Search Results (3,444)

Obesity in women of reproductive age is a major issue. It is associated with reduced fertility and an increased risk of obstetric and perinatal complications. Bariatric surgery is the most effective treatment for severe obesity, leading to substantial weight reduction, improvement of metabolic disorders, and enhanced fertility. Consequently, an increasing number of women are becoming pregnant after undergoing bariatric surgery. The aim of this paper is to review current recommendations and research data regarding the care of women after bariatric surgery in the periconceptional and perinatal periods, as well as throughout pregnancy, delivery, and the postpartum period. Research suggests that pregnancy after bariatric surgery is associated with a lower risk of gestational diabetes, hypertension, preeclampsia, and fetal macrosomia compared with pregnancies in women with similar baseline BMI (body mass index) who have not undergone surgical treatment. At the same time, an increased risk is observed for low birth weight, maternal micro- and macronutrient deficiencies, and complications characteristic of bariatric procedures, such as dumping syndrome or intra-abdominal hernias. Most scientific societies recommend postponing pregnancy planning for 12–18 months after surgery and using effective contraception, preferably methods that do not require gastrointestinal absorption. Regular monitoring of laboratory parameters, individually tailored supplementation, and interdisciplinary care are essential for the safe management of pregnancy after bariatric surgery. In particular, care should include achieving a stable body weight before conception, monitoring of nutritional status, verifying proper weight gain during pregnancy, and considering alternative methods for gestational diabetes screening (e.g., glycaemic monitoring instead of oral glucose tolerance testing) due to the risk of dumping syndrome. Appropriate preparation for pregnancy and proper management throughout its course allow for reducing the risk of perinatal complications. Bariatric surgery itself is not a contraindication to vaginal delivery. Full article

Background/Objectives: The uprighting of mesially tipped mandibular second molars following first molar loss is a complex surgical and orthodontic challenge. Conventional methods often result in reciprocal anchorage loss. Mini-implants (MIs) have emerged as essential temporary anchorage devices (TADs) that provide absolute anchorage and enable more predictable tooth movements. Methods: Numerical simulations were performed to evaluate the forces required for mandibular second molar uprighting under two conditions: first, only with the second molar present, and second, with both the second and the third molars present. Although the periodontal ligament exhibits nonlinear and viscoelastic behavior in vivo, a linear elastic approximation was adopted to allow for a reliable evaluation of comparative stress distribution and initial displacement patterns within the scope of this exploratory biomechanical study. Stress distribution in the roots, periodontal ligament, and alveolar bone was assessed for each scenario. Two three-dimensional (3D) models of the left mandibular segment were created from scans of a human mandible and its teeth. The first model included the canine, the first and second premolars, and the second molar. A second model additionally incorporated the third molar. A retromolar MI was placed in both models. Molar uprighting was simulated using a spring connecting the implant to a button bonded on the mesial surface of the second molar. A force of 200 g was applied because in clinical orthodontic practice, forces that exceed approximately 2 N may cause pain or undesirable tooth mobility. Displacements along the X, Y, and Z axes, as well as regions of peak stress, were analyzed. Results: Model 1 showed maximum displacements at the furcation/mid-root, distal root apex, and distal crown, with von Mises stresses of 0.470 to 0.371 MPa. In Model 2, peak displacements occurred at the mesial root and crown, with stresses of 0.185 and 0.149 MPa, respectively. The magnitude of displacements was in the order of 10⁻⁵ mm. Such values represent initial mechanical responses rather than clinically observable tooth movements. However, the differences between models (e.g., the stress reduction) are expected to be clinically meaningful. Conclusions: Since clinical measurements regarding the stress distribution on teeth and surrounding tissues during orthodontic molar uprighting movements are impossible to perform, the finite element method (FEM) can offer insight into these aspects. The presence of the third molar significantly modulates the biomechanics of second molar uprighting via retromolar MIs. When the third molar is present, the second molar exhibits a reduced tendency for deformation during distalization, although this leads to a slower displacement. This FEM provides biomechanical insights but does not support direct clinical decision-making. The present findings should be viewed as theoretical biomechanical tendencies that require confirmation through clinical, experimental, and longitudinal studies before translation into clinical practice. Full article

