Search Results (4,857)

Introduction: Antibiotics are routinely prescribed for odontogenic abscesses in emergency departments and dental offices. Augmentin is recommended for moderate to severe dentofacial infections. It is usually prescribed in two popular regimens, namely twice (bid) or three times (tid) per day. The aim of this study was to compare the efficacy of two different formulations of amoxicillin–clavulanate, 875/125 mg bid versus 500/125 mg tid, for the treatment of acute dental apical abscesses with orofacial involvement. Methods: Sixty-one patients with acute apical abscesses were prescribed Augmentin in either an 875/125 mg bid or 500/125 mg tid formulation. The patients were tested for inflammatory markers upon admission and again after 72 h. Results: Although all patients experienced a decrease in inflammatory markers over 72 h of antibiotic therapy, there was a statistically significant greater decrease in white blood cells and neutrophils in the patients receiving the 500/125 mg tid regimen. Conclusions: A 500/125 mg tid Augmentin regimen results in a greater decline in inflammatory markers than 875/125 mg bid over 72 h in the setting of dentofacial infection. 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

More than 90% of bladder cancers are classified as urothelial carcinomas (UC), with approximately 75% of these cases presenting as non-muscle-invasive bladder cancer (NMIBC). Bacillus Calmette–Guérin (BCG) is the current standard immunotherapy for NMIBC, yet it suffers from limited efficacy, frequent tumor recurrence, and substantial toxicity. These limitations underscore the need for safer, more effective, and accessible alternatives. We investigated whether uropathogenic Escherichia coli (UPEC), a natural inducer of immune responses in the bladder, could serve as a novel intravesical immunotherapeutic agent. Using orthotopic bladder cancer models in both mice (MB49-luc) and rats (AY-27), we evaluated the efficacy, specificity, immune dependence, and safety of formaldehyde-inactivated UPEC strains, including mutants with altered type 1 fimbriae expression. Intravesical administration of inactivated UPEC significantly reduced tumor burden and prolonged survival, outperforming BCG in murine models and demonstrating equivalent efficacy with markedly reduced toxicity in rats. The antitumor effect was T cell-dependent and partially mediated by type I fimbriae, which facilitated tumor-specific adhesion. Notably, systemic (subcutaneous) administration of UPEC abrogated efficacy and increased mortality, emphasizing the necessity of localized bladder delivery. In conclusion, we identify inactivated UPEC as a potent, tumor-targeting, and T cell-dependent immunotherapeutic agent with a superior safety profile compared to BCG. This approach might represent a promising and practical alternative for bladder cancer treatment. Full article

Background: The pterygoid plates serve as crucial reference points for posterior maxillary surgery and the placement of pterygoid implants; however, population-specific morphometric reference values remain underexplored for adults of Asir region (Abha city) of Saudi Arabia. Methods: This retrospective cross-sectional cone beam computed tomography (CBCT) study analyzed the archived scans obtained at King Khalid University Dental Hospital. Of 100 randomly selected adult CBCT scans collected between June and October 2025, 50 images met the eligibility criteria. The analyses were conducted using OnDemand3D software to measure the bilateral pterygoid plates’ length, thickness at the maximum diameter, and medial-lateral divergence angle. Styloid process length was measured as an exploratory variable. Three calibrated examiners performed the measurements, and the reliability was assessed using interclass correlation coefficients. Results: Fifty CBCT scans met the inclusion criteria (30 males, 20 females). The mean lateral pterygoid plate length was 14.61 ± 3.69 mm on the right and 13.83 ± 3.93 mm on the left, while the mean medial plate length was 11.27 ± 3.52 mm (right) and 11.98 ± 3.82 mm (left). Side to side paired comparisons showed no significant right–left differences in lateral plate length (mean R–L 0.79 mm, 95% CI −0.48 to 2.06), lateral thickness (mean 0.04 mm, 95% CI −0.14 to 0.22), medial thickness (mean 0.01 mm, 95% CI −0.19 to 0.21), or pterygoid angulation (mean 1.99°, 95% CI −1.07 to 5.05), supporting bilateral symmetry. Bilateral correlations were strong for medial plate length (r = 0.729, p < 0.001) and angulation (r = 0.632, p < 0.001). Males had a longer right lateral plate than females (15.74 ± 3.55 mm vs. 12.93 ± 3.31 mm; mean difference 2.81 mm, 95% CI 0.80–4.82; p = 0.007), whereas other measurements did not differ by sex. Plate thickness ranged from approximately 1.33 to 1.46 mm and left medial plate thickness correlated negatively with left medial plate length (r = −0.399, p = 0.004). Styloid process length averaged 22.99 ± 9.76 mm and showed no significant association with pterygoid plate measures. Conclusions: CBCT-derived findings demonstrated overall bilateral symmetry and limited dimorphism in relation to sex. These region-specific morphometries support individualized preoperative posterior maxillary surgery and pterygoid implant planning. Full article

