Comminuted mandibular fractures (CMFs) associated with panfacial trauma are challenging because restoration of skeletal continuity does not necessarily re-establish functional occlusion or facial form. We report a staged multidisciplinary rehabilitation in a 34-year-old man who sustained severe craniofacial injuries in an industrial explosion, including a CMF, multiple midfacial fractures, and extensive anterior maxillary destruction. Initial treatment consisted of hemorrhage control, top-down open reduction and internal fixation, and simultaneous orbital floor reconstruction. Because severe mandibular comminution and fragment interference prevented safe restoration of the mandibular arch and occlusion, stable skeletal fixation was prioritized and the potential need for delayed correction was recognized intraoperatively. After osseous union, persistent mandibular arch discrepancy and malocclusion were reassessed, and definitive corrective surgery was planned using right sagittal split ramus osteotomy and anterior mandibular vertical osteotomy. Subsequent rehabilitation included rhinoplasty, anterior maxillary reconstruction with an autogenous mandibular body block bone graft, implant placement, and prosthetic treatment. The staged approach achieved clinically acceptable occlusion, satisfactory masticatory function, and improved facial symmetry. This case suggests that delayed corrective surgery after skeletal healing can provide a practical pathway when immediate occlusal restoration is unsafe during primary fixation.
Temporomandibular joint (TMJ) internal derangement frequently leads to orofacial pain, joint dysfunction, and limited mandibular movement. Conservative treatment is first, but arthrocentesis may help refractory cases. This case report describes one year of conservative therapy and arthrocentesis with intra-articular hyaluronic acid (HA) and 12.5% dextrose. A 21-year-old woman had right-sided preauricular pain, joint clicking, and intermittent locking for one year. Clinical and magnetic resonance imaging findings confirmed anterior disc displacement with reduction and intermittent locking with osteoarthritis of the right TMJ. After 8 months of physiotherapy, pharmacotherapy, occlusal splint, and diet modification, maximum mouth opening improved from 13 to 36 mm, but symptoms persisted. Two arthrocentesis sessions with prolotherapy were performed: one with HA alone, followed by HA and 12.5% dextrose. At 4-month follow-up, function was restored, symptoms resolved, and joint clicking disappeared. Arthrocentesis with intra-articular HA and 12.5% dextrose relieved pain, improved mouth opening, and restored function in refractory TMJ internal derangement. This case highlights the value of a staged, minimally invasive strategy, though larger controlled studies are needed to validate its efficacy and to standardize treatment protocols. A stepwise approach, from conservative therapy to arthrocentesis with intra-articular HA and 12.5% dextrose, can effectively manage TMJ internal derangement.
Hardware exposure after mandibular reconstruction poses significant management challenges. Incomplete removal of reconstruction plates and screws may compromise stability, particularly when osseointegration prevents screw retrieval. A patient who underwent mandibular resection for odontogenic keratocyst with non-vascularized fibular reconstruction developed exposure of the fixation plate. During revision surgery, exposed screws were removed, but several screws remained firmly integrated within the reconstructed bone and could not be retrieved. To prevent destabilization, the plate was retained with the remaining screws, while polymethyl methacrylate (PMMA) bone cement was adapted in the vacant screw sites to restore stability. Postoperative healing was uneventful, and the reconstruction plate remained stable. This report highlights the novel use of PMMA bone cement as a salvage method for plate stabilization in maxillofacial reconstruction, adapting a material widely established in orthopedic surgery for craniomaxil-lofacial application.
