Search Results (59)

Background/Objectives: Orbital reconstruction remains one of the most demanding procedures in maxillofacial surgery. It requires not only precise anatomical knowledge but also poses multiple intraoperative challenges. Limited surgical visibility—especially in transconjunctival or transcaruncular approaches—demands exceptional precision from the surgeon. At the same time, the complex anatomical structure of the orbit, its rich vascularization and innervation, and the risk of severe postoperative complications—such as diplopia, sensory deficits, impaired ocular mobility, or in the most serious cases, post-traumatic blindness due to nerve injury or orbital compartment syndrome—necessitate the highest level of surgical accuracy. In this context, patient-specific implants (PSIs), commonly fabricated from zirconium oxide or ultra-high-density polyethylene, have become invaluable. Within CAD-based reconstructive planning, especially for orbital implants, critical factors include the implant’s anatomical fit, passive stabilization on intact bony structures, and non-interference with orbital soft tissues. Above all, precise replication of the orbital dimensions is essential for optimal clinical outcomes. This study compares the morphological accuracy of orbital structures based on anthropometric measurements from 3D models generated from fan-beam computed tomography (FBCT) and cone-beam computed tomography (CBCT). Methods: A cohort group of 500 Caucasian patients aged 8 to 88 years was analyzed. 3D models of the orbits were generated from FBCT and CBCT scans. Anthropometric measurements were taken to evaluate the morphological accuracy of the orbital structures. The assessed parameters included orbital depth, orbital width, the distance from the infraorbital rim to the infraorbital foramen, the distance between the piriform aperture and the infraorbital foramen, and the distance from the zygomatico-orbital foramen to the infraorbital rim. Results: Statistically significant differences were observed between virtual models derived from FBCT and those based on CBCT in several key parameters. Discrepancies were particularly evident in measurements of orbital depth, orbital width, the distance from the infraorbital rim to the infraorbital foramen, the distance between the piriform aperture and the infraorbital foramen, and the distance from the zygomatico-orbital foramen to the infraorbital rim. Conclusions: The statistically significant discrepancies in selected orbital dimensions—particularly in regions of so-called thin bone—demonstrate that FBCT remains the gold standard in the planning and design of CAD/CAM patient-specific orbital implants. Despite its advantages, including greater accessibility and lower radiation dose, CBCT shows limited reliability in the context of orbital and infraorbital reconstruction planning. Full article

Background/Objectives: This cross-sectional analytical study investigated the relationship between the craniofacial morphology, condylar displacement, and degenerative changes in the temporomandibular joints (TMJs) in adult patients with class II skeletal malocclusion. To compare cephalometric variables, joint space dimensions, and centric slide measurements between patients with and without CBCT-confirmed TMJ degenerative alterations. Methods: Sixty adults with class II malocclusion were divided into two equal groups (n = 30) based on the presence or absence of TMJ degenerative changes on CBCT. Joint spaces were measured, condylar displacement was evaluated using a condylar position indicator (CPI), and cephalometric analysis was performed in both maximal intercuspation and centric relation. Statistical comparisons were performed using t-tests, chi-squared tests, and Pearson’s correlation analysis. Significance was set at p < 0.05. Results: Patients with degenerative TMJ changes exhibited significantly greater overjet (p = 0.0001) and a trend toward increased ANB angles (p = 0.055). The superior joint space was reduced on the right side (p = 0.031). Condylar displacements ≥ 2 mm were more frequent in the affected group and correlated with sagittal cephalometric discrepancies (45% vs. 24% in controls). Conclusions: Aggravated skeletal class II malocclusion with increased overjet could be associated with TMJ degenerative changes. CR-based cephalometry and CBCT evaluation may aid in diagnostic assessment, but longitudinal studies are needed to confirm the clinical relevance. Full article

Chronic kidney disease (CKD) is an extremely widespread pathology characterized by numerous metabolic alterations, including impairments of calcium–phosphorus and of vitamin D metabolisms, which lead to a condition known as CKD–mineral and bone disorders (CKD-MBDs). In CKD children, this pathological condition induces anomalies in physiological growth processes, alterations in bone morphology, renal osteodystrophy and rickets. CKD-MBDs are not only associated with systemic complications but also show dental and maxillofacial manifestations in children. In fact, children affected by CKD-MBDs present defects in enamel development and dental anomalies when compared to healthy children. Therefore, the aims of this narrative review are to focus on the hard dental tissues and to investigate the possible correlation between the CKD-MBDs in children and the presence of developmental defects of enamel. In addition, the possible risk and protective factors of dental caries in CKD pediatric patients are analyzed. The review describes, with a multidisciplinary nephrological–dental approach, the pathogenic mechanisms that can cause anomalies in dental structure in CKD pediatric patients. Full article

