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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Dentistry and Oral Health".

Deadline for manuscript submissions: 31 May 2026 | Viewed by 22845

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Special Issue Editors

Dr. Luca Aquilanti

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Guest Editor

Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy
Interests: dentistry; oral and maxillofacial surgery

Dr. Giorgio Rappelli

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Guest Editor

Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy
Interests: dentistry; prosthetic dentistry; oral rehabilitation
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Special Issue Information

Dear Colleagues,

We are honored to be the Guest Editors of this Special Issue, entitled In recent years, Oral and Maxillofacial Surgery has experienced significant advancements in materials, techniques, and technology. These significant achievements have resulted in many clinical benefits, that enhanced diagnostic accuracy, allowed to formulate more precise treatment plans, and improved treatment predictability, safety, and efficiency, as well as overall patients’ experience. We have identified four main domains that, as health professionals, we should always consider during our clinical practice: 1. patient centrality, 2. treatment efficacy, 3. treatment effectiveness, and 4. quality of care. These concepts should be applied in all medical fields, including Oral and Maxillofacial Surgery.

This Special Issue welcomes all kinds of research papers aimed at proposing, describing, and evaluating novel procedures and approaches in Oral and Maxillofacial Surgery, intended to enhance the above-described domains.

Dr. Luca Aquilanti
Dr. Giorgio Rappelli
Guest Editors

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Keywords

guided bone regeneration
CAD–CAM technology
digital dentistry
digital maxillofacial surgery
biomaterials
maxillofacial reconstructive surgery
novel medical devices

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Published Papers (9 papers)

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Research

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17 pages, 2270 KB

Open AccessArticle

Guided Implant Surgery in Oral Cancer Patients: Initial Clinical Experience from an Academic Point-of-Care Manufacturing Unit

by Manuel Tousidonis, Jose-Ignacio Salmeron, Santiago Ochandiano, Ruben Perez-Mañanes, Estela Gomez-Larren, Elena Aguilera-Jimenez, Carla de Gregorio-Bermejo, Diego Fernández-Acosta, Borja Gonzalez-Moure, Saad Khayat and Carlos Navarro-Cuellar

Medicina 2026, 62(1), 151; https://doi.org/10.3390/medicina62010151 - 12 Jan 2026

Viewed by 750

Abstract

Background and Objectives: Implant-supported rehabilitation after oral cancer surgery remains technically and biologically demanding due to altered anatomy, scar tissue, and prior radiotherapy. Digital workflows and hospital-based point-of-care (POC) manufacturing now enable personalized, prosthetically driven implant placement with static surgical guides fabricated within the clinical environment. This study reports the initial clinical experience of an academic POC manufacturing unit (UPAM3D) implementing static guided implant surgery in oral cancer patients and compares this approach with conventional outsourcing and dynamic navigation methods. Materials and Methods: A retrospective review of 30 consecutive cases (2021–2024) treated with POC-manufactured static guides was conducted using data from the UPAM3D registry. Each record included design, fabrication, and sterilization parameters compliant with ISO 13485 standards. Demographic, surgical, and prosthetic variables were analyzed, including anatomical site (maxilla or mandible), guide type, material, radiotherapy history, number of Ticare Implants^®, and loading strategy. Results: All surgical guides were designed and 3D printed in-house using biocompatible resins (BioMed Clear, Dental SG, or LT Clear). The annual number of POC procedures increased progressively (2 → 6 → 6 → 16). Most cases involved oncologic reconstructions of the maxilla or mandible, including irradiated fields. When recorded, primary stability values (mean ISQ ≈ 79) allowed immediate or early loading (ISQ ≥ 70). No major intraoperative or postoperative complications occurred, and all guides met sterilization and traceability standards. Conclusions: Point-of-care manufacturing enables efficient, accurate, and patient-specific guided implant rehabilitation after oral cancer surgery, optimizing functional and esthetic outcomes while reducing procedural time and dependence on external providers. Integrating this process into clinical workflows supports personalized treatment planning and broadens access to advanced implant reconstruction within multidisciplinary oncology care. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