Objectives:This study aimed to evaluate changes in keratinized mucosa width (KMW) following an apically positioned flap (APF) during implant placement and to identify factors associated with KMW gain (KMWG). Patients and Methods:This retrospective single-center study included patients who underwent APF during implant placement. KMW was measured at baseline (BKMW), immediately after surgery (T1), and at 6 months after surgery (T2). Clinicodemographic and surgical factors were recorded, and univariable and multivariable generalized estimating equation (GEE) analyses were performed to identify factors associated with KMWG. Results:This study included 78 patients with 207 implants. The mean BKMW was 1.09±1.54 mm, the mean T1 was 4.59±2.29 mm, the mean T2 was 2.71±1.70 mm, and the mean KMWG was 1.62±1.46 mm. In univariable GEE analysis, hypertension, periodontal phenotype, BKMW, and the amount of flap displacement (AFD) were associated with KMWG (P<0.05). In multivariable GEE analysis, hypertension (estimate=0.607, P=0.012), periodontal phenotype (estimate=0.603 for thick phenotype, P=0.014), and AFD (estimate=0.221, P=0.018) were positively associated with KMWG, whereas BKMW was negatively associated with KMWG (estimate=-0.349, P<0.001). Conclusion:An increase in peri-implant KMW was observed after APF performed during implant placement. Clinicodemographic and surgical factors were associated with KMWG, suggesting that preoperative assessment may improve the predictability of peri-implant soft tissue augmentation and support surgical planning. Clinically meaningful KMWG could be achieved even with relatively limited flap extension when APF was performed using a standardized surgical approach.
Gingival black triangles, resulting from loss of the interdental papilla (IDP), adversely affect esthetics, phonetics, and periodontal health, and injectable platelet-rich fibrin (i-PRF) a growth factor-rich platelet concentrate, has emerged as a promising minimally invasive regenerative approach for papilla reconstruction. This study evaluates the clinical effectiveness of i-PRF in the management of gingival black triangles and IDP deficiencies. A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420261321819). Electronic searches of studies including human studies were performed for studies published between 2020 and 2025. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials and the JBI checklists for case reports and series. Fourteen studies met the inclusion criteria, including randomized controlled trials (RCTs), pilot studies, case series, and case reports. Most studies reported improvements in papillary height, papilla presence index, and reduction in black triangle dimensions following i-PRF therapy. Clinical outcomes were generally comparable to hyaluronic acid injections and connective tissue graft procedures, with reduced invasiveness and postoperative discomfort. i-PRF appears to be a promising minimally invasive option for managing gingival black triangles; however, larger RCTs with longer follow-up are needed to confirm long-term effectiveness.
The presence of a mandibular osseous defect significantly complicates revision orthognathic surgery by increasing the risk of unfavorable fractures and inferior alveolar nerve (IAN) injury. In such instances, the high oblique sagittal split osteotomy (HOSSO) serves as a strategic alternative to the conventional bilateral sagittal split osteotomy. We report a case involving a 31-year-old Chinese female presenting with skeletal relapse twelve years after the primary bimaxillary surgery. Preoperative imaging identified a 1.5×1.5 cm circular osseous defect in the right mandibular body, communicating with the IAN canal. To bypass the defect site, a unilateral HOSSO was performed on the right mandible, while a standard sagittal split ramus osteotomy was utilized on the left. Postoperative clinical and radiographic evaluations at six months demonstrated satisfactory facial profile improvement and stable occlusion, with absence of neurosensory deficits or unfavorable fractures. This case underscores the importance of thorough preoperative radiographic assessment and suggests that HOSSO is a safe, effective technique for bypassing localized mandibular body pathology, particularly during revision procedures.
Platelet-rich fibrin (PRF), a second-generation platelet concentrate, has emerged as a promising autologous biomaterial in regenerative medicine. Unlike platelet-rich plasma (PRP), PRF is prepared without anticoagulants or biochemical additives, allowing natural platelet activation and fibrin polymerization. This process generates a three-dimensional fibrin matrix containing concentrated platelets, leukocytes, cytokines, and growth factors that collectively support tissue regeneration. Owing to these regenerative properties, PRF has been increasingly applied in oral and maxillofacial surgery. Despite its widespread clinical use, the precise biological mechanisms underlying PRF-mediated bone regeneration remain incompletely understood. PRF functions not only as a reservoir for growth factors, but also as a dynamic immunomodulatory scaffold that regulates inflammation, angiogenesis, cellular migration, and osteogenic differentiation. Recent evidence further suggests that leukocytes, fibrin architecture, cytokine networks, and osteoimmunological interactions within PRF play critical roles in coordinating tissue regeneration. This scoping review aims to summarize the current understanding of the biological mechanisms and regenerative potential of PRF in bone healing and oral and maxillofacial reconstruction. Particular emphasis is placed on the interplay between growth factor release, fibrin matrix structure, immune modulation, and cellular signaling pathways involved in osteogenesis. Furthermore, recent advances, limitations, and future perspectives regarding PRF optimization and clinical applications are discussed.
