Search Results (59)

Orthognathic surgery (OS) is a complex procedure commonly used to treat dentofacial deformities (DFDs). These conditions, related to jaw position or size and often involving malocclusion, affect approximately 15% of the population. Due to the complexity of OS, accurate planning is essential. Digital assessment using computer-aided design (CAD) and computer-aided manufacturing (CAM) tools enhances surgical predictability. However, limitations in soft tissue simulation often require surgeon input to optimize aesthetic results and minimize surgical impact. This study aimed to evaluate the accuracy of virtual surgery planning (VSP) by analyzing the relationship between planning deviations and surgical satisfaction. A single-center, retrospective study was conducted on 16 patients who underwent OS at San Pedro University Hospital of La Rioja. VSP was based on CT scans using Dolphin Imaging software (v12.0, Patterson Dental, St. Paul, MN, USA) and surgeries were guided by VSP-designed occlusal splints. Outcomes were assessed using the Orthognathic Quality of Life (OQOL) questionnaire and deviations were measured through pre- and postoperative imaging. The results showed high satisfaction scores and good overall outcomes, despite moderate deviations from the virtual plan in many cases, particularly among Class II patients. A total of 63% of patients required VSP modifications due to poor soft tissue fitting, with 72% of these being Class II DFDs. Most deviations involved less maxillary advancement than planned, while maintaining optimal occlusion. This suggests that VSP may overestimate advancement needs, especially in Class II cases. No significant differences in satisfaction were observed between patients with low (<2 mm) and high (>2 mm) deviations. These findings support the use of VSP as a valuable planning tool for OS. However, surgeon experience remains essential, especially in managing soft tissue behavior. Improvements in soft tissue prediction are needed to enhance accuracy, particularly for Class II DFDs. Full article

Background: Vertical ridge augmentations (VRAs), including guided bone regeneration (GBR) techniques, have been utilized in the reconstruction of deficient alveolar ridges for quite some time. GBR-based VRA procedures are technique-sensitive, operator-dependent, and often lead to complications detected during or after the treatment. The main objective of this systematic review was to include randomized and non-randomized human studies that investigated the regenerative outcome differences, as well as the incidence rates of healing and surgical complications of titanium meshes and/or titanium-reinforced membranes with and without collagen membranes utilized in GBR-based VRA. Methods: This systematic review has been prepared and organized according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines and is registered at PROSPERO (Registration ID: CRD420251002615). Medline via PubMed, Scopus, Web of Science, Embase, and the Cochrane Library were searched for eligible studies up to 5 June 2025. Randomized and non-randomized human clinical studies, except for case reports, focused on applying titanium meshes or titanium-reinforced membranes with or without collagen membranes in GBR-based VRA, were eligible. Results: A total of 119 patients from three human randomized clinical trials (RCTs) and one case series reported across nine articles were included. The addition of collagen membranes causes no significant differences in vertical bone gain or surgical/healing complication rates. Conclusions: The addition of collagen membranes on top of titanium meshes and titanium-reinforced membranes might not be necessary in GBR-based VRA. Further human RCTs are required to reach a reliable conclusion. Full article

Background/Objectives: Arthroscopy and arthrocentesis are routinely performed for temporomandibular joint (TMJ) disorders, but high-quality evidence regarding their efficacy relative to each other is scarce. The current study, as part of an ongoing randomized controlled trial, aimed to compare office-based arthroscopic lysis and lavage with arthrocentesis for TMJ pain and dysfunction. Methods: Adults (≥18 years old) referred to a tertiary care hospital with TMJ arthralgia were included. The exclusion criteria comprised systemic rheumatic disease, connective tissue disease, bony ankylosis, congenital or acquired dentofacial deformities, a history of significant jaw trauma, or systemic illnesses. The primary outcome was joint pain during mandibular movement/function (visual analog scale (VAS); 0–100 mm). The secondary outcomes included pain at rest (VAS), maximum mouth opening (mm), maximum mouth opening without increased pain (mm), protrusive and lateral movements (mm), joint noises (absent/present), and mandibular function (mandibular function impairment questionnaire score). The outcomes were registered at baseline and 3-, 6-, and 12-month follow-ups. Linear mixed models and mixed-effects logistic regressions were utilized to evaluate the effects of interventions on the repeated outcome measurements. Results: Twenty subjects were randomly allocated to office-based arthroscopic lysis and lavage (n = 10) or arthrocentesis (n = 10). Multivariable mixed-effects models showed significantly higher pain scores during mandibular movement/function in the arthrocentesis group compared with arthroscopy (22.42 mm (95% CI: 5.28 to 39.57); p = 0.011). The secondary outcomes were not significantly different between the interventions. Conclusions: The preliminary results show the superiority of office-based arthroscopy over arthrocentesis in reducing pain during mandibular movement/function over a follow-up period of 1 year while showing no differences between interventions regarding other study outcomes. Full article

