Search

Background: Jaw osteoradionecrosis (ORN) is a complication in patients with previous head and neck radiotherapy. Its incidence increases with dental extractions. Hence, this review aimed to evaluate the efficacy of adjunctive treatment modalities undertaken at the time of extraction in previous head and neck radiotherapy patients in preventing ORN. Methods: A systematic review was conducted, where studies with data on ORN incidence after extraction with or without adjunctive interventions were included. Meta‐analyses were conducted to estimate the pooled prevalence of ORN per intervention and the pooled odds ratio for incidence of ORN between interventions. Results: In total, 1520 patients in 29 studies were included. Interventions identified were hyperbaric oxygen (HBO), pentoxifylline‐tocopherol (PENTO), antibiotics (ABX), platelet‐rich fibrin and photobiomodulation. The pooled prevalence of ORN for HBO (4.6%), PENTO (3.4%) and ABX (3.8%) was significantly lower than the Control (17.6%). For studies with direct comparisons between groups, HBO had lower but not significant odds of developing ORN than the Control (OR 0.27) and ABX (OR 0.57). Conclusions: HBO, PENTO and ABX may reduce the incidence of ORN compared to no intervention. Given that all three have similar incidences of ORN, ABX may be the most cost‐effective and accessible adjunctive modality. [ABSTRACT FROM AUTHOR]

Paget disease is an intraepithelial neoplastic proliferation, commonly occurring in the breast and apocrine‐rich areas, often associated with an underlying internal malignancy. Extramammary Paget disease (EMPD) of the oral cavity is exceedingly rare, with only eight reported cases, four of which were associated with an underlying internal malignancy. Here, we report a case of oral EMPD involving the buccal mucosa and gingiva of an 81‐year‐old male with no known underlying internal malignancy. The Paget cells were positive for CK7, CK20, CAM5.2, and androgen receptor, but negative for SOX10 and p63. The immunophenotype, association with internal malignancies, and treatment approaches for oral EMPD are reviewed. [ABSTRACT FROM AUTHOR]

Objectives: Tooth extraction is one of the most frequently performed medical procedures. The indication is based on the combination of clinical and radiological examination and individual patient parameters and should be made with great care. However, determining whether a tooth should be extracted is not always a straightforward decision. Moreover, visual and cognitive pitfalls in the analysis of radiographs may lead to incorrect decisions. Artificial intelligence (AI) could be used as a decision support tool to provide a score of tooth extractability. Material and methods: Using 26,956 single teeth images from 1,184 panoramic radiographs (PANs), we trained a ResNet50 network to classify teeth as either extraction-worthy or preservable. For this purpose, teeth were cropped with different margins from PANs and annotated. The usefulness of the AI-based classification as well that of dentists was evaluated on a test dataset. In addition, the explainability of the best AI model was visualized via a class activation mapping using CAMERAS. Results: The ROC-AUC for the best AI model to discriminate teeth worthy of preservation was 0.901 with 2% margin on dental images. In contrast, the average ROC-AUC for dentists was only 0.797. With a 19.1% tooth extractions prevalence, the AI model's PR-AUC was 0.749, while the dentist evaluation only reached 0.589. Conclusion: AI models outperform dentists/specialists in predicting tooth extraction based solely on X-ray images, while the AI performance improves with increasing contextual information. Clinical relevance: AI could help monitor at-risk teeth and reduce errors in indications for extractions. [ABSTRACT FROM AUTHOR]

Introduction: This paper aimed to determine if the level of a dental student's clinical experience in oral surgery influences the student's oral surgery academic outcomes. Materials and Methods: The oral surgery clinical activity and academic outcomes for all students who completed their dental training in 2017, 2018, 2019 and 2020 from the University of Sydney were analysed for correlation. Results: The clinical activity performed by 313 students was recorded. There was a weak, but statistically significant, Pearson correlation between total dental extractions and academic outcomes (r =.243, p = <.001). The total number of dental extractions performed was the only statistically significant variable on academic outcomes with linear regression analysis (β =.227, p =.005; model R2 =.077). The increase of a student's clinical experience from less than 45 to more than 65 dental extractions raised their oral surgery academic results by an average of 6.4%. There were no academic benefits to earlier clinical experience. Conclusion: An increase in experience with dental extractions resulted in an increase in oral surgery academic outcomes, plateauing at 65 dental extractions. There was no academic advantage to dental student's having earlier clinical experience. [ABSTRACT FROM AUTHOR]

ABSTRACT Permanent canines are essential for the preservation of the stomatognathic system, as they are part of the occlusal and aesthetic function and balance. During the normal development of occlusion, canines follow a long and complex trajectory until their eruption, that is, they are more likely to suffer disturbances during this process. Removal of the permanent canine should only be considered in extreme cases, where the canine itself is not susceptible to orthodontic traction. Orthodontic traction is the most indicated treatment due to the high morphofunctional and aesthetic value of the permanent canine. The aim of this study is to report a clinical case of traction surgery of the superior permanent canine included in the maxilla. A 13-year-old female patient attended the dental clinic at the Nilton Lins University accompanied by her guardian, referred by an orthodontistfor canine traction surgery. during the examIn the clinical analysis, tooth 13 was absent from the dental arch. The patient had a computed tomography scan, where it was possible to verify the actual position of the toothimpacted with the partially erupted crown on the alveolar ridge. After planning, surgery was performed to install an orthodontic button and adapt the ligature with a 0.30 mm wire. After the 10-month follow-up period, the presence of the tooth in arch, completely erupted, was observed, showing effectiveness in the proposed treatment. Therefore, the procedure for bonding the orthodontic device was performed satisfactorily without complications or intercurrences, making it possible to continue the orthodontic treatment. The patient remains under follow-up.