This study investigates the synthesis of Zn₂SnO₄@SiO₂@5-FU nanoparticles as an additive for bone fillers in dental maxillofacial reconstruction. Zn₂SnO₄ nanoparticles were synthesized and coated with a SiO₂ shell, followed by the incorporation of 5-Fluorouracil (5-FU), aimed at enhancing the therapeutic properties of classical fillers. Structural analysis using X-ray diffraction confirmed that Zn₂SnO₄ was the single crystalline phase present, with its crystallinity preserved after both SiO₂ coating and 5-FU incorporation. SEM characterization revealed the micro-spherical particles of Zn₂SnO₄ assembled by an agglomeration of nanorods, exhibiting dimensions and morphological characteristics that were consistent after the addition of both the SiO₂ shell and 5-FU. Fourier-transformed infrared spectroscopy provided solid proof of the successful synthesis of Zn₂SnO₄, Zn₂SnO₄@SiO₂, and Zn₂SnO₄@SiO₂@5-FU, confirming the presence of expected functional groups. The SiO₂ layer improved nanoparticle stability in the solution, as indicated by zeta potential measurements, while adding 5-FU significantly increased biocompatibility and targeting efficiency. The existence of the SiO₂ shell and 5-FU is also confirmed by the hydrodynamic diameter, indicating an increase in particle size after incorporating both compounds. Antibacterial assays demonstrated a selective efficacy against Gram-positive bacteria, with Zn₂SnO₄@SiO₂@5-FU showing the strongest inhibitory effects. Biofilm inhibition studies further confirmed the nanoparticles’ effectiveness in preventing bacterial colonization. Cytotoxicity tests on the A-431 human epidermoid carcinoma cell line revealed a dose-dependent reduction in cell viability, highlighting the potential of 5-FU for targeted cancer treatment. These findings highlight the potential of Zn₂SnO₄@SiO₂@5-FU nanoparticles as a multifunctional additive for bone fillers, offering enhanced antimicrobial and antitumor capabilities. Full article

Background/Objectives: Methods for predicting final mandibular length have been studied for many years. We aimed to estimate the final mandibular length at the end of the growth period by analyzing changes in cervical vertebral morphology using longitudinal lateral cephalograms. Methods: Longitudinal lateral cephalograms of elementary school students aged 6–15 who did not undergo orthodontic treatment, collected between 1965 and 1973, were used. For this analysis, 370 images from 44 female individuals were selected, and cervical vertebral morphology was assessed using the semi-landmark method. Generalized Procrustes analysis and principal component analysis were performed, and changes in maxillofacial skeletal and cervical vertebral morphology were analyzed using a linear mixed model with repeated measures. A predictive formula for estimating final mandibular length was developed based on morphological changes in the fourth cervical vertebra. Results: The difference between the predicted and actual final mandibular lengths using the semi-landmark method was 0.17 ± 0.08 mm. The marginal R² value of the prediction formula was 0.957, and the conditional R² was 0.990, demonstrating very high accuracy. The annual increase in mandibular length remained consistent each year but slowed after 14 years of age. Geometric morphometric analysis revealed significant morphological changes in the fourth cervical vertebra at 14 years of age, coinciding with a deceleration in mandibular growth. Conclusions: A highly accurate formula was developed to predict final mandibular length based on morphological changes in the fourth cervical vertebra. Cervical vertebral morphology may provide valuable information related to mandibular growth during adolescence. Full article

