This retrospective multicenter chart review assessed single-tooth rehabilitation following maxillary sinus floor augmentation (MSFA) utilizing the lateral window technique across eight European departments between January 1st, 2018, until December 31st, 2023. Intraoperative, early- and late postoperative data from 224 patients (mean age: 53.1 years; mean residual ridge height: 4.4 mm) were analyzed using a standardized computer-assisted database. Implants were placed simultaneously (n = 124) or staged (n = 100) after a mean healing period of 7.9 months. Coagulum or autogenous bone mixed with xenograft were the most used grafting materials. The incidence of Schneiderian membrane perforation was 17.4%. The implant survival was 96.9% and radiographic peri-implant marginal bone loss was diminutive after a mean period of 25.4 months. There were no predictive parameters for Schneiderian membrane perforation or implant loss, while peri-implant marginal bone loss was significantly correlated to smoking, omission of pre-operative antibiotics, and grafting materials without autogenous bone (P > 0.05). In conclusion, MSFA utilizing the lateral window technique is a highly predictable surgical procedure for prosthetic rehabilitation of the atrophic posterior maxilla. However, meticulous preoperative assessment of patient-related factors, anatomical variations, sinus pathologies, and surgical risk factors is mandatory to improve the long-term implant outcome.

INTRODUCTION:Central giant cell granulomas (CGCGs) are benign but locally aggressive rare neoplasms that affect the bony skeleton, particularly the maxillofacial region. The purpose of this European multicenter study was to describe and assess the characteristics, diagnosis, management, and recurrence of CGCGs at different European oral and maxillofacial surgery centers. METHODS:The data from all the treated CGCGs from the involved oral and maxillofacial surgical units across Europe between January 1st, 2014 and December 31st, 2023 were recorded. RESULTS:A total of 76 patients, including 37 males and 39 females diagnosed with CGCG met the inclusion criteria and were included. The mean age of the study population at diagnosis was 41.8 years. Fifty-three lesions were found in the mandible, with the most frequently involved subsite being the mandibular parasymphysis. Overall, 75.0 % of included CGCGs were unilocular. The most frequent treatment option was surgery alone. A total of 12 recurrences (15.8 %) were observed with a mean follow up of 41 months. DISCUSSION:Further genetic and molecular studies regarding the pathways underlying CGCGs are needed, in order to predict their natural history and to direct non-surgical therapies. In the meantime, surgeons should balance the risks of higher recurrence rates associated with lower surgical morbidity, performing an individualized treatment plan, taking into consideration the clinical and radiological features together with the patients' age and comorbidities. A radiographic follow-up of patients with treated CGCGs could advised for the first 5 years.

INTRODUCTION:Severe odontogenic infections have become a public health issue. Epidemiological data on severe odontogenic infections are limited, and protocols for their management are not standardized and remain debated. The objective of this European multicenter study is to present and discuss the epidemiology and management of severe odontogenic infections. METHODS:All hospitalized and treated cases of severe odontogenic infections at the participating surgical units across Europe between January 1st, 2014, and December 31st, 2023, were recorded. The following data were collected: comorbidities, odontogenic etiology, spaces affected, isolated microorganisms, treatment, duration of hospital stay, and outcome. RESULTS:A total of 6190 patients diagnosed with severe odontogenic infection were included. An older age (p < 0.0001) and the male gender (p = 0.0003) were statistically associated with a longer hospital stay. The presence of comorbidities was not associated with a longer hospital stay or a poorer outcome. Recorded infections originating in the lower premolars and lower molars were associated with a longer hospital stay (p < 0.0001). The most frequently observed microorganisms were Alfa-hemolytic streptococci. The presence of Gram + microorganisms was associated with a longer hospital stay (p < 0.05). Several treatments were administered, with most patients (36.7%) undergoing a course of antibiotics, dental extraction, and an incision and drainage of the abscess. Eleven out of the 6,190 patients (0.18%) died due to a severe odontogenic infection. CONCLUSIONS:Most hospitalized patients with dental infections are previously healthy individuals, predominantly young or middle-aged adults. CLINICAL SIGNIFICANCE:Mandibular molars are the most frequent infectious origin teeth. Despite the potential severity of these infections, mortality rates remain low in Europe.