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12 pages, 309 KB

Open AccessArticle

Impact of the COVID-19 Pandemic on Pathological Stage, Tumor Characteristics and Surgical Outcomes of Oral Squamous Cell Carcinoma: A Retrospective Analysis

by Samer Omari, Murad AbdelRaziq, Kutaiba Alkeesh, Alaa Muhana, Imad Abu El-Naaj and Yasmin Ghantous

Medicina 2025, 61(12), 2225; https://doi.org/10.3390/medicina61122225 - 17 Dec 2025

Viewed by 816

Abstract

Background and Objectives: Oral Squamous Cell Carcinoma (OSCC) requires early diagnosis for favorable outcomes, but global healthcare disruptions caused by the COVID-19 pandemic severely affected cancer care delivery. This study aimed to investigate the pandemic’s influence on OSCC pathological staging and disease-related characteristics at a single medical center. Materials and Methods: A retrospective study was conducted on 148 patients who underwent curative-intent surgery for newly diagnosed OSCC between March 2018 and October 2024. Patients were stratified into a Pre-COVID-19 group (March 2018–January 2020, N = 52) and a Post-COVID-19 group (February 2020–October 2024, N = 96). Patient demographics and risk factors were compared using Chi-squared and Wilcoxon rank-sum tests, while pathological stage, Depth of Invasion (DOI), and surgical outcomes were analyzed. Results: Patient demographics, risk factors, and comorbidities were comparable between the two groups. The Post-COVID-19 cohort presented with significantly more advanced pathological disease, evidenced by an increase in overall TNM stage, including a dramatically higher rate of Stage 4 diagnosis (35% vs. 3.2% in the Pre-COVID-19 group). This group also showed a significantly higher Depth of Invasion (median DOI: 5.0 mm vs. 3.0 mm). Consequently, the Post-COVID-19 group required more aggressive treatment (e.g., higher rates of adjuvant radiotherapy) and experienced worse short-term outcomes, including significantly longer hospitalization (median 15 days vs. 6 days) and higher rates of postoperative pulmonary infection and tracheostomy. Conclusions: The COVID-19 pandemic was associated with a dramatic shift toward the diagnosis of OSCC at advanced pathological stages. This diagnostic delay necessitated more complex surgical management and resulted in significantly worse short-term outcomes. These findings underscore the urgent need for resilient strategies to prevent systemic diagnostic delays during public health crises. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

13 pages, 1843 KB

Open AccessArticle

The Positional Relationship Between the Mandibular Canal and the Lower Third Molar Determined on Cone-Beam Computed Tomography

by Horatiu Urechescu, Ancuta Banu, Marius Pricop, Felicia Streian, Alisia Pricop and Cristiana Cuzic

Medicina 2025, 61(7), 1291; https://doi.org/10.3390/medicina61071291 - 17 Jul 2025

Viewed by 4372

Abstract

Background and Objectives: The extraction of mandibular third molars poses challenges due to their proximity to the mandibular canal and risk of inferior alveolar nerve (IAN) injury. Accurate preoperative evaluation is essential to minimize complications. This study assessed the three-dimensional positional relationship between the mandibular canal and lower third molars using cone-beam computed tomography (CBCT), aiming to identify anatomical positions associated with increased surgical risk. Materials and Methods: This retrospective study analyzed 253 CBCT scans of fully developed lower third molars. The mandibular canal position was classified as apical (Class I), buccal (Class II), lingual (Class III), or interradicular (Class IV). Contact was categorized as no contact, contact with a complete or defective white line, or canal penetration. In no-contact cases, the apex–canal distance was measured. Statistical analysis included descriptive and contingency analyses using the Chi-Square Likelihood Ratio test. Results: Class I was most common (70.8%) and presented the lowest risk, while Classes III and IV showed significantly higher frequencies of canal contact or penetration. Class II exhibited shorter distances even in no-contact cases, suggesting residual risk. Statistically significant associations were found between canal position and both contact type (p < 0.001) and apex–canal distance (p = 0.046). Conclusions: CBCT offers valuable insight into the anatomical relationship between third molars and the mandibular canal. High-risk positions—particularly lingual and interradicular—require careful assessment. Even in the absence of contact, close proximity may pose a risk and should inform surgical planning. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