BACKGROUND: Clear cell carcinoma is a low-grade malignant neoplasm, it represents approximately 1% of salivary gland tumors. It is important to know its clinical and histological characteristics to identify clear cell carcinoma and to be able to make a good definitive diagnosis, since it is a disease that can affect the patient’s quality of life and even become fatal when not treated effectively. CLINICAL CASE: A 56-year-old female patient with a history of arterial hypertension, type 2 diabetes mellitus and chronic renal failure, who attended to the clinic presenting a bilobular tumor lesion with a smooth surface, firm and asymptomatic consistency, located in the labio-geniana, causing facial asymmetry. Histopathologically, mantles of clear cells with ample cytoplasm and a central nucleus that were clearly distinguished were observed. An excisional biopsy was performed on the patient to eliminate the lesion. CONCLUSIONS: A large part of tumors with clear cells are commonly manifested in lungs, breasts, and kidneys; renal cell carcinoma is the most frequent to metastasize in oral cavity. Clear cell carcinoma is a frequently misdiagnosed illness due to the similarity of its histological and clinical characteristics with those of other diseases. [ABSTRACT FROM AUTHOR]

ABSTRACT The aim of this study is to report an unusual case of actinomycosis in the maxilla region of an asymptomatic patient. A 21-year-old white man was referred for the analysis of panoramic radiography and cone beam computed tomography, where it was observed the presence of a hypodense lesion on the left side of the maxilla, which extended from the maxillary left central incisor to the region of the maxillary left second premolar. During intraoral examination, a depression was observed in the hard palate mucosa, as well as a fistula in the alveolar mucosa close to maxillary left central incisor, which had pulp vitality confirmed by thermal tests. A fistulography was performed, with periapical radiography, where it was found that the fistulous path did not originate from the tooth mentioned above. An incisional biopsy was performed for diagnostic purposes. However, given the inconclusive microscopic findings, four months later, a new biopsy was performed. The histopathological examination revealed the presence of a colony of microoganisms with filamentous pattern of radiated rosette, surrounded by polymorphonuclear inflammatory cells. Based on the morphological characteristics, the diagnosis of actinomycosis was established. The treatment was based on antibiotic therapy. Six months after treatment of the infection, no signs of recurrence were observed, and the patient remains in follow-up. Actinomycosis in the maxilla is an uncommon infection with a predilection for males between the ages of 20 and 60, whose treatment is antibiotic therapy associated or not with surgical excision.

Objective: To assess the role of radiological predictive markers on orthopantomogram for inferior alveolar nerve (IAN) injury related to the removal of mandibular third molar surgery and the occurrence of post-operative IAN paresthesia. Material and Methods: This prospective observational study was conducted on 60 patients (aged 17-35 years) indicated for extraction and showed one or more of the seven previously known panoramic radiographic risk signs of IAN injury. Variables such as age, sex, tooth angulation, and relationship with the inferior alveolar canal (IAC) were assessed to see their outcome on IAN injury. Data analysis is presented through tables and descriptive methods. Results: Among patients, 26 were male and 34 were female, with a mean age of 26.17 years. Out of seven radiological predictive markers, only six were found in this study, whereas one marker, viz. interruption of white line of the canal was not found. After surgical removal of the lower third molar, only two patients with radiographic signs showing the deflection of roots and darkening of roots continued with sensory deficit 5 weeks post-operatively. Conclusion: The risk of inferior alveolar nerve injury during lower third molar surgery is very low, even in patients with radiological predictive markers.

Objective: To determine the effects of orthognathic surgery on oral function and vocal quality in order to assess the need for speech therapy after surgery. Material and Methods: Thirty-seven patients scheduled for mono-jaw surgery, specifically maxillary (G1:15 patients), mandibular advancement (G2:10 patients) or mandibular set-back (G3:12 patients), were recruited for this prospective cohort study. Evaluation of oral functions, video recordings of speech articulation and audio recordings of voice were obtained before surgery (T0), and at 1 (T1) and 6 months (T2) after surgery. Spectrographic analysis and self-evaluation questionnaire regarding the vocal performance (VAPP) were performed. Both qualitative and quantitative statistical analysis was performed, mainly using generalized linear models for dichotomous data (p