Background: The temporomandibular joint (TMJ) is a key component of the stomatognathic system, playing a major role in maintaining mandibular stability and function. Temporomandibular disorders (TMDs) are a prevalent disease in the world, with surgical treatment being reserved for complex cases or end-stage TMJ disease. A narrative review was conducted to describe the quantitative and qualitative factors that affect TMJ prosthesis stability. Methods: Studies with a sample size equal to or greater than 10 subjects who underwent surgical procedures for joint replacement using stock or customized ATM prostheses were included. This narrative review examined some variables that may influence in terms of the longevity of the TMJ prosthesis, highlighting issues to be considered in future research. Results: The current development of TMJ prostheses is benefiting from technological advances, offering a suitable adaptation to the patient’s anatomy and superior results in functionality and patient satisfaction. However, the biomechanical complexity of the TMJ shows unique challenges compared to other joints in the body, where anatomical, biomechanical, and functional requirements are high. The stability of the TMJ prosthesis is affected by multiple variables, including the selection of biocompatible materials that resist corrosion and wear, the design of the prosthesis, the diagnosis and indication for its use, and the surgeon’s experience. The success of TMJ replacement can be measured by improving the patient’s quality of life, reducing pain, restoring mandibular functionality, and recovering suitable facial morphology for the patient’s conditions. Conclusion: There is a need for training of maxillofacial surgeons in TMJ surgery and replacement, as well as a greater focus on the research and development of systems to simplify surgical design and procedures and to optimize the results of TMJ replacement. Full article

Background: Aspergillosis is a fungal disease caused by the inhalation of fungal spores of the genus Aspergillus spp. This fungus mainly affects the lungs but can spread and infect the maxillofacial region through the bloodstream or inoculation of the fungus after extraction or endodontic treatment, especially in the upper posterior teeth. The disease has nonspecific clinical manifestations that hinder its early diagnosis. Although the Polymerase Chain Reaction (PCR) technique holds promise as a diagnostic tool for aspergillosis, anatomopathological analysis services do not routinely adopt this method. Objectives: Therefore, the present study aimed to evaluate the applicability of PCR and standardise the techniques of preparation of biological samples for the detection of the three species: Aspergillus niger, Aspergillus fumigatus and Aspergillus flavus. Methods: Six samples of formalin-fixed, paraffin-embedded tissue (FFPE) with a histopathological diagnosis suggestive of aspergillosis were investigated using PCR. As a positive control for the PCR reaction, morphologically and genetically characterized cultures were used, with their sequences deposited at NCBI under accession codes MW837777 (A. fumigatus) and MW837779 (A. niger). The A. flavus culture used is reference RC 2053. Results: Four of the six samples evaluated were positive for Aspergillus spp., of which one was co-infected with A. fumigatus and A. flavus species, while two others were positive only for A. flavus, and one sample was positive only for A. fumigatus. Conclusions: These findings suggest that PCR can be used as an auxiliary method for diagnosing aspergillosis. However, this was a pilot study, and expansion of the sample size and the evaluation of PCR in comparison with other diagnostic tests for aspergillosis are essential to determine the accuracy of the method. Full article

Background/Objectives: Three-dimensional (3D) analysis of maxillofacial structures in dysmorphic patients offers clinical advantages over 2D analysis due to its high accuracy and precision in measuring many morphological parameters. Currently, no reliable gold standard exists for calculating 3D volumetric measurements of maxillofacial structures when captured by 3D surface imaging techniques. The aim of this scoping review is to provide an overview of the scientific literature related to 3D surface imaging methods used for volumetric analysis of the dysmorphic maxillofacial structures of patients affected by CL/P or other syndromes and to provide an update on the existing protocols, methods, and, when available, reference data. Methods: A total of 17 papers selected according to strict inclusion and exclusion criteria were reviewed for the qualitative analysis out of more than 4500 articles published between 2002 and 2024 that were retrieved from the main electronic scientific databases according to the PRISMA-ScR guidelines. A qualitative synthesis of the protocols used for the selection of the anatomical areas of interest and details on the methods used for the calculation of their volume was completed. Results: The results suggest a great degree of heterogeneity between the reviewed studies in all the aspects analysed (patient population, anatomical structure, area selection, and volume calculation), which prevents any chance of direct comparison between the reported volumetric data. Conclusions: Our qualitative analysis revealed dissimilarities in the procedures specified in the studies, highlighting the need to develop uniform methods and protocols and the need for comparative studies to verify the validity of methods in order to achieve high levels of scientific evidence, homogeneity of volumetric data, and clinical consensus on the methods to use for 3D volumetric surface-based analysis. Full article