Dental extractions are among the most frequently performed procedures in dentistry. While anatomical, behavioral, and access-related factors are known to influence extraction outcomes, the role of racial and ethnic characteristics in shaping extraction techniques, preferences, and disparities has not been synthesized. This scoping review aimed to explore and map the existing evidence on how racial, ethnic factors influence dental tooth extraction. A search was conducted across PubMed, Scopus, Google Scholar using a combination of MeSH terms and keywords related to dental extraction, race, ethnicity, anatomy, and sociocultural behavior. The review followed PRISMA-ScR guidelines. A total of 15 studies were included, encompassing anthropological, clinical, forensic, public health perspectives. The review identified key racial anatomical traits (e.g., root morphology, dental arch form, bone density) that affect extraction difficulty, particularly among Caucasoid, Mongoloid, and Negroid populations. Ethnic and cultural factors-health beliefs, care-seeking behavior, and access disparities-played a role in extraction timing and technique. Provider bias, lack of diversity within the dental workforce emerged as contributing factors to inequitable care delivery. Integrating this understanding into dental education, clinical guidelines can support equitable, culturally competent care. Further research is warranted to bridge anatomical evidence with behavioral and structural determinants of extraction disparities.
Existing classification systems for isolated zygomatic arch fractures have substantially advanced clinical management of this injury pattern. However, atypical fracture configurations that do not conform to established subtypes are occasionally encountered in clinical practice. This technical note de-scribes an unusual V-shaped outward displacement fracture of the zygomatic arch and proposes its recognition as a novel subtype within the recently described modified classification system for zygomatic arch fractures. A patient presenting following a motor vehicle accident exhibited an isolated zygomatic arch fracture with outward (lateral) displacement of arch fragments, forming a distinctive V-shaped configuration. Unlike conventional zygomatic arch fractures, which characteristically produce trismus through coronoid process impingement, this variant preserved mouth opening and manifested primarily as an aesthetic deformity. Management considerations for this pattern differ from standard approaches applied to conventional subtypes. The described fracture pattern is clinically and biomechanically distinct from the seven subtypes currently enumerated in the modified clas-sification. Incorporation of this variant as a new subtype would enhance the comprehensiveness and clinical utility of the classification, enabling more accurate diagnosis and tailored surgical planning for atypical isolated zygomatic arch fractures.
Tumours involving the bones of maxillofacial region requires elaborate surgical skills and experience for managing the complexity. Treatment plan-ning majorly depends on the extent of bone involvement, type of erosion and involvement of para mandibular soft tissue. Pertaining to mandible in this paper, marginal and segmental mandibulectomies are the predominant options which are oncologically safe practices done by surgeons. Here we report a case of a patient, who was treated with technique of reverse marginal mandibulectomy. He had a unique presentation of tumour abutting the lower border of mandible with the erosion limited to the outer cortex along with a huge extra nodal growth. This sparsely used technique was performed post neoadjuvant chemotherapy followed by microvascular reconstruction. We intend to draw attention to this hermetic technique as an oncological safe and reliable alternative for a specific group of patients.
Objectives:Jawbone defects following cystectomy for cysts of the jaw may cause postoperative complications such as pathological fractures and secondary infections. Therefore, different bone-grafting procedures have been developed. Novel cotton-like bone graft material composed of β-tricalcium phosphate, poly-L-lactic acid, and polyglycolic acid (β-TCP/PLLA/PGA) has handling properties, three-dimensional shapeability, and bone forming ability, and has potential clinical utility for bone formation. However, no studies have evaluated the clinical outcomes of the novel β-TCP/PLLA/PGA in patients of oral and maxillofacial surgery. Thus, we evaluated the usefulness of β-TCP/PLLA/PGA in bone formation within jawbone defects following cystectomy. Patients and Methods:: 28 patients (19 males and 9 females; mean age: 47.5 years) who visited the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, between November 2022 and April 2024 were included. They underwent cystectomy for cysts of the jaw (maxilla or mandible) and were grafted with β-TCP/PLLA/PGA. All excised cyst were submitted for histopathological examination. Patient demographics, clinical data, and computed tomography (CT) images were retrospectively evaluated to assess the defect dimensions, CT values, and bone continuity of the jawbone defects. Data on postoperative complications were obtained from medical records. Results:Among the 28 cystic lesions (6 maxillary and 22 mandibular jaw cases), 27 were odontogenic cysts (26 odontogenic cysts and 1 orthokeratinized odontogenic cyst), and 1 was a non-odontogenic cyst (nasopalatine duct cyst). Both long- and short-axis lengths of the jawbone defect revealed a significant decrease at 6 months postoperatively compared with the preoperative and 1-month postoperative values. The CT values were significantly increased from 1 month to 6 months postoperatively (P<0.05). At 6 months postoperatively, 39.3% of the patients achieved full bone continuity. No serious adverse events were observed. Conclusion:β-TCP/PLLA/PGA demonstrated excellent handling characteristics and clinical safety as a novel cotton-like bone graft material for jawbone defects following cystectomy.
