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Oral squamous cell carcinoma (OSCC) patients suffer from poor survival due to metastasis or locoregional recurrence, processes that are both facilitated by perineural invasion (PNI). OSCC has higher rates of PNI than other cancer subtypes, with PNI present in 80% of tumors. Despite the impact of PNI on oral cancer prognosis and pain, little is known about the genes that drive PNI, which in turn drive pain, invasion, and metastasis. In this study, clinical data, preclinical, and in vitro models are leveraged to elucidate the role of neurotrophins in OSCC metastasis, PNI, and pain. The expression data in OSCC patients with metastasis, PNI, or pain demonstrate dysregulation of neurotrophin genes. TrkA and nerve growth factor receptor (NGFR) are focused, two receptors that are activated by NGF, a neurotrophin expressed at high levels in OSCC. It is demonstrated that targeted knockdown of these two receptors inhibits proliferation and invasion in an in vitro and preclinical model of OSCC, and metastasis, PNI, and pain. It is further determined that TrkA knockdown alone inhibits thermal hyperalgesia, whereas NGFR knockdown alone inhibits mechanical allodynia. Collectively the results highlight the ability of OSCC to co‐opt different components of the neurotrophin pathway in metastasis, PNI, and pain. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this investigation was to compare three different techniques for soft tissue closure over intraoral particulated bone grafts in a pig model: primary closure and nonprimary closure utilizing a porcine collagen matrix (Mucograft), with or without the addition of platelet-derived growth factor (PDGF). An additional aim was to determine whether the addition of PDGF to the collagen matrix would prevent the need for primary closure or later soft tissue grafting. Materials and Methods: Twenty-four bilateral mandibular alveolar defects were created in 12 minipigs. These defects were reconstructed with a mixture of autogenous bone and bovine bone and secured with a titanium mesh. The animals were randomly assigned to group A (Mucograft + PDGF), group B (Mucograft alone), or group C (primary closure and no Mucograft). In groups A and B the collagen matrix was placed directly over the mesh, and the soft tissue was closed passively. Exposure of the titanium mesh, height of new bone, and the percentage of keratinized mucosa covering the bone graft were analyzed. Results: Average new bone formation in group A was 7.0 mm, whereas groups B and C had less regenerated bone (4.7 mm and 2.5 mm, respectively). Group A had the thickest keratinized mucosa (1.6 mm), versus 0.9 mm for group B and 0.4 mm for group C. Group A had an average of 95% regenerated keratinized tissue, whereas group B had 41% and group B had 22%. Conclusion: The addition of PDGF to the collagen matrix appeared to accelerate soft tissue healing and promote bone formation. Mucograft provided an adequate alternative to autogenous soft tissue grafts or primary closure to cover bone grafts intraorally while eliminating adverse effects, namely disruption of the adjacent soft tissue architecture, loss of vestibular height, and the need for further surgery. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this 1-year pilot prospective study was to evaluate the implant success rate, periimplant tissue response, and complications associated with the immediate loading of two freestanding implants retaining mandibular overdentures. Materials and Methods: Ten adults with a mean age of 59.7 years (range, 43 to 78 years) underwent treatment that included a maxillary removable complete denture opposing a mandibular removable overdenture retained by two freestanding, threaded, titanium oxide-surface implants with a 3-mm machined collar (n = 20 implants). The success of each implant was evaluated clinically and radiographically. Marginal bone levels and changes were evaluated using sequential standardized periapical radiographs. Surgical and prosthetic complications were recorded. Results: Two patients, one with one failed implant, dropped out prior to completion of the study. The failed implants were included in the evaluation of cumulative implant success. The cumulative implant success rate at 1 year was 94% (16/17). The mean marginal bone loss was 1.12 1 1.10 mm at 12 months. However, if the expected bone loss of 0.39 mm above the smooth-rough implant surface junction was considered, the mean marginal bone loss was only 0.73 mm. Mean Periotest values of -4.25 1 0.93 at 1 year implied that osseointegration had been achieved for all successful implants. Modified Plaque Index scores of 0 and 1 were recorded throughout the duration of the study. No irreversible surgical and/or prosthetic complications were observed. Conclusions: In this 1-year pilot prospective study, two immediately loaded unsplinted mandibular symphyseal implants retaining an overdenture resulted in favorable implant success and peri-implant tissue response. [ABSTRACT FROM AUTHOR]

