Search Results (94)

Background/Objectives: In oral and maxillofacial surgery, apicoectomy is a standard procedure for treating persistent periapical infections after insufficient conservative treatment. Traditional techniques rely on direct visualization, while navigated methods offer advantages in precision and safety. This in vitro study compared conventional apicoectomy with dynamically guided navigation. The aim was to assess the feasibility, accuracy, and safety of dynamic navigation and to determine whether it reduces complication risks, improves surgical predictability, and minimizes bone loss. Methods: Ten experienced surgeons performed both techniques on custom-designed models. Operation time was assessed, as well as cavity volume, resected root length, incision width and height, and preservation of adjacent structures. Results: The navigated approach demonstrated significantly improved accuracy in root-end resection, with a reduction in access cavity volume (p < 0.001). No significant differences were found in operation time (p = 0.499), resection length (p = 0.054), or incision dimensions (p > 0.05). The risk of damaging adjacent structures was not significantly different between the two methods. Conclusions: Dynamic navigation for apicoectomy can offer an alternative in cases requiring high precision to conventional techniques. However, the routine clinical implementation of dynamic navigation remains limited due to the extensive preoperative planning required. The necessity for additional planning increases complexity, time, and cost. Full article

Objectives: This study aimed to evaluate the performance of three widely used artificial intelligence (AI) chatbots—ChatGPT-4, Gemini 2.5 Pro, and Claude Sonnet 4—in answering patient-oriented frequently asked questions (FAQs) related to orthognathic surgery. Given the increasing reliance on AI tools in healthcare, it is essential to evaluate their performance to provide accurate, empathetic, readable, and clinically appropriate information. Methods: Twenty FAQs in Turkish about orthognathic surgery were presented to each chatbot. The responses were evaluated by three oral and maxillofacial surgeons using a modified Global Quality Score (GQS), binary clinical appropriateness judgment, and a five-point empathy rating scale. The evaluation process was conducted in a double-blind manner. The Ateşman Readability Formula was applied to each response using an automated Python-based script. Comparative statistical analyses—including ANOVA, Kruskal–Wallis, and post hoc tests—were used to determine significant differences in performance among chatbots. Results: Gemini outperformed both GPT-4 and Claude in GQS, empathy, and clinical appropriateness (p < 0.001). GPT-4 demonstrated the highest readability scores (p < 0.001) but frequently lacked empathetic tone and safety-oriented guidance. Claude showed moderate performance, balancing ethical caution with limited linguistic clarity. A moderate positive correlation was found between empathy and perceived response quality (r = 0.454; p = 0.044). Conclusions: AI chatbots vary significantly in their ability to support surgical patient education. While GPT-4 offers superior readability, Gemini provides the most balanced and clinically reliable responses. These findings underscore the importance of context-specific chatbot selection and continuous clinical oversight to ensure safe and ethical AI-driven communication. Full article

Endoscopic dacryocystorhinostomy (DCR) is a widely recognized and highly effective procedure. This surgical procedure is performed globally, with minimal modifications across different regions. Background/Objectives: The fundamental goal of DCR is to marsupialize the lacrimal sac into the nasal cavity, which helps eliminate epiphora (excessive tearing) and recurrent dacryocystitis (inflammation of the tear sac). With advancements in technology, new instruments are being developed to minimize risks and maximize efficacy, ultimately improving surgeon convenience, patient safety, and quality of life. One such innovation is piezosurgery, a method of bone cutting that utilizes ultrasound vibrations. Originally prevalent in oral and maxillofacial surgery, piezosurgery is now being applied in many clinical applications. Its primary advantages include the preservation of soft tissues, precise bone cutting, and the ability to work effectively in narrow spaces. Methods: This article outlines the standard technique used at our facility for performing endoscopic dacryocystorhinostomy (DCR) with a piezoelectric system. We describe the preoperative evaluation, intraoperative techniques, and postoperative care to present what we consider the standard procedure in our clinic. Results and Conclusions: Piezosurgery’s selective cutting prevents damage to surrounding soft tissues, making it theoretically advantageous in DCR by preserving tissue integrity. Additional case–control and multicenter studies are necessary to compare its outcomes with those of traditional osteotomy, particularly in relation to the potential increase in operative time. Full article

