endodontic and more invasive treatments, as they can cause penetration of Actinomyces into the periapical region which in some cases can lead to more serious complications and even life-threatening situations.

Does maxillomandibular fixation affect skeletal stability following mandibular advancement? A single-blind clinical trial.

BACKGROUND: The stability of the results remains a significant concern in orthognathic surgeries. This study aimed to assess the amount of relapse following mandibular advancement with/without maxillomandibular fixation (MMF). MATERIALS AND METHODS: A single-blind clinical trial was conducted on patients with mandibular retrognathism who underwent BSSO for mandibular advancement and Lefort I maxillary superior repositioning. Patients were randomly divided into two groups of treatment (MMF) and control (no MMF). In the treatment group, MMF was performed for 2 weeks; meanwhile, MMF was not performed in the control group, and only guiding elastics were applied postoperatively. Lateral cephalograms were obtained preoperatively (T1), immediately after surgery (T2), and at 1 year postoperatively (T3). The distance from points A and B to the X and Y plane were measured to identify the amount of vertical and horizontal relapse in 1 year as a primary outcome. An independent t-test was applied in order to find differences in outcomes between the control and treatment groups. RESULTS: Fifty-eight patients were evaluated in two groups (28 patients in the MMF group and 30 in the no-MMF group). The magnitude of mandibular advancement following BSSO was 7.68±1.39 mm and 7.53±1.28, respectively, without significant difference among the groups (p= 0.68). The mean sagittal and vertical changes (relapse) at point B were significantly different between the two groups at 1-year follow-up after the osteotomy (p=0.001 and p=0.05, respectively). CONCLUSION: According to the results of this study, patients with short-term MMF following BSSO for mandibular advancement benefit from significantly greater skeletal stability in the sagittal and vertical dimensions.

Herpes simplex encephalitis following ChAdOx1 nCoV-19 vaccination: a case report and review of the literature.

BACKGROUND: Ever since the administration of early doses of COVID-19 vaccines, instances of adverse effects have been reported. Viral infections, specifically herpes simplex reinfection and coinfections, have been reported following administration of different types of vaccines. To our knowledge, there have not been any reports of herpes simplex encephalitis following administration of any type of COVID-19 vaccine to date. CASE PRESENTATION: In this article intends to report a case of herpes simplex encephalitis in a 27-year-old male patient who was vaccinated with the ChAdOx1 nCoV-19 vaccine. CONCLUSIONS: Our study suggests a possible but very rare side effect of ChAdOx1 nCoV-19 vaccine, which requires immediate medical attention and can lead to devastating consequences if left undiagnosed and untreated.

Evaluation and comparison of antibacterial and physicochemical properties of synthesized zinc oxide-nano particle-containing adhesive with commercial adhesive: An experimental study.

INTRODUCTION: Enamel surface demineralization is one of the most common issues occurring subsequent to orthodontic treatments. This study aims to synthesize a homogenous adhesive, containing zinc oxide nano particles for the purpose of evaluation of antibacterial and mechanical properties in bonding of orthodontic brackets. MATERIALS AND METHODS: Assessments were based on three groups: a control group (synthesized adhesive), ZnO group (synthesized adhesive containing 1.3% mass fraction of zinc oxide nano particles), and XT™ group (Transbond™ XT™, 3M™, USA). Biofilm formation inhibition test was utilized for the evaluation of antibacterial effects and physicochemical tests were further utilized for the assessment of shear bond strength (SBS), adhesive remnant index (ARI), microhardness, degree of conversion (DC), water sorption and water solubility. RESULTS: In terms of antibacterial properties, ZnO-containing adhesives demonstrated a significant difference compared to the control group (P=0.001). The addition of ZnO to the synthesized adhesive did not result in any significant difference compared to the control and XT™ groups in terms of shear bond strength (P=0.007). CONCLUSIONS: Implementation of 1.3% mass fraction of zinc oxide nano particles in synthesized adhesive can add significant antibacterial characteristics and prevent biofilm formation without affecting the structural, mechanical, and chemical properties of the adhesive.

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

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

Conferred with a new life: A case report of management of a severe midface trauma and subsequent oral rehabilitation.

Maxillofacial traumas have been associated with 14%-17% of all facial injuries. The most common etiology of mid-facial traumas is motor vehicle accidents followed by interpersonal assaults. The devastating nature of maxillofacial defects makes reconstruction of the midface challenging, due to multiple required surgeries and extensive rehabilitation phase. The midface has been defined as the area between the zygomaticofrontal sutures and the maxillary occlusal plane. Midface traumas are significantly more challenging to manage compared to isolated facial since there is limited intact and unharmed framework to guide with anatomic reductions. Therefore, the appropriate surgical approach to a maxillofacial trauma must follow a systematic scheme. Besides, one of the main consequences of maxillofacial traumas is destruction of the teeth and teeth bearing alveolar bone. Oral rehabilitation utilizing dental implants of these patients must be considered to provide the higher quality of life. Here, we report the management and further oral rehabilitation of a case suffering severe midface trauma following a motor vehicle accident where the patient was hit by a lorry.

Odontogenic myxoma of the anterior mandible: Case report of a rare entity and review of the literature.

This report intends to compare classic presentations of odontogenic myxoma in contrast to our case. We also suggest a comprehensive evaluation of lesions and strongly advocate against premature treatments before reaching a definitive diagnosis.