Denosumab is a humanized monoclonal antibody targeting receptor activator of nuclear factor-κB ligand(RANKL)and is commonly used in the treatment of osteoporosis and cancer-related bone metastases.However,the per-sistent use of denosumab has been associated with an increasing incidence of denosumab-related osteonecrosis of the jaw(DRONJ),particularly following tooth extraction.This expert consensus aims to develop clinical management guidelines for the perioperative period of tooth extraction in patients who are currently receiving or have previously received deno-sumab therapy.The consensus covers the definition,etiology,epidemiology,staging,and risk factors of DRONJ,focus-ing on preoperative assessment,risk-based prevention strategies,minimally invasive surgical techniques,and postopera-tive follow-up protocols.The core management strategy for DRONJ emphasizes individualized decision-making based on a comprehensive preoperative assessment of medication history,local infection,and systemic conditions.The main risk factors for DRONJ include high-dose and long-term denosumab therapy,preexisting oral infections,such as peri-odontitis and periapical periodontitis,and invasive dental procedures,including tooth extraction,diabetes,and concomi-tant use of glucocorticoids or antiangiogenic agents.Core preventive measures include strict perioperative oral care,risk assessment-based antibiotic prophylaxis,long-term drug holidays,which were developed by dentists and physicians prio-ritizing the primary disease,and minimally invasive surgical techniques for managing trauma,preserving local blood sup-ply,thoroughly removing infected tissues,and ensuring tight wound closure.This consensus highlights the importance of multidisciplinary collaboration between dental and clinical medicine experts in managing DRONJ.High-quality research is necessary to provide an evidence-based foundation for optimizing DRONJ prevention and treatment strategies.

Traditional assessment in undergraduate oral and maxillofacial surgery (OMFS) internships mostly relies on single-skill examinations, focusing only on technical proficiency while ignoring communication ability, clinical reasoning and medical documentation. This study aimed to develop and pilot-validate a comprehensive competency-based assessment system for undergraduate OMFS outpatient internships. This mixed-methods development and pilot validation study identified six core clinical competency domains through literature review and semi-structured interviews with five senior OMFS faculty members. A multi-dimensional assessment framework was established, including theoretical examination, integrated clinical operation evaluation, phased skill assessment aligned with national licensing standards, patient-related indicators and daily performance evaluation. Forty-six students in the development cohort (2024–2025) adopted the new system; 48 students in the reference cohort (2023–2024) received traditional assessment. Each student was independently evaluated by three faculty members from an eleven-person rater panel. Inter-rater reliability was calculated using the intraclass correlation coefficient. Questionnaire feedback and adverse event data were compared between groups. Six core competency domains were finalized. Student ratings of the comprehensiveness of the two assessment systems were not significantly different (8.14 vs. 6.52, P = 0.086). Faculty ratings showed a significant difference in comprehensiveness (9.64 vs. 6.28, P = 0.043). The overall inter-rater reliability was good (ICC = 0.78, 95

The third molar is the most developmentally delayed of the permanent teeth and has the highest incidence of pericoronitis and odontogenic space infections. Impacted third molars significantly increase the risk of periodontitis, dental caries, and external root resorption of adjacent second molars. Third molars are associated with complex surgical procedures, and treatment decisions and clinical management of third molars in this context remain controversial. This expert consensus was generated by oral surgeons and related specialists, who synthesized the current evidence-based literature and contemporary clinical practices. This consensus addresses critical considerations: the developmental trajectory and impaction characteristics of third molars, clinical and radiographic examinations of third molars, classification of impacted third molars, adverse effects of impacted third molars on oral health, indications for extraction, preoperative preparation for impacted third molar removal, anesthetic choices for impacted third molar surgery, recommended surgical protocol for impacted third molar removal, application of implant materials in alveolar sockets, management of common severe complications in impacted third molar extraction, and functional utilization of impacted third molars. Based on a comprehensive expert deliberation, this consensus provides evidence-based clinical guidance and standardized protocols for dental practitioners in the context of third molar management and therapeutic decision-making.