Background/Aim. Gingival biotype can have a significant impact on the outcome of the periodontal therapeutic procedures and the predictability of their aesthetic outcome. There is a strong correlation between the types of biotype and the potential gingival recession after restorative, periodontal, and implant surgical procedures. Therefore, accurate identification of gingival biotypes before initiating these procedures is one of the significant predictive factors for their success. The aim of this study was to evaluate the reliability of accurate gingival biotype determination with the use of the visual method, periodontal, and trans-gingival probing compared to the direct measurement method. Methods. This prospective study involved 33 patients indicated for apical root resection in the intercanine sector of the upper jaw. Gingival biotype identification was performed in all patients using the following techniques: 1) visual method; 2) periodontal probe technique; 3) trans-gingival probing; and 4) direct measurement after flap elevation. Statistical analysis of the obtained data was performed to assess the diagnostic accuracy of the visual method, periodontal probing method, and trans-gingival probing method in relation to the direct measurement method, used as a gold standard, to discriminate the gingival thickness biotype (thin versus thick). Results. The overall accuracy of the tested diagnostic procedures compared to direct gingival biotype measurement was 66.7% for the visual method, 78.8% for periodontal probing, and 97.0% for trans-mucosal probing. Conclusion. The periodontal probing method can be recommended for gingival biotype determination as a routine method since its sensitivity and overall accuracy are higher compared to the visual method. The trans-gingival method, in terms of sensitivity and comprehensive accuracy, almost completely coincides with the direct method, but it is more invasive compared to the periodontal probing method, and it has to be conducted in local anesthesia.

This article delves into the profound impact of various types of disasters, examining some specific contexts. It provides insights into the unique challenges posed by different disasters, ultimately highlighting the invaluable role of maxillofacial surgery in addressing the critical healthcare needs of affected populations. A comprehensive review of the literature was conducted to analyze the role of maxillofacial surgery in disaster management. Relevant studies were examined to gather evidence supporting the criticality of maxillofacial surgeons in disaster response. Continuous training, coordination, and international collaboration among maxillofacial surgeons were reported as key factors in enhancing preparedness and improving post-disaster recovery. Sharing experiences, implementing best practices, and staying updated with advancements in the field seemed crucial for maximizing the impact of maxillofacial surgery in disaster medicine. By prioritizing the inclusion of maxillofacial surgeons in disaster response teams, lives can be saved, functional outcomes can be improved, and hope can be restored in affected communities. Understanding the intricacies and patterns associated with various types of disasters can be crucial details for successful rescue operations., Competing Interests: Declaration of competing interest Authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction Teledentistry has become more prevalent in the provision of oral healthcare since the COVID-19 pandemic. Virtual consultation clinics were introduced at Birmingham Dental Hospital as an adjunct to face-to-face (F2F) consultation clinics. This service evaluation compares virtual and F2F consultation clinics in oral surgery, with particular focus on 'did not attend' (DNA) rates.Methodology Data were collected retrospectively from all clinics conducted within the oral surgery service in April 2021. Information collected included attendance, patient demographics and complications impeding the consultation, including technical difficulties. Patients' postcodes were used to generate deprivation deciles. All data were handled sensitively in line with the Caldicott principles.Results Binomial regression analysis showed that DNA rates were more likely to occur in virtual consultation clinics compared to F2F clinics (p <0.00). DNAs were less likely to occur at review appointments (p <0.00). Lower deprivation decile ratings were associated with higher rates of DNAs, independent of clinic type (eg review or new patient) or method of consultation (virtual versus F2F) (p <0.01).Conclusion While virtual clinics are advantageous for some patient demographics and have shown promising results in other studies, it is important that the delivery of these virtual services does not continue to marginalise vulnerable patient groups and enhance pre-existing oral health inequalities., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

The temporomandibular joint (TMJ) is the critical functional unit in the human stomatognathic system. Damage of the TMJ causes orofacial dysfunction and secondary jaw deformities, leading to seriously decreased quality of life in patients. The TMJ prosthetic replacement is an important treatment method for severe joint destruction because of its remarkable advantages compared with other methods. In recent years, this technique has gradually attracted wide attention in China, but it has not been popularized on a large scale in our country because of several limitations. Thus, in this study, the clinical experience of patients with TMJ prosthetic replacement in clinical units was summarized, and the treatment principles, treatment processes, and technical advantages were systematically discussed, aiming to promote the popularization and application of TMJ prosthetic replacement in China.

