Search Results (394)

Massive segmental bone defects present significant challenges in orthopaedic and maxillofacial reconstruction. As defect size increases, the disparity between tissue volume and diffusion-limited biological processes becomes more pronounced. This narrative review analyses distinctions between centimetre-scale defects and conventional fractures and evaluates current tissue-engineering strategies in relation to vascularisation, osteogenesis, mechanical stability, immune response, neural integration, and manufacturability. This review synthesises evidence from scaffold design, cell-based approaches, growth factor delivery, type-H vessel biology, NGF–TrkA signalling, large-animal models, and early clinical translation. Current findings indicate that no single scaffold, cell source, or growth factor can reliably reproduce the coordinated biological and mechanical environment required for durable regeneration of human long bones. The strongest preclinical evidence is derived from ovine tibial models employing medical-grade polycaprolactone/β-tricalcium phosphate composites or mechanobiologically optimised titanium lattices. Human data remain limited to case reports and small early clinical series, including hybrid vascularised flap–scaffold reconstructions. Successful clinical translation will require patient-specific constructs that integrate rapid vascularisation, appropriate load sharing, immune-compatible degradation, infection control, and scalable manufacturing. Until robust comparative clinical evidence emerges, established reconstructive methods will remain the standard of care. Hybrid vascularised scaffold-guided strategies should be regarded as promising translational approaches rather than definitive solutions. Full article

Background/Objectives: Contemporary patient-specific subperiosteal implants have re-emerged as graftless solutions for oral and maxillofacial rehabilitation, driven by advances in digital planning, CAD/CAM workflows, additive manufacturing, and biomaterial engineering. Their indications have progressively expanded from severely atrophic edentulous jaws to segmental defects, single-tooth replacement, congenital craniofacial anomalies, salvage situations, and oncologic reconstruction. This scoping review aimed to map the current evidence on modern patient-specific subperiosteal implants, focusing on indications, workflow, design principles, materials, outcomes, complications, and maintenance. Methods: A scoping review was conducted according to PRISMA-ScR principles to identify clinical studies, case series, case reports, systematic and scoping reviews, technical notes, finite element analyses, in vitro studies, and relevant translational investigations dealing with contemporary custom-made or CAD/CAM subperiosteal implants. The evidence was narratively synthesized according to clinical indication and thematic domains, including full-arch rehabilitation, sectional and single-tooth applications, congenital and post-oncologic defects, rescue indications, biomechanics, material selection, surface response, prosthetic protocols, and complication management. No quantitative meta-analysis was performed because of the scoping design and the substantial heterogeneity of study types, indications, implant systems, outcome definitions, and follow-up durations. Results: The final evidence map included 116 records, of which 56 were unique human clinical records with extractable denominators and 60 were biomechanical, in vitro, surface-biology, review, consensus, historical, or conceptual records. Of the 56 unique clinical records, 49 were mapped within the six indication-level clinical sections, while seven were retained as cross-cutting clinical evidence addressing patient-reported outcomes, design-related complications, bone apposition, anchorage strategy, comparative graftless rehabilitation, or reconstructive/prosthetic principles. The six indication-level sections included 52 clinical-record assignments: 15 for full-arch rehabilitation, 13 for segmental or sectional rehabilitation, one for single-tooth rehabilitation, four for congenital or craniofacial indications, 13 for post-oncologic or post-ablative reconstruction, and six for rescue or salvage indications. Because three records addressed more than one indication, these counts represent indication-level assignments rather than mutually exclusive clinical records. Reported survival in most short- to mid-term clinical series was generally high, commonly ranging from 90% to 100%, although lower values of 70–80% were reported in selected longer-term cohorts and survival clearly overestimated clinical success in some studies. Expanding applications include posterior mandibular and maxillary defects, lateral incisor agenesis, cleft-related or syndromic deformities, maxillectomy reconstruction, obturator support, and hybrid rehabilitation with endosseous implants; however, evidence for the indications at the extremes of this spectrum—single-tooth replacement and primary oncologic reconstruction—remains limited to small, largely single-group case series and reports. Soft-tissue events, including dehiscence, mucositis, recession, and framework exposure, were the dominant complications and showed wide variability, with reported recession/exposure rates ranging from approximately 10% in some sectional and full-arch series to as high as 65% in bilateral maxillary cohorts; their clinical significance varied from asymptomatic stable findings to progressive inflammatory complications requiring revision. Conclusions: Patient-specific subperiosteal implants represent a promising and increasingly versatile reconstructive option; however, the present findings should be interpreted as evidence mapping rather than as definitive comparative evidence. Their clinical use should remain highly selective, prosthetically driven, and supported by meticulous planning, rigid fixation, soft-tissue management, and structured maintenance. Standardized success criteria, longer follow-up, and comparative prospective studies are required. Full article

