Search Results (65)

Background: Mandibular canal (MC) variants are common and clinically relevant for anesthesia, implant placement, third-molar surgery, and osteotomies. Reported prevalences vary widely because they depend on imaging modality, acquisition parameters, and operational definitions. Methods: This was a focused narrative review with structured methods (PubMed/MEDLINE and Scopus, 2000–6 October 2025; last search 6 October 2025), predefined eligibility criteria and dual independent screening; no meta-analysis was conducted. Study-selection counts are reported in the text. Prevalence statements are contextualized by modality, imaging parameters (e.g., cone-beam computed tomography (CBCT) voxel size magnetic resonance imaging (MRI) field strength/sequences), and diagnostic thresholds (e.g., anterior loop (AL) criteria). Results: Compared with panoramic radiography (PR), CBCT consistently reveals more variant pathways. Typical CBCT estimates for bifid MC fall in the single-digit to low double-digit range, contingent on voxel size and definitions, whereas PR detects far fewer. Trifid canals are uncommon (≈1–2% in CBCT series). Reported retromolar canal frequencies vary broadly across populations and protocols, and AL length and prevalence are threshold-dependent. Selective MRI may complement CBCT by depicting soft-tissue branches not accompanied by a bony canal. We synthesize a variant-aware, imaging-led workflow: PR for screening; CBCT when predefined criteria are met and results are reasonably expected to change management; MRI reserved for targeted soft-tissue questions, in line with As Low as Reasonably Achievable (ALARA)/and As Low As Diagnostically Acceptable (ALADA) principles. We apply the Landfald Clinical Framework (LCF) as a hypothesis-generating, clinical synthesis tool linking variant patterns to procedural modifications and risk mitigation. Conclusions: A narrowed, clinically oriented approach—contextualizing prevalence by modality and definitions and applying an imaging-led, variant-aware workflow—can improve planning and safety in the posterior mandible. The LCF is used pragmatically within this workflow and does not constitute a new anatomical taxonomy; formal reliability and validity testing remain necessary. Full article

Osseodensification (OD) has emerged as a favorable osteotomy preparation technique that preserves and compacts autogenous bone along the osteotomy walls during site preparation, enhancing primary stability and implant osseointegration. While OD has demonstrated promising results in low-density trabecular bone, especially when used in conjunction with acid-etched (AE) implant surfaces, its efficacy in high-density cortical bone remains unclear—particularly in the context of varying implant surface characteristics. In this study, Grade V titanium alloy implants (Ti-6Al-4V, 4 mm × 10 mm) with deep threads, designated bone chambers and either as-machined (Mach) or AE surfaces were placed in 3.8 mm diameter osteotomies in the submandibular region of 16 adult sheep using either OD or conventional (Reg) drilling protocols. Insertion torque values (N·cm) were measured at the time of implant placement to evaluate primary stability. Mandibles were harvested at 3-, 6-, 12-, or 24-weeks post-implantation (n = 4 sheep/time point), and histologic sections were analyzed to quantify bone-to-implant contact (BIC) and bone area fractional occupancy (BAFO). Qualitative histological analysis confirmed successful osseointegration among all groups at each of the healing time points. No statistically significant differences were observed between OD and conventional drilling techniques in insertion torque (p > 0.628), BIC (p > 0.135), or BAFO (p > 0.060) values, regardless of implant surface type or healing interval. The findings indicate that neither drilling technique nor implant surface treatment significantly influences osseointegration in high density cortical bone. Furthermore, as the osteotomy was not considerably undersized, the use of OD instrumentation showed no signs of necrosis, inflammation, microfractures, or impaired osseointegration in dense cortical bone. Both OD and Reg techniques appear to be suitable for implant placement in dense bone, allowing flexibility based on surgeon preference and clinical circumstances. Full article

