Search Results (118)

Hydrogel scaffolds have emerged as instructive microenvironments for craniofacial tissue regeneration, moving beyond passive cell carriers toward platforms that regulate cell fate, vascularization, immune remodeling, and tissue-specific architecture. This review synthesizes hydrogel-associated strategies across dental pulp, periodontal ligament, gingival, bone marrow, jawbone, endothelial, oral mucosal, induced pluripotent stem cell (iPSC), extracellular vesicle (EV), exosome, secretome, and acellular systems. The evidence indicates that craniofacial hydrogel performance is governed by reciprocal interactions among biological source, scaffold composition, matrix mechanics, spatial architecture, mineral or ionic signaling, growth factor delivery, vesicle-mediated communication, and inflammatory niche modulation. Mineralized and ion-releasing hydrogels most consistently supported osteogenesis and bone repair, whereas extracellular matrix (ECM)-mimetic, peptide, collagen, fibrin, gelatin methacryloyl (GelMA), alginate, hyaluronic acid (HA), and chitosan-based systems enabled pulp–dentin, periodontal, peri-implant, oral mucosal, and soft-tissue reconstruction. Responsive, antimicrobial, antioxidant, conductive, and immunomodulatory hydrogels further expanded the field by targeting diseased microenvironments rather than regeneration alone. Despite strong preclinical evidence, translation remains limited by heterogeneity in scaffold formulations, biological sources, analytical endpoints, defect models, and long-term functional validation. Future progress will require standardized characterization, tissue-specific design criteria, clinically relevant large-animal models, scalable cell-free technologies, and integrated assessment of regeneration, immunity, vascularization, innervation, mechanics, and safety. Full article

Medication-related osteonecrosis of the jaw (MRONJ) is a complex condition associated with the use of antiresorptive drugs, such as bisphosphonates and denosumab. The condition is characterized by the presence of exposed bone in the maxillofacial region that fails to heal. MRONJ remains highly intractable, as its pathogenic mechanisms are not yet fully understood. It is therefore essential to elucidate the molecular mechanisms underlying the disease. MiRNA expression analysis and proteomic studies were performed on a selected cohort of patients with MRONJ on jawbone tissue, using qRT-PCR and 2D electrophoresis followed by mass spectrometry. MiRNAs and proteomics data validation was carried out by Western blot analysis of differentially expressed proteins highlighted by a proteome study and predicted targets of differentially expressed miRNAs. Nineteen miRNAs were overexpressed and two downregulated in jawbone tissue from all MRONJ patients. Notably, five of these dysregulated miRNAs are involved in the regulation of angiogenesis and desmosome functions, suggesting a potential link to the molecular alterations observed at the protein level. Proteomic analysis revealed decreased concentrations of the pigment epithelium-derived factor, and of desmoglein-1, a desmosomal cadherin. Validation analysis confirmed the dysregulation of pathways involved in bone remodeling and necroptosis. The pathophysiology of MRONJ arises from a complex interplay of factors, including impaired bone remodeling, affected angiogenesis, and altered cell adhesion and differentiation mechanisms, ultimately leading to necroptosis. Through proteomic analysis and validation of miRNA expression, our study proposes specific molecular alteration in MRONJ-compromised bone tissue, involving desmosomal component imbalance and angiogenesis inhibition. Full article

Titanium–silver (Ti–Ag) and titanium–copper (Ti–Cu) alloys have been developed to improve the mechanical properties and machinability of titanium (Ti) for dental applications while maintaining corrosion resistance comparable to that of pure Ti. Herein, cylindrical dental implants composed of experimental Ti–20Ag, Ti–30Ag, Ti–5Cu, and Ti–10Cu (mass%) alloys were fabricated and implanted into the jawbones of beagle dogs to evaluate bone compatibility. Pure Ti and Ti–6Al–4V alloy implants were used as controls. Because the implant surfaces were mechanically polished, the experimental alloys, which exhibited higher hardness than Ti, showed lower surface roughness than Ti. Radiographic observations revealed no remarkable bone resorption around any implants during the experimental period. Histological evaluation demonstrated new bone formation and partial bone contact around implants at 1 and 3 months post-implantation. Although the bone–implant contact ratio was relatively low owing to the cylindrical implant design and limited initial stability, no significant differences were observed between the experimental alloys and Ti. These results indicate that Ti–Ag and Ti–Cu alloys improve mechanical properties while maintaining bone compatibility comparable to that of Ti, suggesting their potential as candidate materials for dental implant applications, particularly for narrow dental implants. Full article