Objectives: Autologous bone grafting remains the gold standard for maxillofacial reconstruction but is limited by tissue scarcity and donor-site morbidity. Consequently, substitutes like bioactive glass (BG), beta-tricalcium phosphate (β-TCP), and deproteinized bovine bone (DBB) are widely used. However, comprehensive mechanistic comparisons among them remain scarce. Materials and Methods: We systematically evaluated these substitutes under standardized in vitro conditions to compare their physicochemical transformations, degradation profiles, biological performances, and underlying osteogenic molecular pathways. Results: In simulated body fluid, BG underwent rapid hydroxyapatite mineralization, whereas the highly porous DBB and dense β-TCP remained structurally inert. Degradation assays revealed BG exhibited the fastest mass loss and ion release, β-TCP showed intermediate degradation, and DBB maintained high in vitro structural stability. Biologically, all materials showed favorable cytocompatibility and comparable angiogenic potential. However, BG demonstrated significant antibacterial activity (E. coli, S. aureus) and a strong potential to enhance osteogenic differentiation, significantly upregulating the protein-level expression of RUNX2 and OCN, alongside the transcriptional upregulation of Bmp2, Runx2, and Ocn. Transcriptomic profiling and pharmacological validation suggest that the enhanced osteogenic performance of BG might be associated with specific regulatory pathways, supporting the hypothesis that the suppression of NF-κB-mediated inflammation and the activation of the ECM-Integrin-FAK mechanotransduction axis play potential roles. Conclusions: BG offers high bioactivity and notable potential to enhance osteogenic differentiation in vitro but degrades rapidly. DBB ensures structural durability without intrinsic osteoinductivity, and β-TCP provides a balanced, intermediate profile. These in vitro mechanistic insights provide a theoretical foundation for future in vivo evaluations and designing next-generation bone scaffolds. Full article

Mandibular angle fractures pose a significant clinical challenge in maxillofacial surgery, and conventional fixation systems often show merely adequate biomechanical performance. This study presents a new mini-plate geometric configuration and outlines its rigorous verification and a preliminary validation procedure. The proposed ‘U’-shaped grade 4 titanium mini-plate with self-tapping screws was developed specifically for the stable fixation of mandibular angle fractures. A three-dimensional mandible model incorporating an angular fracture gap exceeding 1 mm was constructed and analyzed using SolidWorks. Finite Element Analysis (FEA) was employed as a verification tool to evaluate stress, strain, and displacement distributions in the mandibular ramus, plate, and screws under bilateral masticatory muscle loading, with material integrity assessed against yield-strength thresholds using von Mises’ stress theory. Rapid and functional prototypes were subsequently fabricated to physically validate the proposed mini-plate. The maximum stress across the entire model was 446.8 MPa, localized at the middle lower screw, while the maximum stress at the designed plate was 110 MPa, which remains well within the safe limits and is approximately 60.7% lower than the reported maximum stress values for conventional fixation systems. The new mini-plate exhibited robust biomechanical performance, offering a more favorable mechanical environment conducive to bone healing. Full article

