Search Results (275)

Advanced cases of unilateral condylar hyperplasia might need combined joint reconstruction and orthognathic surgery. This report illustrates the feasibility of integrating digital planning, patient-specific prosthesis design, and orthognathic correction within a single-stage surgical workflow. A 23-year-old female patient presented with skeletal Class III malocclusion, facial asymmetry, and mandibular midline deviation due to left condylar hyperplasia. After preoperative orthodontic alignment, virtual surgical planning was carried out using specialised software to simulate resection of the hyperplastic condyle, with concurrent total TMJ replacement, contralateral sagittal split ramus osteotomy, and Le Fort I osteotomy. Based on this plan, patient-specific prosthetic components, surgical guides, and fixation plates were designed and manufactured. Surgery was performed according to the digital plan using a combined intraoral and extraoral approach. At 3-month follow-up, clinical and radiological assessments showed stable prosthesis positioning, improved occlusal relationships, restoration of facial symmetry, and high patient-reported satisfaction. However, given the single-case design and short follow-up, these findings should be considered preliminary, and further studies are necessary to evaluate long-term functional outcomes and reproducibility. Full article

Background/Objectives: Craniofacial malformations such as orofacial clefts affect ~1 in 700 births; 40–60% lack clear genetic etiology, and many exhibit asymmetry and variable expressivity unexplained by classical Sonic Hedgehog (SHH) morphogen gradient models. We investigated whether integrated molecular modules linking morphogen signaling with metabolic stress responses may better account for craniofacial developmental outcomes. Methods: Sequential UniProt gene set integration identified 186 candidate craniofacial regulators. STRING network analysis revealed modular architecture. Molecular docking profiled 17 compounds against SMO, CK1δ, PINK1, and TIE2 (control). Pathway reconstruction integrated the SHH–CK1δ–HIF1A–HEY1–PINK1 axis with in-silico-predicted CK1δ phosphorylation sites on SMO (S615, T593, S751), HIF1A (Ser247), and GLI1/2/3 transcription factors. A developmental decision tree mapped affinity profiles to node-specific phenotype hypotheses. Results: CK1δ and PINK1 emerged as candidate nodes coupling morphogen signaling with mitochondrial quality control. Cross-docking showed preferential binding to developmental kinases (CK1δ: −8.34 kcal/mol; PINK1: −8.80 kcal/mol) versus TIE2 control (−6.76 kcal/mol; p < 0.001). Pathway reconstruction suggested that CK1δ-mediated Ser247 phosphorylation of HIF1A disrupts ARNT dimerization, redirecting HIF1A toward ARNT-independent HEY1 induction and consequent PINK1 suppression. Based on computed profiles, node-specific associations were proposed as computational hypotheses: SMO perturbation → midline defects; CK1δ → facial asymmetry/clefting; PINK1 → mandibular hypoplasia. Multi-target compounds (e.g., purmorphamine, taladegib) generated composite phenotype predictions consistent with clinical complexity. Conclusions: This strictly in silico study identifies candidate integrated morphogenic modules whose multi-node perturbation may underlie anatomically specific craniofacial malformation patterns. Node–phenotype associations are prioritized computational hypotheses requiring experimental validation; if confirmed, the framework could inform developmental toxicity assessment, therapeutic design, and reclassification of idiopathic craniofacial anomalies. Full article

Segmental mandibular resection may be indicated as a treatment in, for example, advanced stages of oral squamous cell carcinoma (OSCC). Osseous reconstruction of these defects is a fundamental part of static and dynamic masticatory rehabilitation, particularly when dental implants are required. The Segmental Mandibular Defect Reconstruction (SMDR) Registry aims to generate real-world evidence on SMDR through an international, prospective, multicentre case series designed as a registry. While OSCC is a common indication for segmental mandibular resection, the SMDR Registry also aims to capture outcomes for rarer mandibular conditions and the increasing number of collateral damage cases resulting from systemic medication therapies (antiresorptive drugs, immunotherapeutics) or irradiation, which may likewise lead to medication-related osteonecrosis of the mandible (MRONJ) or osteo(radio)necrosis with tumour-like segmental resection of the mandible, highlighting the value of an international database for these less frequent pathologies. Primary objectives are to describe the patient population and current treatment modalities, describe the outcomes and adverse events (AEs) for different treatment modalities, and identify potential predictors for successful autologous reconstruction of SMDs. Approximately 300 patients with a mandibular lesion resulting from bisphosphonate- and immunomodulatory drug-induced osteonecrosis of the mandible, ameloblastoma or osteosarcoma of the mandible, oral metastases related mandibular lesions indicated for segmental resection, or OSCC undergoing SMDR or intending to undergo one- or two-stage reconstruction will be prospectively recruited over a 36-month period. Baseline information, treatment details, and outcome measures will be documented. All treatments will be per the usual practice at participating sites. Outcome measures include clinical, patient-reported, and radiological outcomes; AEs related to the condition and/or treatment with a possible influence on the outcome will be recorded. Full article