INTRODUCTION:The purpose of this European multicenter study was to describe and assess the characteristics, diagnosis, management, and recurrence of oral malignant melanoma at different European oral and maxillofacial surgery centers. MATERIALS AND METHODS:This study was based on a systematic computer-assisted database that allowed the recording of data for all primary oral mucosal melanomas treated in the involved surgical units across Europe between January 1, 2003 and December 31, 2022. The following data were recorded for each patient: gender, age, site, TNM staging, metastases, symptoms, imaging features, histopathological features, treatment, complications, recurrence, follow up, and survival. RESULTS:A total of 29 patients (15 females, 14 males) with a primary oral mucosal malignant melanoma fulfilled the inclusion criteria. The mean age was 64.4 years. The most frequent primary site was the vestibular and crestal maxillary gum. Nineteen patients had been diagnosed with a T3 oral melanoma, nine patients with a T4a oral melanoma, and one patient with a T4b neoplasm. Three patients had distant metastases at diagnosis. Clinically, the most frequently observed clinical features were hyperpigmentation, nodular appearance, ulceration, and hemorrhage. Among the 27 surgical cases, radical/clear margins were obtained in 24 cases, non-radical/invaded margins were obtained in two cases, while in one case a non-specific result of margin positivity was found. The overall 2-year survival was 62%. The 2-year disease-free survival was 52%. CONCLUSIONS:Oral mucosal melanoma is an aggressive and often asymptomatic malignancy. The overall long-term survival for patients with oral mucosal melanoma is poor, with a high rate of distant metastasis, independently from the performed treatment. Prevention and early diagnosis could be crucial to improving the disease-free survival of patients with oral mucosal melanomas.

Introduction: Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous condition that includes a spectrum of oral clinical manifestations ranging from mild painless white lesions to painful erosions and ulcers. The purpose of this European multicenter study is to describe the general characteristics of OLP lesions, the clinical and histopathological diagnosis, and the management of OLP at different European Oral Medicine and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the current trends in the treatment of OLP across Europe. Materials and methods: Data and histopathological records of patients with OLP were retrospectively revised and only those patients that fulfilled the diagnostic criteria from the 2016 position paper by American Academy of Oral and Maxillofacial Pathology were included. The following data were recorded for each patient: gender, age, voluptuary habits, risk factors for OLP (psychological stress, medications, systemic diseases), location of OLP lesions, clinical presentation, patterns of clinical expression, symptoms, treatment, possible clinical improvement, and malignant transformation. Results: A total of 565 OLP patients (422 females, 143 males) fulfilled the inclusion criteria. The mean age of the study population at diagnosis was 60.11 years. In 262 patients (46.4 %), just a site of OLP was identified: in 186 of these "one-site" patients, OLP was diagnosed just in buccal mucosa. The most frequently observed clinical pattern was reticular. When evaluating the treatment received, 294 patients were kept in follow up with a Wait-and-see approach. The most frequent treatment regimen was the use of topical corticosteroids (123 patients). A significant statistical association was found between the prescription of topical corticosteroids (P < .0005) or retinoids (P < .000005) and symptoms improvement. Squamous cell carcinoma associated with OLP lesions was observed during the follow-up in 9 OLP patients out of 565(1.6 %). Conclusions: Reticular and mixed clinical patterns are the most frequent subtypes of OLP. The use of topical corticosteroids and retinoids for the management of OLP seems to allow good improvement results of symp-toms and signs. A clinical long-term follow-up is fundamental due to the chronic nature of OLP and possible malignant transformation. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

INTRODUCTIONThe purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe.MATERIALS AND METHODSThe following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence.RESULTSA total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005).CONCLUSIONSA longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions.