This study compared the wound-healing response and osteogenic gene expression profile of osteoblasts exposed to pediatric-equivalent concentrations of dexmedetomidine (DXMT) and propofol (POF). Human osteoblast-like SAOS-2 cells were assigned to control, low- and high-dose DXMT and POF groups based on pharmacokinetically derived free-drug levels. Scratch-wound closure was quantified over 24 h, and expression of osteogenesis- and cytoskeleton-related genes (RANKL, RUNX2, SP7, BMP2, VIM, VCL, OCN, ALP) was measured by SYBR Green quantitative Polymerase Chain Reaction (qPCR). Normality was assessed using the Shapiro–Wilk test, and group differences were analyzed with two-way ANOVA followed by Tukey’s multiple comparisons test (p < 0.05). All groups demonstrated complete scratch closure by 24 h, with no differences at 6 h. At 18 h, POF did not differ from the control, whereas DXMT significantly accelerated closure at both doses in a dose-dependent fashion. High-dose DXMT significantly increased VIM (3.95 ± 3.12, p = 0.0144) and BMP2 (2.28 ± 0.70, p = 0.0002) expression, while RUNX2, SP7, and RANKL remained comparable to controls. ALP (1.68 ± 0.40, p = 0.0005) and OCN (3.31 ± 0.35, p = 0.0108) were significantly elevated only in the high-dose DXMT group, whereas POF showed no significant effects. At clinically relevant concentrations, DXMT was associated with enhanced scratch closure and increased expression of selected osteogenesis- and cytoskeleton-related genes in SAOS-2 cells, whereas POF showed limited effects under the tested conditions. These findings suggest that DXMT may influence early in vitro cellular responses relevant to bone healing and should be further validated in functional differentiation models and in vivo studies. Full article

Jawbone cavitations have been described for decades under various terminologies, including neuralgia-inducing cavitational osteonecrosis (NICO) and fatty degenerative osteolysis of the jawbone (FDOJ). Their biological nature and clinical relevance remain controversial. The present review aimed to summarize the current understanding of jawbone cavitations, identify relevant research gaps, and propose a unified descriptive terminology. This narrative literature review was conducted using PubMed/MEDLINE, Google Scholar, and manual searches of relevant journals. The available evidence was qualitatively synthesized. The results indicate that most published data on jawbone cavitations are derived from observational, retrospective, and cohort studies, with etiological concepts largely based on histopathological findings. Recent three-dimensional radiological analyses suggest that intraosseous non-mineralized areas frequently observed at former extraction sites may represent a physiological outcome of socket collapse and incomplete ossification rather than a pathological condition. This review introduces Covered Socket Residuum (CSR) as a radiological descriptive term and clearly distinguishes it from pathological entities such as NICO and FDOJ. Recognition of CSR is clinically relevant, particularly in dental implant planning, where unrecognized non-mineralized areas may compromise primary stability. The findings emphasize the role of three-dimensional radiological assessment for diagnosis and implant planning and discuss preventive and therapeutic strategies, including Guided Open Wound Healing (GOWH^TM). Prospective controlled clinical studies are required to validate this concept and determine its clinical relevance. Full article

The occurrence of cysts and tumors in pediatric patients varies across different age groups. Follicular and dentigerous cysts are among the most common lesions. However, typical odontogenic tumors in juvenile patients are not frequently observed. Early stages of cyst and odontogenic tumor development might exhibit some similar characteristics due to the presence of unerupted teeth or their relationship with various stages of tooth formation and eruption. Many small lesions are discovered accidentally on routine orthopantomography (OPG), while the bigger ones manifest themselves as bone swelling, cortical perforation, or displacement and mobility of teeth. Each odontogenic tumor has characteristic clinical and radiological features. Biopsy of larger lesions, or incisional biopsy of smaller lesions, allows detailed histopathological evaluation to determine tumor type and growth behavior and guide appropriate treatment planning. In some cases, atypical signs on OPGs, like asymmetry in dental follicles, occurrence of round or oval bone lesions near impacted or retained teeth, and visibility of irregular radiolucent, radiopaque, or mixed jawbone lesions, might suggest the occurrence of some possible odontogenic tumor in juvenile patients. Each case should be handled individually. In this case, we demonstrate how atypical appearances of dental follicles on panoramic radiographs may not correspond with cone-beam computed tomography findings and may indicate the early stages of odontogenic myxoma in a juvenile patient. Full article