OBJECTIVES:This study aimed to evaluate and compare the surgical precision of coronectomy for mandibular third molars (M3Ms) performed with the aid of a dynamic navigation system (DNS) versus the conventional freehand technique. METHODS:A single-blind randomized controlled trial was conducted in 110 patients undergoing M3M coronectomy. After withdrawal of three patients, 107 patients (teeth, N = 117) were included in the final analysis. Teeth were randomly allocated to the DNS-assisted group (patients, n = 52; teeth, N = 57) or the freehand group (patients, n = 55; teeth, N = 60). The primary outcome measure was the root mean square (RMS) deviation between the achieved osteotomy plane and the preoperative virtual plan, assessed for the entire resection surface as well as the mesial and distal subregions. Secondary outcomes included: (i) maximum and mean positive and negative deviations in all regions; (ii) curvature parameters (RMS, maximum, and minimum) for the complete osteotomy plane and its subregions; and (iii) total procedure duration and active operative time. Postoperative cone-beam computed tomography (CBCT) scans were processed with Geomagic software for three-dimensional deviation analysis. RESULTS:The DNS-assisted group showed significantly reduced RMS deviations (overall: 1.02 ± 0.50 mm; mesial: 1.06 ± 0.58 mm; distal: 0.92 ± 0.54 mm) compared with the freehand group (overall: 1.44 ± 0.90 mm; mesial: 1.46 ± 1.07 mm; distal: 1.48 ± 1.25 mm; P < 0.05). Consistent advantages of DNS were also observed in maximum and mean positive deviations, RMS curvature, and minimum curvature values. However, operative duration was significantly longer with DNS than with the freehand method (28 min vs. 14 min, P < 0.05). CONCLUSIONS:Dynamic navigation significantly improves the accuracy of M3M coronectomy, achieving millimeter-level precision that surpasses that of the freehand technique. CLINICAL SIGNIFICANCE:These findings highlight the value of a fully digital workflow from preoperative planning through postoperative validation in DNS-guided coronectomy, underscoring its potential to improve safety and precision in complex M3M surgeries.

Accurate extraction of impacted teeth remains a technically demanding procedure. This study aimed to develop a model-based experimental protocol to assess the surgical accuracy of a dynamic navigation system (DNS) assisted extraction of impacted maxillary anterior teeth. A standardized custom model simulating impacted maxillary supernumerary teeth was constructed. Preoperative planning, including the definition of osteotomy boundaries and tooth sectioning planes, was performed using integrated intraoral scanning and cone-beam computed tomography (CBCT) data. During surgery, the DNS guided critical surgical procedural steps, including tooth localization, osteotomy, and segmentation. Postoperative CBCT imaging was used to compare actual surgical outcomes with the preoperative plan by quantifying three-dimensional deviations. Outcome measures included root mean square (RMS) deviation, angular deviation, and other geometric discrepancies. Total osteotomy area and operative time were also recorded. Fourteen models were evaluated, with seven assigned to the DNS-assisted group and seven to the control group. Compared with the preoperative plan, the DNS group demonstrated significantly lower RMS deviation in segmentation plane accuracy than the control group (0.43 ± 0.18 mm vs. 0.85 ± 0.38 mm; P = 0.02). Angular deviation was reduced in the DNS group (8.97° vs. 14.76°; P = 0.04), along with curvature RMS (1.72 rad vs. 3.54 rad; P = 0.04) and maximum deviation (0.77 mm vs. 1.30 mm; P < 0.01). These results indicate that DNS-assisted extraction of impacted maxillary anterior teeth significantly enhances surgical accuracy compared with conventional techniques, improving procedural accuracy, stability, and overall safety.