INTRODUCTION: The aim of the present article was to review and depict the main radiological features of odontogenic keratocysts (OKCs), thus helping the differential diagnoses from other odontogenic cysts and neoplasms. EVIDENCE ACQUISITION: A review of articles published between January 2000 and October 2020 using Medline and the MeSH Term "odontogenic keratocyst" in combination with the following terms "imaging," "radiology," "panoramic radiograph," and "computed tomography," was performed. EVIDENCE SYNTHESIS: Radiographically, OKCs are well-defined unilocular or multilocular radiolucencies bounded by corticated margins. Most lesions are unilocular; instead, multilocular OKCs represent about the 30% of cases, mainly involving the posterior mandible. When, particularly in large lesions, OKCs display a multilocular presentation with adjacent satellite cysts (daughter cysts) a "soap-bubble appearance" can be recognized. DISCUSSION: Panoramic radiograph and CT still play an important role in the diagnosis and treatment planning of OKCs. Unfortunately, it may not be easy to differentiate OKCs from other odontogenic lesions, especially when they are small and unilocular. CONCLUSIONS: Histopathological findings are still necessary to obtain a definitive diagnosis.

Introduction Odontoma is the most commonly diagnosed odontogenic tumor of the oral cavity. The objective of the present study was to assess the demographic variables, patterns, diagnostic features, and management issues of odontomas treated at several European departments of maxillofacial and oral surgery. Materials and methods This study was conducted at 8 European departments of oral surgery between January 1, 2004, and December 31, 2018. Only patients with odontomas were included. The following data were recorded for each patient: gender, age, comorbidities, site, size of odontomas, radiographic features, type of odontoma, treatment of odontomas, treatment of associated teeth, complications, and recurrence. Results A total of 127 patients (70 male and 57 female patients) with odontomas were included. The mean age was 22 years; 71 odontomas were found in the mandible, whereas 56 in the maxilla. In the mandible, the most frequently involved subsite was the parasymphysis, while in the maxilla, the most common subsite was the upper incisor region. The mean size of included odontomas was 15.3 mm. On the whole, 62 complex odontomas, 50 compound odontomas, and 15 mixed-type odontomas were observed. Complete excision of the odontomas was performed in 121 patients. In 24 patients, the extraction of deciduous teeth was performed, and in 43 patients, one or more permanent teeth were removed. Finally, in 9 patients, a partial excision of the odontoma was performed. Recurrence was observed in 4 cases out of 127 patients. Conclusions Dental practitioners should be aware of the distinct clinical and radiographic features of odontoma in order to perform an appropriate and early diagnosis. Conventional radiography, such as panoramic radiograph, is often sufficient technique for a diagnosis after clinical suspicion or for an incidental diagnosis to prevent later complications, such as impaction or failure of eruption of teeth.

INTRODUCTION The aim of the present article was to review and depict the main radiological features of odontogenic keratocysts, thus helping the differential diagnoses from other odontogenic cysts and neoplasms. METHODS A review of articles published between January 2000 and October 2020 using Medline and the MeSH Term "odontogenic keratocyst" in combination with the following terms 'imaging,' 'radiology,' 'panoramic radiograph,' and 'computed tomography,' was performed. RESULTS Radiographically, OKCs are well-defined unilocular or multilocular radiolucencies bounded by corticated margins. Most lesions are unilocular; instead, multilocular OKCs represent about the 30% of cases, mainly involving the posterior mandible. When, particularly in large lesions, OKCs display a multilocular presentation with adjacent satellite cysts (daughter cysts) a "soap-bubble appearance" can be recognized. CONCLUSIONS Panoramic radiograph and CT still play an important role in the diagnosis and treatment planning of OKCs. Unfortunately, it may not be easy to differentiate OKCs from other odontogenic lesions, especially when they are small and unilocular. Histopathological findings are still necessary to obtain a definitive diagnosis.