Background/Objectives: Super-selective intra-arterial chemoradiotherapy (SSIACRT) is an alternatively effective treatment for locally advanced oral cavity cancer although no comparative studies on prognosis between SSIACRT and surgical resection with or without post-operative radiotherapy (S+R) have been reported. This study aimed to compare the 5-year survival rate and Quality of Life (QoL) between S+R and SSIACRT for locally advanced oral cavity cancer. Methods: From a total of 326 patients with stage III and IV oral cavity cancer treated between 2000–2020 at a single institution, 149 patients treated with S+R and SSIACRT were analyzed by using Propensity Score Matching (PSM) method, a pseudo-randomized controlled trial, and the matched cases were retrospectively evaluated. The 5-year survival rate and QoL were evaluated using the Kaplan–Meier method and the University of Washington QoL questionnaire, respectively. Log-rank test and Cox proportional hazards model were used to compare 5-year survival rate and to assess factors affecting survival rates, respectively. Paired t-test was used to compare QoL. Results: To compare the 5-year survival rate and QoL between S+R and SSIACRT, 48 and 15 cases were matched after PSM. The 149 cases were further evaluated for covariates affecting survival rates. The 5-year disease-specific survival rate and 5-year crude survival rate were 52.4% and 44.3% for S+R and 71.3%, and 62.9% for SSIACRT, respectively. There was no statistical difference in survival rates between both treatments, based on Log-rank test analysis. Treatment method was the only independent variable that influenced survival rates. SSIACRT showed better statistical difference in QoL evaluation, specifically in appearance, activity, recreation, swallowing, speech, shoulder, taste, mood, and total score. Conclusions: Propensity score-matched analysis demonstrated survival outcomes that were comparable to, and not inferior to, S+R. However, SSIACRT was associated with superior quality-of-life outcomes compared with S+R, as shown by Cox proportional hazards modeling. These findings suggest that SSIACRT is an effective treatment option and, from a quality-of-life perspective, may be considered a preferable approach in the management of locally advanced oral cavity cancer. Full article

Background: Orbital dermoid cysts are common benign lesions; however, deep-seated or recurrent lesions near the orbital apex pose major surgical challenges due to their proximity to critical neurovascular structures. Lateral orbitotomy remains the reference approach, but accurate osteotomies and stable reconstruction can be difficult to achieve using conventional techniques. This study reports our initial experience using a fully digital, hospital-based point-of-care (POC) workflow to enhance precision and safety in complex orbital dermoid cyst surgery. Methods: We present a case series of three patients with orbital dermoid cysts treated at a tertiary center (2024–2025) using a comprehensive digital workflow. Preoperative assessment included CT and/or MRI followed by virtual surgical planning (VSP) with orbit–tumor segmentation and 3D modeling. Cutting guides and patient-specific implants (PSIs) were manufactured in-house under a certified hospital-based POC protocol. Surgical strategies were tailored to each lesion and included piezoelectric osteotomy, intraoperative navigation, intraoperative CT, and structured-light scanning when indicated. Results: Complete en bloc resection was achieved in all cases without capsular rupture or optic nerve injury. Intraoperative CT confirmed complete lesion removal and accurate PSI positioning and fitting. Structured-light scanning enabled radiation-free postoperative monitoring when used. All patients preserved full ocular motility, visual acuity, and facial symmetry, with no complications or recurrences during follow-up. Conclusions: The integration of VSP, in-house POC manufacturing, and image-guided surgery within a lateral orbitotomy approach provides a reproducible and fully integrated workflow. This strategy appears to improve surgical precision and safety while supporting optimal long-term functional and aesthetic outcomes in challenging orbital dermoid cyst cases. Full article

Unlike skeletal Class I and II patients, the application of maxillomandibular advancement (MMA) in skeletal Class III patients with obstructive sleep apnea (OSA) is not well documented. The aim of this scoping review was to explore the variations and outcomes of MMA techniques in this unique subgroup. A comprehensive search of PubMed, Embase, Cochrane and LILACS databases were conducted for articles published up to May 2025. Nine studies met the inclusion criteria. Three main variations of MMA were identified: (1) Bimaxillary advancement, which provides the most significant airway enlargement across all pharyngeal regions but carries the highest risk of facial aesthetic distortion; (2) Maxillary advancement with mandibular auto-rotation, a less invasive option suited for patients with isolated maxillary retrusion and symmetrical mandibular anatomy; (3) Maxillary advancement with mandibular setback, which addresses aesthetic concerns in patients with mandibular excess but may compromise oropharyngeal airway space. All variations were reported to be effective in treating OSA (Reduction of AHI by at least 50%) but with different considerations. Surgical planning for skeletal Class III patients with OSA should be individualized based on craniofacial morphology, anatomical site of airway obstruction, and aesthetic considerations. A decision flowchart was shared in this study. Full article