To evaluate the reliability and quality of YouTube videos focused on coronectomy using DISCERN, Video Information and Quality Index (VIQI), and Global Quality Scale (GQS) tools. Two reviewers independently identified 53 videos for final analysis and classified based on their quality and content relevance using DISCERN, VIQI, and GQS. Most videos were targeted to the general public (81.1

This study aimed to preliminarily evaluate the precision of a dynamic navigation system (DNS) in guiding a piezoelectric surgical device for the removal of impacted anterior maxillary teeth. Patients with impacted teeth in the anterior maxilla were enrolled in the study. Preoperative cone-beam computed tomography (CBCT) scans were used to digitally plan the osteotomy site and tooth sectioning trajectory within the DNS software. During surgery, a DNS-guided piezoelectric device was applied to perform both the bone flap osteotomy and tooth sectioning. The actual osteotomy field was intraoperatively scanned using an intraoral scanner, and the postoperative osteotomy contours were compared with the preoperative virtual plan to assess surgical accuracy. Eleven patients with a total of 12 impacted teeth were included. The mean osteotomy duration was 10.33 ± 3.82 min. The average deviation at the boundary apex was 1.17 ± 0.77 mm, while the boundary angle and boundary length deviations were 5.90 ± 4.22° and 0.57 ± 0.50 mm, respectively. The mean intersection-over-union value for the osteotomy area was 0.81 ± 0.07. Only mild postoperative symptoms were reported, and no significant injury to adjacent anatomical structures occurred. These preliminary findings suggest that DNS-guided piezoelectric surgery is a viable approach for extracting impacted anterior maxillary teeth, demonstrating encouraging accuracy and safety. The integration of dynamic navigation technology with piezoelectric instrumentation provides a minimally invasive and precise method for managing impacted anterior maxillary teeth.

This study compared the precision of cortical-window osteotomy and tooth sectioning performed with an active robotic system versus conventional freehand techniques during the modified mid-segment-first (MMSF) extraction of impacted mandibular third molars (M3Ms). The feasibility of applying active robotic technology to alveolar surgery was also assessed. Standardized mandibular replicas containing fully impacted horizontal M3Ms (n = 18 per group) were allocated into two groups: an active robot-assisted group (ARG) and a freehand group (FHG). For all specimens, preoperative CBCT scans were merged with intraoral digital impressions to design the osteotomy and tooth sectioning pathways. Primary endpoints were cortical bony window accuracy and tooth segmentation accuracy. Dice similarity scores were significantly higher in the ARG compared with FHG (0.90 ± 0.03 vs. 0.29 ± 0.09, p < 0.001). Root mean square (RMS) deviation (0.14 [0.10–0.22] mm vs. 1.39 [1.07–2.09] mm, p < 0.001) and angular deviation (2.02 [1.31–3.16]° vs. 19.48 [13.30–29.07]°, p < 0.001) were lower in the ARG group, as was bone injury depth (0.00 [0.00–1.15] mm vs. 2.21 [0.89–3.56] mm, p < 0.001). Both excessive and insufficient removal were significantly less frequent in robotic procedures (p < 0.001). Robotic-assisted MMSF extraction demonstrated greater precision, reduced invasiveness, and improved safety compared to freehand techniques in vitro. These findings support the preliminary feasibility of active robotic systems in alveolar surgery; however, as this was an in vitro study, further evaluation is needed to balance the gains in accuracy against the inherent limitations. This study provides the first quantitative in vitro evidence validating the technical feasibility of an active robotic platform for dentoalveolar surgery, laying the groundwork for future clinical applications.

The present study explored the trueness of active robotic system-assisted cortical-window osteotomy and tooth sectioning relative to conventional freehand surgery, employing a labial approach to remove impacted maxillary midline supernumerary teeth. Standardized three-dimensional maxillary replicas containing an impacted midline supernumerary tooth were randomized into an Active Robot-assisted Group (ARG) or a Freehand Group (FHG). Preoperative CBCT and intraoral scans were merged to plan osteotomy and tooth sectioning trajectories. Parameters analyzed included cortical-window formation and tooth segmentation trueness, bone injury, and operative duration. The ARG achieved significantly higher Dice similarity coefficients (0.93 vs. 0.71, p < 0.001) and lower centroid deviations (0.31 mm vs. 1.15 mm, p < 0.001) than the FHG. Both excessive and insufficient bone removal were markedly reduced in the ARG group (p < 0.001). The root mean square (RMS) deviation (0.19 mm vs. 0.96 mm, p < 0.001) and angular deviation (5.70° vs. 17.90°, p < 0.001) were significantly smaller in the ARG group, while the depth of bone injury was lower (0.00 [0.00–0.77] vs. 0.87 [0.45–1.51], p = 0.039), and the operative duration was slightly longer (160 s vs. 132 s). Robot-assisted extraction of impacted maxillary midline supernumerary teeth demonstrated greater trueness and reduced collateral bone injury than conventional freehand surgery. The robotic system enhanced surgical safety, reproducibility, and trueness. These in vitro findings demonstrate the technical feasibility of active robotic systems for minimally invasive, high-trueness extraction of supernumerary teeth.