The present study aimed at assessing the epidemiology including demographic variables, diagnostic features, and management of ameloblastomas at several European departments of maxillofacial and oral surgery. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, site, size, radiographic features, type, histopathological features, kind of treatment, length of hospital stay, complications, recurrence, management and complications of the recurrence. A total of 244 patients, 134 males and 110 females with ameloblastomas were included in the study. Mean age was 47.4 years. In all, 81% of lesions were found in the mandible, whereas 19% were found in the maxilla. Mean size of included ameloblastomas was 38.9 mm. The most frequently performed treatment option was enucleation plus curettage/peripheral ostectomy in 94 ameloblastomas, followed by segmental resection (60 patients), simple enucleation (46 patients), and marginal resection (40 patients). A recurrence (with a mean follow up of 5 years) was observed in 47 cases out of 244 ameloblastomas (19.3%). Segmental resection was associated with a low risk of recurrence (p = 0003), whereas enucleation plus curettage/peripheral ostectomy was associated with a high risk of recurrence (p = 0002). A multilocular radiographic appearance was associated with a high risk of recurrence (p < .05), as well as the benign solid/multicystic histologic type (p < .05). Within the limitations of the study it seems that the management of ameloblastomas will probably remain controversial even in the future. Balancing low surgical morbidity with a low recurrence rate is a difficult aim to reach.

The objective of the present study was to assess the epidemiology including demographic variables, diagnostic features, and the management of odontogenic keratocyst (OKCs) at several European departments of maxillofacial and oral surgery. This study is based on a systematic computer-assisted database that allowed the recording of data from treated OKCs. The following data were recorded for each patient: gender, age, voluptuary habits, comorbidities, site, size, radiographic features, treatment of OKCs, length of hospital stay, complications, recurrence, management and complications of eventual recurrence. A total of 405 patients, 249 male and 156 female, with 415 OKCs (407 sporadic and 8 syndromic lesions) were included in the study: 320 lesions were found in the mandible, whereas 95 were found in the maxilla. In the mandible, the most frequently involved subsite was the angle, whereas in the maxilla it was the molar region. The most frequently performed treatment option was enucleation plus curettage/peripheral ostectomy in 204 OKCs (recurrence rate, 9%). Decompression without residual cystectomy (recurrence rate, 66%), marsupialization with residual enucleation with the use of Carnoy's solution (recurrence rate, 50%), decompression with residual cystectomy (recurrence rate, 43%), and simple enucleation (recurrence rate, 24%) were the treatment options with the highest recurrence rates. An appropriate management of odontogenic keratocysts should be individualized, taking into consideration clinical and radiological findings, as well as patients' age and comorbidities.

When facial trauma involves elderly patients, the possible presence of frailty and comorbidities in victims of trauma may worsen the posttraumatic symptoms and decrease quality of life. The aim of this multicenter study was to assess the quality of life following surgical or non-operative management of maxillofacial trauma in elderly patients. This cohort study was based on the administration of validated self-administered questionnaires to all the geriatric patients (70 years or more) with facial fractures from the involved maxillofacial surgical units across Europe, since 1st January 2019 to 31st June 2019. The following questionnaires were administered: SF36 questionnaire; the VFQ-25 questionnaire; the Oral Health Impact Profile – 14 (OHIP14). Outcome variables were VFQ-25 and OHIP-14 results. A total of 37 patients (14 male and 23 female patients) met the inclusion criteria and were included in the study. Elderly patients had an improvement in almost all the categories examined by the SF-36 questionnaire 6 months after trauma, with the only exception of a worsening as for role limitations due to physical health. An improvement was observed in almost all the categories at SF-36 test. A worsening of scores of OHIP-14 for all the considered dimensions in the whole study population was observed too. Elderly patients following facial trauma experience significant emotional, social, and functional disturbances. We observed that emotional problems, energy/fatigue, social functioning, and generally social limitations played a great role in the decrease of QoL in elderly patients following maxillofacial trauma.