An urgent issue is the preservation or reconstruction of the volume of bone tissue in planning and surgical treatment in the fields of medicine, such as traumatology, orthopedics, maxillofacial surgery and dentistry. After tooth extraction, resorption of the bone tissue of the alveolar crest of the jaws occurs, which must either be further eliminated by performing additional operations or using osteoplastic material for socket preservation at the extraction stage. Background and Objectives: The aim of the study was a comparative analysis of various osteoplastic materials used to preserve the volume of bone tissue in the preimplantation period. Materials and Methods: As part of the study, 80 patients were treated, who underwent socket preservation using xenografts, plasma enriched with growth factors, an autologous dentin matrix (ADM) and hydroxyapatite. Results: The results of the treatment 16 weeks after removal were comprehensively analyzed using a morphometric analysis of the bone’s volume, cone beam tomography and morphological examination of burr biopsy specimens, as well as by determining the stability of the installed implant at different stages of treatment. Conclusions: The lowest level of bone tissue resorption according to the CBCT data was noted in the ADM and xenograft groups. It should be noted that the use of osteoplastic material in jaw surgery when reconstructing alveolar defects is an essential procedure for preventing the atrophy of bone tissue. Full article

Patient-specific 3D models of the human mandible are finding increasing utility in medical fields such as oral and maxillofacial surgery, orthodontics, dentistry, and forensic sciences. The efficient creation of personalized 3D bone models poses a key challenge in these applications. Existing solutions often rely on 3D statistical models of human bone, offering advantages in rapid bone geometry adaptation and flexibility by capturing a range of anatomical variations, but also a disadvantage in terms of reduced precision in representing specific shapes. Considering this, the proposed parametric model allows for precise manipulation using morphometric parameters acquired from medical images. This paper highlights the significance of employing the parametric model in the creation of a personalized bone model, exemplified through a case study targeting mandibular prognathism reconstruction. A personalized model is described as 3D point cloud determined through the utilization of series of parametric functions, determined by the application of geometrical morphometrics, morphology properties, and artificial neural networks in the input dataset of human mandible samples. With 95.05% of the personalized model’s surface area displaying deviations within −1.00–1.00 mm relative to the input polygonal model, and a maximum deviation of 2.52 mm, this research accentuates the benefits of the parametric approach, particularly in the preoperative planning of mandibular deformity surgeries. Full article

Background and Objectives: There are many surgical techniques for oroantral communication treatment, one of which is the buccal fat pad. Of particular interest is the high reparative potential of the buccal fat pad, which may be contributed to by the presence of mesenchymal stem cells. The purpose of this work is to evaluate the reparative potential of BFP cells using morphological and immunohistochemical examination. Materials and Methods: 30 BFP samples were provided by the Clinic of Maxillofacial and Plastic Surgery of the Russian University of Medicine (Moscow, Russia) from 28 patients. Morphological examination of 30 BFP samples was performed at the Institute of Clinical Morphology and Digital Pathology of Sechenov University. Hematoxylin–eosin, Masson trichrome staining and immunohistochemical examination were performed to detect MSCs using primary antibodies CD133, CD44 and CD10. Results: During staining with hematoxylin–eosin and Masson’s trichrome, we detected adipocytes of white adipose tissue united into lobules separated by connective tissue layers, a large number of vessels of different calibers, as well as the general capsule of BFP. The thin connective tissue layers contained neurovascular bundles. Statistical processing of the results of the IHC examination of the samples using the Mann–Whitney criterion revealed that the total number of samples in which the expression of CD44, CD10 and CD133 antigens was confirmed was statistically significantly higher than the number of samples where the expression was not detected (p < 0.05). Conclusions: During the morphological study of the BFP samples, we revealed statistically significant signs of MSCs presence (p < 0.05), including in the brown fat tissue, which proves the high reparative potential of this type of tissue and can make the BFP a choice option among other autogenous donor materials when eliminating OAC and other surgical interventions in the maxillofacial region. Full article