Objective: Lower third impacted molar extraction, despite being a routinary procedure for oral and maxillo-facial surgeons, may often result in a significantly negative impact in patient’s post-operatory quality of life. Among others, treatments based on oxygen-enriched oils have been shown to provide valuable therapeutic benefits in promoting wound healing, and therefore improving the immediate post-operatory symptomatology. The aim of this triple-blinded randomized controlled study is to supplement the existing evidence in the scientific literature by assessing the effectiveness of NovoX^®-Drop (Moss S.p.A., Lesa, Novara), a specific type of oxygen enriched oil-based device in reducing pain and inflammatory stimulus of post-surgical wounds following the extraction of lower third impacted molars. Materials and methods: Seventy-one patients undergoing surgical extraction of a single lower third impacted molar were randomly assigned to receive either NovoX^®-Drop (Group A) or a glycerin-based gel (Group B). Additionally, both patient groups followed the same standard therapy with amoxicillin-clavulanic acid and ibuprofen. Data were collected preoperative (T0) and after three (T3) and seven (T7) days postoperative in order to assess the following outcomes: mean visual analogue scale (VAS) score during the seven days protocol treatment, total duration of nonsteroidal anti-inflammatory drug (NSAID) usage, trismus (maximum mouth opening) and facial oedema. Results: Group A (treatment group) reported significatively lower pain levels at T7 compared to group B (average VAS value during the week: Group A: 3.57 ± 0.39 cm; Group B: 4.47 ± 0.40 cm; p-value = 0.0014) despite a significatively shorter period of NSAID usage (average NSAID usage duration: Group A: 2.43 ± 0.38 days; Group B: 3.38 ± 0.44 days; p-value = 0.00001). Therefore, trismus seems to be better controlled in group A, although the difference between the groups did not reach the threshold for statistical significance. Conclusions: The results of this study suggest that application of NovoX^®-Drop is capable of significantly reducing the post-operatory pain as well as NSAID usage, representing a promising and effective option for third impacted molar extraction surgery management. Full article

Background: Advancements in virtual reality (VR) and augmented reality (AR) technologies have the potential to revolutionize surgical training in oral (OS) and maxillofacial surgery (OMFS). This review aims to discuss the current state of VR and AR applications in surgical training, as well as their impact on education and skills acquisition. Methods: Main search terms used in combination: student, education, training, VR, AR, OS, OMFS, oral surgeon, and maxillofacial surgeon. A comprehensive literature search was conducted from 2012 to 2023 using databases including Cochrane Library, Medline, PubMed, Scopus, Embase, Web of Science, and Google Scholar. Results: Out of 545 potential studies, 12 met the inclusion criteria. The review found that VR applications are predominantly used in surgical training, while AR is notably scarce in this context. Conclusions: While VR cannot replace traditional training methods, its integration into surgical education programs could supplement practical experience on phantoms and real patients. Full article

Background/Objectives: A previous study evaluating convex facial profiles at rest demonstrated that combined orthodontic and orthognathic surgical treatment is more effective in enhancing facial aesthetics compared to orthodontic camouflage alone. The present follow-up study aimed to reassess these findings by incorporating both profile and frontal facial views in the aesthetic evaluation. Methods: This retrospective cohort study sample included 36 consecutively selected patients with convex facial profiles and Class II Division 1 malocclusion. Two groups of 18 non-growing patients with similar characteristics were compared. Group A was treated with orthodontics and orthognathic surgery, whereas Group B was treated with orthodontics exclusively. Pre- and post-treatment profile and frontal facial photographs were simultaneously presented to orthodontists, oral and maxillofacial surgeons, convex profile patients, and laypeople, asking them to assess changes in facial appearance. Results: Significant positive changes in facial appearance were perceived for Group A, in contrast to no changes for Group B, with a difference of 17/100 visual analogue scale (VAS) units. The rater groups demonstrated a high degree of consistency (ICC > 0.88). Multivariate analysis revealed significant differences in perceived changes between the two treatment groups (F = 14.63, p < 0.001, Pillai’s Trace = 0.36, and partial η² = 0.36), with no significant effects from the rater group (p > 0.05). Similar results are evident when only profile photos were rated (p > 0.05). Conclusions: The combined orthodontic and orthognathic surgery approach effectively enhances facial appearance in convex profile cases, whereas orthodontic treatment alone does not result in significant changes. These findings should be clearly communicated during patient consultations and considered in treatment planning. Full article