Objectives: The synergistic effect of shock wave-enhanced emission photoacoustic streaming (SWEEPS) and antimicrobial photodynamic therapy (aPDT) in mandibular molar root canal disinfection remains underexplored, particularly against dual-species biofilms that better simulate clinical conditions. This study evaluates their combined antimicrobial efficacy against Enterococcus faecalis and Candida albicans biofilms and assesses potential tooth discoloration caused by riboflavin and nano-curcumin. Materials and Methods: The mesiobuccal canals of 57 extracted mandibular molars were inoculated with E. faecalis and C. albicans biofilms. The antimicrobial effects were assessed using riboflavin or nano-curcumin with a 450 nm diode laser (BDL), SWEEPS, or their combinations, compared to 5.25% NaOCl (positive control) and saline (negative control). Biofilm reduction was quantified by colony-forming units (CFUs/mL), and discoloration was evaluated using the ΔE metric in the CIE L*a*b* color space. Results: Both microorganisms showed a significant decrease in colony numbers in all experimental groups compared to the negative control (p < 0.001), except for E. faecalis, where no significant difference was observed between the riboflavin/nano-curcumin groups and the negative control. Combining riboflavin or nano-curcumin with SWEEPS or BDL significantly enhanced antimicrobial efficacy compared to individual treatments (p < 0.001). The combined photodynamic therapy and SWEEPS groups showed the lowest colony counts. The ΔE values were, on average, 1.81 for riboflavin and 1.09 for nano-curcumin. Conclusions: The combination of SWEEPS and aPDT effectively reduces E. faecalis and C. albicans biofilms in molars, supporting its potential as an adjunct in endodontic disinfection. Minimal discoloration further highlights its clinical applicability. Full article

Background: Condylar hyperplasia (CH) leads to mandibular overgrowth with anatomical, aesthetic, and functional consequences, particularly affecting facial harmony. It is characterized by severe mandibular prognathism (MP) in bilateral cases. This study aims to propose a therapeutic algorithm for diagnosing and treating bilateral condylar hyperplasia (BCH) based on demographic, clinical, craniofacial growth, and clivus ratio uptake conditions. Methods: Ten patients with severe skeletal Class III by MP, whose alteration was clinically associated with BCH, were consecutively evaluated in a specialized dentofacial deformity center between the period of 2019 and 2024. A detailed protocol was followed to gather clinical history, assess anatomical features, evaluate malocclusion, and identify potential BCH. When suspicion arose, a nuclear medicine test measured condylar scintigraphy uptake. If the result was positive, patients underwent bilateral condylectomy, following one of three treatment protocols. Results: Severe PM, pronounced Class III with excessive negative overjet, elongated condyles of normal anatomy, absence of family history, and accelerated growth since preadolescence and adolescence were common characteristics in these patients. Regarding the treatment protocol chosen according to the characteristics of the patients, five cases followed treatment protocol A: condylectomy and surgical correction of the alteration in two surgical stages. Two cases followed protocol B: bilateral condylectomy and orthognathic surgery in the same surgical time, and three cases followed protocol C: condylectomy and later post-surgical orthopedics and/or orthodontics without a second surgical intervention. Histopathological results confirmed bilateral hyperplastic growth and stability in mandibular size, and occlusion was observed during follow-up. Conclusions: Specialists need to recognize the clinical signs of BCH and use scintigraphy tests to measure condylar metabolic activity when suspected. Early detection of BCH is crucial, as it influences treatment decisions and helps prevent relapses in orthodontic or surgical interventions aimed solely at correcting or compensating for Class III malocclusion caused by MP. Full article

Maxillary deficiency, a common transversal dentofacial deformity, affects aesthetics and function. Timely intervention during adolescence is crucial, as the growth potential of the maxilla provides an opportunity to optimize treatment outcomes. This review explores various approaches for adolescent maxillary expansion, including orthopedic and surgical methods. Orthopedic appliances effectively address transverse deficiencies without surgery and are particularly beneficial in managing conditions in children and early adolescents. In mid- to late-stage adolescents, bone-borne devices with mini-surgery offer better skeletal expansion outcomes. However, in cases of severe deficiencies, or where skeletal resistance limits non-surgical methods, surgical interventions become essential. Procedures like surgically assisted maxillary expansion and orthognathic surgery offer superior skeletal corrections. These techniques are particularly valuable for late adolescents with complex conditions. This review comprehensively summarizes the applications, outcomes, and limitations of these treatment options, highlighting the importance of selecting individualized, growth stage-appropriate interventions. Full article

