Search Results (363)

(1) Background: Mandibular condylar fractures continue to be a subject of debate, traditionally framed as a choice between open and conservative management. However, this binary approach fails to adequately account for fracture-level anatomy, Temporomandibular joint (TMJ) involvement, and functional outcomes. (2) Purpose: To present an imaging-guided, fracture-level-based algorithm that integrates radiologic evaluation, surgical approach selection, fixation biomechanics, and functional rehabilitation. (3) Review Strategy: This invited review combines current evidence with a 13-year institutional experience involving 495 joints. High-resolution Computed Tomography (CT) Imaging was used to assess fracture morphology, displacement, and ramal height, while Magnetic Resonance Imaging (MRI) was selectively employed in intracapsular fractures to evaluate disc–condyle relationships when intra-articular involvement was suspected. Management decisions, including surgical approach and fixation strategy, were guided by an institutional algorithm tailored to fracture characteristics. (4) Results: Implementation of this approach yielded consistent and predictable outcomes. Mouth opening improved from approximately 18.77 mm preoperatively to 40 mm at 6 months. Lateral excursions became symmetrical (~9.6 mm), occlusion was restored in all patients, and bite force returned to near-physiological levels. Pain scores showed near complete resolution within 1 month. Postoperative morbidity remained low, with predominantly transient facial nerve weakness. (5) Conclusions: This imaging-guided, algorithmic framework provides reproducible functional outcomes and signifies a shift toward structured, anatomically driven management of condylar fractures. Full article

This study evaluated the effects of restorative material, restoration type, and fiber strip reinforcement on the fracture strength (FS) of endocrown (EC) and post-core (PC) restorations in endodontically treated premolars. Specimens were allocated according to restorative material [resin-nanoceramic (RNC) or feldspathic ceramic (FC)], restoration type (EC or PC), and reinforcement [fiber strip-reinforced (FR) or -non-reinforced (NF)]. FS was determined using a universal testing machine under axial loading. Statistical analysis was performed using three-way ANOVA and Bonferroni tests (α = 0.05). Material, restoration type, and reinforcement significantly affected FS (p < 0.05). RNC restorations exhibited higher FS than FC restorations (861 ± 181 N vs. 715 ± 212 N; p < 0.001). EC restorations exhibited higher FS than PC restorations (828 ± 173 N vs. 748 ± 236 N; p = 0.046). FR groups exhibited higher FS than NF groups (848 ± 180 N vs. 728 ± 222 N; p = 0.003). The highest FS was observed in the RNC–PC–FR group (965 ± 144 N), whereas the lowest occurred in the FC–PC–NF group (480 ± 177 N). Although EC restorations showed higher FS than PC restorations, the effect of restoration type depended on material and reinforcement. Full article

Background and Objectives: Temporomandibular disorders (TMDs) are prevalent conditions affecting the temporomandibular joint and associated musculature, arising from a complex interplay of biomechanical, neuromuscular, and psychosocial factors. Increasing evidence supports functional interconnections among the TMJ, cervical spine, and shoulder girdle, suggesting that dysfunction in one region may influence others; however, these relationships remain incompletely understood. This study aimed to evaluate the association between scapulohumeral trauma, postural abnormalities, and TMDs, and to assess their evolution following interdisciplinary rehabilitation. Materials and Methods: A retrospective observational study with prospective follow-up was conducted in patients with scapulohumeral fractures associated with TMD and postural abnormalities. Postural parameters and the clinical features of temporomandibular disorders (TMDs) were evaluated at baseline and follow-up using a structured clinical assessment informed by the DC/TMD framework, together with clinical examination, electromyographic analysis, and mandibular mobility measurements. Postural evaluation was performed using digital baropodometric analysis (Free Med™ platform with FreeStep™ software, standard Medica sensor, Rome, Italy. Patients received individualized multidisciplinary treatment, including orthopaedic rehabilitation, occlusal splint therapy, physiotherapy (twice weekly), pharmacological management, and odonto-periodontal care. Statistical analyses were performed using non-parametric tests (p < 0.05). Results: Significant postural improvement was observed (p < 0.01), with the proportion of patients with normal posture increasing from 0% to 22.2% and the proportion with moderate forward lean decreasing from 53.3% to 15.6%. TMD severity decreased progressively across evaluations (Friedman χ² = 72.35, p < 0.01). No statistically significant differences were found between treatment groups with respect to postural outcomes, although descriptive differences in TMD improvement were observed at later evaluation points. Conclusions: Interdisciplinary rehabilitation was associated with significant improvements in both postural alignment and TMD severity. Scapulohumeral trauma may be associated with alterations in TMJ function and overall posture, while multimodal therapy supports functional recovery. Further randomized controlled studies are needed to confirm these findings. Full article