Background/Objectives: In recent years, interest has grown in the clinical applications of artificial intelligence (AI)-based chatbots powered by large language models (LLMs) in oral and maxillofacial surgery (OMFS). However, there are conflicting opinions regarding the accuracy and reliability of the information they provide, raising questions about their potential role as support tools for both clinicians and patients. This systematic review aims to analyze the current literature on the use of conversational agents powered by LLMs in the field of OMFS. Methods: The review was conducted following PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. Original studies published between 2023 and 2024 in peer-reviewed English-language journals were included. Sources were identified through major electronic databases, including PubMed, Scopus, Google Scholar, and Web of Science. The risk of bias in the included studies was assessed using the ROBINS-I tool, which evaluates potential bias in study design and conduct. Results: A total of 49 articles were identified, of which 4 met the inclusion criteria. One study showed that ChatGPT provided the most accurate responses compared to Microsoft Copilot (ex-Bing) and Google Gemini (ex-Bard) for questions related to OMFS. Other studies highlighted that ChatGPT-4 can assist surgeons with quick and relevant information, though responses may vary depending on the quality of the questions. Conclusions: Chatbots powered by LLMs can enhance efficiency and decision-making in OMFS routine clinical cases. However, based on the limited number of studies included in this review (four), their performance remains constrained in complex clinical scenarios and in managing emotionally sensitive patient interactions. Further research on clinical validation, prompt formulation, and ethical oversight is essential to safely integrating LLM technologies into OMFS practices. Full article

Background: This systematic review aimed to evaluate the efficacy of immunoenhancing nutritional therapy compared to conventional nutritional care in reducing perioperative complications in adult patients undergoing surgery for oral cancer. Given the unclear role of immunonutrition in this specific surgical setting, we synthesized available randomized controlled trials to assess outcomes such as surgical site infections, wound healing complications, hospital stay, and adverse events. Methods: Patients who underwent planned oral cancer surgery were included. The intervention group received oral or enteral immunoenhancing nutritional agents preoperatively, postoperatively, or both, while the control group received standard care (intravenous fluids) and/or macromolecular nutritional supplements. PubMed, Cochrane CENTRAL, and Central Medical Journal were comprehensively searched for randomized controlled trials (RCTs); eight RCTs were included. The primary outcomes were mortality, suture/healing failure, surgical site infection (SSI), and hospital stay length, with evidence certainty assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Results: Although mortality estimation was not feasible, hazard ratios from the meta-analysis showed that the intervention significantly improved suture/healing failure, SSI, and hospital stay length. The certainty of evidence was “low” for suture/healing failure and SSI and “moderate” for hospital stay length. Conclusions: Perioperative management with enteral nutritional agents fortified with immunonutrients should be considered in adult patients scheduled for (advanced) oral cancer surgery. Full article

Background/Objectives: Vascular anomalies represent a complex group of conditions including vascular malformations and haemangiomas. Haemangiomas are benign tumours that have an endothelial origin. In contrast, vascular malformations are characterized by the abnormal dilation of vessels without proliferation. Depending on the extension of the disease, there is a higher risk of life-threatening haemorrhages that may occur during simple dental procedures. The aim of this case report is to present the interdisciplinary treatment for patients with venous malformation and to discuss the possible dental management of these patients. Methods: A 66-year-old male patient with an extensive venous malformation of the head and neck was referred for a tooth extraction. The venous malformation involved lips, buccal mucosa, tongue, and floor of the oral cavity. Its proximity to the tooth requiring extraction was associated with a high risk of severe bleeding. Results: Prior to the treatment, CBCT and CT scans were performed to confirm the extensions of the lesion and visualise its margins. Considering the possible risks related with venous malformation, the procedure consisted of tooth removal in a hospital setting with control over severe bleeding complications. Conclusions: The presence of an extensive vascular malformation in the head and neck region is burdened with a higher risk of haemorrhages during simple dental procedures. The radiological and clinical planning enables the choice of an accurate treatment strategy to avoid possible difficulties. In cases where such complications cannot be avoided, it is important to perform the treatment in a hospital setting with the cooperation of maxillofacial surgeons. Full article