Background/Objectives: The objective of this study was to analyze the profiles of sphingosine (Sph), sphinganine (SPA), sphingosine-1-phosphate (S1P), and ceramides (C14 Cer, C16 Cer, C18:1 Cer, C18 Cer, C20 Cer, C22 Cer, C24:1 Cer, and C24 Cer), along with caspases (CAS-3, CAS-6, and CAS-9), in serum and in the periosteum of the maxilla and mandible in patients with dentofacial deformities undergoing treatment with titanium fixations (miniplates and miniscrews). Methods: The study group comprised 20 patients who underwent bilateral jaw osteotomy due to dentofacial deformities. The osteotomy segments were stabilized with titanium alloy miniplates and screws. The control group consisted of 20 patients who had not yet received surgical treatment for maxillofacial defects. Results: Sphinganine (SPA) and ceramide C22 (C22 Cer) were the only compounds found to be significantly elevated in the serum of the study group compared to the control group. The concentrations of Sph, SPA, C14 Cer, C16 Cer, C18 1 Cer, C18 Cer, C22 Cer, C24 1 Cer, C24 Cer, and S1P were significantly lower in the maxillary periosteum of patients in the study group compared to those in the control group. The concentration of C20 Cer was significantly higher in the maxillary periosteum of patients in the study group compared to the control group. In contrast, the concentrations of Sph, SPA, C14 Cer, C16 Cer, C18 1 Cer, C22 Cer, C24 1 Cer, and C24 Cer were significantly lower in the mandibular periosteum of the study group compared to the control group. The concentrations of C20 Cer and S1P were significantly elevated in the mandibular periosteum of patients in the study group compared with the control group. The activity of CAS-3 was significantly higher in the mandibular periosteum of patients in the study group compared to those in the control group. Conclusions: Titanium fixations induce local changes in the sphingolipid profile within the periosteum of the maxilla and mandible, while no systemic impact on this metabolism was observed. Full article

Objectives: Orthognathic surgery (OGS) is performed to correct dentofacial deformities, improving both function and aesthetics. While prior research suggests positive impacts on quality of life (QoL), self-esteem, and psychosocial well-being, a comprehensive assessment incorporating emotional stability and depressive symptoms remains limited. This study aimed to evaluate the psychological and social effects of OGS, including indication-specific QoL, self-esteem, depression, and emotional stability. Methods: A cross-sectional study was conducted using validated questionnaires: the Orthognathic Quality of Life Questionnaire (OQLQ), FACE-Q, Rosenberg Self-Esteem Scale (RSES), Freiburg Personality Inventory (FPI), and Patient Health Questionnaire-9 (PHQ-9). Data were collected from 90 patients who had undergone OGS at a single institution. Results were compared to existing normative data and reference studies on patients before and after OGS and purely aesthetic facial procedures. Results: Postoperative patients demonstrated significantly improved QoL across all OQLQ domains. FACE-Q scores indicated high satisfaction with facial appearance and function, aligning with reference studies. The study group exhibited higher self-esteem scores compared to the general population (p < 0.001) and showed predominantly balanced emotional stability. However, depressive symptoms were more prevalent in the study group compared to normative data, particularly among male participants (p < 0.001). Conclusions: The findings suggest that OGS leads to significant improvements in QoL, self-esteem, and emotional stability, reinforcing its positive psychological impact. However, the persistence of depressive symptoms in a subset of patients highlights the need for psychological support during treatment. Given the cross-sectional design, future longitudinal studies are necessary to confirm long-term effects and optimize patient care. Full article