The accuracy of static computer-aided implant surgery (s-CAIS) is fundamental for predictable clinical outcomes. The objective of this study was to evaluate the influence of different guide-support modalities on the linear and angular accuracy of implant placement. In this retrospective clinical investigation conducted at a single specialty hospital, a total of 180 implants were analyzed, divided into three equal groups (n = 60) based on the guide support type: tooth-supported, bone-supported, and mucosa-supported. Accuracy was assessed by superimposing preoperative virtual plans with postoperative cone-beam computed tomography (CBCT) scans, measuring linear deviations at the neck and apex of the implant, as well as angular discrepancies. The type of guide support was found to be a significant factor associated with surgical accuracy (p < 0.001). Tooth-supported guides demonstrated the highest level of accuracy, with a mean angular deviation of 1.81° ± 0.45° and linear deviations at the neck and apex of 0.59 ± 0.18 mm and 0.73 ± 0.19 mm, respectively. These were followed by bone-supported guides (2.14° ± 0.48°; 1.04 ± 0.26 mm; 1.61 ± 0.31 mm), while mucosa-supported guides exhibited the greatest deviations (2.95° ± 0.60°; 1.47 ± 0.29 mm; 1.87 ± 0.37 mm). Significant intergroup differences and large effect sizes were observed, particularly regarding angular and horizontal discrepancies. These findings demonstrate a distinct gradient of accuracy based on guide support, establishing tooth-supported guides as the most accurate, followed by bone-supported and, lastly, mucosa-supported guides. While all modalities are clinically applicable, the use of mucosa-supported guides necessitates increased safety margins to account for the increased risk of linear and angular discrepancies inherent to mucosal tissue displacement. Full article

Background and Objectives: Severe alveolar atrophy may pose significant challenges for dental rehabilitation. Recent advances in digital planning and CAD/CAM technology have renewed the interest in patient-specific subperiosteal implants as a treatment option for anatomically challenging cases. This cohort study evaluated changes in oral health-related quality of life and patient satisfaction following rehabilitation with customized subperiosteal implants in severe alveolar atrophy. Materials and Methods: This cohort study included all consecutive adult patients with severe alveolar atrophy who underwent reconstruction with patient-specific subperiosteal implants at the Department of Oral and Maxillofacial Surgery of “Evangelismos” General Hospital, Athens, Greece, in 2025. Oral health-related quality of life was assessed using the validated OHIP-14 questionnaire preoperatively and 12 months postoperatively. Patient satisfaction was evaluated using a numerical rating scale (NRS). Secondary outcomes included postoperative complications, implant exposure, implant stability, and need for reoperation. Comparisons between baseline and 12-month scores were performed using the Wilcoxon signed-rank test. Results: Nine patients who had completed 12-month follow-up were included. Five were male, and all implants were placed in the maxilla. Significant improvement was observed in oral health-related quality of life, with the median OHIP-14 total score decreasing from 41 preoperatively to 1 at the 12-month follow-up. Patient satisfaction also improved significantly, with the median NRS total score increasing from 17 to 58. Improvements were consistent across all OHIP-14 domains and all NRS items. No major complications were recorded. One patient developed early wound dehiscence, and one patient presented with implant exposure at the anterior palate. At the final follow-up twelve months postoperatively, all implants remained clinically and radiographically stable. Conclusions: These preliminary short-term findings suggest that customized subperiosteal implants may be a promising option for selected patients with severe alveolar atrophy in whom placement of conventional endosseous implants is not feasible; however, the results should be interpreted cautiously given the very small sample size and observational design. Full article

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

Objectives: To retrospectively evaluate the survival rate and complications of immediately loaded implant-supported restorations in atrophic mandibles of patients subjected to inferior alveolar nerve relocation for the placement of dental implants. Methods: Consecutively treated patients having a follow-up of four years after loading of implants immediately placed after inferior alveolar nerve repositioning were included. Outcome measures were implant and prothesis survival rates and any type of complications related to the surgery, in particular related to post-operative neurosensory disturbance. Results: Data from 14 consecutive patients rehabilitated with 51 implants were analyzed. All provisional prosthetic restorations could be immediately placed after implant placement, none failed, and no patient dropped out over the four years after definitive loading. Only one implant failed. One day postoperatively, all patients experienced dysesthesia or paresthesia. At two weeks, nine patients had a total neurological recovery and one had partial recovery, while the remaining four patients did not recover. One mandible fractured three weeks after implant placement. At one-year post-loading, one patient was still affected by neurosensory dysfunction and three partially recovered (one of these had it preoperatively). After three years, two patients still presented partial recovery. After four years, no further changes were recorded, and no patients reported total neurosensory dysfunction. The patient with the fractured mandible recovered completely with no neurosensory disturbances. Conclusions: Implant placement in atrophic mandibles following inferior alveolar nerve transposition or lateralization may represent a viable alternative to vertical ridge augmentation, with the added advantage of allowing immediate fixed provisional prothesis. Although severe complications and neurosensory disturbances are not uncommon, all patients experience gradual recovery within one to three years. Full article