Background and objectivesThe purpose of this study is to use a data-driven method to analyze the time taken by junior doctors to extract lower wisdom teeth and the factors affecting the difficulty of the procedure. It aims to reveal the distribution characteristics of difficulty factors at different stages of development, establish a mathematical model for procedural difficulty, evaluate the effectiveness of the existing difficulty scale, and provide difficulty indicators for the extraction training of impacted teeth for young doctors at different stages.Materials and methodsWe collected surgical records of 419 cases of lower impacted wisdom teeth extraction completed by 9 residents. The difficulty index was based on a scale with 14 primary indicators and 37 secondary indicators. We proposed a data-driven method for surgeon-specific difficulty assessment (DDSS) of third molar extraction surgery. When assessing the surgical difficulty for a surgeon, the DDSS uses a method based on Lasso regression to classify the doctor as either a junior doctor who has completed grade 1 training or a novice doctor. It then calls upon the corresponding pre-trained model to conduct targeted difficulty prediction and provide key difficulty factors.ResultsOur method achieved an accuracy of 80% and an AUC of 0.85 with SVM. The methods we proposed outperformed the methods without decoupling. The clustering analysis revealed that inexperienced surgeons are affected by a larger number of factors, while experienced surgeons are primarily influenced by four key factors: Crown resistance, impacted type, mouth opening, and gender. Learning curves indicated that surgeons typically become proficient after 8 months of practice.ConclusionWe propose a data-driven decoupling-prediction model, which improves the model’s performance in the task of assessing dental surgery difficulty. We also draw the learning curve of novice surgeons based on the data decoupling method we proposed. This provides a new perspective for surgical difficulty assessment and surgeon training, and offers a reliable conclusion.

OBJECTIVES:To study bone healing of two-wall bone defects after alveolar ridge preservation using mineralized dentin matrix.MATERIALS AND METHODS:After distal roots extraction of second and fourth premolars (P2, P4) on one lateral mandible in 12 beagles, two-wall bone defects (5 × 5 × 5 mm) were surgically created distally to the remaining mesial roots of P2 and P4. A total of 24 sites were randomly allocated to three groups (implant material- time of execution): mineralized dentin matrix (MDM)-3 m (MDM + collagen membrane; 3 months), MDM-6 m (MDM particles + collagen membrane; 6 months), and C-6 m (collagen membrane only; 6 months). Clinical, radiographic, digital, and histological examinations were performed 3 and 6 months after surgery.RESULTS:The bone healing in MDM groups were better compared to Control group (volume of bone regenerated in total: 25.12 mm3 vs. 13.30 mm3, p = .046; trabecular volume/total volume: 58.84% vs. 39.18%, p = .001; new bone formation rate: 44.13% vs. 31.88%, p = .047). Vertically, the radiological bone level of bone defect in MDM-6 m group was higher than that in C-6 m group (vertical height of bone defect: 1.55 mm vs. 2.74 mm, p = .018). Horizontally, no significant differences in buccolingual bone width were found between MDM and C groups at any time or at any level below the alveolar ridge. The percentages of remaining MDM were <1% in both MDM-3 m and MDM-6 m groups.CONCLUSIONS:MDM improved bone healing of two-wall bone defects and might be considered as a socket fill material used following tooth extraction.