Medication-related osteonecrosis of the jaw (MRONJ) is a devastating complication arising primarily after invasive dentoalveolar procedures in patients treated with antiresorptive, antiangiogenic, or targeted therapies. Although recognized risk factors are established, the distinctive vulnerability of jawbones compared to long bones is not fully understood. This review comprehensively synthesizes recent advances regarding the embryological, anatomical, and physiological disparities that contribute to region-specific susceptibility to MRONJ. Recent evidence suggests that jawbones diverge significantly from long bones in embryonic origin, ossification pathways, vascular architecture, innervation patterns, and regenerative capacities. These differences affect bone metabolism, healing dynamics, response to pharmacologic agents, and local cellular activities, such as enhanced bisphosphonate uptake and specialized microcirculation. Experimental and clinical evidence reveals that mandibular periosteal cells exhibit superior osteogenic and angiogenic potentials, and the jaws respond differently to metabolic challenges, trauma, and medication-induced insults. Furthermore, site-specific pharmacologic and inflammatory interactions, including altered periosteal microcirculation and leukocyte–endothelial interactions, may explain the development of MRONJ, although rare cases of medication-related osteonecrosis have also been reported in long bones. Emerging research demonstrates that immune dysregulation, particularly M1 macrophage polarization with overexpression of matrix metalloproteinase-13 (MMP-13), plays a crucial role in early MRONJ development. Understanding these mechanisms highlights the critical need for region-specific preventive measures and therapeutic strategies targeting the unique biology of jawbones. This comparative perspective offers new translational insights for designing targeted interventions, developing tissue engineering solutions, and improving patient outcomes. Future research should focus on gene expression profiling and cellular responses across skeletal regions to further delineate MRONJ pathogenesis and advance personalized therapies for affected patients. Full article

Background: In the treatment of dentofacial deformities, miniplates and screws made of titanium and its alloys (Ti6Al4V) are currently used for osteosynthesis of bone segments, which is due to the high biocompatibility of these materials. Despite the unquestionable advantages of titanium implants, there is an ongoing discussion about their potential negative impact on the human body, both at the implantation site and systemically. This study aimed to assess the influence of titanium fixations (miniplates and screws) on the texture and to identify the texture features that vary in the surrounding bone tissue. Methods: The orthopantomograms were obtained from 20 patients who were treated at the Department of Maxillofacial and Plastic Surgery, University of Bialystok. Regions of Interest (ROIs) of bone tissue surrounding titanium fixations in the maxilla and mandible were annotated using separate masks and compared to healthy areas of the same structures in the same patients. The images were independently filtered using Mean, Median, and Laplacian Sharpening filters, followed by analysis of the texture parameters obtained through methods such as First-Order Statistics (FOS), the Gray-Level Co-occurrence Matrix (GLCM), Neighbouring Gray Tone Difference Matrix (NGTDM), Gray-Level Dependence Matrix (GLDM), Gray-Level Run Length Matrix (GLRLM), and Gray-Level Size Zone Matrix (GLSZM). Results: The results showed that FOS, GLCM, and GLDM provide the most informative features for quantitative assessment of the areas around titanium fixations, and that smoothing filters reduce measurement noise and artifacts. Conclusions: The findings confirm that texture analysis can support the diagnosis of structural alterations in the bone surrounding titanium fixations, in both the maxilla and mandible. Full article

Background: Marginal bone loss (MBL) is a condition leading to implant loss and treatment failure. MBL is one of the main complications in dental implantology. The aim of this research is to show the method that can predict bone loss around implants and protect patients from implant loss. Methods: A total of 1026 intraoral standardized radiographs of dental implants were included in this study. A total of 2052 peri-implant jawbone image samples were analyzed in MaZda 4.6 software. A new scale was calculated and described. MBL was measured, and groups of patients were compared. Results: After 3 months of functional loading, the Corticalization Index (CI) was calculated to be 210.70 ± 149.78 and increased after 60 months to 277.88 ± 198.78. In the 60-month observation, MBL was 0.85 mm ± 1.29 mm, and it has been noted that low MBL is associated with CI lower than 300, high MBL with CI higher than 500, and critical high MBL appeared when CI was higher than 1200. Conclusions: Authors created a new scale, and research showed that the specified CI in our scale may predict MBL around dental implants with a five-year forecast horizon. It allows us to implement specific treatment and protect implants from loss. Full article