This study aimed to determine the accuracy of large language models (LLMs) in answering oral and maxillofacial surgery (OMS) multiple choice questions. A total of 259 questions from the university's question bank were answered by the LLMs (GPT-3.5, GPT-4, Llama 2, Gemini, and Copilot). The scores per category as well as the total score out of 259 were recorded and evaluated, with the passing score set at 50%. The mean overall score amongst all LLMs was 62.5%. GPT-4 performed the best (76.8%, 95% confidence interval (CI) 71.4-82.2%), followed by Copilot (72.6%, 95% CI 67.2-78.0%), GPT-3.5 (62.2%, 95% CI 56.4-68.0%), Gemini (58.7%, 95% CI 52.9-64.5%), and Llama 2 (42.5%, 95% CI 37.1-48.6%). There was a statistically significant difference between the scores of the five LLMs overall (χ 2 = 79.9, df = 4, P < 0.001) and within all categories except 'basic sciences' (P = 0.129), 'dentoalveolar and implant surgery' (P = 0.052), and 'oral medicine/pathology/radiology' (P = 0.801). The LLMs performed best in 'basic sciences' (68.9%) and poorest in 'pharmacology' (45.9%). The LLMs can be used as adjuncts in teaching, but should not be used for clinical decision-making until the models are further developed and validated., Competing Interests: Competing interests None., (Copyright © 2024 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study is to determine if supervised machine learning algorithms can accurately predict voided computerized physician order entry in oral and maxillofacial surgery inpatients., Methods: Data from Electronic Medical Record included patient demographics, comorbidities, procedures, vital signs, laboratory values, and medication orders were retrospectively collected. Predictor variables included patient demographics, comorbidities, procedures, vital signs, and laboratory values. Outcome of interest is if a medication order was voided or not. Data was cleaned and processed using Microsoft Excel and Python v3.12. Gradient Boosted Decision Trees, Random Forest, K-Nearest Neighbor, and Naïve Bayes were trained, validated, and tested for accuracy of the prediction of voided medication orders., Results: 37,493 medication orders from 1,204 patient admissions over 5 years were used for this study. 3,892 (10.4%) medication orders were voided. Gradient Boosted Decision Trees, Random Forest, K-Nearest Neighbor, and Naïve Bayes had an Area Under the Receiver Operating Curve of 0.802 with 95% CI [0.787, 0.825], 0.746 with 95% CI [0.722, 0.765], 0.685 with 95% CI [0.667, 0.699], and 0.505 with 95% CI [0.489, 0.539], respectively. Area Under the Precision Recall Curve was 0.684 with 95% CI [0.679, 0.702], 0.647 with 95% CI [0.638, 0.664], 0.429 with 95% CI [0.417, 0.434], and 0.551 with 95% CI [0.551, 0.552], respectively., Conclusion: Gradient Boosted Decision Trees was the best performing model of the supervised machine learning algorithms with satisfactory outcomes in the test cohort for predicting voided Computerized Physician Order Entry in Oral and Maxillofacial Surgery inpatients., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

ABSTRACT The diagnosis and treatment of supernumerary teeth pose a challenge for dental clinicians and pediatric dentists. These teeth are asymptomatic and may cause the delayed eruption of the permanent dentition, altered bone growth and ectopic positioning. This paper reports a case of the surgical removal of supernumerary teeth in the anterior region of the maxilla of a child under general anesthesia in a hospital setting. A six-year-old female patient visited a private dental office in the city of Garanhuns, Brazil, accompanied by her mother, who reported a tooth with a “strange shape” in the anterior region as the main complaint and also reported that her daughter’s first dental experience was negative. The clinical examination and imaging tests were performed under general anesthesia to confirm the diagnosis. In view of the patient’s dental and behavioral history, surgical treatment was performed in a hospital setting and assisted by a multidisciplinary team. Care in the hospital setting was found to be feasible, providing greater comfort for uncooperative patients.

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To compare intra- and post-operative consequences associated with Z-frenuloplasty and laser therapy for both upper labial and lingual frenulectomies. Material and Methods: Clinical data of 120 consecutive patients with a mean age of 11 years and 2 months (age range from 9 years and 1 month to 14 years and 3 months) with hypertrophic labial and lingual frenula were assembled. Of the 70 labial frenula, 35 were removed through Z-frenuloplasty (Group 1) and 35 with laser (Group 2); of 50 lingual frenula, instead, 25 were extracted through Z-frenuloplasty (Group 1A) and 25 with laser (Group 2A). The cutting device was Laser Diode Handy 10 in continuous mode. Finally, the time of the surgery, pain and swelling were measured 24-48 hours after the removal. VAS scale was used. Results: The time of the surgery, VAS score after the removal and the swelling were lesser in Group 2 and 2A. Conclusion: Both Z-frenuloplasty and Laser therapy are valid instruments to remove frenula. Moreover, laser offers more advantages like less use of anesthesia, no bleeding in the operating phase, no need for suturing, a faster tissue healing and minor limitations in speech and nutrition.

Background and aim: Surgical navigation development and utilization in oral and maxilla-facial surgery quickly progressed in current years, and therapeutic indicators would be presented. The present systematic review and meta-analysis aimed at assessment of therapeutic indications of surgical navigation in maxillofacial surgery. Materials and methods: MEDLINE, PubMed, Cochrane Library, Embase, ISI, google scholar has been utilized as the electronic databases for performing systematic literature until 2010 to 2019. Therefore, Endnote X9, which is one of the software programs in the market, has been utilized to manage the titles electronically. Searches were performed with keywords, “Orthognathic surgery”, “reconstruction surgery”,” maxillofacial surgery”,” Computer Assisted OR Computer methods”, “navigation” “Maxillofacial Injuries”, “Osteotomy, maxillary”. The current systematic review has been conducted about the primary issue of the PRISMA Statement–Preferred Reporting Items for Systematic Reviews and Meta-analysis. Results: Heterogeneity found (I2 = 80.3%; P=0.000) and meta-analysis indicated a risk ratio of 0.187 (95% CI: 0.16– 0.21) (figure2). Surgical navigation could be considered a useful surgical tool. In orthognathic surgery, Heterogeneity found (I2 = 72.3%; P=0.006) and meta-analysis suggested a risk ratio of 0.10 (95% CI: 0.08–0.14). Finally, SN demonstrated to be a great tool to treat the diseases. Conclusion: This study indicated SN could be a beneficial device for each intended indication.

