Is the Pre-Shaping of an Orbital Implant on a Patient-Specific 3D-Printed Model Advantageous Compared to Conventional Free-Hand Shaping? A Systematic Review and Meta-Analysis.

This study aimed to perform a systematic review and meta-analysis to compare pre-shaped implants on a patient-specific 3D-printed (3DP) model to manual free-hand shaping (MFS) for orbital wall reconstruction. The PRISMA protocol was followed in this study, and the review was registered in the PROSPERO database (CRD42021261594). A search was conducted in MEDLINE (PubMed), Embase, Cochrane Library, Clinicaltrials.gov, Google Scholar, and the grey literature. Ten articles were included, and six outcomes were analyzed. In total, 281 patients were in the 3DP group and 283 were in the MFS group. The studies had an overall high risk of bias. 3DP models resulted in a better accuracy of fit, anatomical angle reproduction, and defect area coverage. The correction of orbital volume was also superior with statistical significance. There was a higher percentage of the correction of enophthalmos and diplopia in the 3DP group. Intraoperative bleeding and hospital stay were reduced in the 3DP group. The meta-analysis of operative time showed a reduction in the average operative time by 23.58 min (95% CI: -43.98 to -3.19), which was statistically significant (t(6) = -2.8299, p = 0.0300). The 3DP models appear advantageous for an accurate orbital wall reconstruction, with fewer complications than those for conventional free-hand-shaped implants.

Advances in Tissue Engineering of the Temporomandibular Joint Disc: An Overview of Current Status and Future Directions.

Advances in tissue engineering have progressed to potentially offer a solution to temporomandibular joint disc (TMJ) disorders not amenable to conservative therapies. Conclusive treatment options for patients with end-stage disc disorders requires discectomy and reconstruction of the articular disc with various materials. Tissue engineering TMJ disc is a promising alternative to the limited and sometimes inadequate clinical options in the management of such disorders. However, tissue engineering is far from completion for the TMJ disc regeneration. This review briefly discusses the properties of native disc, the mechanism by which TMJ disorders manifest, and how a tissue engineered disc could assuage the problems inherent in the management of such disorders. Furthermore, the review addresses and provides updates to relevant themes of tissue engineering in regards to the TMJ disc, namely, the scaffolds, cells and biomarkers, hurdles in tissue engineering of the disc, and its application in translation to the clinical practice and future directions.

Is There a Weekend Effect in the Management of Maxillofacial Trauma Patients?

BACKGROUND: Many previous studies have shown that patients admitted to the hospital at weekends have a longer delay than those on weekdays. It has been proposed that the equality of specialist services throughout the week could mitigate the 'weekend effect.' This study aimed to determine whether or not a weekend effect is observed in Oral and Maxillofacial surgery patients at a medical college and teaching hospital. METHODS: Our primary predictor variable was the day of admission. Our primary outcome of interest was the length of hospital stay from admission to operation. Descriptive analysis, correlation analysis, One way ANOVA, and post hoc comparison were performed for statistical analysis. RESULTS: Out of 1185, 1005 (84.8%) were male and 180 (15.2%) female, with a mean age of 30.3 (SD=14.1) years. There was a significantly higher admission on weekends, Friday, and Saturday, and the weekend admissions were associated with a longer delay from admission to operation. The night shift was also associated with a longer delay from admission to operation. The diagnosis based procedure had the most significant effect on delay from admission to operation. The patient's age and gender had no association with the primary outcome. CONCLUSIONS: There is a delay in the definitive treatment of maxillofacial surgery patients admitted on weekends. These findings have implications for adequate staffing and resource allocation on the weekends based on admission volume.

What Are the Complications, Success and Survival Rates for Autotransplanted Teeth? An Overview of Systematic Reviews and Metanalyses.

BACKGROUND: Autotransplantation is the surgical repositioning of a tooth within the same patient. It can be thought of as the controlled avulsion and re-implantation of a tooth and can be a viable alternative to other dental rehabilitation options. This review aimed to evaluate the survival rate (SR), major complications such as ankylosis rate (AR) and infection-related root resorption (RR), and overall success and failure rate (FR) in autotransplanted teeth. METHODS: Six databases were accessed up to January 2021 to obtain all systematic reviews and meta-analyses (SRs and MAs). STUDY SELECTION: After title and abstract reading, data extraction was performed from eligible SRs. The methodological quality was calculated for the included SRs using the risk of bias in systematic reviews (ROBIS) tool. RESULTS: Six SRs were included in this review. The overall failure rate ranged from as low as 2.0% to 10.32%. The 1-year survival was very high (97.4-98.0%). The 5-year survival rate ranged from 81 to 98.2%. Major complications of AR ranged from 1.2 to 6.2%, and RR ranged from 2.1 to 10.4%. CONCLUSION: The overall findings from these SR and MA are promising; however, all the SRs include only single-arm prospective or retrospective studies, the SRs are of overall low methodological quality, and for the heterogeneity of the included SRs, well-designed comparative studies with a long-term follow-up are recommended.