Background and Objectives: Postoperative delirium and postoperative cognitive dysfunction are common complications in older adults undergoing elective non-cardiac surgery, associated with increased morbidity and mortality, functional decline, and prolonged hospital stay. Prolonged preoperative fasting may intensify inflammatory responses and insulin resistance. Preoperative oral carbohydrate loading within ERAS protocols may modulate this response and reduce cognitive risk. Materials and Methods: A scoping review was conducted following the methodological recommendations of Arksey and O’Malley, the Joanna Briggs Institute, and PRISMA-ScR. A systematic search was performed in PubMed and Scopus for studies published up to September 2025. Randomized controlled trials and observational studies including adults ≥ 65 years undergoing elective non-cardiac surgery were included if they evaluated fasting modifications or preoperative carbohydrate loading and reported postoperative delirium or cognitive dysfunction. Results: A total of eight publications were included: four randomized controlled trials, one prospective cohort study, two cross-sectional studies, and one descriptive/correlational study. Populations included older adults undergoing elective abdominal, orthopedic, colorectal, or hip surgery, as well as hospitalized elderly surgical patients. Interventions included oral carbohydrate loading, assessment of preoperative nutritional status, and enteral versus parenteral nutrition. Only four of the eight included studies directly evaluated neurocognitive outcomes. Postoperative delirium was assessed in three studies, using the Confusion Assessment Method in two studies and the Delirium Rating Scale in one study. Postoperative cognitive dysfunction was evaluated in one study using a Mini-Mental State Examination-based cognitive assessment, while the remaining four studies did not assess neurocognitive outcomes and instead focused on metabolic, inflammatory, or perioperative well-being outcomes. Conclusions: Available evidence suggests that perioperative fasting protocols and preoperative carbohydrate loading may influence metabolic and inflammatory responses related to postoperative neurocognitive outcomes in older adults. However, evidence remains limited and heterogeneous. Findings are exploratory and hypothesis-generating, highlighting the need for well-designed trials assessing neurocognitive outcomes in geriatric surgical populations. Full article

Periodontitis is a highly prevalent chronic inflammatory disease with significant oral and systemic consequences, including associations with cardiovascular disease, diabetes, and adverse pregnancy outcomes. Although mechanical debridement remains the cornerstone of therapy, adjunctive antibiotic use is increasingly limited by antimicrobial resistance, biofilm-associated tolerance, pharmacokinetic constraints, and disruption of the commensal microbiome, leading to inconsistent outcomes and disease recurrence. This review highlights the mechanistic limitations of conventional antibiotic therapies in periodontitis and critically examines emerging next-generation therapeutic strategies aimed at overcoming these challenges. Specifically, it explores antimicrobial peptides, quorum sensing inhibitors, nanotechnology-based drug delivery systems, host modulation approaches, and microbiome-targeted therapies, with emphasis on their molecular mechanisms, clinical relevance, and translational potential. By integrating microbial, host, and pharmacological perspectives, this review provides a comprehensive framework for advancing precision-guided periodontal therapy and supports the shift toward targeted, sustainable, and personalized treatment strategies. Full article