The aim of the study was to evaluate the effect of titanium implants (Ti6Al4V) on the surrounding tissues by analyzing the concentration of titanium particles, TNF-α, and caspase-3 in patients treated for jaw fractures and dentofacial deformities. The research material consisted of peri-implant tissues: fragments of periosteum adhering to a titanium miniplate and blood serum collected from 42 patients treated for mandibular fractures (Group I), and dentofacial deformities (Group II) who underwent bimaxillary osteotomy. The control group consisted of 24 generally healthy patients before bimaxillary osteotomy. The concentrations of selected cytokines, caspase-3, TNF-α in blood serum, and homogenized tissues, were determined using the immunoenzymatic method (ELISA). The concentration of titanium particles was assessed using a scanning electron microscope equipped with an X-ray microanalyzer. A significant increase in the concentration of titanium, caspase-3, and TNF-α was observed in serum and periosteum in all patients who underwent bone fixation. Increased TNF-α levels indicate an intense immune response, which may lead to the degradation of peri-implant tissues and bone resorption around the miniplates and screws, while an increase in caspase-3 levels suggests that cells surrounding the implants are destroyed in response to inflammatory stress or damage induced by the presence of titanium particles. Full article

Background: Patients with a triad of severe temporomandibular joint (TMJ) pathologies, obstructive sleep apnea (OSA), and dentofacial deformities often experience significant functional and aesthetic impairments. A combination of total TMJ reconstruction and maxillomandibular advancement (MMA) has emerged as a promising treatment option, which can address the complexity of these conditions simultaneously. Methods: This paper presents a practical protocol for TMJ reconstruction using patient-specific alloplastic total joint prosthesis in conjunction with additional splintless osteotomies. This approach integrates the recent advancements in virtual surgical planning (VSP), custom TMJ prostheses, and three-dimensional (3D) custom osteotomy guide and implant manufacturing, allowing for precise anatomical correction and enhanced treatment outcomes. Three patients were treated with the present protocol. Postoperative assessments mainly included maximum inter-incisal opening, apnea–hypopnea index (AHI), and patient satisfaction with facial aesthetics. Results: All surgeries were performed without complications. The follow-up period ranged from 7 to 12 months. For the two patients with TMJ ankylosis, the postoperative maximum inter-incisal opening (MIO) increased from 3–5 to 35 mm and from 12 to 32 mm, respectively. Additionally, all three cases demonstrated that the protocol could significantly decrease AHI (with improvements of 57.5, 49, and 66.4 events/h, respectively) and achieve satisfactory aesthetics. Conclusions: These findings suggest that this protocol is a viable option for addressing complex cases involving severe TMJ pathologies, OSA, and dentofacial deformities. Future studies with larger cohorts and long-term follow-up are needed to further validate these findings. Full article

Titanium is widely recognized for its biocompatibility and utility in maxillofacial and orthopedic surgery; however, its influence on bone remodeling biomarkers remains underexplored. This study investigates the effects of uncoated titanium plates on both the growth factors and diacylglycerols (DAGs) in the periostea of the maxilla and mandible, as DAG signaling is an essential secondary messenger molecule involved in intracellular signaling connected to various growth factors. The study group comprised 20 patients undergoing bimaxillary osteotomies using miniplates and screws made of Ti6Al4V titanium, from whom bone fixations were removed, while the control group included 20 patients operated on for dentofacial deformities (before the insertion of titanium fixations). Diacylglycerol levels in the serum and periosteum were analyzed using tandem mass spectrometry coupled with ultra-high performance liquid chromatography. Growth factors in the periosteum were measured via ELISA with commercially available assay kits. Our findings demonstrate a significant reduction in growth factors, including IGF-1, PDGF, and FGF-23, alongside decreased total DAG levels, suggesting titanium plate stabilization may modulate bone remodeling dynamics. Notably, while overall DAG levels declined, specific DAG species such as C16:0/16:0 and C18:0/18:0 were elevated, whereas polyunsaturated DAGs showed reductions, indicating selective regulation of lipid signaling pathways. Correlation analyses highlighted complex interactions between growth factors and DAGs, with distinct regional differences observed in the mandibular and maxillary periostea. These alterations may result from chronic titanium exposure, potentially inducing a low-grade immune response or modifying the local biochemical environment. This study emphasizes the need for further research into the long-term effects of titanium implants, particularly their influence on lipid metabolism, growth factor dynamics, and bone healing. Full article

Class III patients have classically been managed through monomaxillary techniques, mainly involving mandibular setback movements. More recently, according to the upper incisor to soft tissue plane (UI-STP) or Barcelona Line (BL) planning protocol, bimaxillary procedures for upper maxilla advancement and reduced mandibular setback have been recommended in order to secure better aesthetic outcomes and avoid upper airway constriction. The present study describes the jaw movements in the sagittal plane performed in class III patients subjected to bimaxillary surgery following the BL protocol. A retrospective evaluation was performed on 124 class III patients subjected to bimaxillary surgery. All subjects underwent upper maxilla advancement. A total of 112 patients received mandible advancement movement (90.3%), nine received mandibular setback (7.25%), and the mandible underwent no movement along the sagittal dimension in the three remaining patients (2.4%). Mandibular advancement was significantly the most frequent treatment option. The presented results suggest that when the BL planning protocol is used as an aesthetic and functional reference, class III occlusion appears mostly related to maxillary sagittal hypoplasia instead of mandible hyperplasia, so bimaxillary advancement surgery should be considered as one of the first-choice procedures for the treatment of these patients. Full article

