Background: Accurate three-dimensional (3D) facial landmarking is essential for craniofacial analysis, but manual identification is time-consuming and subject to variability. Automated systems offer a solution but require robust validation and calibration. This study aims to validate a previously described automated augmented intelligence (AI) platform for 3D facial landmarking in a Caucasian population. Methods: Thirty-seven 3D facial scans from a single cohort of Caucasian adults aged 18-40 years were used. Twenty-one landmarks were manually identified on each 3D face with texture overlay. The same landmarks were automatically plotted by the AI platform (https://3dmedx.nl) using geometric data only (texture removed). Ten linear distances and angles were derived from the landmarks. Paired t-tests were used to compare manual and AI-derived measurements. Results: The mean error across all linear distances was 1.30 +/- 0.89 mm and for angles was 1.14 +/- 0.76 degrees, representing a mean percentage error of less than 2.5%. The percentage of landmarks within 2, 3, and 4 mm was 75.1%, 89.8%, and 96.7%, respectively. Statistically significant differences were found for landmarks, such as Nasion-Pronasale-Subnasale (P=0.02) and Nasion-Pronasale-Pogonion (P=0.043). Conclusions: The evaluated AI platform demonstrated good accuracy for 3D facial landmarking in a Caucasian cohort, with errors comparable to reported inter-observer variability. It shows promise as a timesaving tool for initial assessment and research, and as the technology evolves can be used in things like diagnostic facial imaging and precise surgical planning.
Peri-implantitis is a complex condition marked by bacterial-associated inflammatory process around dental implants, leading to the destruction of surrounding bone and soft tissue. Reconstructive or regenerative therapy for peri-implantitis is the ultimate treatment goal aiming not only to halt the progression of peri-implant disease but also to regenerate lost peri-implant structures; thereby restoring the original functional and esthetic integrity of the implant site. This review article provides a comprehensive exploration of surgical regenerative therapies in managing peri-implantitis, including the indications, stepby-step procedures, decontamination methods, adjunctive approaches, and biologics, as well as personalized treatment strategies. While many animal studies on peri-implantitis have provided histological outcomes for re-osseointegration after reconstructive therapy, human histological evidence is scarce but emerging. Histological evidence from recent human studies is summarized in a table to demonstrate the potential to achieve bone to previously-diseased implant surface re-osseointegration, which defines the regenerative outcome. This review also highlights the need for professional maintenance therapies in managing periimplantitis, which play a vital role in preventing the peri-implant disease recurrence and supporting longterm stability. Challenges remain in predicting long-term success after regenerative therapy due to the complex interplay of local and systemic factors. Future research should continue to refine these regenerative techniques and validate their effectiveness, ensuring improved treatment outcomes, implant longevity, and patient satisfaction.
Background: Facial soft tissue injuries are a relatively common cause of visits to hospital emergency rooms. Studies on the impact of traumatic facial injuries include bony injuries but exclude soft tissue injuries with few studies on the impact of these injuries. This study undertook a comprehensive assessment of aesthetic, functional, and psychological outcomes following traumatic facial soft tissue injuries and compared patient perspectives and physician assessments. Methods: A prospective observational study was conducted in the Department of Oral & Maxillofacial Surgery of Manipal College of Dental Sciences Mangalore with inclusion of consecutive patients who reported for the management of facial soft tissue injuries from December 2020 to December 2022. Injuries were categorized into contusion, abrasion, and laceration. Outcomes were aesthetic sequelae measured using Patient and Observer Scar Assessment Scale (POSAS), incidence of functional sequelae like nerve injuries, loss of hair, scar contracture and psychological sequelae measured using Trauma Screening Questionnaire (TSQ). Independent t-test was used to compare the difference between POSAS. Chi-square test was used to test the association of TSQ score at 1 and 3 months with age, gender and type of injury. P<0.05 was considered as statistically significant. Results: Of the 96 participants included in the study, 54 (56%) were males and 42 (44%) females. Mean age was 38 +/- 15 years (range, 17-87 years). Collision in road traffic accident was the commonest cause of injury 53 (55.2%). The highest incidence was lacerations 54 (56.3%) followed by abrasion 30 (31.3%) and contusion 12 (12.5%). The most injured facial subunit was forehead 25 (26%). Mean scar assessment scored by the patient at 1 week, 1 month and 3 months was 7.53 +/- 0.71, 5.09 +/- 0.67 and 3.43 +/- 0.61 respectively and by the observer 6.63 +/- 0.72, 4.72 +/- 0.59 and 2.95 +/- 0.66 respectively and these differences were statistically highly significant (P<0.001). Hypopigmentation, hyperpigmentation, and scar thickening (elements evaluated in POSAS) were aesthetic sequelae for lacerations, none for contusions, and hypopigmentation for abrasions. Scar contracture 3 (3.1%) and hair loss 7 (7.3%) were the residual functional outcomes at 3 months, in the eyelid and chin facial subunits respectively. Mean TSQ score at 1 month was 5.54 +/- 2.010, and 3 months 4.22 +/- 1.819 (P<0.001), with no difference in TSQ score between sexes, age or type of injury (P>0.05). Conclusions: Aesthetic sequelae were highest for lacerations. Patients' self-perception of scarring was consistently worse than that of observers', but overall score improved over 3 months. Scar contracture and hair loss were functional sequelae persisting beyond 3 months and risk of developing post-traumatic stress disorder is best evaluated after 3 months.