Background: Severe trismus and post-oncologic maxillary defects often prevent conventional zygomatic implant placement. This study evaluates a novel implant specifically designed for reverse insertion (from the zygoma toward the oral cavity) and assesses its feasibility and accuracy in a cadaveric model. Materials and Methods: A Brown Class II maxillectomy was simulated in a fresh-frozen cadaver. Four custom reverse zygomatic implants were virtually planned and placed using CAD/CAM surgical guides. Superior and inferior orbital approaches were compared. Postoperative CT was superimposed onto the preoperative plan to measure linear and angular deviations, and a 3D-printed verification bar assessed prosthetic alignment. Results: All implants were successfully inserted with primary stability and without compromising critical structures. The superior orbital approach yielded lower deviations and better guide stability, which was reflected in the results: deviation at the zygomatic bone was 1.25 mm in the superior approach vs. 2.32 in the inferior approach, intraorally 4.7 mm vs. 7.3 mm, and angular deviation 1.85° vs. 5.63°. Despite minor distal deflection, intraoral emergence remained within clinically acceptable limits, allowing partial seating of the verification bar. Conclusions: Reverse-insertion zygomatic implants are technically feasible, anatomically safe, and compatible with fixed prosthetic rehabilitation in cases where conventional placement is impossible. Penetrating the orbit, injuring the skin or the infraorbital nerve could be possible but guided surgery seems to prevent them. A forthcoming clinical series of eight additional cases will further validate this protocol. Full article

Background/Objectives: Providing an appropriate diet to older adults with dysphagia can prevent aspiration, choking, and nutritional deficiencies and help preserve their quality of life. Therefore, assessments for determining the appropriateness of food types are required. This multicenter study aimed to determine the reliability and validity of the Meal Rounds Observation Form (MROF), which was developed to identify food forms that can be safely consumed by older adults with dysphagia. Methods: We analyzed 532 food–texture observations obtained from 155 participants (114 men and 41 women). The reliability and validity of the MROF were compared with those of videofluoroscopic (VF) or videoendoscopic (VE) examinations of swallowing. Results: The food-form categories were water (108 pairs), 0j (54 pairs), 0t (118 pairs), 1j (20 pairs), 2-1 (28 pairs), 2-2 (37 pairs), 3 (68 pairs), 4 (67 pairs), and normal food (32 pairs) based on JDD 2021 codes. The AUC was lowest for the water (0.568) category and highest for food forms requiring chewing, such as those of the 4 and normal food (0.678) categories. The sensitivity and specificity of the Gugging Swallowing Screen were 60.1% and 69.1%, respectively (p < 0.001). The agreement between the Gugging Swallowing Screen and the MROF evaluation for food types requiring mastication was 73.2%. Logistic regression analysis revealed asymmetric movement of the corners of the mouth and coughing as important indicators when evaluating food types requiring mastication. Conclusions: The MROF is useful for determining food intake safety when VF or VE tests cannot be performed in medical and nursing care settings and can guide clinical decision-making. However, caution is required in applying it clinically because of its relatively low specificity. Full article

Background: Emphysema is a rare complication of dental procedures. The highest incidence has been associated with the use of air turbine handpieces. If not recognized and treated promptly, this complication can lead to serious outcomes. Methods: We present a case of a 43-year-old man who developed deep cervicofacial and subcutaneous emphysema of the face, neck and chest along with the specific voice change due to nose blowing shortly after alveolectomy of the lower right third molar. Results: The patient was hospitalized, conservatively treated, monitored and treated with intravenous antibiotic therapy. After two weeks he made a full recovery. Conclusions: It is essential to recognize and adequately manage emphysema, and to inform patients postoperatively not to blow their nose after third molar alveolectomy to prevent this rare but potentially serious complication. To our knowledge, this is the first reported case of voice alteration caused by nasopharyngeal emphysema following third molar alveolectomy. Full article

Objectives: Temporomandibular joint (TMJ) disorders are an increasingly common problem affecting patients. This systematic review aimed to analyze the available literature regarding the effectiveness of intra-articular ozone gas injections and their effects on pain reduction and jaw mobility. Methods: The review was conducted in accordance with PRISMA 2020 guidelines. Bielefeld Academic Search Engine, Cochrane Library, Google Scholar, PubMed, and references were searched (October 2025). Randomized controlled trials evaluating intra-TMJ gas injection compared to other intra-articular administration were included in the review. Analyses were performed both within and between groups. Risk of bias was assessed using the Cochrane RoB-2 tool, and the certainty of evidence was assessed using the GRADE approach. Results: Five studies out of 180, including a total of 230 patients, were included in the review. The studies reported using ozone at concentrations of 10–30 μg/mL. All included studies reported reductions in pain and improvements in mandibular mobility after treatment. In some comparisons, ozone-based interventions showed more favorable outcomes than control interventions; however, the findings were not consistent across outcomes, and the certainty of evidence was limited. Conclusions: Current evidence is insufficient to determine the effectiveness of intra-articular ozone injections for TMJ disorders. Some studies suggest possible short-term benefits in pain reduction and jaw mobility; however, the evidence is limited by high risk of bias, heterogeneity in treatment protocols, and very low certainty, particularly for longer-term outcomes. More rigorous and standardized randomized trials are required. Full article