Introduction: This study analyzed oncologic patient management from initial tumor diagnosis to tumor follow-up in oral and maxillofacial surgery (OMFS) in Germany., Material and Methods: A dynamic online questionnaire with a total of 44 questions was used to generate general and specific data regarding oncologic patient management with head and neck malignancies, supportive care, and (pre-) rehabilitation from initial tumor diagnosis to tumor follow-up and head and neck cancer center (HNCC) structures in OMFS in Germany. The questionnaire was sent to 81 OMFS departments affiliated with the German-Austrian-Swiss Working Group for Tumors of the Jaw and Facial Region (DÖSAK) and the German Association of Oral and Maxillofacial Surgery (DGMKG). Data analysis was conducted descriptively., Results: Forty-eight OMFS departments participated (response rate 59.26%), of which 36/48 (75%) were certified HNCC. 28/34 (82.4%) reported subjective improvements in oncologic care, most often interdisciplinary collaboration (21/33, 63.64%) and clinic structure changes (21/34, 61.76%). Nearly all OMFS departments present patients in multidisciplinary tumor boards (45/46, 97.83%) and aim for osseous reconstruction post-tumor resection (43/44, 97.73%). Significant discrepancies regarding the frequency of masticatory-functional dental rehabilitation following osseous reconstruction were observed. Before oncologic therapy, patients are offered various supportive services, mostly psychotherapy and psycho-oncological support (24/26, 92.31%). Post-therapy, speech therapy (43/43, 100%), physiotherapy (40/43, 93.02%), lymphatic drainage, and follow-up rehabilitation (39/43, 90.7%, respectively) are most often offered. 17/43 (39.53%) have oncological nursing staff. 36/40 (90%) manage patients and side effects during adjuvant therapy, while 5/41 (12.2%) provide proprietary palliative care. 36/41 (87.8%) offer counseling to patients and families., Conclusion: Oncologic patient care in OMFS is highly standardized and potentially attributable to many certified HNCCs in Germany. Certain treatment aspects are handled differently, possibly due to institution-specific reasons., Clinical Relevance: The high homogeneity in treatment protocols reflects the widespread high and comparable treatment quality of head and neck malignancies in OMFS in Germany., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose of Review: The objective of this article is to understand the uptake in use of Telehealth services during the COVID-19 pandemic as a way to provide compelling impetus for further research and promotion of Telehealth in general. A data review of Outpatient Department data from 2020 to 2023, as compiled by the Surgical Outcomes improvement Unit., Recent Findings: Telehealth was widely adopted during the COVID-19 pandemic for clinicians to provide healthcare to patients whilst adhering to strict lockdown guidelines aimed at limiting exposure and spread of the respiratory virus. There has been minimal analysis, however, of the ethical and legal implications of telemedicine. Whilst it seems that access to care is improved via telehealth, there are subtle, inherent barriers intrinsic to it., Summary: There was a significant increase in the use of audio and audiovisual aids in the delivery of Oral and Maxillofacial Outpatient care during the COVID-19 period. Further analysis and improvements need to be made to the system before it can be considered as sufficient and adequate. Where there is rapid adoption of Telehealth in the delivery of Oral and Maxillofacial Surgery Services, there must be concurrent rigorous review and update of systems in order to address the key areas of patient safety and accuracy of treatment., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: This study aims to evaluate the correctness of the generated answers by Google Bard, GPT-3.5, GPT-4, Claude-Instant, and Bing chatbots to decision-making clinical questions in the oral and maxillofacial surgery (OMFS) area., Study Design: A group of 3 board-certified oral and maxillofacial surgeons designed a questionnaire with 50 case-based questions in multiple-choice and open-ended formats. Answers of chatbots to multiple-choice questions were examined against the chosen option by 3 referees. The chatbots' answers to the open-ended questions were evaluated based on the modified global quality scale. A P-value under .05 was considered significant., Results: Bard, GPT-3.5, GPT-4, Claude-Instant, and Bing answered 34%, 36%, 38%, 38%, and 26% of the questions correctly, respectively. In open-ended questions, GPT-4 scored the most answers evaluated as grades "4" or "5," and Bing scored the most answers evaluated as grades "1" or "2." There were no statistically significant differences between the 5 chatbots in responding to the open-ended (P = .275) and multiple-choice (P = .699) questions., Conclusion: Considering the major inaccuracies in the responses of chatbots, despite their relatively good performance in answering open-ended questions, this technology yet cannot be trusted as a consultant for clinicians in decision-making situations., Competing Interests: Declaration of interest The authors have no conflict to disclose regarding this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: Hospitals in many European countries have implemented Additive Manufacturing (AM) technology for multiple Oral and Maxillofacial Surgery (OMFS) applications. Although the technology is widely implemented, surgeons also play a crucial role in whether a hospital will adopt the technology for surgical procedures. The study has two objectives: (1) to investigate how hospital type (university or non-university hospital) influences surgeons' views on AM, and (2) to explore how previous experience with AM (AM experience or not) influences surgeons' views on AM., Materials and Methods: An online questionnaire to capture surgeons' views was designed, consisting of 11 Likert scale questions formulated according to the Consolidated Framework for Implementation Research (CFIR). The questionnaire was sent to OMF surgeons through the channel provided by the Association of Oral and Maxillofacial Surgery in Sweden. Data were analyzed using the Mann-Whitney U test to identify significant differences among OMF surgeons in terms of organizational form (i.e., university hospital or non-university hospital) and experience of AM (i.e., AM experience or no-experience)., Results: In total, 31 OMF surgeons responded to the survey. Views of surgeons from universities and non-universities, as well as between surgeons with experience and no-experience, did not show significant differences in the 11 questions captured across five CFIR domains. However, the "individual characteristics" domain in CFIR, consisting of three questions, did show significant differences between surgeons' experience with AM and no-experience (P-values: P = 0.01, P = 0.01, and P = 0.04)., Conclusions: Surgeons, whether affiliated with university hospitals or non-university hospitals and regardless of their prior experience with AM, generally exhibit a favorable attitude towards AM. However, there were significant differences in terms of individual characteristics between those who had prior experience with AM and those who did not., Clinical Relevance: This investigation facilitates the implementation of AM in OMFS by reporting on the views of OMF surgeons on AM., (© 2024. The Author(s).)