Background: Osteoporosis is a prevalent condition characterized by low bone mass and altered microarchitecture, increasing fracture risk. Early detection remains challenging, as conventional methods such as DXA are limited to specialized settings and often detect disease only after a fracture. Radiomics and three-dimensional (3D) imaging techniques, such as CBCT, may provide novel approaches for assessing bone quality. Methods: This pilot study analyzed 68 CBCT scans from adult patients (41 females, 27 males; mean age 57 years). Three-dimensional regions of interest (ROIs) were delineated in seven maxillofacial and mandibular sites (total 309 ROIs). Radiomic texture features were extracted and compared with corresponding T-scores from DXA measurements. Additionally, synthetic 3D reference phantoms with controlled variations in density, trabecular connectivity, and structural anisotropy were generated to evaluate the sensitivity of texture features to microarchitectural changes. Results: Several radiomic features, including GLCM-, ARM-, and Gradient-derived parameters, demonstrated consistent monotonic trends correlating with bone density and microstructural deterioration. Differences in feature values were observed across healthy, osteopenic, osteoporotic, and advanced osteoporotic states. Reference phantoms confirmed that the observed trends were attributable to structural differences rather than imaging variability. Features such as Sum Variance and Correlation exhibited potential as early indicators of microarchitectural degradation. Conclusions: Three-dimensional CBCT texture analysis may provide a non-invasive, supplementary tool for assessing bone quality and detecting early osteopenic changes. Further studies with larger cohorts are warranted to validate radiomic markers and develop predictive indices for osteoporosis screening. Full article

Background: Oral and cranio-maxillofacial (OCMF) surgery is a complex specialty that requires detailed anatomical knowledge and, in fracture care, the ability to interpret imaging accurately. Mixed reality (MR) may improve spatial understanding in anatomy-based disciplines, but its value for teaching mandibular fracture classification remains uncertain. Methods: Medical and dental students at the University of Zurich were randomized 1:1 to classify four unilateral mandibular fractures using either MR or conventional two-dimensional (2D) imaging. Primary outcomes were perceived usefulness, ease of use, learning, and user satisfaction, assessed with a 15-item usability questionnaire. Secondary outcomes were fracture-classification accuracy and time to fracture classification. Results: Forty medical and dental students were included. Baseline characteristics were comparable between groups, and overall fracture-classification accuracy did not differ significantly between MR and 2D. Both groups became faster across successive cases, indicating a learning effect, although the 2D group completed classifications more quickly overall. MR participants reported higher scores for learning and user satisfaction, whereas the 2D group rated ease of use more favorably. Conclusions: MR increased user satisfaction but did not improve fracture-classification accuracy compared with 2D imaging. When integrated thoughtfully into OCMF education, MR may complement, rather than replace, conventional imaging approaches. Full article