Background/Objectives: This study assessed the efficacy of photobiomodulation therapy (PBM) by 808 nm and 660 nm alone and in combination for the treatment of paresthesia in rats. Methods: This animal study was conducted on 36 adult male Wistar rats. After general anesthesia, the facial nerve of the right side of the face of rats was surgically exposed and pinched, returned in place, and sutured. The rats were randomly assigned to six groups (n = 6) of (I) no-intervention (control), (II) no-laser, (III) 808 nm laser (250 mW, 4 W/cm², 20 s, 8 J/cm², (IV) 660 nm laser (150 mW, 0.25 W/cm², 32 s, 8 J/cm², (V) 808 nm plus 660 nm laser with the original settings, and (VI) 808 nm plus 660 nm laser with half of the time and energy density. After 16 days, a biopsy sample was taken from the nerve injury site and underwent histological, histometric, and immunohistochemical assessments. Results: Significantly lower edema and congestion were seen in the combined laser group with original settings (p < 0.05); this group had no significant difference with the control group regarding degenerative changes of the nerve fibers and Schwann cells (p > 0.05). The 660 nm, and combined laser groups, had a significantly lower accumulation of inflammatory cells (p < 0.05). The number of blood vessels in combined laser groups was significantly lower than that in the no-laser group (p < 0.05). Conclusions: The results showed the positive efficacy of PBM by 808 nm and 660 nm lasers in resolution of inflammation and reduction of degenerative changes of Schwann cells and nerve fibers. Full article

Class III malocclusions, a dentofacial deformity requiring early intervention, pose significant challenges due to the need for prolonged use of facemasks by young patients. The SuperPowerMe project aims to improve compliance with the orthodontic treatment by integrating personalised, sensor-equipped facemasks with gamification. Through a design thinking process, the facemasks were custom-fitted using 3D facial scanning and 3D-printed with biocompatible materials to ensure comfort and ergonomic fit. Sensors embedded in the mask monitored wear time, and data collected were used to engage children in a video game allowing children to progress through game challenges as they complied with the treatment. Observational studies were conducted, evaluating patients’ adherence and comfort levels. The results indicated a substantial increase in daily wear time and patient satisfaction, with self-reported compliance closely matching sensor data. The personalised design and gamified elements fostered higher patient autonomy over the treatment period, although minor technical issues with the facemasks were noted. In conclusion, the results suggest that gamification paired with custom devices holds promise as a strategy for improving adherence to long-term orthodontic treatments in children. Further refinement of the system and broader trials are promoted to fully validate the efficacy of therapy gamification. Full article

Objectives: Titanium miniplates and screws are commonly used in the surgical management of dentofacial deformities. Despite the opinion of the biocompatibility of these bone fixations, some patients experience symptoms of chronic inflammation around titanium implants even many years after their application. The aim of this study was to examine the levels of cytokines, chemokines, and growth factors released from the maxilla and mandible periosteum surrounding titanium fixations 11 months after the implantation procedure. Methods: From the study group (n = 20) consisting of patients with maxillofacial defects who underwent bimaxillary osteotomy, fragments of the periosteum of the maxilla and mandible adjacent to the titanium miniplates and screws were taken during routine bone fixation removal procedures. From the control group subjects (n = 20), fragments of healthy maxillary and mandibular periosteum were taken prior to surgical treatment of dentofacial deformities. The examination of cytokines, chemokines, and growth factors levels released from the periosteum of jaws was performed using the Bio-Plex Pro Human Cytokine Screening Panel (48-Plex). Results: The study group was characterized by a significant increase in the concentration of most of the tested-for proinflammatory cytokines/chemokines/growth factors compared to the control group, with greater amounts of inflammatory factors released from the periosteum covering the titanium implants in the mandible than from the periosteal cells surrounding the titanium implants in the maxilla. Conclusions: Prolonged exposure to titanium miniplates and screws leads to a disturbance of immune homeostasis in the periosteal cells of the maxilla and mandible. The data obtained indicate the need to remove fixations after the bone fragments have healed. Full article