New Advances and Challenges in Oral and Maxillofacial Surgery

Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive therapy. Although several local and systemic risk factors have been documented, the role of metabolic biomarkers and their relationship with clinical characteristics remains insufficiently investigated. The aim of the present study was to evaluate the relationships between antiresorptive therapy, serum vitamin D levels, demographic characteristics, and lesion location in patients diagnosed with MRONJ. Materials and Methods: This retrospective study included 72 patients diagnosed with MRONJ, divided into three groups according to the antiresorptive therapy administered: zoledronic acid (n = 30), denosumab (n = 22), and oral bisphosphonates (n = 20). Clinical and demographic data, including age, sex, smoking status, serum vitamin D levels, number of extracted teeth, lesion location (mandibular versus maxillary), and associated comorbidities, were obtained from medical records. Statistical analysis was performed using Welch’s ANOVA, Welch’s t-test, chi-square, Fisher’s exact, and Pearson and Spearman correlation analyses. Results: No significant differences in serum vitamin D levels were observed among the three antiresorptive therapy groups. However, patients with mandibular MRONJ had significantly lower serum vitamin D levels than those with maxillary involvement (p = 0.046). Lower serum vitamin D levels were independently associated with mandibular MRONJ after multivariable adjustment. Female sex and thyroid disease were more frequent in the oral bisphosphonate group. Additionally, patient age was moderately positively correlated with the number of extracted teeth (r = 0.440, p < 0.001). Conclusions: This retrospective study identified a possible association between lower serum vitamin D levels and mandibular MRONJ. Given the observational design of the study, these findings should be interpreted with caution and require confirmation in larger prospective studies. Full article

Background and Objectives: Temporomandibular disorders (TMDs) encompass a broad spectrum of functional and structural abnormalities of the temporomandibular joint (TMJ). Conventional diagnostic tools, although essential, often fail to capture the underlying biochemical mechanisms driving disease progression. Synovial fluid (SF), by virtue of its direct proximity to intra-articular tissues, represents an accessible biological matrix for identifying molecular signatures of inflammation, cartilage degradation, lubrication failure, oxidative stress, and angiogenic activation. The objective of this review is to synthesize current evidence on SF proteomics in TMD and evaluate its potential translational value in precision medicine. Materials and Methods: A narrative review of the literature was conducted on PubMed to identify human studies focused on SF proteomic and biochemical biomarkers in TMD. Eligible studies included original research articles assessing SF composition in relation to specific TMJ pathologies, diagnostic categories, or clinical phenotypes. Extracted data included study design, sample characteristics, analytic methodology, biomarkers investigated, and key findings. Google Gemini (Google LLC, Mountain View, CA, USA) was used as an AI-assisted tool to support language editing and manuscript writing during the preparation of this article. The use of this tool was limited to linguistic refinement; all scientific content, data interpretation, and conclusions were formulated and verified by the authors. Results: Across the analyzed studies, TMD phenotypes—particularly disc displacement with or without reduction (DDwR, DDwoR) and osteoarthritis (OA)—were characterized by consistent alterations in cytokines (IL-1β, IL-6, IL-8, TNF-α), extracellular matrix (ECM) components (aggrecan, glycosaminoglycans (GAGs), decorin, MMP-2, MMP-9), lubrication molecules (lubricin/PRG4), oxidative stress mediators (myeloperoxidase (MPO), nitric oxide (NO), glutathione peroxidase (GPX)), adipokines (chemerin, resistin, adiponectin), and angiogenic factors (vascular endothelial growth factor (VEGF), fibroblast growth factor-2 (FGF-2)). Recent liquid chromatography–tandem mass spectrometry (LC–MS/MS) analyses further revealed phenotype-specific protein clusters and pathways related to inflammation, ferroptosis, hypoxia signaling, and proteoglycan metabolism. Conclusions: Current evidence suggests that SF proteomics and multi-analyte biomarker profiling offer a promising, hypothesis-generating approach for understanding the biological mechanisms underlying TMD. The integration of proteomic, metabolic, and inflammatory markers holds future potential for diagnostic panel development; however, prospective clinical validation is still required before SF-based molecular profiling can be implemented as a precision medicine tool in TMJ disorders. Full article

Background and Objectives: Presurgical infant orthopedics aims to reduce cleft severity and facilitate primary surgical repair during the early neonatal period, when increased tissue plasticity enhances molding. Nasoalveolar molding is widely used but requires intraoral appliances, laboratory support, specialized training, and frequent follow-up visits, which may limit accessibility and adherence. This case series reports the clinical application of presurgical lip–alveolus–nose approximation (PLANA), an extraoral technique for early presurgical cleft management, and describes the clinical changes observed during treatment in four infants. Materials and Methods: A prospective case series conducted in neonates with non-syndromic unilateral or bilateral cleft lip and/or palate referred within the first 10 days of life to the Alabama Cleft Center. Treatment consisted of a prefabricated silicone nasal aligner combined with hydrocolloid lip adhesive taping. No intraoral plates or dental impressions were used. Devices were worn 20 to 22 h daily. Follow up occurred every 2 to 4 weeks, with remote monitoring used when appropriate. Qualitative clinical observations focused on apparent changes in nasal symmetry, columellar length, septal alignment, nasal tip projection, premaxillary position, nostril dimensions, alar base width, cleft width, and lip approximation, as well as feeding tolerance, skin tolerance, and treatment adherence. These observations were assessed qualitatively through serial clinical examinations and clinical photographs; no standardized quantitative morphometric measurements were performed. Results: Four infants with complete unilateral or bilateral cleft lip and palate received PLANA treatment. Serial clinical examinations and photographs documented qualitative changes in nasolabial morphology over the course of treatment in all four patients. Qualitative clinical assessment of serial photographs and examinations suggested greater apparent nasal symmetry, apparent columellar elongation, more central-appearing nasal alignment, increased apparent nasal tip projection, apparent cleft-width reduction, and progressive lip approximation. In unilateral clefts, changes were observed in both the cleft and non-cleft nasal sides, while bilateral clefts demonstrated changes in nasal morphology bilaterally. No device-related complications or clinically significant skin intolerance were documented during the reported treatment periods. Parent-reported device wear was approximately 20–22 h per day. Conclusions: In this four-patient prospective descriptive case series, PLANA was applied clinically, with no clinically significant treatment-related complications documented during the reported treatment periods. Serial clinical observations suggested changes in nasolabial morphology during treatment. Given the small sample size, absence of a contemporaneous control group, and qualitative nature of the assessments, these findings should be interpreted as preliminary and hypothesis-generating rather than as evidence of treatment efficacy or comparative effectiveness. Larger prospective, multicenter comparative studies incorporating standardized quantitative measurements, objective adherence assessment, and long-term surgical and aesthetic outcomes are needed to evaluate the effectiveness, reproducibility, and clinical applicability of the PLANA approach. Full article