Distraction osteogenesis is a predictable method for restoring missing tissue prior to implant placement. However, pull from the soft tissue can alter the desired direction of the distraction. This article describes and illustrates techniques that are useful for maintaining the desired vector during alveolar distraction osteogenesis. These methods can prevent the need for further intervention and allow for ideal placement of endosseous dental implants without compromising results. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the present study was to evaluate the safety and efficacy of the compression-resistant collagen-based cross-linked matrix for augmentation of maxillary and mandibular soft tissue defects in an animal model. Materials and Methods Six rhesus macaque monkeys were subjected to soft tissue grafting in 4 sites intraorally; the anterior maxilla was subjected to hard and soft tissue grafting with implant placement. Each site was randomly assigned 1 of 3 treatments: a compressive-resistant collagen matrix membrane (CM), a subepithelial connective tissue autograft (SCTG), or sham treatment, in which a partial-thickness flap was elevated and then sutured closed with no further treatment (control). The following methods were used for data collection: in vivo evaluation by periodontal probing, ultrasound, shear modulus elasticity, polyether impressions for volumetric analysis, and in vitro analysis by histologic biopsy examinations. In vitro analysis provided by histologic measurements and evaluations was performed on nondecalcified sections. The follow-up period was 6 months. Results The SCTG and CM showed favorable tissue integration. No adverse reaction to or deviation from the normal healing processes was detected. The CM integrated well in all sites, with a variable range of soft tissue volume increases. Volumetric discrepancies were appreciated in the histologic analyses and differences were found when the CM and SCTG were applied in the anterior maxilla in combination with hard tissue grafting and implant placement. Histologic evaluation showed favorable integration, no immunogenic response to the CM, and stable volumetric retention in autograft and CM sites during the experimental period. Conclusion The compressive-resistant CM could be a safe and efficacious alternative for soft tissue augmentation by obviating a donor site and the consequent morbidity. Although a similar performance between the CM and SCTG was observed, further studies will be necessary to estimate the clinical potentiality and describe the limits of the technique. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether changing "oral and maxillofacial surgeon" (OMS) to "oral and facial surgeon" improves the perception and awareness of the OMS's role and surgical scope of practice in undergraduate biomedical and dental students.Materials and Methods: This cross-sectional study requested undergraduate and dental students to select 1 of 5 specialists to treat 21 conditions. Two different surveys were presented: 1 designating specialists as "oral and maxillofacial surgeons" and 1 designating specialists as "oral and facial surgeons." The independent variable was the specialist "oral and maxillofacial surgeon" or "oral and facial surgeon." The dependent variables included specialists chosen for the procedure (ear, nose, and throat surgeon; OMS vs oral and facial surgeon; plastic surgeon; periodontist; and "other"). The test of proportions (z test) with the Yates correction was performed.Results: The sample was composed of 1,671 undergraduate upper division science students and 568 senior dental students. Results showed that undergraduate students' perception of an OMS's surgical scope increased significantly from 28 to 33% when "oral and facial surgeon" was used instead of "oral and maxillofacial surgeon." Dental students' perception of an OMS's surgical scope remained the same whether "oral and maxillofacial surgeon" or "oral and facial surgeon" was used.Conclusion: The results of this study suggest that using "oral and facial surgeon" instead of "oral and maxillofacial surgeon" increases awareness of an OMS's surgical scope of practice in undergraduate upper division science students, which could be an important step toward increasing the recognition of the profession by the general public and other non-dental medical colleagues. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the rate of complication outcomes of mandibular fracture repairs across different injury-to-repair time spans.Patients and Methods: We conducted a retrospective cohort study of patients with repaired mandibular fractures. The independent variable was the time span from injury to surgical repair. The primary outcome variable was the rate of complications measured postoperatively during the follow-up appointments. Other variables were grouped for performance of a stratified analysis: favorability of the fracture, patient compliance, substance abuse, and fracture location. Descriptive and bivariate statistics were computed.Results: The final sample was composed of 505 patients, and the time span from injury to repair ranged from 0 to 90 days. The total number of patients from the sample with reported complications was 124. There was no statistical significance correlating the time spans and complication rates (P = .796). The variables for the stratified analysis also showed no significant correlations except for fracture location. Body fractures resulted in the highest rate of complications (33%; P = .041). Of the noncompliant patients (n = 144), 28.5% presented with complications (P = .352). No significance was seen in unfavorable fractures (n = 283), with a rate of complications of 28.6%. No significance could be correlated with substance abuse (n = 107, 29.9% with complications; P = .262).Conclusions: The results of this study suggest that although time from injury to repair does not affect the rate of complications, the global standard of care for the management of non-emergent mandibular fractures should consider the cost-effectiveness of delaying treatment while exercising a reasonable length of delay for the comfort of the patient. [ABSTRACT FROM AUTHOR]