Objectives:Titanium platelet-rich fibrin (T-PRF) usage as sustained drug delivery system (SDDS) has been recently started. Hence present study aimed to evaluate hard tissue regenerative efficacy of T-PRF clots incorporated with amoxiclav (AMX)/metronidazole (MET)/neem (NE) gels individually in osseous defects created in Wistar rats. Materials and Methods:In this in vivo animal model trial, 12 female Wistar rats were procured and subjected to ligature induced periodontitis. Bone defects were created and incorporated with T-PRF plain, T-PRF clots+AMX/MET/NE gels individually. Rats were sacrificed after 2 months and checked under light microscopy and micro (μ)-computed tomography analysis for bone regeneration. Frequency distribution percentages, chi-square test, ANOVA and un-paired t-test were used for conducting the statistical analysis. Results:Inflammatory response was reported in T-PRF+MET Group followed by AMX Group and no inflammatory response was recorded for T-PRF plain with statistical significance (P=0.008), for mineralized and un-mineralized bone formation there was no significant difference (P=0.133). Mean comparisons of bone density there was no significant difference (P=0.545) among all (AMX=551.00±18.68, MET=578.00±18.25, NE=569.00±24.58, T-PRF plain=507.67±118.50). For gene expression significantly (P<0.001) higher alkaline phosphatase and bone morphogenetic protein-2 levels were recorded for T-PRF+NE Group (7.60±3.04, 10.85±1.28) followed by MET (4.65±1.52, 4.64±0.45)>AMX (2.47±0.84, 1.89±0.18)>T-PRF plain (1.00±0.00, 1.00±0.00). Conclusion:Research results showed that T-PRF can be a SDDS and addition of antibiotics or herbal extract didn't alter the hard tissue healing property of T-PRF and resulted in new bone formation.
Oronasal fistula (ONF) is an epithelialized tract between the oral and nasal cavities, for which various flaps are used in surgical closure. ONF may lead to regurgitation of food into the nasal cavity, nasal obstruction, halitosis, and other symptoms that contribute to patient discomfort and impaired qual-ity of life. Surgical closure is challenging, occasionally requiring multiple procedures and carrying a risk of recurrence. The nasolabial flap (NLF) is a well-established local flap for soft tissue reconstruction in the orofacial region; superiorly based flaps are typically used for defects of the nasal dorsum, tip, and ala, while inferiorly based flaps are applied to defects of the nasal floor, lips, and buccal mucosa. The NLF provides dependable vascularity and favorable donor-site esthetic outcomes. Although superiorly based NLFs are not commonly used for intraoral reconstruction, this case report suggests that they can serve as a feasible option for ONF closure in carefully selected patients when the flap lies within an appropriate distance from the maxilla
Objectives: To assess the efficacy of salmon calcitonin spray on postoperative pain, serum calcitonin levels, and bone healing after surgical removal of impacted mandibular third molar. Materials and Methods: This prospective study included 100 patients who required surgical removal of impacted mandibular third molars under local anesthesia. Group I included 50 patients who received intranasal serum calcitonin spray, and Group II included 50 patients who did not receive serum calcitonin spray. The postoperative pain was evaluated on the 1st, 3rd and 7th days. The serum osteocalcin levels were assessed at 1 month, and bone density was evaluated at the 3rd month postoperatively. Results: The severity of pain was less in Group I on days 3, and 7 postoperatively compared to Group II (P<0.05). The postoperative serum calcitonin level was higher in Group I compared to Group II (P<0.05), and the bone density was greater in Group I when compared to Group II evaluated at the 3rd month postoperatively (P<0.05). Conclusion: The results of our study delineate that Group I patients had better efficacy in controlling pain and improved bone healing with calcitonin nasal spray when compared to Group II patients
We describe a simple technique in which traction sutures placed at the palatal flap margin are passed through interdental embrasures and stabilized against adjacent teeth in the contra-lateral arch. This technique was used for 10 patients with impacted maxillary canines.In our clinical use, the technique eliminated the continuous demand of manual retraction, slippage of retractors during the procedure, palatal flap tear due to uneven distribution of retraction forces. Self-stabilizing interdental traction sutures are a practical, reproducible, and minimally invasive adjunct for palatal flap retraction during surgical exposure of impacted canines in selected clinical situations. The technique is particularly advantageous in single-surgeon procedures, resource-limited settings, and cases requiring prolonged palatal exposure for adjunctive orthodontic procedures, including button or attachment placement.