Background: Mandibular fractures constitute a significant proportion of maxillofacial trauma resulting from traffic accidents and present valuable information about the severity of the trauma mechanism. The aim of this study was to evaluate the demographic characteristics, fracture patterns, and accompanying injuries of mandibular fractures resulting from traffic accidents. Methods: A retrospective examination was made of 94 patients who presented for forensic medicine evaluation following a traffic accident between 1 January 2019 and 31 December 2024 and were determined with mandibular fracture. The demographic data, accident characteristics, localization of the mandibular fracture, number of fractures, displacement status, and accompanying injuries were analyzed. Results: The analyzed cases comprised 68.1% males and 31.9% females, with a mean age of 29.27 ± 14.34 years. The mandibular fractures were displaced in 52.1% of cases, and closed in 98.9%. The fracture regions were determined to most often be the ramus (32.9%) and the condyle (32.9%). A single fracture was present in 54.9% of cases and multiple fractures in 45.1%. A significant correlation was seen between ramus fractures and male gender, driver status, and concomitant systemic injuries, whereas no significant relationship was found between some fracture types and the demographic and accident-related variables. Conclusions: Mandibular fractures resulting from traffic accidents may represent relatively high-energy trauma mechanisms, and certain fracture patterns may occur together with multiple and systemic injuries. The localization and characteristics of mandibular fractures present important clues about the biomechanics of the trauma and a holistic approach is required in the forensic medicine evaluation. Full article

The mandible, due to its anatomical position, mobility, and functional role, is one of the bones most frequently involved in maxillofacial trauma, with fracture patterns influenced by impact mechanisms and anatomical characteristics. This study aimed to analyse the relationship between trauma mechanisms and affected anatomical subsites in patients with isolated mandibular fractures treated at a regional public hospital in Buenos Aires Province. A retrospective cross-sectional observational study was conducted using medical records, surgical reports, and diagnostic imaging of patients treated between 2011 and 2024. Isolated mandibular fractures were included, while pathological fractures, dentoalveolar injuries, and cases with incomplete data were excluded. Trauma mechanisms were classified as interpersonal aggression, vehicular accidents, falls from height, contact sports, and blows with blunt objects. Interpersonal aggression was the most frequent trauma mechanism, followed by falls from height and vehicular accidents. The mandibular angle, parasymphysis, and condyle were the most commonly affected anatomical sites. Multivariable analysis showed a higher probability of condylar fractures in falls from height (OR = 4.75; 95% CI: 2.24–10.3; p < 0.001) and vehicular accidents (OR = 3.02; 95% CI: 1.28–7.13; p = 0.01). Falls were also associated with a lower probability of mandibular angle fractures (OR = 0.16; 95% CI: 0.06–0.36; p < 0.001), while blunt object trauma showed a positive association with mandibular body fractures (OR = 3.12; 95% CI: 1.04–8.95; p = 0.04). These findings indicate that trauma mechanisms influence the anatomical distribution of mandibular fractures, providing relevant information for diagnostic assessment and surgical planning. Full article

Background and objectives: Head and neck cancer patients frequently undergo radiotherapy, which can affect the properties of dental hard tissues. This study aimed to evaluate the effects of root canal treatment, radiotherapy, and sonic activation during irrigation on the fracture resistance of mandibular anterior teeth. Methods: 80 extracted mandibular anterior teeth were randomly divided into five groups: untreated control (Group I); root canal treatment without radiotherapy or sonic activation (Group II); root canal treatment without radiotherapy but with sonic activation (Group III); root canal treatment with 70 Gray (Gy) radiotherapy and sonic activation (Group IV); and root canal treatment with radiotherapy but without sonic activation (Group V). Radiotherapy was administered in fractionated doses (2 Gy/day, 5 days/week) over 7 weeks. Following instrumentation, root canal obturation was performed accordingly. Fracture resistance was measured using a universal testing apparatus with vertical loading until fracture. Statistical analyses included Shapiro–Wilk normality testing followed by appropriate non-parametric Kruskal–Wallis test followed by Dunn’s post hoc test with Bonferroni correction for multiple comparisons. Results: All root canal-treated groups exhibited significantly lower fracture resistance compared to the untreated control group [1572.3 (1217.0–1841.2) N, p < 0.05]. No statistically significant differences were observed between irradiated and non-irradiated groups (p > 0.05). Similarly, sonic activation during irrigation did not significantly affect the fracture resistance values (p > 0.05). Conclusions: Under the specific conditions of this in vitro protocol, fractionated radiotherapy and sonic activation did not demonstrate statistically significant effects on fracture resistance in mandibular anterior teeth, while endodontic procedures reduced fracture resistance. Full article