Primordial odontogenic tumor (POT) was first described in 2014. It typically presents in the posterior mandible of a child or adolescent as a "dentigerous cyst-like" well-circumscribed radiolucency associated with an unerupted molar. POT consists of an ellipsoidal mass of dental papilla-like myxoid connective tissue entirely enveloped in a delicate membrane of ameloblastic epithelium. It shows features of a developing tooth with a huge dental papilla, and because it is devoid of dental hard tissue, it could be regarded a soft tissue odontoma. The lesion histologically mimics early (primordial) stages of tooth development. This report describes a case of POT and POT-like proliferations in an unrelated complex odontoma. [ABSTRACT FROM AUTHOR]

The aim of this study is to report the efficacy of a lingual pedicle flap for soft tissue pre-prosthetic surgery in implant rehabilitation. While it has been demonstrated that keratinized gingiva is an important factor for implant success, there remains a dearth of case reports concerning the use of a lingual pedicle flap to achieve this desired outcome in such a large reconstructive effort. For this case report, the patient underwent an anterior mandibular resection of an ameloblastoma and subsequent reconstruction, resulting in soft tissue loss. To satisfy the patient's desires, both functionally and esthetically, a bilateral rotated pedicled lingual flap was performed to augment keratinized tissue on the anterior mandibular ridge. An additional vestibuloplasty with two collagen matrices was also performed, and an acrylic splint was then applied to achieve better stabilization. The primary outcome was to evaluate the efficacy of this technique, which, until now, was used only for exposed root coverage. The site demonstrated excellent healing over time, even resulting in an excess of healthy and pink soft tissue, which later had to be corrected with a small gingivectomy. Although the patient reported slight discomfort for a few days after surgery, she was nonetheless pleased both with her ability to function and her appearance. The results of this study show that the bilateral rotated pedicled lingual flap is a viable technique for the correction of soft tissue defects in implant dentistry, providing a good amount of keratinized gingiva. [ABSTRACT FROM AUTHOR]

Research in oral and maxillofacial surgery has focused mainly on principles founded in the biological and chemical sciences, which have provided excellent answers to many questions. However, recent technologic advances have begun to gain prominence in many of the medical sciences, providing clinicians with more effective tools for diagnosis and treatment. The era of modern physics has led to the development of diagnostic techniques that could provide information at a more basic level than many of the current biochemical methods used. The goal of this report is to introduce 2 of these methods and describe how they can be applied to oral and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