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15 pages, 1168 KB

Open AccessArticle

Epidemiological Overview and Traits into Disorders of the Orbital Walls in North-Eastern Romania

by Ștefan Gherasimescu, Daniela Șulea, Petrica Florin Sava, Alexandra Carp, Lidia Cureniuc, Mihai Liviu Ciofu, Otilia Boișteanu, Marius Gabriel Dabija and Victor Vlad Costan

Medicina 2025, 61(6), 953; https://doi.org/10.3390/medicina61060953 - 22 May 2025

Viewed by 1314

Abstract

Background and Objectives: This study aimed to assess the frequency and distribution of facial bone injuries in terms of age, sex, residence, location, and etiology in the north-eastern region of Romania. Materials and Methods: This retrospective study was conducted within the Oral and Maxillofacial Clinics of “Sf. Spiridon” Hospital, Iași. The study group included 701 subjects (mean age 41.02 ± 18.45; sex: 603 males and 98 females) who were diagnosed with an orbital wall disorder. The epidemiological data on orbital wall fractures—including sociodemographic features, etiology, and location—were statistically analyzed. Results: The prevalence of orbital pathology was 1.47% congenital cases, 1.75% tumors, and 96.7% orbital fractures. The distribution of sex, age group, residence, and orbital localization varied significantly among the three diagnostic categories: tumors, congenital conditions, and fractures. Regarding sex, fractures were significantly more frequent in males (87.0%) compared to congenital cases (70.0%) and tumors (41.7%), while tumors showed a female predominance (58.3%) (p < 0.001). Congenital conditions predominantly affected patients under 20 years old (90.0%), whereas fractures were more evenly distributed across age groups, with higher frequencies between 31 and 50 years. In contrast, tumors involving the orbital walls were more frequent in older patients, with 33.3% in the 61–70 age group and 25.0% over 70 years. Regarding orbital localization, fractures were more likely to be bilateral (37.3%) or on the right side (44.3%), whereas congenital orbital defects and orbital tumors were predominantly unilateral and left-sided (70.0% and 66.7%, respectively). Bilateral involvement was rare in congenital cases (10.0%) and absent in tumors. Conclusions: The data support the finding that men are significantly more prone to trauma and orbital fractures, especially as a result of interpersonal violence and accidents, highlighting the need for preventive measures tailored to sex and socio-professional context. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

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9 pages, 259 KB

Open AccessArticle

Analysis of Postoperative Bleeding After Oral Surgery in Patients Receiving Anticoagulants: A Retrospective Study

by Jae-Il Lee, Hyejun Seo, Yeong-Cheol Cho, Jang-Ho Son and Iel-Yong Sung

Medicina 2025, 61(3), 425; https://doi.org/10.3390/medicina61030425 - 28 Feb 2025

Cited by 4 | Viewed by 3583

Abstract

Background and Objectives: Patients taking anticoagulants, particularly warfarin and non-vitamin K oral anticoagulants (NOACs), face an elevated risk of postoperative bleeding during minor oral surgeries, highlighting the urgent need to identify reliable predictors for bleeding complications. In this study, we evaluated the effectiveness of predictors of bleeding complications in patients receiving anticoagulants who underwent minor oral surgeries. Materials and Methods: The electronic medical and dental records of 206 patients who underwent oral surgery at the University of Ulsan Hospital between 2015 and 2023 were retrospectively reviewed. Patients were categorized into those taking warfarin and those taking NOACs, and postoperative bleeding was determined. Risk factors were statistically analyzed using the chi-square or Fisher’s exact test and Student’s t-test. Results: Among the 206 patients (86 on warfarin, 120 on NOACs), 84 (36 on warfarin, 48 on NOACs) experienced bleeding complications following their procedures. Time in the therapeutic range (TTR) and international normalized ratio (INR) values were significantly associated with bleeding complications in the warfarin group, while the type of NOAC was associated with bleeding in the NOAC group. Perioperative bleeding was significantly correlated with postoperative bleeding in both groups. Conclusions: Taken together, these findings highlight the correlations between postoperative bleeding and specific factors associated with anticoagulant drugs in patients that underwent oral surgery. Identifying these predictors can improve patient management by enhancing pre- and perioperative assessments, reducing the risk of bleeding, and optimizing surgical outcomes. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