Medication-related osteonecrosis of the jaw (MRONJ) is a refractory disease for which no established treatment currently exists. Surfactin, a biosurfactant produced by Bacillus subtilis, exhibits antimicrobial activity, anticancer effects, and anti-inflammatory properties, suggesting its potential medical applications. This study aimed to elucidate the ability of surfactin to modulate the immune response induced by lipopolysaccharide (LPS) derived from periodontal pathogens (Aggregatibacter actinomycetemcomitans), clarify the underlying molecular mechanisms, and explore its potential utility in the treatment of MRONJ. Reverse transcription quantitative polymerase chain reaction demonstrated that surfactin suppresses LPS-induced interleukin-6 (IL-6) expression and secretion in J774.1 cells in a concentration-dependent manner. Western blot analysis showed that surfactin inhibited activation of the JNK-c-Jun-AP-1 axis and the JAK/STAT signaling pathways in J774.1 cells. The effects of surfactin administration were further evaluated in an in vivo MRONJ model. Co-treatment with surfactin significantly reduced the extent of LPS-induced bone necrosis. Overall, these findings suggest that surfactin suppresses LPS-induced IL-6 expression in macrophages and inhibits osteonecrosis induced by bisphosphonate preparations and LPS through negative regulation of the JNK-c-Jun-AP-1 axis and inhibition of the JAK/STAT pathway. Hence, surfactin may represent a promising candidate for MRONJ management. 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/Objectives: Isolated cleft lips and/or palates often require orthognathic treatment. Traditional planning based on 2D images and plaster models limits precision; therefore, virtual surgical planning (VSP) and Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) technologies are increasingly being used. The aim of this scoping review was to analyze the techniques, outcomes, and gaps in research on VSP in orthognathics for patients with isolated (non-syndromic) clefts. Methods: Searches were conducted in July 2025 in seven databases (including PubMed, Scopus, and Cochrane) without language restrictions, in accordance with the PRISMA guidelines for scoping reviews. Of the 2836 records, 36 publications were eligible after deduplication and full-text screening, and their Level of Evidence (LoE) was assessed using the Oxford CEBM scale. A risk of bias assessment was also conducted according to JBI tools. Results: The identified studies primarily comprised LoE III and IV; there were no systematic reviews or randomized controlled trials (LoE I). Descriptions of bimaxillary procedures and LeFort I osteotomies dominated. The most commonly used software was ProPlan CMF, Dolphin 3D, and Rhinoceros, although other tools have emerged in recent years. The available studies suggest that VSP increases translational and rotational accuracy and facilitates individualized treatment, and bimaxillary procedures bring better functional and aesthetic outcomes in patients with severe maxillary hypoplasia. Conclusions: Despite the growing interest in VSP in orthognathics, the scientific evidence is limited and mostly of lower quality. Well-designed prospective studies are needed to assess the long-term stability, quality of life, and cost-effectiveness of modern technologies. Full article

In addition to standardized lateral cephalometric radiographs, comprehensive assessment using dental cone-beam computed tomography (CBCT) and CT has become commonplace in the diagnosis and treatment of jaw deformities. Simulation based on cephalometric and CT data is particularly useful in the management of jaw deformities, both for evaluation and prognostic prediction. As such imaging examinations cover a wide anatomical region, it is not uncommon for various incidental pathologies to be discovered. This review emphasizes the necessity of evaluating the entire imaged area in addition to the chief complaint. Furthermore, it outlines the essential anatomical structures that should be assessed during diagnostic imaging performed prior to representative surgical procedures for jaw deformities (e.g., sagittal split ramus osteotomy and Le Fort I osteotomy). This review paper is descriptive in nature, incorporating our facility’s empirical aspects, and presents representative cases in a narrative format; it is not a systematic review. In other word, as the evidence-based literature does not cover all aspects of pretreatment evaluation, these criteria are based on the past experience of the authors. Full article