By using virtual surgical planning (VSP) and 3D printed guides, complex maxillofacial defects can be reconstructed with high accuracy and predictability. A fully digital workflow resulting in a modular all-in-one 3D printed guide system for fibula osteotomies, bone segment positioning, fully guided dental implant placement and dental prosthesis fixation for mandibular reconstruction was developed at Ghent University Hospital. A follicular ameloblastoma of the left mandible was resected in a 28-year-old male. The defect was reconstructed with a two-segment fibular free flap with immediate placement of three dental implants and immediate implant loading with a screw-retained bridge. A split thickness skin graft and Elemental PerioPlast were used as wound dressing. Comparison of the preoperative planning with the postoperative CT-scan showed a deviation immediately after surgery, which was no longer present at the 6-month follow-up. The patient achieved a stable occlusion and 44 mm mouth opening and reported high satisfaction. This case illustrates that fully digital, immediate mandibular reconstruction with simultaneous implant placement and prosthetic rehabilitation is feasible and accurate and enhances early functional recovery. Future improvements in intraoperative validation may further refine accuracy and reproducibility in complex oncologic reconstructions. Full article

Background/Objectives: Root canal procedures on multi-rooted teeth, including first molars, depend on experience, tactile perception, and anatomical knowledge to avoid perforation in the furcation region. Studies using various methodologies and populations have reported discrepant findings on pulpal floor thickness. No study using micro-computed tomography (Micro-CT), the gold standard, has been conducted on a Black South African sample to evaluate pulpal floor thickness. Methods: In this cross-sectional, descriptive, quantitative study, Micro-CT scans of 91 maxillary and 77 mandibular first molars were reconstructed in 3D and oriented according to a reference plane along the cemento-enamel junction using Avizo software. Measurements were taken from the midpoint of the pulpal chamber floor to the perpendicular point on the furcation. In maxillary molars, an additional measurement between the mesiobuccal and distobuccal roots was taken. The effects of arch, side, age, and sex were assessed. Results: Neither sex, arch, nor side had a significant influence on the pulpal floor thickness. The central mandibular and maxillary pulpal floor thicknesses increased significantly with aging, while the effect on the buccal maxillary pulpal floor thickness was not significant. The mean central mandibular and maxillary pulpal floor thicknesses were 2.66 and 2.83 mm, respectively, while the buccal maxillary pulpal floor thickness was significantly smaller at 2.37 mm. Conclusions: More accurate and repeatable findings compared to the literature could be attributed to the use of Micro-CT, which provides higher resolution images, and to Avizo, which enables precise localization of 3D points. Variations from the literature might also be explained by differences in the age and geographical origin of the samples. Full article

Background/Objectives: An accurate description of facial sexual dimorphism is essential in clinical, forensic, and anthropological contexts to support accurate diagnosis of craniofacial dysmorphisms and differences, treatment planning and evaluation, as well as biological profiling, craniofacial reconstruction, and personal identification. This study investigates sexual dimorphism of the facial soft tissues in a sample of healthy Italian adults, providing reference data and deepening our understanding of normal craniofacial variation. Methods: Three-dimensional stereophotogrammetric facial images of 342 Italian adults (172 males and 170 females; 18–40 years old) were analyzed using a 3D spatially dense geometric morphometric approach to assess both shape and form. Principal Component Analysis (PCA) and Partial Least Squares Regression (PLSR) were used to explore facial variation and to quantify sex-related differences. Results: Centroid size was significantly larger in males. While PCA revealed that sex is a significant factor in facial shape and form variation, PLSR highlighted the existence of significant associations between sex and both shape and form. Color-coded morphometric maps underlined the most sexually dimorphic traits: males exhibited bigger faces with deep-set eyes and central facial projection extending from the supraorbital rims to the chin, whereas females display smaller faces with fuller cheeks, and a more vertical forehead profile. Conclusions: While our results are consistent with those of previous studies, our study revealed important, distinctive group-specific traits: flatter labiomandibular folds in males and wider temples and fuller cheeks in the infraorbital region extending to zygomatic and mandibular areas in females. Thus, this study provides high-resolution reference data supporting related applications. Full article