Sports-related oral and maxillofacial trauma exhibits distinct injury mechanisms depending on the type of sport; however, comprehensive analyses integrating these characteristics remain limited. This study aimed to elucidate the clinical features of sports-related oral and maxillofacial trauma. This single-center retrospective study included 1615 patients (mean age 41.04 years; 64.8% male) treated between 2012 and 2025 in Shimane University Hospital, Department of Oral and Maxillofacial Surgery/Maxillofacial Trauma Center, Shimane, Japan. Among them, 239 (14.8%) had sports-related injuries and were significantly younger and more frequently male (p < 0.001). Multivariable analysis showed that nasal bone (odds ratio [OR] 5.900, 95% confidence interval [CI] 3.309–10.521), orbital wall (OR: 8.044, 95% CI: 4.664–13.874), zygomatic and zygomatic arch (OR: 3.239, 95% CI: 1.455–7.213), and naso-orbito-ethmoidal fractures (OR: 6.507, 95% CI: 1.971–21.483), as well as contusions (OR: 2.601, 95% CI: 1.385–4.885), were positively associated, whereas mucosal lacerations (OR: 0.485, 95% CI: 0.290–0.811) and referral from dental/medical clinics (OR: 0.312, 95% CI: 0.178–0.546) were negatively associated (all p < 0.01). However, panfacial fractures occurred less frequently. Sports-related trauma was primarily associated with nasal, orbital wall, zygoma and zygomatic arch, and naso-orbito-ethmoidal fractures. These findings indicate that sports-related oral and maxillofacial trauma is characterized by distinct and predominantly midfacial fracture patterns. Full article

Bone loss in the maxillofacial region arises from multiple causes, including periodontal disease, trauma, surgical procedures, infection, congenital anomalies, and cancer. Traditional treatment relies on bone grafting, either alone or in combination with biomaterials. Advances in tissue engineering have introduced synthetic or natural scaffolds to mimic the mineralized bone matrix. Natural scaffolds offer excellent biocompatibility and similarity to native tissue but often lack sufficient mechanical strength and exhibit poor degradation rates. Synthetic scaffolds provide tunable porosity and mechanical stability; however, their biological inertness makes them poor sources of osteogenic signaling. A key factor in the success of any scaffold is its interaction with the host immune system. Upon implantation, the innate immune response is initiated, with neutrophils and macrophages being the first cells to contact the scaffold. Macrophage polarization toward proinflammatory (M1) or anti-inflammatory (M2) phenotypes determines whether the microenvironment favors inflammation or remodeling. The adaptive immune response also plays a critical role: T and B lymphocytes may promote tolerance and integration through Th2/Treg pathways and antibody-mediated regulation, or they may trigger chronic inflammation and rejection through Th1/Th17 activation. This review examines the natural and synthetic materials used for bone remodeling and their biological properties. It then outlines the sequence of immune events occurring from the moment a scaffold is implanted to its potential integration or failure. Finally, this study highlights the relevance of cellular models and in vitro assays for the early evaluation of immunogenicity and biocompatibility, which are essential for optimizing scaffold design and improving outcomes in maxillofacial bone regeneration. 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

Background: Desmoplastic fibroma (DF) is a rare, benign, but locally aggressive intraosseous tumor with a predilection for the mandible in pediatric patients. Owing to its low incidence, evidence guiding management remains limited. Objective: To provide a comprehensive review of the clinical presentation, radiographic features, treatment strategies, and outcomes of pediatric DF of the jaws. Methods: A comprehensive literature review was conducted using PubMed/MEDLINE, Embase, Cochrane Library, and IEEE Xplore to identify relevant studies published between 2000 and 2026. Given the rarity of this entity, a broad search strategy was applied. Eligible studies were analyzed to extract data on patient demographics, clinical features, imaging findings, treatment modalities, and outcomes. Results: A total of 32 studies comprising 45 pediatric cases were identified. The mandible was involved in 86.7% of cases. The most common presentation was painless swelling or facial asymmetry (68.9%). Wide or segmental resection was the primary treatment in 68.9% of cases. Recurrence data were available for 75.6% of cases, with an overall recurrence rate of 2.9%, occurring following incomplete resection. Conclusions: Pediatric DF of the jaws is a rare but locally aggressive tumor requiring accurate diagnosis and individualized surgical management. Complete resection with clear margins appears to provide the most reliable outcomes. However, interpretation of outcomes is limited by the predominance of case reports, heterogeneous reporting, and incomplete follow-up. Future multicenter studies and standardized reporting are needed to better define optimal management strategies. Full article