Background/Objectives: The deep circumflex iliac artery (DCIA) free flap with internal abdominal oblique muscle (IAOM) is a well-known method of reconstruction used in cases of oral cavity neoplasms. Because the IAOM can be insufficient for extensive defects after removal of advanced carcinomas of the tongue, floor of the mouth, or gingiva, the additional preparation of a perforator-supported external abdominal oblique (EAOM) muscle flap can be useful. The aim of this study was to introduce the use of a DCIA flap with an IAOM and EAOM island in the reconstruction of oral cavity compound defects. Methods: A retrospective analysis was performed involving eight patients who underwent reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Patients underwent the operation between June 2021 and February 2025 in the Department of Maxillofacial Surgery of the Rydygier Hospital in Kraków, Poland. Results: A group of eight patients underwent an operation due to squamous cell carcinoma of the oral cavity. The most common primary subsite of disease was the floor of the mouth (n = 4, 50%), followed by the lower gingiva (n = 2, 25%) and retromolar area (n = 2, 25%). All patients required resection involving part of the mandible, the floor of the mouth, and part of the tongue simultaneously with reconstruction using a DCIA free flap with IAOM and perforator-supported EAOM island. Osteotomies were performed in two flaps (one single osteotomy, one double osteotomy). Reconstruction was successfully performed in seven out of eight patients (overall success rate 88%). Conclusions: The DCIA free flap with IAOM and perforator-supported EAOM flap is a reliable method for compound soft tissue and bone defects in maxillofacial reconstruction. The use of IAOM and EAOM can be helpful in cases of three-dimensional soft tissue defects of the lower gingiva, the floor of the mouth, and the tongue. The lower gingiva and floor of the mouth can be reconstructed with IAOM, while the more mobile part of the tongue can be reconstructed with a perforator-supported EAOM island. Full article

Background/Objectives: The mandibular lingula (ML) is a small bony projection on the medial surface of the ramus and serves as the first reference point identified during sagittal split ramus osteotomy (SSRO) or inferior alveolar nerve block (IANB). Anatomical variations in the mandibular ramus have been shown to exist across different populations. Understanding these population-specific differences enhances both clinical safety and diagnostic precision. However, there is a paucity of anthropological data amongst the Mongoloid population, especially in Southeast Asia. Hence, this study aimed to investigate the (i) distance of the lingula to different mandibular anatomical landmarks and its localization, (ii) lingula shape, and (iii) differences between gender and the sides of the mandible amongst the local ethnic groups. Methods: This retrospective cross-sectional study consisted of 206 cone-beam computed tomography (CBCT) images of 77 males and 129 females (mean age 33), with a total of 412 hemimandibles. Measurements were performed on three-dimensionally reconstructed CBCT images. Results: The most common shape was the truncated type. The distance of the lingula to the anterior (LiA), posterior (LiP), superior (LiS), and inferior (LiI) borders of mandible were 17.84 (2.25) mm, 14.46 (3.44) mm, 17.73 (3.00) mm, and 27.05 (4.40) mm, respectively. No significant difference exists between the sides of the mandible. Sexual dimorphism existed for all lingula measurements except LiA. Indians have smaller rami with more anteriorly and inferiorly placed ML than Malay and Chinese. The majority of ML was located 8.55 mm above the occlusal plane. Conclusions: This study provides information on the ML and its surrounding ramus structure in the local population. Such variations must be accounted for in SSRO and IANB. Full article

Background/Objectives: The aim of this study was to investigate the accuracy of implementing a virtual treatment plan in orthognathic surgery. Methods: The study included 30 patients (11 males and 19 females with a mean age of 23.7 years) with a digital surgical plan. All patients underwent bimaxillary orthognathic surgery: LeFort I osteotomy of the maxilla combined with bilateral split sagittal osteotomy (BSSO) of the mandible. Eleven landmarks on the pre-surgical (planned) model and the same landmarks on the post-surgical model were used for comparison and linear difference measurements between the real and predicted outcomes in all three planes—transversal, sagittal, and vertical. Results: All median values fell within the 2 mm range in the transversal plane, and the mean displacement was 0.57 mm. In the sagittal and vertical planes, the treatment outcome in the maxilla was more precise than in the mandible. The mean displacement in the sagittal plane was −0.88 mm and that in the vertical plane was 0.44 mm. All deviations were less than 2 mm. Conclusions: The data obtained in this study show that the digital surgical plan for orthognathic surgery is clinically reliable in all planes. Full article

End-stage masticatory muscle fibrosis may occur following trauma, resulting in the inability to open the mouth for eating, drinking, panting and vomiting. Following MRI and EMG confirmation of end-stage muscle fibrosis, a bilateral wedge ostectomy was performed of the mandibles, leaving a permanent mouth opening of 3.5 cm. The osteotomies were stabilized with 6-hole dynamic compression plates and screws. A temporary percutaneous endoscopic gastrotomy tube was placed while the dog underwent rehabilitation and reconditioning. The dog was able to eat, drink, and pant after recovery, which allowed the dog to live a relatively normal and good quality life. Wedge osteotomies of the mandibles with bone plate stabilization may allow dogs with permanent restrictive mouth opening due to fibrosis of the masticatory muscles to live a relatively normal life. Full article