Full-arch zirconia prostheses for mandibular All-on-4 rehabilitations are provided as screw-retained monolithic zirconia (Zr-Mono) or as a zirconia suprastructure luted to a CAD/CAM titanium bar (Zr-TiBar). Because zirconia is a brittle and flaw-sensitive ceramic, design assessment should incorporate stress-field-weighted fracture risk. This in silico study compared zirconia tensile stress, deformation, and Weibull-based reliability between Zr-Mono and Zr-TiBar designs in a standardized edentulous mandibular All-on-4 model (posterior implants tilted 30°) using linear static finite element analysis. Accordingly, 300 N posterior unilateral loads were applied at the first molar (axial; 45° oblique). Outcomes were maximum principal tensile stress in zirconia (S1max), total prosthesis deformation, and Weibull-predicted fracture probability (Pf) derived from the tensile S1 field. Under axial loading, S1max was essentially identical between designs (~277 MPa). Under oblique loading, S1max was modestly lower for Zr-TiBar (~227 MPa) than for Zr-Mono (~234 MPa), and deformation was slightly lower for Zr-TiBar (<0.07 mm in all cases). Pf remained very low for both designs (10⁻⁶–10⁻⁷ range) and differed only slightly between them. Under the modeled single 300 N posterior load case, the titanium-bar support reduced deformation and modestly reduced oblique-load peak tensile stress but did not materially reduce the predicted zirconia Pf compared with monolithic zirconia. Full article

Introduction: Stage three osteonecrosis of the jaw (ONJ), whether medication-related (MRONJ) or osteoradionecrosis (ORN), often necessitates aggressive surgical management due to extensive necrosis, infection, and risk of pathologic fracture. While free flap reconstruction remains the gold standard post-segmental mandibulectomy, it may not be feasible for elderly or systemically compromised patients. Objective: The presentation of our own experience with advanced mandibular ONJ on patients managed exclusively with a contemporary titanium reconstruction plate system and to evaluate the clinical outcomes of this approach in the context of the current literature. Methods: From a group of 21 patients treated for ONJ, just four patients with Stage 3 MRONJ or Grade III ORN, unfit for microvascular surgery, underwent segmental mandibulectomy followed by alloplastic reconstruction using standard titanium plating. Outcomes were assessed clinically and radiographically over a follow-up period ranging from 3 to 20 months. A focused literature review was conducted to contextualize results. Results: All patients demonstrated stable reconstruction without plate exposure, fracture, or intraoral bone exposure during follow-up. Esthetic and functional outcomes are reported. No hardware complications were reported. The review of the literature supports plate-only reconstruction as a valid alternative for patients unsuitable for free flap surgery, especially when using rigid, anatomically adaptive systems with robust soft tissue coverage. Conclusions: Titanium plate–only reconstruction following segmental mandibulectomy can provide reliable short- to mid-term outcomes in selected patients with advanced ONJ. Used titanium plating systems appears to be a promising option. Full article