Implant-associated acute inflammation remains a major challenge in orthopedic, dental, and maxillofacial applications, often impairing osseointegration and leading to early implant failure. In this study, multifunctional cellulose acetate/hydroxyapatite–dexamethasone (CA/HA–DEXA) composite membranes were developed to locally modulate inflammation while supporting early bone–implant interactions. Cellulose acetate provides a flexible matrix, hydroxyapatite enhances bioactivity and osteoconductivity, and dexamethasone acts as an anti-inflammatory agent. The membranes exhibited composition-dependent swelling and drug release behavior. The swelling degree decreased from ~11% for pristine CA to ~5% for the highest HA–DEXA loading, indicating a denser structure with restricted water uptake. Dexamethasone release showed a biphasic profile, with cumulative release reaching ~68%, ~88%, and ~93% for 0.5%, 1%, and 2% HA–DEXA loadings after 72 h, respectively. In vitro evaluation indicated improved biomineralization for CA/HA–DEXA membranes compared to neat CA, attributed to the role of hydroxyapatite as a nucleation promoter. These findings suggest that CA/HA–DEXA composite membranes represent a promising strategy for controlling early inflammatory responses while supporting bone regeneration at the implant interface. Full article

Background: Maxillary sinus lift is among the most common preprosthetic procedures in the posterior maxilla due to alveolar ridge resorption and the maxillary sinus pneumatization. It often extends treatment duration, significantly increases costs, and is not without complications. Objective: To explore the prevalence and morphology of the palatal bone reservoir as a viable site for dental implant insertion, offering a conservative alternative to avoid maxillary sinus lift. Methods: DICOM data sets from helical CT of maxillofacial trauma patients aged 50 years and older were used to perform virtual dental implant positioning in the edentulous second premolar, first molar, or second molar areas using ImplaStation software (version 5.3.2; ProDigiDent, Inc., Scottsdale, AZ, USA). A 3D Slicer software (version 5.3.2; ProDigiDent, Inc., Scottsdale, AZ, USA) was used to calculate the volume of the palatal bone reservoir and identify its mean density. The density of the residual alveolar process was also identified and compared with that of the previous one. Results: A total of 1822 maxillofacial trauma cases with helical CT between 2015 and 2025 were retrieved. After exclusion, 305 cases were analyzed. A total of 65 implants were virtually positioned in 50 patients. The mean volume of the palatal bone reservoir was 229 ± 139.2 mm³ with a mean radiodensity of 546.7 ± 159.6 HU. The mean radiodensity of the residual alveolar process was 286.3 ± 118.0 HU. The palatal bone reservoir was significantly denser than the residual alveolar process (95% CI [184.2, 336.6]; p < 0.01). Conclusions: The presence of a palatal bone reservoir is not uncommon and can offer a more conservative alternative for implant placement, potentially increasing primary stability and facilitating immediate loading. Full article

Background: COVID-19 is primarily a respiratory disease, but increasing evidence suggests possible oral and maxillofacial complications. This study presents a case series of post-COVID maxillary osteonecrosis (PC-RONJ) cases from western Romania and explores the possible association between SARS-CoV-2 infection, its treatment, and this complication. Methods: We conducted a multicenter retrospective case series of two patients with recent PCR-confirmed SARS-CoV-2 infection who subsequently developed maxillary osteonecrosis (ONC) between 2021 and 2023. Clinical examination, CT imaging (including 3D reconstructions), and ENT assessment were used to assess the severity of the disease. All medical records were reviewed to identify comorbidities, details of COVID-19 treatment, and the appearance of maxillofacial symptoms. Results: Both patients had been hospitalized for severe COVID-19 and treated according to the national protocol with systemic corticosteroids, oxygen therapy, anticoagulation, and antivirals. CT scans revealed marked osteolytic destruction of the maxilla and maxillary sinus walls, with extension toward adjacent facial bones. Microbiological analysis revealed a complex polymicrobial profile, including Gram-positive and Gram-negative bacteria as well as opportunistic fungal species, consistent with a chronic biofilm-associated infectious process. Patients received surgical treatment, followed by local care and, in both cases, prosthetic rehabilitation with maxillary obturators, which improved speech, chewing, and oral function. Conclusions: This case series suggests a possible association between severe COVID-19, its treatment, and subsequent maxillary osteonecrosis in susceptible patients; however, the small number of cases precludes causal inference. To our knowledge, this is the first Romanian report describing such cases in patients without prior antiresorptive therapy. These findings highlight the need for careful use of systemic corticosteroids and vigilant post-recovery monitoring of maxillofacial complications. Further studies are required to clarify the underlying mechanisms and risk factors. Full article