Background: Computer-aided design and manufacturing (CAD/CAM) technology has been increasingly adopted for mandibular and maxillary reconstruction using fibula free flaps. However, its clinical and economic advantages over the conventional freehand technique remain debated. The objective of this study was to compare perioperative outcomes and institutional costs between CAD/CAM-guided and conventional freehand fibula flap reconstructions. Methods: An ambispective observational study was conducted including patients who underwent mandibular or maxillary reconstruction with an osteocutaneous free fibula flap between 2017 and 2024. Reconstructions were performed either using CAD/CAM-guided virtual surgical planning or the conventional freehand technique. Demographic data, perioperative variables, postoperative outcomes, oncologic margin status, transfusion requirements, and total institutional costs were analyzed. Univariate comparisons were performed between groups, and multivariate linear regression models were used to assess the independent association of CAD/CAM guidance with operative time and hospital length of stay. Results: Fifty-one patients were included (25 CAD/CAM-guided and 26 freehand). CAD/CAM-guided reconstruction was associated with a significantly shorter operative time (542.3 ± 65.8 vs. 604.9 ± 79.5 min; p = 0.0036) and a shorter overall hospital stay (19.6 ± 7.2 vs. 30.6 ± 26.2 days; p = 0.047) in univariate analysis. The need for perioperative blood transfusion was significantly lower in the CAD/CAM group. No significant differences were observed in ICU stay, flap failure, reintervention rate, or postoperative hemoglobin decrease. Although margin status did not differ significantly between groups, a higher proportion of negative margins was observed in the CAD/CAM cohort. In multivariate analysis adjusting for age and perioperative variables, CAD/CAM guidance remained independently associated with reduced operative time, but not with hospital length of stay. Despite higher upfront planning costs, total per-patient cost was lower in the CAD/CAM group due to improved perioperative efficiency. Conclusions: CAD/CAM-guided fibula free flap reconstruction is a safe and effective technique that is associated with reduced operative time and lower transfusion requirements while maintaining comparable oncologic outcomes. When perioperative efficiency gains are achieved, these advantages may offset the higher planning costs, resulting in overall cost savings at the institutional level. CAD/CAM-assisted reconstruction may therefore be particularly advantageous in high-volume oncologic centers and anatomically complex cases. 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

Background/Objectives: Restoration of mandibular anatomy following complex trauma remains challenging when conventional anatomical and occlusal references, such as dental occlusion, contralateral morphology, condylar position, or mandibular continuity are lost. This technical note describes the clinical application of a mandibular statistical shape model as an alternative anatomical reference for diagnosis, virtual planning, and postoperative evaluation in patients with severe post-traumatic deformities. Methods: The MAGIC-SSM, an open-source, age-, and sex-specific three-dimensional model derived from a normative population dataset, enables reconstruction of plausible mandibular geometry in the absence of residual landmarks. Three clinical cases were analyzed using MAGIC-SSM-based reference alignment, with distance mapping applied when indicated. Results: The model provided an additional anatomical reference that supported decision-making in secondary correction, hybrid reconstruction with patient-specific implants, and quantitative evaluation of postoperative outcomes. Conclusions: By replacing lost spatial references with population-based geometry, the MAGIC-SSM offered support for restoring mandibular form and symmetry. These preliminary findings illustrate the feasibility of applying the MAGIC-SSM as an anatomical framework in complex trauma when conventional guides are absent. As its clinical application involved clinician-guided alignment and scaling, reproducibility and reliability remain to be established and require further validation. Full article