This article summarizes and organizes relevant publications in journals, along with a review of medical history, systematically summarizing the development process of dental alveolar surgery in China. The initial establishment phase (1935-1952) marked the starting point of Chinese Alveolar Surgery. Despite the impact of wars, it laid the foundation for subsequent research and practice. During the early development phase (1953-1966), the "Chinese Journal of Stomatology" was founded, which promoted the development of Alveolar Surgery. Research focused on tooth extraction methods and complications. Tooth Transplantation and Preprosthetic Surgery gradually began to take off. The stagnant phase (1967-1977) occurred due to the interruption of international exchanges, leading to an almost complete halt in the development of Alveolar Surgery. Entering the rapid catch-up phase (1978-1985), Alveolar Surgery scholars in China began striving to overcome the stagnation of the previous decade. While some progress was made, no significant innovative achievements emerged. In the scientific development phase (1986-2010), clinical research, basic experiments, and paper writing in modern Chinese Alveolar Surgery began to adhere to scientific standards with the rise of experimental medicine. The exploration and innovation stage (2011-2023) is the current development phase, during which Chinese Aveolar Surgery has reached its peak, making substantial progress in technology, clinical practices, and basic research, gradually reaching or even surpassing international advanced levels. Looking back at the development history in China, we can find the wisdom and hard work of the older generation of Alveolar Surgery scholars. However, contemporary challenges and issues, such as standardizing technology, promoting clinical practices, and talent cultivation, need to be addressed by present-day Alveolar Surgery professionals as they forge ahead.

To investigate the impact of mineralized dentin matrix (MDM) on the prognosis on bone regeneration and migration of retained roots after coronectomy. Patients were divided into three groups based on the type of bone graft after coronectomy: Group C (n = 20, collagen), Group T (n = 20, tricalcium phosphate (TCP) + collagen), and Group D (n = 20, MDM + collagen). CBCT scans, conducted immediately and 6 months after surgery, were analyzed using digital software. Primary outcomes, including changes in bone defect depth and retained root migration distance, were evaluated 6 months after surgery. After 6 months, both Groups D and T exhibited greater reduction of the bone defect and lesser retained root migration than Group C (p < 0.001). Group D had greater regenerated bone volume in the distal 2 mm (73 mm3 vs. 57 mm3, p = 0.011) and lesser root migration (2.18 mm vs. 2.96 mm, p < 0.001) than Group T. The proportion of completely bone embedded retained roots was also greater in Group D than in Group C (70.0

To conduct a finite element analysis of the impact of different variables on tooth sectioning efficiency and trauma to surrounding tissues when utilizing high-speed surgical handpieces and elevators. CBCT data from the horizontally impacted third mandibular molar (M3M) of a patient were utilized to establish digital models of the M3M, adjacent M2M, and surrounding bone. To simulate tooth sectioning, a 3D finite element model was established with the following variables: remaining tooth tissue thickness (1–5 mm), tooth section fissure width (1–3 mm), elevator depth in fissure (2–6 mm), elevator position (buccal, lingual, central), elevator width (2–5 mm), and application of force (rotating, levering). Using this model, the distribution of stress on the M3M and the surrounding tissue was assessed while measuring tooth sectioning efficiency and trauma to the surrounding tissue. Factors associated with uniform stress at the site of sectioning included thin (≤ 3 mm) remaining tooth tissue, appropriate fissure width ( 2 mm), a wide (≥ 4 mm) elevator, and central elevator positioning. Levering the elevator yielded greater stress on the M3M than rotating force. Greater sectioning efficiency was associated with increased stress placed on the distobuccal side of M2M. Tooth sectioning efficiency can be improved by adjusting the high-speed surgical handpiece and elevator. However, it is important to remain attentive to the trauma to which adjacent teeth are exposed during this process. These results offer guidance for approaches to improving operator efficiency and reducing trauma to surrounding tissues during tooth sectioning.