Objective: To compare the agreement of clinical and radiographic diagnosis with the histopathological diagnosis in fibro-osseous lesions of the jaws. Material and Methods: An analytical and exploratory study was made based on systematic collected data, carried out in the laboratory of surgical pathology of a public Dental School. There were evaluated cases of fibrous dysplasia (FD), cemento-osseous dysplasia (COD) and ossifyng fibroma (OF), diagnosed by clinical, radiographic (panoramic and periapical radiography), and histopathological analysis, in a period of 12 years (from March 2001 to June 2013). Descriptive and inferential statistics (Fisher's exact test) were obtained. Results: Ninety-six cases of FOLs were evaluated. The radiographic aspects of the FOLs studied did not differ significantly (p=0.09). Radiolucent lesions were the least frequent, corresponding to approximately 13.5% of radiographic findings. Mixed lesions and radiopaques were more present, how they were COD and FD, respectively. The more aggressive variation of OF (Juvenile Ossifying Fibroma - JOF) was less frequent among the pathologies evaluated. In approximately 61.46% of the cases clinical and radiographic diagnosis were confirmed by histopathological diagnosis of FOLs. The highest agreement and the highest disagreement were observed in COD cases (40.7% and 62.2%, respectively). Conclusion: FOLs of the maxillaries represent a group of lesions in which the establishment of the clinical and radiographic diagnosis supported by the histopathological confirmation is critical and challenging.

Objective: To evaluate the effect of pain and swelling related to third molars on patients' quality of life prior to third molar surgery. Material and Methods: The effects on quality of life with reference to oral health of 246 healthy patients seeking treatment of third molars were analyzed using the 14-item Oral Health Impact Profile (OHIP) questionnaire before surgery. The patients' sociodemographic characteristics, medical and dental history, reasons for third molar removal were recorded. Adverse effects of pain and swelling on oral health-related quality of life were recorded. Results: The mean age of the patients included in the study was 23.15 years, with maximum male patients and the mean OHIP-14 score of 8.01 ± 7.51. About 36.97% of patients reported that their chief complaint was pain/swelling due to third molar infection, and 27.9% of subjects reported one or more of the 14 OHIP items. The odds of reporting for age with ≥25 years was approximately 2 times greater than age with ≤25 years (OR=1.56, 95% CI: 1.01-2.57) and tooth loss due to traumatic history (OR=3.14, 95% CI: 2.12-6.54). Conclusion: Adverse influences on quality of life were seen in a significant number of patients seeking third molar removal. The probabilities increased by 3-fold for patients who had experienced pain or swelling than asymptomatic individuals.

Objective: To compare and assess the primary and secondary closure techniques following extraction of impacted third molars for post-operative complications. Material and Methods: In total, 30 patients ranging between 18-30 years of age and of either sex who had bilaterally impacted mandibular third molars were randomly selected. Split mouth study method was used so that the participants served as their own control. Group 1 consisted of primary closure of left mandibular impacted third molars and Group 2 consisted of secondary closure of right mandibular impacted third molars. Basement evaluations were recorded for each patient along with subjective and objective evaluations for postoperative 7 days. Data analysis was carried out by SPSS 17.0 software using Mann-Whitney U test, Wilcoxon matched-pairs test and t-test. A p-value ≤ 0.05 was assigned as statistically significant. Results: When compared to group 1, group 2 revealed statistically less pain and swelling following the secondary closure of wound from day 1 to 7. There was a significant improvement in mouth opening in Group 2 at day 1 (p=0.0005) and at day 7 (p=0.00001). Conclusion: Secondary wound closure after disimpaction of mandibular third molar results in better postoperative recovery than primary closure.