Background/Objectives: Maxillofacial reconstruction with a vascularized free bone flap for facial contour restoration serves as a foundation for dentition rehabilitation. Although state-of-the-art studies have reported promising results with implant-supported prostheses in such cases, evidence for dental implant prognosis remains insufficient. This study aims to synthesize the mid-term clinical outcomes of implants placed in vascularized free bone flaps, taking into account the biological responses and associated complications. Methods: Studies with a minimal 3-year follow-up, no less than 10 patients, and reporting implant survival/success rate were included. Literature published from 2000 to 2025 was collected from PubMed, Embase, and Scopus. Meta-analyses were performed to pool the implant survival and success rates for the entire cohort, the biological complication rates, the odds ratio for radiotherapy, and the pooled implant failure rates associated with radiotherapy. Parameters related to biological prognosis were collected. ROBINS-E and NOS scale were used to assess the risk of bias. Results: Of the 949 records identified, 14 retrospective and 2 cohort studies were included, yielding a total of 1165 dental implants placed in free bone flaps. On the implant level, meta-analysis demonstrated a pooled implant survival rate of 97.9% (95% CI: 0.922–0.994, I² = 64.4%) and a pooled implant success rate of 88.1% (95% CI: 0.803–0.931, I² = 68.3%). The pooled biological complication rate was 8.6% (95% CI: 0.052–0.138; I² = 69.5%). Among patients who underwent radiotherapy, the pooled implant failure rate was 13.7% (95% CI: 0.087–0.210; I² = 0.0%; p = 0.4702) with an odds ratio of 3.086 (I² = 66.5%) for radiotherapy-associated implant failure. Conclusions: Implant-related outcomes in these complex cases are generally acceptable, with high survival, moderately high success rates and overall stable biological response. Additionally, radiotherapy adds to the risk of implant failure on implant level. However, the statistical heterogeneity and inconsistent definitions of biological outcomes in the literature suggest that caution is warranted when planning implant therapy in these cases. Further studies with long-term follow-up, focused on peri-implant tissue conditions and adopting more stratified study designs to minimize confounding factors, are needed. Full article

Background: The PITX1 gene encodes a transcription factor that plays a crucial role in the development of the lower limbs, pelvis, and structures derived from the first branchial arch. Pathogenic variants in PITX1 are associated with a limited spectrum of rare disorders, including congenital talipes equinovarus with or without long bone anomalies and/or mirror-image polydactyly, and Liebenberg syndrome. In 2020, a novel clinical phenotype, Mandibular–Pelvic–Patellar (MPP) syndrome, resulting PITX1 missense variants, was proposed. Case presentation: We report the fourth documented case of MPP syndrome worldwide, identified in a 17-year-old female patient presenting with congenital lower limb deformities, patellar aplasia, and micrognathia. Whole-genome sequencing revealed a heterozygous PITX1 missense variant NM_002653.5: c.412A>C, p.(Lys138Gln). The clinical phenotype included knee flexion contractures and severe equinovarus and planovalgus foot deformities requiring multiple staged reconstructive surgical procedures. Conclusions: This case supports recognition of MPP syndrome as a clinically and genetically distinct PITX1-related disorder. Our findings expand the phenotypic spectrum of MPP syndrome and suggest that severe congenital foot deformities represent a consistent and clinically relevant feature of this condition. Full article

Background: Rehabilitation of the severely atrophic posterior mandible remains surgically challenging, and inferior alveolar nerve (IAN) repositioning is a well-established technique that enables implant placement in anatomically compromised cases. Although neurosensory outcomes following nerve relocation have been extensively investigated, the regenerative capacity of the mandibular canal itself has not been previously evaluated. This study presents the first computer-assisted, cone-beam computed tomography (CBCT)-based assessment of bony canal regeneration after IAN transposition. Methods: Twenty-two patients who underwent unilateral IAN transposition were evaluated using standardized CBCT one year postoperatively. A semi-manual segmentation workflow was performed using Mimics Core Medical software version 27.0 (Materialise), and regenerated canal walls were identified according to four strict criteria: (1) canal continuity across sequential CBCT sections, (2) defined canal walls demonstrating high-density bone (>800 HU, or >400 HU), (3) ≥270° circumferential bony enclosure, and (4) morphology consistent with the native mandibular canal. Regeneration was quantified as the proportion of the surgically disrupted canal segment exhibiting a fully, or near fully, reconstructed canal. Results: Mandibular canal regeneration was observed in all patients. The mean regeneration at one year was 72.7% ± 13% when applying strict >800 HU criteria, with 20 patients demonstrating substantial (>70%) reformation and 2 patients showing partial regeneration (<40%). When a lower density threshold (>400 HU) was applied to include early or less mineralized bone, the mean regeneration increased to 78.1% ± 11%, indicating the presence of maturing bone structures that did not yet meet full-density criteria. Conclusions: Computer-assisted CBCT analysis demonstrates that partial to extensive regeneration of the mandibular canal occurs within one year following IAN transposition. This study provides the first quantitative evidence of this phenomenon, highlighting the intrinsic regenerative potential of the mandibular canal and suggesting a possible association with postoperative neurosensory recovery. Full article