11 pages, 6307 KB

Open AccessArticle

The TACOS Technique: A Stepwise Protocol for Alveolar Ridge Augmentation Using Customized Titanium Mesh

by Mauro Merli, Luca Aquilanti, Marco Merli, Giorgia Mariotti and Giorgio Rappelli

Medicina 2025, 61(1), 58; https://doi.org/10.3390/medicina61010058 - 2 Jan 2025

Cited by 4 | Viewed by 4102

Abstract

Background: Alveolar ridge resorption following tooth loss poses a significant challenge for successful dental implant placement. In cases of severe atrophy, bone augmentation is required to restore sufficient bone volume. This technical note outlines a detailed, stepwise surgical protocol for horizontal and vertical alveolar ridge augmentation using customized titanium mesh. Materials and Methods: The procedure includes precise mesh fitting, autologous bone grafting, and the application of bioactive agents to promote bone regeneration. Emphasis is placed on the technique’s feasibility, predictability, and the critical steps necessary for preventing complications. Results: The use of customized mesh ensures stability and improved bone regeneration outcomes, enabling clinicians to achieve successful implant placement even in severely atrophic ridges. Conclusions: The described protocol has demonstrated predictable results in both clinical and radiographic evaluations, offering an effective solution for complex bone augmentation cases. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

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Review

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55 pages, 2022 KB

Open AccessReview

Post-COVID-19 Jaw Osteonecrosis: A Narrative Review

by George Cătălin Alexandru, Loredana-Neli Gligor, Doina Chioran, Ciprian I. Roi, Mircea Riviș, Marius Octavian Pricop, Andrei Urîtu, Aliteia-Maria Pacnejer, Horațiu Cristian Manea and Tudor Rareş Olariu

Medicina 2026, 62(4), 641; https://doi.org/10.3390/medicina62040641 - 27 Mar 2026

Cited by 1 | Viewed by 1028

Abstract

Background and Objectives: Osteonecrosis of the jaw (ONJ) occurring after infection with SARS-CoV-2 has emerged as an increasingly reported complication in the post-COVID-19 era. Post-COVID-19 osteonecrosis of the jaw (PC-ONJ) has been described in association with both COVID-19-associated mucormycosis (CAM) and non-fungal phenotypes. This narrative review aims to synthesize and critically analyze the available evidence regarding terminology and classification, epidemiology and risk factors, pathophysiological mechanisms, clinical and imaging characteristics, diagnostic challenges, and management strategies relevant to oral and maxillofacial surgery practice. Materials and Methods: An extensive literature search was conducted in the PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and Google Scholar databases. The search targeted peer-reviewed publications published between 2020 and 2025, reflecting the post-pandemic emergence of this clinical spectrum. Original studies, systematic and narrative reviews, multicenter case series, consensus guidelines, and well-documented case reports were considered. Results: Available data, largely derived from case reports and small series, demonstrate a predominance of maxillary involvement and frequent association with diabetes mellitus and systemic corticosteroid therapy. Proposed mechanisms include COVID-19-associated endothelial dysfunction, microvascular thrombosis, immune dysregulation, metabolic imbalance, and treatment-related effects. Clinically, patients may present with persistent orofacial pain, tooth mobility, exposed or probeable bone, and frequent sinonasal extension, with symptoms sometimes preceding bone exposure. Diagnostic challenges arise from the overlap with medication-related osteonecrosis of the jaw (MRONJ), osteoradionecrosis (ORN), and chronic osteomyelitis. Imaging is essential for assessing disease extent but remains insufficient for etiologic differentiation, making histopathological examination and targeted microbiological investigations necessary, particularly to exclude invasive fungal infection. Conclusions: Management must be etiology-driven. CAM requires urgent antifungal therapy combined with surgical debridement, whereas non-fungal forms are generally managed with conservative surgery and appropriate antimicrobial stewardship. Standardized diagnostic criteria and prospective multicenter studies are needed to reduce nosological ambiguity and optimize clinical decision-making in this emerging post-viral condition. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