Oral lichen planus (OLP) is a chronic, T cell-mediated inflammatory disorder classified by the World Health Organization as an oral potentially malignant disorder (OPMD). Despite decades of research, its precise etiology remains incompletely understood and involves a complex interplay between genetic predisposition, environmental triggers, and autoimmune-like responses. This review provides a comprehensive update on OLP pathogenesis, emphasizing the role of CD8 positive cytotoxic T lymphocyte-driven basal keratinocyte apoptosis and the skewing of the T-cell receptor (TCR) repertoire. We highlight the significance of the epidermal growth factor receptor (EGFR) signaling pathway as a molecular bridge between chronic inflammation and epithelial proliferation. Furthermore, we discuss a stepwise therapeutic approach that prioritizes the management of the oral microenvironment—specifically Candida colonization and periodontal health—before escalating to immunosuppressive agents. Finally, we explore emerging precision medicine frontiers, including IL-17/IL-23 inhibitors and JAK inhibitors, alongside traditional Japanese Kampo medicine (Hange-shashin-to) and systemic adjuncts like Cepharanthine, offering a contemporary perspective on modern OLP management. This integrative framework redefines OLP not merely as a chronic inflammatory disorder, but as an immunologically sustained, microenvironment-driven, potentially malignant condition. Full article

Currently, GLP-1RAs are peptide drugs, typically administered by injection due to insufficient absorption, and only one GLP-1RA, semaglutide, is available as an orally administered drug. To overcome the absorption challenges of oral peptides, this drug product contains the absorption enhancer SNAC. As the tablet is eroded in the stomach, SNAC neutralizes the acidic gastric environment, thereby protecting the semaglutide from enzymatic degradation. Then, SNAC fluidizes the stomach lipidic membrane to increase semaglutide transcellular permeability across the gastric epithelium. It is necessary to realize that the use of such a unique drug product, that relies solely on the stomach for absorption, is expected to be affected by the extreme gastric anatomy/physiology changes post-MBS. Hence, we analyzed the key mechanisms that may affect the bioavailability of oral semaglutide post-MBS. Several mechanisms appear to potentially reduce oral semaglutide absorption post-MBS, including decreased inner gastric surface area, decreased gastric contractility, and faster gastric emptying. Hence, the effectiveness of the complex formulation, that relies solely on the stomach for the SNAC activity and semaglutide absorption, may be severely hampered post-MBS; clinicians should be aware of the potential malabsorption of oral GLP-1RA post-MBS, and preferably consider subcutaneous therapy until specific pharmacokinetic/clinical data are available. Full article

Tongue squamous cell carcinoma (TSCC) is clinically heterogeneous, and patients with a similar TNM stage can experience markedly different outcomes. We systematically reviewed omics-driven studies to identify prognostic TSCC biomarkers. Although fundamentally prognostic, we discussed their theoretical translational relevance regarding future clinical decisions—such as treatment stratification or surveillance intensity—while strictly framing them as preliminary, hypothesis-generating targets. PubMed, Scopus, Web of Science, and Cochrane were searched for original human studies published between 2014 and 2024 using high-throughput genomic or transcriptomic profiling. Study selection followed referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), data were extracted with a structured workbook, and risk of bias was assessed using QUIPS and PROBAST, with reporting completeness appraised using REMARK. Seventeen studies were included, identifying 85 distinct biomarkers. Across biomarkers supported by multivariable overall survival analyses, higher-risk associations were reported for NELL2, PDE4D, CTTN, HBEGF, and CA9, whereas lower-risk associations were reported for AC139530.1, LINC01711, CCDC96, CYP2J2, and SPAG16. Recurrent biological themes included IL-17 signaling, ECM-receptor interaction, and focal adhesion. CA9 was the only biomarker reported in more than one included study, supporting its prioritization for validation. Although the evidence remains heterogeneous and largely hypothesis-generating, these markers may support the future validation of response-oriented therapeutic stratification in TSCC. Full article