Background: In maxillofacial reconstruction, even small inaccuracies can compromise aesthetics, function, and safety. Surgeons currently rely on preoperative imaging; however, recent advances in intraoperative imaging now provide three-dimensional, real-time guidance, possibly enhancing surgical outcomes. This review evaluates the current application of intraoperative imaging in maxillary and mandibular surgery including its impact on accuracy, efficiency, and outcomes. Methods: Two separate systematic reviews (PROSPERO CRD420251125497, CRD420251124600), analyzing maxillary and mandibular repair were conducted through Cochrane, Medline, Embase, and Web of Science. Both reviews adhered to the PRISMA guidelines. Inclusion criteria encompassed intraoperative digital imaging or navigation in maxillary or mandibular surgery. Studies without human subjects, intraoperative imaging, or the surgery of interest were excluded. Bias was assessed with NIH Quality Assessment. Results: A combined total of 795 publications were screened, with 35 studies ultimately included in this review, encompassing 1643 patients. Techniques included intraoperative computed tomography (CT) (n = 12, 34.3%), stereotactic navigation (n = 16, 45.7%), augmented reality (n = 2, 5.7%), ultrasound, fluoroscopy, infrared stereoscopic and electromagnetic (n = 1, 2.9%, each). The most common indication for surgery was fracture repair. Reporting was heterogeneous, with variable metrics and reporting for accuracy, complications, and revisions. Overall, cone-beam CT (CBCT) and stereotactic navigation both demonstrated significant restoration of normal symmetry, and stereotactic navigation enabled accuracy of <2 mm. CBCT added the shortest amount of time intraoperatively, ranging from 1 to 20 min. Reporting on long-term outcomes was heterogeneous. Conclusions: A variety of intraoperative imaging and navigation techniques are being applied in maxillofacial surgery. However, inconsistent reporting metrics, small study size, and study feasibility-focused study design limit meaningful comparison across technologies. Rigorous prospective studies with standardized outcome measures are needed to further define their clinical value and guide adoption. Full article

Objective: This retrospective study was conducted to evaluate long-term outcomes lcomplication rates of crown restorations supported by different types of endodontic posts and to determine the influence of post material on biological and technical outcomes. Materials and Methods: Clinical and radiographic data from 437 crowned teeth retained by fiber, metallic, or custom-made posts were collected at Qassim University Dental Hospital between August and November 2025. Biological (secondary caries, periapical lesions) and technical (debonding, fracture, chipping) complications were recorded. Kaplan–Meier and life-table analyses were used to estimate complication-free survival, and Cox regression was employed to identify significant predictors (α = 0.05). Results: The mean observation period was 6.76 ± 4.88 years. The overall complication rate was 56.8%. Crowns restored with fiber posts exhibited the lowest complication rate (40.0%) and the highest 15-year cumulative survival (52%), followed by custom-made (38%) and metallic posts (15%). Fiber posts demonstrated a significantly lower hazard of complications than metal posts (HR = 1.70, p = 0.009). Female sex (HR = 1.69, p = 0.001) and mandibular location (HR = 1.36, p = 0.048) were associated with increased risk. Metal–ceramic crowns showed a protective effect compared to ceramic crowns (HR = 0.56, p = 0.001). Conclusions: The type of post significantly affected long-term prognosis of crowned endodontically treated teeth. Fiber posts provided the most favorable outcomes by minimizing catastrophic root fractures, while metallic and custom-made posts demonstrated higher complication hazards. Crown material, arch location, and patient factors further influenced survival outcomes. Full article

Background: Rotary instrument fracture during third molar extraction is rare but clinically relevant, presenting diagnostic and therapeutic challenges. Aim: This scoping review summarizes available evidence on bur breakage and displacement during third molar surgery, focusing on causes, clinical manifestations, and management strategies. Materials and Methods: A systematic search of PubMed, Virtual Health Library, and Google Scholar was conducted for studies published from January 2008 to March 2025 reporting rotary instrument fracture during third molar extraction. Extracted data were qualitatively analyzed. Results: Eight studies reporting eleven clinical cases were included. All fractures occurred during mandibular third molar extractions. Pain was the most frequent symptom (45%), followed by swelling (27%) and trismus (18%). Management varied from immediate surgical retrieval to conservative observation. Conclusions: Although uncommon, rotary bur fracture during third molar extraction requires preventive attention and accurate reporting. Adherence to manufacturer recommendations, single-use bur policies, and adequate irrigation should be considered. Prospective multicenter and mechanical studies are needed to establish standardized management protocols. Full article