Background/Objectives: Maxillofacial trauma poses significant challenges in emergency medicine, requiring rapid interventions to minimize morbidity and mortality. Traditional segmentation methods are time-consuming and error-prone, particularly in high-pressure settings. Real-time artificial intelligence (AI) segmentation offers a transformative solution to streamline workflows and enhance clinical decision-making. This study evaluated the potential of real-time AI segmentation to improve diagnostic efficiency and support decision-making in maxillofacial trauma emergencies. Methods: This study evaluated 53 trauma patients with moderate to severe maxillofacial injuries treated over 16 months at Galilee Medical Center. AI-assisted segmentation using Materialise Mimics Viewer and Romexis Smart Tool was compared to semi-automated methods in terms of time and accuracy. The clinical impact of AI on diagnosis and treatment planning was also assessed. Results: AI segmentation was significantly faster than semi-automated methods (9.87 vs. 63.38 min) with comparable accuracy (DSC: 0.92–0.93 for AI; 0.95 for semi-automated). AI tools provided rapid 3D visualization of key structures, enabling faster decisions for airway management, fracture assessment, and foreign body localization. Specific trauma cases illustrate the potential of real-time AI segmentation to enhance the efficiency of diagnosis, treatment planning, and overall management of maxillofacial emergencies. The highest clinical benefit was observed in complex cases, such as orbital injuries or combined mandible and midface fractures. Conclusions: Real-time AI segmentation has the potential to enhance efficiency and clinical utility in managing maxillofacial trauma by providing precise, actionable data in time-sensitive scenarios. However, the expertise of oral and maxillofacial surgeons remains critical, with AI serving as a complementary tool to aid, rather than replace, clinical decision-making. Full article

Background: Wisdom tooth extraction is a routine procedure with potential complications. In the lower arch, the displacement of a root or its fragment into the submandibular space is a relatively common occurrence that can lead to permanent damage to peripheral nerve fibers. Recent advancements in dental technologies, including CAD-CAM and artificial intelligence, have contributed to improved clinical outcomes in surgical procedures. Methods: Following a brief introductory narrative review, this clinical case describes the extraction of the left third inferior molar, which was sectioned by the oral surgeon to facilitate its removal. The procedure led to the progressive migration of a root fragment into the submandibular space, triggering an infective process. Efforts to retrieve the root fragment resulted in irreversible damage to the somatosensory motor nerves associated with the inferior alveolar nerve after the second surgery was performed by a maxillofacial surgeon. Results: Determining the responsibility for the damage (caused either by the oral or maxillofacial surgeon) involves both technical and ethical considerations, which are particularly relevant in cases involving re-intervention by different specialists. This case highlights the importance of a thorough preoperative evaluation of the patient’s anatomical, bone, and dental characteristics. The use of new technologies can significantly reduce the risk of complications that may otherwise lead to permanent damage and complex determinations of professional responsibility. Conclusions: Given the potential, albeit rare, for permanent disturbance of sensory and motor functions, managing complications and assessing the resulting damage are critical and sensitive steps in resolving such case both clinically and legally. Full article

Background and Objectives: Medication-related osteonecrosis of the jaw (MRONJ) was first recognized as a disease entity and reported in the literature in 2003. Within a few years, the incidence of MRONJ has increased significantly, to the point where now it can be seen in every dental clinic around the world. Its prevention and management still remain major challenges for dentists and oral and maxillofacial surgeons. Materials and Materials and Methods: This prospective clinical study was conducted at the Oral and Maxillofacial Surgery Clinic in Timisoara for a 6-month period and included a total of 85 patients under chronic antiresorptive and antiangiogenic medication. There were two groups of patients: G1 received PRF growth factors, while the other group, G2, was treated with classical surgical methods. Post-operative wound healing was assessed at 2, 4, and 8 weeks by monitoring the absence of local gingival dehiscence, suprainfection, or loco-regional fistulas, both in cases of dental extractions and sequestrectomies in MRONJ cases. Results: The use of PRF in post-extraction sockets in patients predisposed to developing MRONJ aids in local healing in 96% of cases, compared to cases where it was not used, in which normal healing occurred in only 64.29% of patients; there was a significant difference between the two groups (p = 0.016). In MRONJ confirmed cases, application of PRF after excisional debridement of necrotic bone does not appear to have the same therapeutic value as in post-extractional sockets, with a p-value of 0.299 indicating no statistical significance. Conclusions: PRF use can be considered an effective approach in preventing osteonecrotic complications following dental extractions in patients with antiresorptive treatment. Additional studies are needed to establish its role in MRONJ confirmed cases. Full article