Objectives:This study aimed to investigate the clinical characteristics, treatment outcomes, and factors influencing treatment success in patients with denosumab (Dmab)-related osteonecrosis of the jaw (DRONJ). Patients and Methods:This retrospective cohort study included the patients who were diagnosed with DRONJ and treated at the authors' affiliated hospital, between August 2019 and August 2024. The patients were divided into the three groups; Group 1, low-dose Dmab; Group 2, transition from bisphosphonates (BPs) to low-dose Dmab; Group 3, high-dose Dmab. Differences in clinical characteristics among the groups were compared. Surgical outcomes were classified into three categories: complete healing, partial healing, and no healing. "Treatment success" was defined as the combined proportion of complete and partial healing. Results:A total of 178 DRONJ patients were included in this study. Most of DRONJ occurred in osteoporosis patients. In patients treated with lowdose Dmab, prior BP use resulted in the development of MRONJ within a shorter period after Dmab administration but did not affect disease severity or treatment outcomes. Overall postoperative healing outcomes were favorable at 3 months after DRONJ treatment. The overall treatment success rate was 81.5%; Group 1, 85.0%; Group 2, 82.8%; Group 3, 53.8%, P=0.027). Multiple regression analysis demonstrated that Dmab dosage was a significant factor influencing treatment success, whereas age, treatment duration, lesion location, and DRONJ stage were not (odds ratio, 5.13; 95% confidence interval, 1.19-22.14; P=0.028). Conclusion:The earlier onset in the BP to Dmab transition group may be attributable to the cumulative duration of antiresorptive therapy. Patients treated with high-dose Dmab demonstrated poorer prognosis and more frequent recurrence after MRONJ treatment compared with those treated with low-dose Dmab or BP to Dmab transition therapy. herefore, these findings need to be considered for treatment of DRONJ.
Severe odontogenic deep neck infections (DNIs) can rapidly extend along cervical fascial planes and progress to descending necrotizing mediastinitis (DNM) with high mortality, requiring early diagnosis and multidisciplinary management, especially in elderly patients with comorbidities. We report two elderly patients with rapidly progressive odontogenic infections: one with DNM fulfilling Estrera's criteria (Endo type IIA) and another with extensive DNI without mediastinal spread. Clinical features, serial contrast-enhanced computed tomography (CECT) findings, laboratory risk indicator for necrotizing fasciitis (LRINEC) score trends, microbiological results, surgical approaches were analyzed. Both patients presented with high LRINEC scores (≥8) and polymicrobial infections, involving multidrug-resistant organisms. Case 1 required five staged cervicothoracic debridements, negative pressure wound therapy, and delayed skin grafting. Case 2 underwent three surgeries with gland excision, hemorrhage control. Airway patency was maintained without tracheostomy through coordinated airway monitoring. Targeted antimicrobial adjustments and systemic optimization facilitated infection control. Both patients recovered fully without recurrence. These cases emphasize the importance of early CECT evaluation, cautious interpretation of LRINEC scores in patients with metabolic comorbidities, individualized surgical debridement tailored to anatomical spread, and multidisciplinary collaboration. Personalized reconstructive strategies based on defect size and tissue viability are essential for functional restoration and successful outcomes.