Background: Temporomandibular disorders (TMDs) are frequently underdiagnosed in patients with psoriatic arthritis (PsA), and the mechanisms underlying their development remain poorly understood. While inflammatory processes may contribute, central pain sensitization and psychological factors could play a significant role in TMD pathogenesis. Objective: The objectives of this study were to evaluate clinical characteristics, disease activity, psychiatric comorbidities, and pain processing mechanisms in PsA patients with and without TMD and to identify factors independently associated with temporomandibular involvement. Methods: This cross-sectional observational study included 190 consecutive PsA patients (CASPAR criteria) from a single tertiary center. Patients with fibromyalgia were excluded. TMD was assessed by maxillofacial specialists. Disease activity (cDAPSA), functional status (HAQ-DI), disease impact (PsAID-12), central sensitization (Central Sensitization Inventory, CSI), kinesiophobia (Tampa Scale for Kinesiophobia, TSK-11), pressure pain threshold (algometry), and emotional comorbidities (Hospital Anxiety and Depression Scale, HADS) were evaluated. An exploratory binary logistic regression identified a factor independently associated with TMD. Results: Twenty-five patients (13.1%) had confirmed TMD, with a significant female predominance (76% vs. 39%; p = 0.001). Only 24% of patients exhibited structural damage on orthopantomography. TMD patients showed higher CSI scores (52 vs. 32; p < 0.001), greater kinesiophobia (TSK-11: 30 vs. 23; p = 0.002), lower pressure pain thresholds (2.1 vs 2.7 kg/cm²; p = 0.03), and higher anxiety (HADS-A: 9 vs. 5; p = 0.001) and depression scores (HADS-D: 6.5 vs. 3; p = 0.001). TMD patients also exhibited worse functional status (HAQ-DI: 0.7 vs. 0.3; p = 0.001) and greater disease impact (PsAID-12: 4.8 vs. 2.9; p = 0.001). In multivariate analysis, central sensitization (OR: 1.1; 95%CI: 1.04–1.18; p = 0.001) and anxiety (OR: 1.2; 95%CI: 1.02–1.61; p = 0.02) were independently associated with TMD (Nagelkerke R² = 0.48). Conclusion: TMD in PsA is associated with central sensitization and anxiety rather than mechanisms secondary to bone damage. These findings support a multidimensional approach incorporating screening for central sensitization and psychiatric comorbidities in PsA patients with temporomandibular symptoms. 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

Temporomandibular joint osteoarthritis (TMJOA) is a degenerative maxillofacial disorder marked by progressive cartilage degradation and subchondral bone resorption, severely compromising patients’ quality of life. Intra-articular injection (IA), a standard route for conservative therapy, offers clinical advantages in safety and efficacy; however, outcomes remain limited due to short drug retention, poor tissue penetration, and variable agent efficacy, necessitating repeated administration. To overcome these limitations, fisetin-loaded poly (lactic-co-glycolic acid) nanoparticles (FST-PNP) were developed as a localized drug delivery system (DDS) for TMJOA treatment. Physicochemical analyses showed FST-PNP had uniform spherical morphology, excellent dispersibility, stability, high encapsulation efficiency, and substantial drug loading capacity. An in vitro study demonstrated more sustained and stable release from FST-PNP than free fisetin. The in vivo IA administration of FST-PNP preserved mandibular condylar osteochondral structures in TMJOA models. Notably, FST-PNP suppressed the expression of metalloproteinase-13 and a disintegrin and metalloproteinase with thrombospondin motifs-5 (ADAMTS5) as catabolic enzymes and downregulated p16 and p21 as senescence markers, indicating synergistic anti-inflammatory and anti-senescent effects. These findings highlight FST-PNP as a DDS integrating controlled-release with multifaceted therapeutic actions, providing a promising strategy for IA therapy of TMJOA. 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