This study aimed to evaluate mandibular fixation techniques using monocortical plates following sagittal split ramus osteotomy in skeletal Class III patients. Ninety-three patients were categorized into three groups based on fixation methods: four-hole miniplate with one proximal and two distal screws (Group 1); four-hole miniplate with four screws (Group 2); sliding plate with two proximal and one distal screws (Group 3). Cone-beam computed tomography scans were obtained at three time points: immediately postoperative (T1), 6 months (T2), and 12 months (T3). The yaw, roll, and pitch rotations of the proximal segment, as well as horizontal and vertical changes of the pogonion, were evaluated. Group 1 exhibited significantly greater counterclockwise rotation of the proximal segments at T2 (p = 0.021) and T3 (p = 0.035) compared to the other groups. Additionally, Group 1 showed significantly smaller anterior and superior displacement of the pogonion at T3 (0.97 ± 2.10 mm, p = 0.009; 0.03 ± 1.62 mm, p = 0.011, respectively). Following surgical wafer removal, intimate occlusal contact is archived and the elimination of premature contacts through postoperative orthodontic treatment contributes to counterclockwise autorotation of the mandible. Therefore, anterior and superior movements of the pogonion are expected if firm fixation between the proximal and distal segments is achieved. Therefore, these findings suggest that a single proximal screw, as seen in a three-screw fixation, may act as a fulcrum, insufficiently resisting postoperative clockwise rotation of the distal segments. Full article

Background: The autogenous bone core block (BCB) is a viable, biologically advantageous, and minimally invasive alternative to other augmentation procedures for small bone defects around dental implants. This study focused specifically on horizontal vestibular defects in the mandible, a frequently encountered yet underrepresented clinical situation, to evaluate the effectiveness and predictability of bone core grafting. Methods: Cylindrical autogenous bone cores, harvested from the implant-site osteotomy using trephine drills with a 2.5 internal diameter, were stabilized with osteosynthesis screws, and implants were placed simultaneously. Initial preoperative measurements of the edentulous ridge width were performed based on cone beam computer tomography (CBCT). At 4 months postoperatively, a subsequent CBCT measurement was performed for each implant site. Results: A total of 38 augmentation procedures were analyzed with a mean horizontal bone gain of 1.8 mm (p = 0.000). Improved outcomes were observed in V-shaped defects with remaining vertical bony walls, which contributed to better graft stability and volume preservation. While Khoury et al. previously validated the general applicability of this technique across various defect types, our study refines its indication by offering a clear protocol tailored to a common clinical niche. Conclusions: The proposed BCB method proved to be a safe, efficient, and with reduced morbidity procedure, providing clinicians with a practical and evidence-based tool for predictable horizontal bone augmentation. Full article

Objectives: Cleft lip and palate is a multifactorial disease that causes various problems, such as maxillary and facial morphological abnormalities, oral dysfunction, and postoperative scarring due to lip and palate formation after birth. This condition can easily cause obstruction and may require surgical orthodontic treatment in the future. Methods: In this study, we performed multi-segment Le Fort type 1 osteotomy on a patient with a cleft lip and palate who presented with a crossbite, horizontal inclination of the occlusal plane due to dental arch stenosis on the left side of the maxilla, and deviation of the mandible. Results: In this case, close occlusion was achieved by improving the patient’s facial appearance and occlusal relationship by combining sagittal division of the mandibular ramus, and the stability of the occlusion was measured without relapse 1 year after the surgery. Conclusions: This case is considered of great medical significance, as there have been few reports of cases showing a stable course. Full article

This animal study compared the healing performance of a novel implant design characterized by a shift in thread geometry and core diameter with two different surfaces with that of an apically tapered implant. Test Bioactive (n = 9), Test Porous (n = 7) and Control (n = 8) implants were placed in the mandibles of minipigs. Following healing, bone samples were harvested for determining bone-to-implant contact (BIC) and marginal bone loss (MBL). Comparative statistics were based on Levene’s test, Shapiro–Wilk tests, the Kruskal–Wallis test and Wilcoxon tests with Holm correction (α = 0.05). The mean undersizing of the osteotomy was 0.15 mm for Control, while in the test groups 0.33 mm and 0.34 mm were calculated. Insertion torques ranged from 61.5 Ncm (Control) to 76.1 Ncm (Test Bioactive). Maximum BIC was seen in Test Porous with 55.83%, while Test Bioactive showed only 48.11%. MBL was 4.1 mm in Test Bioactive, while Test Porous and Control exhibited 2.8 mm. No significant differences between the implant groups were observed (p > 0.05). Despite greater undersizing, the novel implant type performed comparably to the established Control implants. The rougher surface of the bioactive implants increased the insertion torque and led to more MBL. Full article