How effective is 5-Fluorouracil as an adjuvant in the management of odontogenic keratocyst? A systematic review and meta-analysis.

Odontogenic keratocyst (OKC) is known for its benign but aggressive clinical behaviour, and presents a challenge in its management due to high recurrence rate following surgical intervention. The sourcing of Carnoy's solution, the widely used adjunct in OKC treatment, has lately become difficult especially after its banning by the United States Food and Drugs Agency (FDA). This has generated interest in exploring alternative chemical agents such as 5-Fluorouracil (5-FU) and Modified Carnoy's solution (MCS). We conducted a systematic review and meta-analysis to assess the effectiveness of 5-FU as an adjunct following surgical intervention of OKC. A protocol was registered in PROSPERO prior to the literature search. All studies reporting the use of 5-FU in OKC treatment were included in the initial search of multiple literature databases. Of the 148 initially identified articles, three met the criteria for the final appraisal. The relevant data were extracted and a meta-analysis was undertaken in relation to recurrence rate and nerve paraesthesia. There were no recurrence observed in cases treated with 5-FU (n=56), and the incidence of nerve paraesthesia was 20% (none permanent). This systematic review has revealed early encouraging results for 5-FU as an adjunct, however a caution is recommended due to overall low quality of evidence related to individual studies. We present the cumulative evidence on the effectiveness of 5-FU in OKC treatment with discussion on its mechanism of action, safety profile, application protocol, and the implications for clinical practice.

Transport distraction osteogenesis compared with autogenous grafts for ramus-condyle unit reconstruction in temporomandibular joint ankylosis: a systematic review and meta-analysis.

This systematic review was planned to assess the clinical outcomes of transport distraction osteogenesis (TDO) compared with autogenous grafts for reconstruction of the ramus condyle unit (RCU). We searched Medline, Embase, Cochrane Library, Clinicaltrial.gov, and the references of included trials. The primary outcome was maximal incisal opening (MIO). Of the 148 studies retrieved, five were included (TDO = 49, autogenous grafts =123). The mean difference in MIO between TDO and autogenous graft RCU reconstruction, based on the random-effects model was 1.28 mm (95% CI 0.167 to 2.403) in favour of TDO. Re-ankyosis was observed in four cases in the costochondral graft group and none in the TDO group. Reconstruction of the RCU using TDO is comparable to autogenous grafts after the release of TMJ ankylosis, though the evidence is weak considering the small number of trials, high risk of bias, and absence of long-term results.

Are Physics Forceps Less Traumatic than Conventional Forceps for Tooth Extraction? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This systematic review and meta-analysis studied the clinical outcomes with physics forceps compared to those with conventional forceps for closed dental extraction. A systematic literature search was performed to identify all the published randomized clinical trials that compared the relevant clinical outcomes with physics forceps to those with conventional forceps for closed dental extraction. A total of 11 studies were included. The adverse events were significantly lower with physics forceps (n = 48) compared to with conventional forceps (n = 120), with an odds ratio of 0.42 [0.25, 0.70], Z = 3.78 (p = 0.0002), and I2 = 21%. There were statistically significant differences in the incidence of GL (p = 0.04), and tooth or root fracture (p = 0.0009). Operating time was significantly lower in physics forceps than that of conventional forceps, mean difference (-20.13 (-30.11, -10.15)), Z = 3.78 (p = 0.0001), I2 = 79%. The available evidence is limited by a high risk of bias and low evidence certainty. Based on the current evidence, physics forceps might be better than the conventional extraction forceps in terms of the extraction duration, pain after extraction, trauma to both hard and soft tissue, and complications. Physics forceps are newer instruments that have not yet been introduced in the teaching of dental graduates. The introduction of physics forceps can be time saving, less invasive and reduce post-extraction complications.

Morphology of Maxillary Labial Frenum in Chepang Community of Chitwan.

BACKGROUND: Labial frenum is a fold of mucous membrane whose function is to attach lips and cheek to the alveolar mucosa, gingiva and underlying periosteum. The maxillary labial frenum has lot of variation in shape, size location. This study was aimed to assess the variation of maxillary labial frenum in the indigenous Chepang community of Nepal. METHODS: A descriptive cross-sectional study was conducted among the Chepang community at Madi municipality in Chitwan, Nepal. The clinical examination was done by distending the upper lip upward for viewing. The obtained data was classified according to Mirko and Sewerin classification. Data was entered into Statistical Package for the Social Sciences version 16 and descriptive statistics was performed. RESULTS: All the Chepang participants 102 (100 %) had mucosal type of maxillary frenum. Among the variations normal frenum was mostly present 74 (72.5%). This type was mostly present in male participants 44 (43.1%). Apart from this frenum with nodules and appendix was also observed. CONCLUSIONS: The mucosal type of frenal attachment was prevalent in Chepang Community and normal frenum was the most common type of frenal morphology.