Objective: To establish a two-stage surgical procedure of impacted mandibular third molars (IMTM) extractions assisted by coronectomy and microimplant anchorage traction and to investigate the influencing factors of root movement and the effects of different traction angles on the clinical outcomes. Methods: Fifty-three IMTM in contact with inferior alveolar nerve (IAN) that underwent tooth extraction in the Department of Oral and Maxillofacial Surgery Peking University School of Stomatology from January 2022 to June 2023 were included, with coronectomy and microimplant anchorage implantation in the first stage of the surgery, root traction was achieved with orthodontic elastic and microimplant anchorages by about 5.886 N of force, when the IMTM root was detached from IAN, a second surgery was performed to extract the residual root. The basic information of patients and M3M, data on the microimplant anchorage implantation and traction, imaging measurements, and complications were recorded and analyzed. Results: The movement distance of the residual roots was (1.80±0.92) mm, and the duration of traction was (32.9±7.9) d. Multiple linear regression analysis showed that the residual root movement distance was significantly correlated with age, gender, number of roots, traction angle, and depth of the distal bone defect of the second molar (P<0.05). The smaller the traction angle, the more significant the movement of the residual roots (P=0.044). In one case, the patient experienced abnormal sensation in the lower lip 16 days after one IMTM (1.9%, 1/53) traction. Conclusions: The two-stage surgical method of combined coronectomy with rapid traction technique to extract the IMTM allows for rapid movement of the residual root and reduces the risk of IAN injury. The efficiency of root movement can be accelerated by appropriately reducing the traction angle during surgery. The traction effect can be predicted based on indicators such as age, gender, number of roots and depth of distal bone defects of second molar.

OBJECTIVES:This study investigated the application of an intraoral banana peel suturing model in helping students to acquire intraoral surgical techniques.METHODS:This is a self-control study conducted from January 2021 to March 2021. An intraoral banana peel suturing model was implemented to provide oral suture experience for undergraduates majoring in stomatology. The sutures students placed in the model were photographed and evaluated blindly by a professional team using an established scoring system. Training scores were recorded before (training 1) and after 2 months of training (training 2). Linear regression was used to examine factors related to the scores. Suturing training was conducted in the School and Hospital of Stomatology at Peking University. A total of eighty-two students in Peking University School and Hospital of Stomatology were in their fourth pre-clinical year and followed a workshop on surgical sutures according to the curriculum. All students who should take this course were included, and the response rate was 100%.RESULTS:The mean training 2 score (23.04 ± 3.83) was higher than the mean training 1 score (13.94 ± 3.15). The training 1 score was not significantly correlated with any of the students' general characteristics. The training 2 score was correlated with the training 1 score and the cumulative duration of practice outside of class.CONCLUSION:The intraoral banana peel suturing model can be used for suture training, and dental students' suture ability was improved after using the banana peel for suture practice.

Journal of Dental EducationVolume 87, Issue 9 p. 1215-1216 ISSUE INFORMATIONFree Access Journal of Dental Education Volume 87 Number 9/August 2023 First published: 31 August 2023 https://doi.org/10.1002/jdd.12990AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume87, Issue9September 2023Pages 1215-1216 RelatedInformation

Objectives: The study represents a preliminary evaluation of the accuracy of the dynamic navigation system (DNS) in coronectomy of the mandibular third molar (M3M).Methods: The study included participants with an impacted M3M near the inferior alveolar canal. The coronectomy planes were designed before the surgery using cone-beam computed tomography (CBCT) imaging data and then loaded into the DNS program. Intraoperatively, the navigation system was used to guide the complete removal of the target crown. Postoperative CBCT imaging was used to assess any three-dimensional deviations of the actual postoperative from the planned preoperative section planes for each patient.Results: A total of 12 patients (13 teeth) were included. The root mean square (RMS) deviation of the preoperatively designed plane from the actual postoperative surface was 0.69 +/- 0.21 mm, with a maximum of 1.45 +/- 0.83/-1.87 +/- 0.63 mm deviation. The areas with distance deviations < 1 mm, 1-2 mm, and 2-3 mm were 71.97 +/- 5.72 %, 22.96 +/- 6.57 %, and 4.52 +/- 2.28 %, respectively. Most patients showed extremely high convexity of the surface area located in the mesial region adjacent to the base of the extraction socket. There was no observable evidence of scratching of the buccolingual bone plate at the base of the extraction socket by the handpiece drill.Conclusions: These results provide preliminary support for the use of DNS-based techniques when extracting M3M using a buccal approach. This would improve the accuracy of coronectomy and reduce the potiential damage to the surrounding tissue.