In recent years, advances in technology are propelling the field of oral and maxillofacial surgery into new realms.With a relatively thin alveolar mucosa overlying the underlying bone, significant diagnostic and therapeutic advantages are present; however, there remains an enormous gap between advancements in physics, in particular optics, and oral and maxillofacial surgery. Improvements in diagnosis, classification, and treatment of the various bone pathologies are still being sought after as advancements in technology continue to progress. Combining the clinical, histological, and pathological characteristics with these advancements, patients with debilitating pathologies may have more promising treatment options and prognosis. Defects in the facial bones, particularly in the jaws, may be due to a number of reasons: pathology, trauma, infections, congenital deformities, or simply due to atrophy. Bone grafting is commonly employed to correct such defects, and allows new bone formation through tissue regeneration. Growing use of dental implants has focused attention on osseointegration and its process. Osseointegration refers to the actual process of the direct contact between bone and implant, without an intervening soft tissue layer. The theories proposed regarding this process are many, yet a clear, unified stance on the actual process and its mechanisms has not emerged. Further investigation using optical probes could provide that unifying answer. The primary goal of this manuscript is to introduce pioneers in the field of optics to the field of oral and maxillofacial surgery. With a brief introduction into the procedures and techniques, we are hopeful to bridge the ever-widening gap between the clinical science and the basic sciences. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the soft tissue changes in upper lip, vermilion, and alar bases after surgically assisted rapid palatal expansion (SARPE). A new flap design was proposed to obtain more esthetic results. Methods: Sixteen patients who had undergone SARPE for skeletal deformities were evaluated. None of the patients treated had any previous maxillary or nasal surgery, nor did they have any previous trauma to the midface. The soft tissue was clinically evaluated before and after surgery. Lip length and width were traced and measured on the radiograph, both preoperatively and postoperatively, by the same investigator. Preoperative and 6-month postoperative photographs were added. Results: The data suggested that the greater the stability in the soft tissue, particularly in the vermilion width and alar base, the more conservative the maxillary vestibular incision could be. Conclusion: A conservative anterior vestibular incision at 6 months resulted in better esthetics, influencing a smaller loss of vermilion and less widening of alar bases. Otherwise, a traditional incision associated with decreased lip length slightly increased with the modified incision. SARPE can be effectively performed with a more conservative vestibular incision to prevent excessive scarring and shortening of the lip to achieve predictable results. [ABSTRACT FROM AUTHOR]

Alveolar defects are characterized by missing soft and hard tissues. It is often necessary to combine secondary procedures to address the soft-tissue component. The authors describe a technique that uses a split-thickness flap design that is placed over the crest of the remaining ridge and extends in a palatal direction. This allows advancement of the flap with its exposed connective tissue over the bone graft and provides restoration of both bone and keratinized tissue. Seventeen patients with defects involving the anterior maxilla who required grafting procedures were including in this study. All patients had an autogenous bone graft (n = 17) combined with osseointegrated implants (n = 41). A split-thickness flap design was used at the time of bone graft placement (primary) in 9 patients and at the time of implant uncovering (secondary) in 8 patients. There were no cases of flap necrosis or dehiscence with exposure of the bone graft. All patients demonstrated an increase in keratinized tissue involving the peri-implant area. An apical repositioned split-thickness flap provides an increased zone of keratinized tissue with improved esthetics and implant maintenance. This technique can be performed simultaneously with the grafting procedure, thus avoiding extensive undermining of the adjacent soft tissue. [ABSTRACT FROM AUTHOR]

Endosseous implants are the treatment of choice for restoring function and reconstructing most edentulous areas of the maxilla and mandible. In general, alveolar bone defects can be reconstructed by either distraction osteogenesis or autogenous bone grafting. After alveolar reconstruction, endosseous implants are used to support and retain the prosthesis for restoration of form and function. Eighty-two consecutive patients requiring alveolar augmentation prior to implant placement were evaluated. All patients were given treatment options for reconstructing their alveolar defects, which included autogenous bone grafting vs distraction osteogenesis. Sixty-five patients received autogenous grafts (anterior iliac crest: 44; retromolar: 17; tibia: 2; chin: 2), and 17 patients underwent distraction osteogenesis prior to implant placement. A total of 184 implants were placed in the autogenous bone-grafted sites and 56 implants in the distracted bone sites. Implants placed in sites restored with autogenous bone grafts had an implant success rate of 97% (178/184), whereas implants placed in distracted bone sites had a success rate of 98% (55/56). In the autogenous grafted group, 3 implants failed in the posterior mandible, one in the anterior maxilla, one in the anterior mandible, and one in the posterior maxilla. In the distraction group, one implant failed in the posterior mandible. Both techniques are associated with good success rates. There was no statistical difference between implant success in autogenous bone vs distracted bone sites in this group of patients. [ABSTRACT FROM AUTHOR]