Objective: Reconstructing the anterior mandible in patients with irradiated and contracted soft tissues remains challenging despite advances in computer-assisted design and three-dimensional printing. Unpredictable soft-tissue changes reduce the effectiveness of these technologies. This paper explores an alternative using a single-adjustable-osteotomy fibula flap technique. Methods: A retrospective study was performed on patients with anterior segmental mandibular defects due to recurrent tumors, secondary reconstruction, or osteoradionecrosis and previously received radiotherapy who represented the highest risk of soft tissue complexity while limiting the utility of computer technology. All patients underwent mandible reconstruction using the adjustable, single-osteotomy fibula method, which eliminated the need for computer-assisted design. We evaluated the effectiveness and outcome. Results: From 2016 to 2023, 11 patients were included in this study. The median patient age was 58 (ranging 49–65) years. Included patients had either recurrent tumors (n = 6), secondary reconstruction needs (n = 3), or mandibular osteoradionecrosis (n = 2). No complete flap failures occurred. Five of six patients with recurrent cancer required two skin island fibular flaps for intraoral and external defect repair. One patient experienced partial skin paddle loss requiring an additional free flap, and another had plate exposure requiring removal after bone union was achieved. Conclusions: The adjustable single-osteotomy fibula flap technique offers a reliable alternative for anterior mandibular reconstruction in complex cases. This approach demonstrates advantages in surgical simplicity and flexibility while maintaining acceptable outcomes. However, careful patient selection and consideration of defect extent remain crucial for success. 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

Background: Mandibular reconstruction has evolved significantly since its inception in the early 1900s. Currently, the fibula free flap (FFF) is considered the gold standard for mandibular and maxillary reconstructions, particularly for extensive defects, and the introduction of Extended Reality (XR) and virtual surgical planning (VSP) is revolutionizing maxillofacial surgery. Methods: This study focuses on evaluating the accuracy of using in-house cutting guides for mandibular reconstruction with FFF supported by virtual surgical planning (VSP). Planned and intraoperative osteotomies obtained from postoperative CT scans were compared in 17 patients who met the inclusion criteria. The proposed analysis included measurements of deviation angles, thickness at the centre of gravity, and the maximum thickness of the deviation volume. Additionally, a mandibular resection coding including 12 configurations was defined to classify and analyze the precision of mandibular osteotomies and investigate systematic errors. Preoperative, planned, and postoperative models have been inserted in an interactive VR environment, VieweR, to enhance surgical planning and outcome analysis. Results: The results proved the efficiency of adopting customized cutting guides and highlighted the critical role of advanced technologies such as CAD/CAM and VR in modern maxillofacial surgery. A novel coding system including 12 possible configurations was developed to classify and analyze the precision of mandibular osteotomies. This system considers (1) the position of the cutting blade relative to the cutting plane of the mandibular guide; (2) the position of the intersection axis between the planned and intraoperative osteotomy relative to the mandible; (3) the direction of rotation of the intraoperative osteotomy plane around the intersection axis from the upper view of the model. Conclusions: This study demonstrates the accuracy and reliability of in-house cutting guides for mandibular reconstruction using fibula free flaps (FFF) supported by virtual surgical planning (VSP). The comparison between planned and intraoperative osteotomies confirmed the precision of this approach, with minimal deviations observed. These findings highlight the critical role of CAD/CAM and XR technologies in modern maxillofacial surgery, offering improved surgical precision and optimizing patient outcomes. 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

Background/Objectives: Mandibular gingival squamous cell carcinoma (SCC) is the second most common oral cancer after tongue cancer. As these carcinomas often invade the mandible early, accurately defining the resection extent is important. This report highlights the use of preoperative virtual surgery data, computer-aided design and manufacturing (CAD/CAM) technology, surgical guidance, and extended reality (XR) support in achieving highly accurate marginal mandibulectomy without recurrence or metastasis. Methods: CT imaging data obtained a month before surgery were imported into Materialize Mimics and Materialize Magics (Materialize, Leuven, Belgium, Ver22.0) CAD/CAM software and used to design an osteotomy guide. An STL file was generated, and the guide was fabricated using a 3D printer (Objet 260 Connex; Stratasys Ltd., Eden Prairie, MN, USA) prior to the operation. An XR application, installed on a HoloLens (Microsoft, WA, USA) head-mounted display, projected a hologram onto the surgical field. Results: The rapid intraoperative diagnostic tests were negative, and histopathology confirmed SCC without vascular or perineural invasion. No complications, including occlusal or feeding problems and sensory abnormalities, were observed. Postoperative imaging 3 years later showed no recurrence. Conclusions: Combining CAD/CAM and XR techniques for mandibulectomy may improve surgical accuracy and safety in oral and maxillofacial surgeries, whereas in-house 3D printing aids in managing tumor progression. Full article