Regeneration of jawbone defects poses major challenges. The combination of dental pulp stem cells (DPSCs) or DPSC-derived extracellular vesicles (EVs) with bone substitute materials shows promising potential for bone tissue engineering in vitro. This study evaluated the in vivo bone regeneration potential of DPSCs and EVs with bone graft substitutes in a novel intrabony defect model. DPSCs were isolated from 35 male Sprague–Dawley rat incisors, and EVs were collected from the cell culture medium. DPSCs were seeded onto alloplastic and xenogeneic bone graft materials and implanted into bone defects. Control groups received bone substitutes without DPSCs or EVs. Micro-computed tomography (µCT) was performed at 12 and 24 weeks post-implantation to assess bone volume (BV), bone density (BD), trabecular thickness (Tr.Th), bone growth rate (BGR), and bone-to-mineral ratio (BMR). Both graft types increased BV and BD, with no significant differences between them. Tr.Th increased across all treatments after 24 weeks, indicating ongoing bone remodeling. Notably, xenogeneic grafts combined with DPSCs and EVs significantly improved BGR (p = 0.034) and BMR (p = 0.021) compared to alloplastic grafts with DPSCs. Xenogeneic bone grafts combined with DPSCs and EVs appear to be a promising approach for bone regeneration of alveolar bone defects. Full article

Background: Central giant cell granuloma of the jaw is a benign but potentially aggressive lesion that can cause pain, facial deformity, tooth loss, and jaw destruction. Many treatment methods are described in the literature, but the less invasive ones are associated with a higher recurrence rate. For several decades, extensive bone resection procedures have been the most effective treatment to date. This study aimed to evaluate a minimally invasive treatment protocol combining multiple weekly intralesional steroid injections with surgical removal of residual tumor tissue and chemical cauterization using Carnoy’s solution. Methods: Thirteen patients with histologically confirmed central giant cell granulomas of the jaws were treated according to the protocol, including weekly triamcinolone injections and, when necessary, fenestration of the cortical bone to access residual lesions. Patients were monitored clinically and radiologically over six years, with reconstruction of bone defects using autogenous grafts and platelet-rich fibrin. Results: The treatment effectively reduced tumor size, restored cortical bone, and allowed preservation of jaw structure. Only one recurrence was observed, and complications were minor and transient. The protocol was equally effective for both aggressive and non-aggressive lesions, regardless of patient age or comorbidities. Conclusions: These findings suggest that combining pharmacological and surgical approaches with chemical cauterization provides a safe, effective, and tissue-preserving strategy for managing central giant cell granulomas, minimizing recurrence while reducing surgical morbidity. Full article

Xenograft bone, autologous bone grafts or allogeneic bones from a bone bank are used for bone augmentation, reconstruction or other purposes, when the volume, shape, and size of each jawbone defect require different bone materials. In the case of some bigger and locally advanced bone defects, the use of allogeneic bone can be suitable and used with great success if the wound and bone are especially carefully maintained; however, the healing period of each bone depends on good and stable wound closure followed by improved local antiseptic protocol. The individuality of each bone defect might also require additional prophylactic titanium plating in order to decrease the risk of possible mandibular fracture or to help improve bone stability, reduce bone mobility and possible inflammation or granulation tissue formation. Early radiological estimation of bone healing evaluation might be troublesome and not fully visible in radiological evaluation in the early stages of bone healing. On the other hand, possible bone inflammation, radiolucent defects, and granulation formation could be noted in cases of acute or long-lasting bone grafting material inflammation, bacterial contamination within the bone defect area, or the presence of fistula. The presented case describes a very good outcome from a dentigerous cyst removal with bone defect grafting and plating; however, because of wound dehiscence and allogeneic bone graft exposure, the patient required one additional procedure. Full article