Management of maxillofacial trauma in the geriatric population poses a great challenge due to anatomical variations and medical comorbidities. The aim of this study was to analyze the management variables, timing, and outcomes of facial fractures in elderly patients (aged 70 years or more) at several European departments of oral and maxillofacial surgery. This study was based on a systematic computer-assisted database that allowed the recording of data from all geriatric patients with facial fractures from the involved maxillofacial surgical units across Europe between 2013 and 2017. A total of 1334 patients were included in the study: 665 patients underwent closed or open surgical treatment. A significant association ( P  < .005) was found between the presence of concomitant injuries and a prolonged time between hospital admission and treatment. The absence of indications to treatment was associated with comorbidities and an older age ( P  < .000005). Elderly patients require specific attention and multidisciplinary collaboration in the diagnosis and sequencing of trauma treatment. A prudent attitude may be kept in selected cases, especially when severe comorbidities are associated and function is not impaired.

INTRODUCTION:Management of body fractures in patients with edentulous atrophic mandibles represents a challenging task due to patient's age, medical comorbidities, poor bone quality, and vascularity, as well as reduced contact area between the fracture ends. The aim of the study was to assess the demographic and clinical variables, the surgical technique, and outcomes of unilateral body fractures of the edentulous atrophic mandible managed at several European departments of oral and maxillofacial surgery.METHODS:This study is based on a systematic computer-assisted database that allowed the recording of data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between 2008 and 2017. The following data were recorded for each patient: gender, age, comorbidities, etiology, synchronous body injuries, degree of atrophy of the mandible according to Luhr classification, type of surgical approach and fixation, length of hospitalization, and presence and type of complications.RESULTS:A total of 43 patients were included in the study: 17 patients' mandibles were classified as class I according to Luhr, 15 as class II, and 11 as class III. All patients underwent open reduction and internal fixation by extraoral approach in 25 patients, intraoral in 15 patients, and mixed in 3 patients. A single 2.0 miniplate was used in 16 patients, followed by a single 2.4 reconstruction plate in 13 patients, by two 2.0 miniplates, and three 2.0 miniplates. Outcome was considered to be satisfying in 30 patients, with no complications. Complications were observed in 13 cases.CONCLUSIONS:Treatment of unilateral body fractures of the edentulous mandible must still be based on the type of fracture, degree of atrophy, experience of the surgeon, and patients' preference. An adequate stability can be obtained by different plating techniques that have to be appropriately tailored to every single specific patient.

Introduction: The objective of the present study was to assess the demographic variables, causes, and patterns of edentulous atrophic fractures of the mandible managed at several European departments of oral and maxillofacial surgery. The results of this multicenter collaboration over a 10-year period are presented. Methods: The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017 were recorded: gender; age; voluptuary habits; comorbidities; etiology; fracture sites; synchronous body injuries; atrophy of the mandible according to Luhr classification; eventual type of treatment; timing of the eventual surgery; length of hospital stay. Results: A total of 197 patients (86 male and 111 female patients) with 285 mandibular fractures were included in the study. Mean age of the study populationwas 75 years. Statistically significant associations were found between Luhr classes I - II and condylar fractures on one hand (p <.0005), and between Luhr class III and body and parasymphyseal fractures on the other hand (p <.05). Finally, 135 patients underwent open reduction and internal fixation, 56 patients did not undergo any intervention, and 6 patients underwent closed reduction. No statistically significant association was observed between treatment, timing of treatment, comorbidities, and concomitant injuries. Conclusions: The management of edentulous atrophic mandibular fractures remains challenging. Treatment decisions should continue to be based on the clinician's previous experience and on the degree of bone resorption in edentulous mandible in relation to fracture subsites. (C) 2019 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