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16 pages, 602 KB

Open AccessReview

Clinical Applications and Efficacy of Cyanoacrylates in Oral Surgery and Periodontology: A Scoping Review

by Davide Gerardi, Pierangelo Burdo, Ilser Turkyilmaz, Francesca Diomede, Gustavo Duarte Mendes, Maurizio Piattelli and Giuseppe Varvara

Medicina 2025, 61(7), 1286; https://doi.org/10.3390/medicina61071286 - 17 Jul 2025

Cited by 4 | Viewed by 2049

Abstract

Background and Objectives: Cyanoacrylate (CA) tissue adhesives have gained increasing attention as alternatives to sutures in oral surgery and periodontology. The objective of this scoping review is to assess their clinical applications and effectiveness in wound closure and postoperative management. Materials and Methods: The review was conducted following the JBI methodology and PRISMA-ScR guidelines. A comprehensive search was performed in PubMed, Scopus, and Web of Science to identify randomized controlled trials published between 2015 and 2025 evaluating the use of CAs in oral surgery and periodontal procedures. Results: A total of 19 studies were included. Cyanoacrylate adhesives demonstrated comparable or superior outcomes to other wound healing strategies in terms of operative time, postoperative pain reduction, and early wound healing. Their use was particularly beneficial in free gingival grafts and palatal donor site management. However, the findings across studies were not always consistent, and some trials did not report statistically significant differences. The use of long-chain CA formulations is associated with minimal toxicological risk, though these adhesives demonstrate intrinsic hemostatic and antimicrobial effects. Conclusions: Cyanoacrylate tissue adhesives represent a valid alternative to sutures in several dental surgical contexts, especially in procedures involving mucogingival grafts. Further high-quality clinical studies are needed to clarify their long-term outcomes and broaden their indications in dentistry. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

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Other

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15 pages, 1995 KB

Open AccessSystematic Review

The Comparative Efficacy of Burs Versus Piezoelectric Techniques in Third Molar Surgery: A Systematic Review Following the PRISMA Guidelines

by Rocco Franco, Mattia Di Girolamo, Carlo Franceschini, Sofia Rastelli, Mario Capogreco and Maurizio D’Amario

Medicina 2024, 60(12), 2049; https://doi.org/10.3390/medicina60122049 - 12 Dec 2024

Cited by 5 | Viewed by 3645

Abstract

Background and Objectives: Third molar (wisdom tooth) extraction is one of the most common surgical procedures in oral and maxillofacial surgery. Traditional rotary instruments and burs have long been the standard tools for this procedure. However, recent advancements in surgical techniques, such as piezoelectric surgery, have gained popularity due to their purported advantages in terms of precision, safety, and postoperative outcomes. This systematic review aims to evaluate the efficacy, safety, and clinical outcomes of third molar surgery performed using burs versus piezoelectric surgery. Materials and Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using the PubMed, Scopus, Web of Science, and Cochrane databases to identify relevant studies published up until October 2024. Randomized controlled trials (RCTs), clinical trials, and comparative studies assessing third molar surgery using either burs or piezoelectric instruments were included. The primary outcomes evaluated were surgical time, postoperative pain, swelling, nerve damage, and healing time. The data extraction and quality assessment were performed independently by two reviewers using standardized tools, and any discrepancies were resolved by a third reviewer. Results: A total of five studies met the inclusion criteria, and the meta-analysis revealed that piezoelectric surgery resulted in significantly lower postoperative pain and swelling compared to traditional bur techniques (p < 0.05). Additionally, the incidence of nerve injury was lower in the piezoelectric group, though the difference was not statistically significant. Surgical time was found to be longer with piezoelectric devices, but this was offset by improved healing outcomes and patient comfort. Conclusions: Piezoelectric surgery offers a less traumatic alternative to traditional burs for third molar extraction, with reduced postoperative morbidity and enhanced patient outcomes. Although the longer surgical duration may be a drawback, the overall benefits, particularly in terms of pain management and tissue preservation, support the adoption of piezoelectric techniques in clinical practice. Further high-quality randomized trials are recommended to strengthen the evidence base for these findings. Full article

(This article belongs to the Special Issue Research on Oral and Maxillofacial Surgery)

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