Aim: The aim of the present study was to evaluate the microbial contamination in internal and external walls of cone morse implant walls. Methods: Eleven patients with edentulous mandibular posterior area were selected to received dental implants, divided into groups: submerged (S), non-submerged (NS), and immediately loaded (IL). Microbiological evaluations (microorganisms’ number, aerobic and anaerobic colony forming units (CFU) number and microorganisms’ qualification) were divided into internal and external collection of the implant walls, at different stages: T0 (surgical procedure), T2 (suture removal), T4 (reopening S group), T6 (suture removal S group), and T8 (abutment placement in S and NS). All data were submitted to statistical analyses, with confidence level of 0.05. Results: There was difference in number of microorganisms observed over time within the same group (p < 0.05). A difference was observed in CFU when evaluated within the same group over time (p < 0.05), except for the IL group. In internal collection, a predominance of non-formation of microorganisms was observed at T0 in all groups, while formation of Gram-positive Diplococci and Gram-positive Bacilli was observed at T8 (p>0.05). In external collection, an increase in number of microorganisms was observed at T0. Conclusion: There was no difference in microbial contamination among the evaluated groups. The microorganism’s colonization changed over time.

Abstract A randomized, blind and prospective clinical trial was conducted to compare two clinical rehabilitation protocols in patients submitted to orthognathic surgery, during the first 60 days after surgery. Pain, edema, mandibular movement, masticatory efficiency and quality of life were evaluated. Nineteen (19) patients were separated into control and experimental groups. The control group consisted of 10 patients followed by oral and maxillofacial surgeons and submitted to a rehabilitation protocol that involved active and passive mouth opening exercises. The experimental group had 9 patients and followed the surgeons’ protocol, in addition to an Early Recovery After Surgery (ERAS) protocol performed by speech therapists, and involving specific motricity exercises and lymphatic drainage. The Student’s t-test was applied to compare the results, and the Fisher’s exact test of independence, to analyze the quality of life and the masticatory efficiency variables. The statistical significance was set at 5% (p < 0.05) for all the tests. The results showed that the ERAS protocol made a positive difference in pain perception in the first 14 days. However, it did not improve the other variables. Although many variables showed no significant difference, it was concluded that the surgeons can delegate patient rehabilitation to qualified professionals, so that they can optimize their postoperative clinical time.

Abstract Third molar removal surgery usually comes accompanied by postoperative discomfort, which could be influenced by the surgical approach chosen. This scoping systematic review aimed at compiling the available evidence focused on the influence of flap design, including envelope flap (EF), triangular flap (TF), and modified triangular flap (MTF), on postoperative pain, swelling, and trismus, as primary outcome measures, and any result mentioning healing promotion or delay, as secondary outcome measure, after mandibular third molar extraction surgery. An electronic search, complemented by a manual search, of articles published from 1999 to 2020 was conducted in the Medline (PubMed), EMBASE and Web of Science databases including human randomized controlled trials, prospective, and retrospective studies with at least 15 patients. The risk of bias of the included studies was assessed either with the Cochrane’s Risk of Bias tool or with the Newcastle-Ottawa scale. Every step of the review was performed independently and in duplicate. The initial electronic search recovered 2102 articles. After applying the inclusion criteria, 12 articles were included. For patient’s perceived postoperative pain, TF and MTF frequently reported better results than EF. For swelling, the literature is divided, despite a trend favoring EF. For trismus, data showed that its occurrence is mostly associated with the duration of the surgery rather than with the chosen flap. For healing, the limited data is inconclusive. Finally, randomized studies showed a high risk of bias, whereas nonrandomized studies were mostly of good quality and low risk of bias. Although there was no clear consensus regarding the influence of different flap designs for third mandibular molar extraction on postoperative clinical morbidities; the surgeon’s experience, estimated surgical difficulty, molar position and orientation, and surg ery duration should be considered when choosing among the different flap designs.

Purpose: While the numbers of oral maxillofacial surgery (OMFS) residents increased over time, women and residents from underrepresented minority backgrounds are still underrepresented. The objectives were to assess dental students' OMFS‐related personal and educational experiences and attitudes and explore which factors correlate with their interest in future OMFS careers. Methods: Data were collected from 493 dental students in 1 dental school and 206 students from 15 other US and Canadian dental schools. Results: The students in the national sample were more likely to have experienced an OMFS procedure themselves (64.6% vs. 50.7%; P = 0.001), have shadowed an OMFS in an operating room (23.2% vs. 14.9%; P = 0.009) prior to coming to dental school and to be much/very much interested in an OMFS career (36.4% vs. 12%; P < 0.001) than the students at the home school. While the majority of both groups rated their experiences with rotations in the OMFS department in the dental school (68% vs. 62.5%) and in the hospital (80.3% vs. 85.7%) as very interesting, the students in the national sample were more likely to agree/strongly agree that they were satisfied with their OMFS experiences (68.1% vs. 36.3%; P < 0.001) and had learned a lot from the OMFS faculty (57.9% vs. 30.8%) than the students in the home school. For both groups, the degree of interest in an OMFS career correlated with having had more personal OMFS experiences (home: r = 0.28; P < 0.001/other: r = 0.39; P < 0.001), more interesting OMFS experiences in the dental school (r = 0.23; P < 0.05/r = 0.40; P < 0.001) and the hospital (0.33; P < 0.05/r = 0.50; P < 0.001) and more positive attitudes toward OMFS faculty (r = 0.26; P < 0.001/r = 0.37; P < 0.001). Conclusions: Positive personal and educational OMFS experiences and positive attitudes toward OMFS faculty were associated with an interest in OMFS careers. These findings provide a basis for developing educational interventions aimed at increasing the percentage of women and residents from URM backgrounds in OMFS programs. [ABSTRACT FROM AUTHOR]