Background/Objectives: Titanium fixation remains the gold standard for stabilizing mandibular fractures; however, associated complications often necessitate a second surgery for hardware removal. Consequently, biodegradable systems were introduced, though questions persist regarding their mechanical reliability and potential for tissue reactions. This systematic review and meta-analysis was conducted to compare the efficacy and morbidity of biodegradable versus titanium osteosynthesis systems for the treatment of mandibular fractures. Methods: Following PRISMA guidelines, a systematic literature search was conducted in MEDLINE, Embase, and CENTRAL. Comparative studies, such as randomized controlled trials (RCTs) and non-randomized studies, were included. The primary outcome was the rate of hardware removal; therefore, a random-effects meta-analysis was performed to calculate a pooled Odds Ratio (OR), while the risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools. Results: Eight studies, including four RCTs, comprising a total of 369 patients, were included, with most studies judged to be at a high or serious risk of bias due to inadequate randomization, lack of blinding, and confounding co-interventions. The meta-analysis of four RCTs on hardware removal revealed no statistically significant difference between the biodegradable and titanium groups (pooled OR 0.28, 95% CI 0.04 to 1.90), with substantial and statistically significant heterogeneity observed (I² = 66.1%). Qualitative synthesis indicated that biodegradable systems were associated with higher rates of intraoperative screw breakage and longer operative times, while rates of successful bone union were comparable between the two groups. Conclusions: Biodegradable osteosynthesis systems represent a viable alternative to titanium for mandibular fracture fixation, demonstrating similar efficacy in achieving bone union, which is counterbalanced by higher rates of screw breakage and longer operative times. The decision to use a biodegradable system involves a critical trade-off that should be designed for the specific clinical scenario. The high risk of bias and significant heterogeneity limit the certainty of these findings, underscoring the imperative for future high-quality, long-term RCTs. Full article

Background/Objectives: Subcondylar mandibular fractures represent a challenging subset of maxillofacial trauma due to their proximity to the temporomandibular joint and the facial nerve. The retromandibular approach can be performed through either an anteroparotid or a transparotid route, but comparative clinical data remain limited. This study aimed to evaluate clinical outcomes, complication profiles, and operative parameters associated with the retromandibular anteroparotid versus transparotid approach for open reduction and internal fixation (ORIF) of subcondylar fractures. Methods: A retrospective analysis was conducted on 80 consecutive patients treated for subcondylar mandibular fractures at the Department of Maxillofacial Surgery, Umberto I General Hospital, Sapienza University of Rome, between 2018 and 2025. All patients underwent ORIF via a retromandibular approach (anteroparotid or transparotid) with a minimum follow-up of 6 months. Demographic data, trauma etiology, fracture morphology (classified as simple or complex), associated fractures, surgical approach, fixation details, operative time, hospital stay, and postoperative complications were collected. Facial nerve function was clinically assessed and graded using the House–Brackmann scale. Associations between fracture type, surgical approach, number of plates, and complications were evaluated using Chi-square or Fisher’s exact tests, while operative time was compared using one-way ANOVA and Kruskal–Wallis tests (p < 0.05). Results: The cohort had a mean age of 41.9 years and was predominantly male (67.5%). The anteroparotid route was used in 54 patients (67.5%) and the transparotid route in 26 (32.5%). Overall, 10 patients (12.5%) developed postoperative complications, including transient facial nerve weakness, malocclusion, visible scarring, and sialocele. All cases of sialocele occurred in the transparotid subgroup, whereas no salivary complications were observed after the anteroparotid approach. No permanent facial nerve deficits, temporomandibular joint ankylosis, or long-term facial asymmetry were recorded at 6 months. No significant association was found between surgical approach and overall complication rate, but complex fracture patterns were significantly associated with increased operative time. Conclusions: The retromandibular approach is a safe and effective option for ORIF of subcondylar mandibular fractures. Both anteroparotid and transparotid routes provided reliable exposure and stable fixation with low complication rates. The anteroparotid route appears to minimize parotid-related complications, such as sialocele, while maintaining comparable functional outcomes. These findings support the retromandibular anteroparotid approach as a valuable alternative in the surgical management of subcondylar fractures. Full article