Background: The reconstruction of scalp defects after major oncological resections remains a complex challenge, despite advances in reconstructive surgery. Scalp reconstruction requires careful consideration of multiple factors due to the anatomical constraints of the scalp, including limited tissue mobility and aesthetic considerations such as hair preservation. This study aims to develop a practical algorithm to guide surgical decision-making in scalp reconstruction, optimizing outcomes and minimizing complications. Methods: We conducted a retrospective study of 35 patients with acquired oncologic scalp defects who underwent surgical reconstruction between 2015 and 2021. Patient variables recorded included age, tumor type, defect size, location, and postoperative complications. Reconstruction techniques used were categorized into five types: primary closure, skin graft, local flap, regional flap, and microsurgical free flap. Based on these findings and the surgical team's experience, an algorithm was developed to aid preoperative planning and optimize surgical outcomes. Results: Thirty-five patients who underwent oncological resection of benign or malignant lesion located in the scalp were included in the study. Squamous cell carcinoma was the most common tumor type (60%), followed by melanoma, basal cell carcinoma, and other neoplasms. Defects ranged in size and location, influencing the choice of reconstructive technique. The five defined reconstruction categories demonstrated different levels of efficacy based on defect size, tissue involvement, and previous or planned radiotherapy (RT). Microsurgical-free flaps were used in 28.6% of cases, especially for extensive defects requiring robust vascularized tissue. Local flaps were used in 45.7% of cases, providing a satisfactory aesthetic outcome and reduced complication rates for medium-sized defects. The algorithm takes into account factors such as defect size, bone involvement, RT history, and patient-specific considerations like body mass index (BMI) to guide the selection of an appropriate reconstructive approach. Conclusions: Radical resection followed by immediate reconstruction remains the gold standard for scalp tumor management. Our proposed algorithm serves as a practical tool for head and neck surgeons, facilitating preoperative planning to achieve optimal oncological and functional outcomes with minimal morbidity. For patients with deep-margin involvement or those requiring RT, the use of richly vascularized tissue, such as microsurgical free flaps, proved effective in reducing postoperative complications and supporting long-term outcomes. This algorithm offers a structured approach for achieving individualized, effective reconstruction for patients with oncologic scalp defects.
Background: Intraosseous hemangioma is a benign neoplasm, often found in the skull and vertebral column. Within the head and neck, the mandible is the most common site, of which there are fewer than 130 documented cases. Case Description: This report describes a case of a 56-year-old Caucasian female presenting with a known lesion of the right mandible, previously asymptomatic for 6 years, now with recent onset expansion prior to presentation. A computed tomography (CT) maxillofacial without contrast demonstrated a 3 cm x 3 cm lesion of the right mandible with a distinct sunburst appearance, identical to that of osteosarcoma (OS) or Ewing sarcoma (ES). Incisional biopsy yielded a diagnosis of intraosseous capillary hemangioma, with subsequent diagnostic cerebral angiogram displaying no feeder vessels. Patient was subsequently managed via clinical observation with no change in size over a 24-month period. Conclusions: Intraosseous hemangiomas must not be overlooked in the differential diagnosis of an expansile lesion with a sunburst appearance in the mandible. Treatment options can include surgical intervention; however, success can be found with clinical observation without surgical intervention.
Background: Myelodysplastic syndrome (MDS) is a rare clonal hematopoietic stem cell disorder that causes chronic pancytopenia. The disease rapidly progresses to acute myeloid leukemia (AML), with a poor prognosis. Most patients have oral manifestations ranging from bleeding to acute ulcerations. This is a unique as MDS was diagnosed in a middle-aged female patient without prior exposure to radiation or chemotherapy. Case Description: A 34-year-old Asian female patient presented palpitations, generalized weakness, and light weariness for six months on admission our hospital in July 2017. She had no relevant medical, family, or social history. She was found with spontaneous gingival bleeding and gingival hyperplasia. Bone marrow aspiration and fluorescence in situ hybridization (FISH) analysis raised the possibility of MDS. However, biopsy was deferred due to her low blood counts. Due to refusal for treatment during first visit, she was advised to maintain oral hygiene. Two months later gingival hyperplasia was superimposed by ulcerations and necrosis. Chemotherapy [tablet lenalidomide 5 mg once daily (OD) for 2 months] had commenced at this stage. However, she was lost for follow-up after 2 months of chemotherapy. Conclusions: Oral physician plays an important role in identifying these manifestations and referring the patients at the earliest. Comprehensive dental assessment is vital prior to commencement of treatment to minimize the complications associated with the condition and subsequent treatment. This requires a multidisciplinary team consisting of oral physician, oral surgeon, periodontist, endodontist, dietician, and liaison with Haemato-oncologist to deliver effective dental treatment.
Background: In edentulous patients, a complete denture has traditionally been the recommended course of care. However, obtaining positive outcomes can be very difficult, particularly when the mandibular arch exhibits severe alveolar ridge resorption. Since Branemark first proposed the idea of osseointegration, implant-supported overdentures have developed into a common form of treatment for people who are missing all of their teeth. There are numerous attachments with various designs available. The objective of this study was to evaluate and compare the change in retentive force of three different attachment systems: ball, locator and Hader bar and clip attachment for two implant-supported overdentures at baseline, 3 months, 6 months and 1 year duration. Methods: Three types of attachments were used: ball, locator, and Harder bar. All the group consisted of 6 samples. Overdenture models were then designed to be dislodged by using a universal testing machine. The retentive values were evaluated at baseline, 3 months, 6 months and 1 year duration which was synchronized at baseline, 270 cycles, 540 cycles and 1,080 cycles considering insertion and removal activities done by the patient three times a day. Results: Group III (bar attachments) showed the highest retentive values for all cycles, followed by Group II (locator attachments) whereas, Group I (ball attachments) showed least retentive values (P<0.001). Conclusions: Even though all the attachment systems showed loss of retentive values from baseline to the corresponding cycles, bar attachments were having better retention followed by locator attachments and ball attachments.