Background and Objectives: Academic point-of-care (POC) manufacturing enables the in-hospital design and production of patient-specific medical devices within certified environments, integrating clinical practice, engineering, and translational research. This model represents a new academic ecosystem that accelerates innovation while maintaining compliance with medical device regulations. Gregorio Marañón University Hospital has established one of the first ISO 13485-certified academic manufacturing facilities in Spain, providing on-site production of anatomical models, surgical guides, and custom implants for oral and maxillofacial surgery. This study presents a retrospective review of all devices produced between April 2017 and September 2025, analyzing their typology, materials, production parameters, and clinical applications. Materials and Methods: A descriptive, retrospective study was conducted on 442 3D-printed medical devices fabricated for oral and maxillofacial surgical cases. Recorded variables included device classification, indication, printing technology, material type, sterilization method, working and printing times, and clinical utility. Image segmentation and design were performed using 3D Slicer and Meshmixer. Manufacturing used fused deposition modeling (FDM) and stereolithography (SLA) technologies with PLA and biocompatible resin (Biomed Clear V1). Data were analyzed descriptively. Results: During the eight-year period, 442 devices were manufactured. Biomodels constituted the majority (approximately 68%), followed by surgical guides (20%) and patient-specific implants (7%). Trauma and oncology were the leading clinical indications, representing 45% and 33% of all devices, respectively. The orbital region was the most frequent anatomical site. FDM accounted for 63% of the printing technologies used, and PLA was the predominant material. The mean working time per device was 3.4 h and mean printing time 12.6 h. Most devices were applied to preoperative planning (59%) or intraoperative use (35%). Conclusions: Academic POC manufacturing offers a sustainable, clinically integrated model for translating digital workflows and additive manufacturing into daily surgical practice. The eight-year experience of Gregorio Marañón University Hospital demonstrates how academic production units can enhance surgical precision, accelerate innovation, and ensure regulatory compliance while promoting education and translational research in healthcare. 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

Background: The macrogeometry and shape of dental implants strongly influence primary stability, which may at times result in excessively high insertion torque. This in vitro study aimed to evaluate whether increasing coronal thread density could reduce insertion torque without compromising primary stability. Methods: Two conical implants with identical macrogeometry and surface characteristics (Ø 4.2 × 11.5 mm) differed only in the thread pitch of the coronal 3 mm: a modified version (27% more coronal threads; Group 1) and a standard, commercially available version (Group 2). Thirty implants of each design were inserted into high-density (D1; 40 PCF; pounds per cubic foot) and low-density (D3; 20 PCF) polyurethane blocks (n = 120). Insertion torque (IT) and implant stability quotient (ISQ, measured by resonance frequency analysis) were recorded. Group comparisons used the Kruskal–Wallis test, and a generalized linear model (GLM) assessed the independent effects of IT and design on ISQ in D1 bone. Results: In D1 bone, Group 2 showed higher IT (median 74.0 vs. 63.5 N·cm; p < 0.001) and ISQ (mean 79.1 vs. 77.4; p ≤ 0.030). The GLM identified IT as a negative predictor of ISQ (β = −0.267 per 1 N·cm; p < 0.001), and Group 2 was associated with higher ISQ (+3.90; p < 0.001). In D3 bone, Group 2 again exhibited higher IT (median 37.5 vs. 33.0 N·cm; p < 0.001), while ISQ values were similar between designs (all p > 0.35). Conclusions: Increasing coronal thread density lowers insertion torque without reducing stability in softer bone and maintains sufficient ISQ for immediate loading in dense bone, making the design advantageous for varied bone qualities. Full article

Glucocorticoids are widely applied intra-articularly to alleviate inflammation and pain in osteoarthritis (OA). However, repeated administration and high local concentrations can lead to crystal deposition on the cartilage surface, contributing to chondrocyte damage and extracellular matrix (ECM) degradation, potentially accelerating OA progression. Calcium-dependent mechanosensors play a critical role in mediating catabolic responses in chondrocytes, but it remains unclear whether glucocorticoids affect chondrocyte mechanosensitivity or biomechanical properties. This in vitro study examined the dose-dependent effects of triamcinolone acetonide (TA) on chondrocyte biomechanics and mechanosensitivity. Primary human chondrocytes (N = 23) were cultured for one week with TA (2 µM–2 mM) or control medium. Cytoskeletal organization was visualized by F-actin staining (N = 6), and cellular elasticity (N = 5) was quantified via atomic force microscopy (AFM). Mechanotransduction was analyzed by Ca²⁺ imaging (Fluo-4 AM) upon AFM-based indentation (500 nN). Expression of matrix-related and mechanosensitive genes (N = 9) was assessed by qPCR. TA exposure induced a concentration-dependent reorganization of the F-actin cytoskeleton, pronounced at 0.2 mM, accompanied by a significant increase in the elastic modulus (p < 0.001). TA further augmented Ca²⁺ fluorescence intensity under basal conditions and during mechanical stimulation. Blocking cationic mechanosensitive channels with GsMtx4 (N = 3) markedly reduced the TA-evoked Ca²⁺ influx (p < 0.0001). Significant reduction in MMP1 was observed on the transcriptional level (N = 9) after TA-treatment (p < 0.05). In summary, TA enhances chondrocyte stiffness through cytoskeletal condensation and amplifies Ca²⁺-dependent mechanotransduction but reduces MMP1 expression, indicating a dual biomechanical response of chondrocytes to OA under exposure of potent corticosteroid. Full article