Objectives: The aim of this study was to compare the stiffness-related mechanical response and peak von Mises stress distribution of low-profile 2.4 mm mandibular reconstruction systems (a conventional reconstruction plate, a 3D grid-type plate, and a customized plate) in a virtual atrophic mandible model with a 5 cm segmental defect. Materials and Methods: A CT-based three-dimensional mandible model was created and instrumented with three plate configurations (G1–G3). Linear static finite element analyses were performed under a 300-N masticatory load combined with literature-based muscle force vectors. Peak von Mises stresses were recorded for plates and screws, and the locations of maximum stress concentration were identified. Results: Peak plate stress was highest in the conventional reconstruction plate (G1: 695.5 MPa), followed by the 3D grid-type plate (G2: 595.6 MPa), and lowest in the customized plate (G3: 185.2 MPa). The peak screw stress was 692.9 MPa (G1), 898.0 MPa (G2), and 595.6 MPa (G3). The 3D grid-type plate increased construct stiffness but shifted stress concentration toward the mandibular angle and adjacent screws, whereas the customized plate reduced the peak plate stress and limited the extent of the high-stress region across the defect. Conclusions: Within the limitations of a linear static FEA (stiffness/stress distribution rather than failure load or fatigue resistance), the customized plate (G3) demonstrated the most favorable biomechanical performance (lowest peak plate stress). The 3D grid-type plate (G2) reduced peak plate stress compared with the conventional design (G1) but produced the highest peak screw stress. Practical considerations such as manufacturing lead time and resource requirements may favor off-the-shelf plates; however, a formal cost or operative-time analysis was not performed. Full article

Background: Microvascular osseous free flaps play a central role in head and neck reconstruction; surgeons often rely on fragmented and inconsistently reported data when counselling patients and planning reconstructive strategies. This systematic review and meta-analysis aimed to quantify postoperative complication rates and to evaluate complication patterns according to flap type. Methods: The study protocol was registered in PROSPERO (CRD420251237516). Studies published between January 2000 and November 2025 reporting postoperative complications following mandibular or maxillary reconstruction with osseous free flaps were identified. Eligible studies included adult cohorts with a minimum sample size of twenty patients. Random-effects meta-analyses of proportions were conducted. Risk of bias was assessed using the ROBINS-I tool. Results: Fourteen retrospective studies encompassing 1198 flaps were included. The pooled incidence of total flap loss was 6% (95% CI 3–9%), and partial flap loss was 6% (95% CI 3–10%). The pooled rates for postoperative infection, fistula formation, and wound dehiscence were 7% (95% CI 2–22%), 12% (95% CI 7–20%), and 16% (95% CI 8–31%), respectively, with substantial heterogeneity. Fibular free flaps demonstrated pooled rates of 6.1% for total flap loss, 6.6% for partial flap loss, 9.0% for infection, 10.4% for fistula formation, and 17.1% for wound dehiscence. For scapular free flaps, pooled total flap loss was 5% (95% CI 1–29%). DCIA flaps demonstrated hardware-related complications (8.1%), fistulas (16.7%), bone exposure (4.2%), and wound dehiscence (29.7%). Donor site morbidity was inconsistently reported and could not be quantitatively synthesized. Conclusions: Osseous free flap reconstruction shows relevant complication rates, highlighting the need for standardized reporting to support evidence-based decision-making. Full article