Background: Jawbone invasion is a common and prognostically unfavorable feature of oral squamous cell carcinoma (OSCC). Although cancer-associated fibroblasts (CAFs) are recognized for their role in tumor progression, their spatial dynamics at the tumor–bone interface remain poorly understood. Methods: We analyzed 14 OSCC specimens with confirmed jawbone invasion using histopathological and immunohistochemical techniques. Digital pathology combined with AI-assisted image analysis was employed to quantify and visualize the spatial distribution of OSCC cells (RANKL-positive), CAFs (α-SMA and FAP-positive), and osteoclasts (cathepsin K-positive) within defined regions of interest at the tumor–bone invasive front. Results: A consistent laminar stromal region enriched in CAFs was observed between the tumor nests and jawbone. CAFs were spatially clustered near OSCC cells and osteoclasts, with 81% and 74% residing within 50 μm, respectively. On average, 11.4 CAFs were present per OSCC cell and 23.2 per osteoclast. These spatial proximities were largely preserved irrespective of stromal thickness, suggesting active bidirectional cellular interactions. Conclusions: Our findings demonstrate that CAFs are strategically positioned to facilitate intercellular signaling between tumor cells and osteoclasts, potentially coordinating OSCC proliferation and bone resorption. This study highlights the utility of AI-assisted spatial histology in unraveling tumor microenvironmental dynamics and proposes CAFs as potential therapeutic targets in OSCC-induced osteolytic invasion. Full article

Background/Objectives: Sarcoidosis is a granulomatous disorder of unknown etiology that can affect multiple organs, including the oral cavity. This study aimed to compare the clinical and demographic characteristics of sarcoidosis cases with and without bone involvement in the jaw. Methods: A systematic review of the case reports and case series of sarcoidosis in the oral cavity between 1943 to 2024 were analyzed. Variables assessed included age, sex, presenting symptoms, duration of symptoms, diagnosis methodology, treatment approaches, and outcomes. Results: A total of 59 studies reporting 77 patients were included, with a mean age of 43.3 yrs. Female predominance was noted in both, bone-involved (61.5%) and non-bone-involvement cases (72.5%). Patients with bone involvement often presented with localized symptoms such as loose teeth (34.6%), bone loss (69.2%), and nasal obstruction (15.4%), whereas non-bone-involvement cases frequently exhibited soft tissue manifestations, like swelling (38%) and bleeding (14%). Treatment typically involved surgical intervention and steroid therapy in both groups, with favorable outcomes achieved in most cases. Conclusions: This systematic review presents the most extensive analysis of oral sarcoidosis. Oral sarcoidosis presents as two distinct clinical entities based on bone involvement. Soft tissue lesions often serve as an early diagnostic clue for systemic disease, while bony manifestations suggest a later, more destructive complication. Recognizing this dichotomy is crucial for dentists and clinicians to ensure timely diagnosis and appropriate referral, and this underscores the oral cavity’s critical role as an indicator of systemic illness and mandates a multidisciplinary management strategy. Full article

Background/Objectives: Severe jawbone atrophy, particularly in elderly or medically compromised patients, presents a significant challenge for conventional implant placement. In cases where bone augmentation is not feasible, alternative techniques—such as short, narrow, tilted, and zygomatic implants—may be indicated for the rehabilitation of the atrophic jaw. Subperiosteal implants have re-emerged as a further viable alternative, especially with recent advancements in digital planning and custom fabrication. This study aims to evaluate the clinical outcomes and complications associated with subperiosteal implants through a literature review and a supporting case series, and to propose clinical preliminary guidelines for their use. Methods: Fourteen studies—including case reports, case series, retrospective studies, and systematic reviews—were analyzed to assess the effectiveness and risk profile of subperiosteal implants. Additionally, we present a case series of nine patients with advanced vertical and horizontal alveolar bone atrophy treated using custom-made, digitally-designed subperiosteal implants. Surgical techniques, prosthetic workflows, and complications were recorded and assessed. Results: Subperiosteal implants were found to be particularly suitable for patients with narrow alveolar crests and severe atrophy where traditional implants are contraindicated. Literature and case series data indicated favorable outcomes, with early complications such as soft tissue inflammation and prosthetic misfit being manageable. A low complication rate was recorded in our series, with digital workflows contributing to improved implant fit and reduced technical errors. Conclusions: Subperiosteal implants could offer an effective solution for complex atrophic cases, provided that patient selection, surgical precision, and prosthetic design are meticulously managed. Based on our findings, clinical recommendations are proposed to guide their application in contemporary practice. Full article