Background and Objectives: Ectodermal dysplasia (ED)—a genetic disorder—is characterized by severe tooth deficiency. We compared the mandibular volume and the sagittal and horizontal mandibular widths between patients with ED (ED group) and individuals without tooth deficiency (control group) using three-dimensional modeling. We hypothesized that the mandibular volume differs in ED cases owing to congenital tooth deficiency. Materials and Methods: We used previously obtained cone-beam computed tomography (CBCT) images of 13 patients with ED. The control group data comprised retrospective CBCT images of patients of similar age and sex with a skeletal relationship of class 1. Further, using the three-dimensional image analysis software, the tooth crowns were separated from the mandible, the mandible was reconstructed and the gonion-to-gonion distance in the mandible was marked, the distance to the menton point was measured, and the distance between the two condyles was measured and compared with the control group. Results: Overall, 46.2% and 53.8% of the participants were men and women, respectively. In the ED group, the mean age of the participants was 15.46 (range, 6–24) years, and the mean number of mandibular teeth was 4.62. Notably, the edentulous mandible volume of the ED group (27.020 mm³) was statistically significantly smaller than that of the control group (49.213 mm³) (p < 0.001). There was no difference between the two groups in terms of the marked points. For data analysis, the Shapiro–Wilk test, independent samples t-test, and Mann–Whitney U test were used. Conclusions: It has been considered that mandible volume does not develop in ED cases because of missing teeth. Modern practices, such as the CBCT technique and three-dimensional software, may be effective in identifying the true morphologic features, especially in patients with genetic syndromes affecting the maxillofacial structure. Full article

The aim of this study was to morphologically evaluate the differences in the cutting surfaces of bone segments obtained by reciprocating saw (RS) and two piezosurgical devices (Piezosurgery Medical—PM—and Piezosurgery Plus—PP) in ex vivo human fibulae. The ultimate goal was to identify the presence of debris, scratches, and microcracks on the cutting surface that might affect bone healing, a key aspect in oral and maxillofacial surgery. Ten patients who underwent a microsurgical reconstruction of the mandible with a free fibula flap were enrolled. The fibula segments usually discarded after surgery were cut using RS, PM, and PP, obtaining transverse sections to analyze under an environmental scanning electron microscope to perform a histomorphological qualitative evaluation. Bone surfaces cut with the RS presented several scratches, and haversian canals were frequently filled with bone debris/chips. On the contrary, PM and PP devices produced smoother and sharper cutting surfaces, with lower production of bone debris/chips, preventing vascular spaces’ closure. Microcracks were found in both PM and PP cut specimens, and they could be associated with the triggering of bone remodeling, thus improving the formation of new bone, while their presence was rarely observable in RS cut samples. The use of piezosurgical devices showed superior performance, providing cleaner and smoother cutting surfaces that favor vascularization and bone remodeling; altogether, these processes could lead to accelerated bone healing, a fundamental goal in all surgical procedures that involve bone cutting. Full article

This cross-sectional study aimed to explore the correlation between maxillofacial morphology and caries risk, assessed using salivary tests, in orthodontic patients. Despite enhancing the oral health-related quality of life, orthodontic treatment may adversely affect oral hygiene and increase caries risk. This study included 1071 patients all of whom underwent orthodontic examinations and salivary tests before starting orthodontic treatment at a hospital. Salivary tests were performed to assess the secretion rate, pH, buffering capacity, and counts of cariogenic bacteria. The maxillofacial morphology was evaluated using cephalometric X-rays and dental models. Statistical analyses revealed significant correlations among salivary characteristics, bacterial scores, and maxillofacial morphology. Notably, the facial angle and Y-axis values were associated with salivary secretion (p < 0.001), pH (p < 0.001), buffering capacity (p < 0.05), and cariogenic bacterial scores (p < 0.01), respectably. In conclusion, assessing the maxillofacial morphology before orthodontic treatment may aid in predicting the risk of bacterial oral diseases, offering valuable insights into personalized preventive measures. These findings underscore the potential for comprehensive evaluations to enhance caries risk assessment in orthodontic patients. Full article

Facial asymmetry is often seen in patients with skeletal mandibular prognathism and is associated with deformities in the maxillofacial and head regions. The maxillofacial deviation is three-dimensional and affects not only the lateral deviation of the mandible and midface, but also the cranium. This study conducted a three-dimensional morphological evaluation of the cranial base morphology of patients with skeletal mandibular prognathism (ANB < 0°, Wits < 0 mm) with the aim of examining the relationship between deformities of the head region and facial asymmetry. Data obtained from computed tomography conducted during the initial examination of patients with and without skeletal mandibular prognathism with facial asymmetry were used. Differences in the position of structures present in the cranial base were measured, and the association between cranial deformities and mandibular deviation was assessed. The middle cranial base area and the lateral deviation of the mandibular fossa were significantly larger in patients with facial asymmetry compared to those without facial asymmetry. In addition, a correlation between the amount of mandibular deviation and the area of the anterior cranial base was identified in patients with significant cranial deformity (p = 0.012). Given the identified association between the structure of the head region and facial asymmetry, further studies are needed to determine the factors implicated in the growth process. Full article