INTRODUCTION:Treatment of condylar fractures in patients with atrophic edentulous mandibles is a peculiar field that has been little considered in the literature. The aim of the study was to assess the demographic and clinical variables as well as management and outcome of mandibular condylar fractures in edentulous patients with atrophic mandibles that were treated at several European departments of oral and maxillofacial surgery. METHODS:The data of all patients with fractures of the atrophic edentulous mandible from the involved maxillofacial surgical units across Europe between January 1, 2008, and December 31, 2017. Only patients that were diagnosed with condylar fractures of the edentulous atrophic mandible were included. RESULTS:A total of 52 patients met the inclusion criteria and were included in the study: 79% of patients reported one or more comorbidities. Thirty-four unilateral neck or subcondylar fractures, 9 bilateral neck or subcondylar condylar fractures, 7 unilateral head condylar fractures, and 2 bilateral head condylar fractures were diagnosed. No treatment was performed in 37 cases, whereas in 4 patients a closed treatment was decided, and 11 patients underwent open reduction and internal fixation. Outcome was considered to be satisfying in 48 patients, with no complications. CONCLUSIONS:The golden rule still remains that the diagnosis of a subcondylar or neck fracture in an edentulous patient should constitute an indication for open reduction and internal fixation. However, an appropriate choice of management options has to be individualized on a case by case basis, also depending on the patient consent.

OBJECTIVE:The aim of this study was to analyze the complications and outcomes of surgical treatment of angle fractures managed at departments of maxillofacial surgery in several European countries.STUDY DESIGN:Patients hospitalized with unilateral isolated angle fractures between 2013 and 2017 were included. The following data were recorded: gender and age of patients, fracture etiology, presence of the third molar, maxillomandibular fixation, osteosynthesis technique, and complications.RESULTS:In total, 489 patients were included in the study. The Champy technique was found to be the most frequently chosen osteosynthesis technique. Sixty complications were observed, at a rate of 12.3%. Complications were associated with the absence of third molars (P < .05). Instead, the Champy technique was associated with fewer complications (P < .05), in comparison with the other adopted techniques.CONCLUSIONS:The management of angle fractures still represents a challenging task with a significant complication rate. The Champy technique still seems to be a valid option for the treatment of such injuries.

PurposeFractures of the zygomaticomaxillary complex (ZMC) are common injuries that may lead to loss of an aesthetically pleasing appearance and functional impairment. The aim of this study was to analyze the demographics, causes, characteristics, and outcomes of zygomatic fractures managed at several European departments of oral and maxillofacial surgery.Materials and methodsThis study is based on a multicenter systematic database that allowed the recording of all patients with ZMC fractures between 1 January 2013 and 31 December 2017. The following data were recorded: gender, age, personal medical history, etiology, side of zygomatic fracture, classification of ZMC fracture, associated maxillofacial fractures, symptoms at diagnosis, type of performed treatment, and sequelae/complications.ResultsA total of 1406 patients (1172 males, 234 females) were included in the study. Statistically significant correlations were found between assault-related ZMC fractures and the A3 class (p < .0000005) and between Infraorbital Nerve (ION) anesthesia and B class (p < .00000005).ConclusionThe most frequent cause of ZMC fractures was assault, followed by falls. The most frequently involved decade of age was between 20 and 29 years. The decision and type of surgical treatment of ZMC fractures depends on several issues that need to be considered on a case by case basis.

Tooth extraction causes transitory bacteremia, which was first described by Okell and Elliott in 1935. [1] Historically, several different authors have been pursuing the subject of bacteremia following open extraction. [2-4] Chlorhexidine mouthwashes have a pronounced antimicrobial effect on salivary microflora [5,6] and supragingival plaque [7], as suggested by evidences in the literature. Therefore, the notion exists, that such mouthwashes can be used prior to oral surgical procedures in order to reduce the number of bacteria in the mouth, and hence – the number of bacteria, which enter the circulation. However, scientific evidences on the effect of chlorhexidine – the most thoroughly studied antiseptic for prevention of bacteremia after dental procedures – are conflicting. [8-10] Aim of the present study is to investigate the effect of preoperative rinsing with 0.2% chlorhexidine digluconate on the bacteremia following open extraction of tooth.