A randomized, blind and prospective clinical trial was conducted to compare two clinical rehabilitation protocols in patients submitted to orthognathic surgery, during the first 60 days after surgery. Pain, edema, mandibular movement, masticatory efficiency and quality of life were evaluated. Nineteen (19) patients were separated into control and experimental groups. The control group consisted of 10 patients followed by oral and maxillofacial surgeons and submitted to a rehabilitation protocol that involved active and passive mouth opening exercises. The experimental group had 9 patients and followed the surgeons' protocol, in addition to an Early Recovery After Surgery (ERAS) protocol performed by speech therapists, and involving specific motricity exercises and lymphatic drainage. The Student's t-test was applied to compare the results, and the Fisher's exact test of independence, to analyze the quality of life and the masticatory efficiency variables. The statistical significance was set at 5% (p < 0.05) for all the tests. The results showed that the ERAS protocol made a positive difference in pain perception in the first 14 days. However, it did not improve the other variables. Although many variables showed no significant difference, it was concluded that the surgeons can delegate patient rehabilitation to qualified professionals, so that they can optimize their postoperative clinical time. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate patient perception of surgical discomfort in third molar surgery and the association with clinical variables and polymorphisms associated with the FKBP5, SLC6A4, and COMT genes. This cross-sectional observational study was carried out on 196 participants aged between 18 and 64 years at the Federal University of Paraná in 11 months. The intensity of surgical discomfort was assessed using the QCirDental questionnaire. Data on surgical and individual procedures were also cataloged. The oral health related quality of life was assessed by the Oral Health Impact Profile questionnaire (OHIP-14). The DNA sample was obtained from cells of the oral mucosa. Five markers of the FKBP5, SLC6A4, and COMT genes were genotyped. The data were submitted to statistical analysis with a significance level of 5%. Women reported greater intensity of discomfort associated with third molar surgery compared to men (p = 0.001). In the recessive model, the AA genotype of the rs3800373 marker was associated with greater surgical discomfort (p = 0.026). Therefore, women and individuals of the AA genotype for the rs3800373 marker in the FKBP5 gene reported greater surgical discomfort associated with third molar surgery. [ABSTRACT FROM AUTHOR]

The present paper provides a historical context for chaos theory, originating in the 1960s with Edward Norton Lorenz's efforts to predict weather patterns. It introduces chaos theory, fractal geometry, nonlinear dynamics, and the butterfly effect, highlighting their exploration of complex systems. The authors aim to bridge the gap between chaos theory and oral and maxillofacial surgery (OMFS) through a literature review, exploring its applications and emphasizing the prevention of minor deviations in OMFS to avoid significant consequences. A comprehensive literature review was conducted on PubMed, Web of Science, and Google Scholar databases. The selection process adhered to the PRISMA-ScR guidelines and Leiden Manifesto principles. Articles focusing on chaos theory principles in health sciences, published in the last two decades, were included. The review encompassed 37 articles after screening 386 works. It revealed applications in outcome variation, surgical planning, simulations, decision-making, and emerging technologies. Potential applications include predicting infections, malignancies, dental fractures, and improving decision-making through disease prediction systems. Emerging technologies, despite criticisms, indicate advancements in AI integration, contributing to enhanced diagnostic accuracy and personalized treatment strategies. Chaos theory, a distinct scientific framework, holds potential to revolutionize OMFS. Its integration with advanced techniques promises personalized, less traumatic surgeries and improved patient care. The interdisciplinary synergy of chaos theory and emerging technologies presents a future in which OMFS practices become more efficient, less traumatic, and achieve a level of precision never seen before., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest to disclose., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Purpose: The surge in digitalization and artificial intelligence has led to the wide application of robots in various fields, but their application in dentistry started relatively late. This scoping review aimed to comprehensively explore and map the current status of the clinical application of robots in dentistry., Study Selection: An iterative approach was used to gather as much evidence as possible from four online databases, including PubMed, the China National Knowledge Infrastructure, the Japan Science and Technology Information Aggregator, Electronic, and the Institute of Electrical and Electronics Engineers, from January 1980 to December 2022., Results: A total of 113 eligible articles were selected from the search results, and it was found that most of the robots were developed and applied in the United States (n = 56; 50%). Robots were clinically applied in oral and maxillofacial surgery, oral implantology, prosthodontics, orthodontics, endodontics, and oral medicine. The development of robots in oral and maxillofacial surgery and oral implantology is relatively fast and comprehensive. About 51% (n = 58) of the systems had reached clinical application, while 49% (n = 55) were at the pre-clinical stage. Most of these are hard robots (90%; n = 103), and their invention and development were mainly focused on university research groups with long research periods and diverse components., Conclusions: There are still limitations and gaps between research and application in dental robots. While robotics is threatening to replace clinical decision-making, combining it with dentistry to gain maximum benefit remains a challenge for the future.