Background: Mandibular reconstruction remains challenging in oral and maxillofacial surgery due to its complex anatomy and functional requirements. While Deep Circumflex Iliac Artery (DCIA) flaps offer advantages in bone height and natural contour, their application with computer-aided surgical planning remains limited. Aim: This preliminary study aimed to evaluate the accuracy and clinical outcomes of mandibular reconstruction using DCIA free flaps with patient-specific surgical guides and customized plates. Materials and Methods: A pilot study of five patients who underwent mandibular reconstruction using DCIA free flaps was conducted. Virtual surgical planning was performed using Cone-Beam Computed Tomography (CBCT) and pelvic Computed Tomography (CT) data to design patient-specific cutting guides and reconstruction plates. All surgeries were performed by a single experienced surgeon using standardized techniques. Results: The mean deviation between the virtual planning and actual surgical outcomes was 0.73 ± 0.23 mm, with maximum deviations ranging from 3.87 to 7.83 mm. All flaps achieved 100% survival, with one case (20%) experiencing screw loosening that required plate removal. This complication led to the modification of the plate design to include six or more holes in subsequent cases. Conclusions: Despite limitations including the small sample size and short follow-up period, our preliminary results demonstrate that computer-aided surgical planning with patient-specific devices can significantly improve the accuracy and predictability of DCIA flap mandibular reconstruction, even in challenging revision cases. Further studies with larger patient cohorts are needed to validate these findings. Full article

Background/Objectives: The aim of this study is to identify the most accurate and consistent landmarks for determining the precise location of the mandibular foramen (MF) and the mandibular ramus, suggesting appropriate adjustments to anesthesia techniques based on these variations in order to improve the success rate of the inferior alveolar nerve (IAN) block. Methods: CT scans of the mandibles from 100 patients were analyzed to measure the distance between the MF and various landmarks, including the sigmoid notch, gonion, posterior and anterior margins of the ramus, temporal crest, and the mandibular ramus height from the condyle to the gonion. The width of the mandibular ramus was also assessed, with correlations made to age and gender. Results: The MF was found to be closer to the sigmoid notch (mean = 21.2 mm), p = 0.393, than to the gonion (mean = 22.6 mm), p = 0.801, and closer to the posterior margin of the ramus (mean = 13.1 mm), p = 0.753, than to the anterior margin of the ramus. Additionally, the MF was closer to the temporal crest. Age also influenced the position of the MF, with a posterior and superior movement of the foramen, reducing the distance between the MF and the posterior margin of the ramus as well as the MF and the sigmoid notch (p < 0.001). Conclusions: A precise understanding of the MF’s location will help dentists and oral and maxillofacial surgeons improve the success of the IAN block, avoid injury to the inferior alveola neurovascular bundle, and minimize surgical complications such as paresthesia, permanent anesthesia, and hemorrhage. Full article

Background/Objectives: Computer-assisted mandibular reconstruction requires sophisticated technical expertise alongside surgical knowledge. This study aims to establish and validate an efficient collaborative protocol between oral and maxillofacial surgeons and bioengineers for virtual surgical planning in mandibular reconstruction. Methods: We developed a structured protocol with four sequential phases: (1) generation of 3D models from CT data, (2) virtual resection planning, (3) reconstruction design, and (4) surgical guide fabrication. Protocol efficiency was assessed through seven simulation trials measuring planning duration and required revisions. Clinical validation was performed in four mandibular reconstruction cases. Accuracy was evaluated by comparing virtual surgical plans to postoperative outcomes using 3-matic 13.0 software analysis. Results: Protocol implementation showed consistent efficiency across simulations with a mean planning duration of 2.86 working days (SD = 1.35). Only two of seven simulations required design revisions. Clinical application in four cases (three ameloblastomas, one odontogenic myxoma) demonstrated high precision with a mean virtual-to-actual discrepancy of 0.90 mm (SD = 0.34). Successful reconstructions were achieved across varying defect spans (29–53 mm) using both bicortical deep circumflex iliac artery (DCIA) flaps and monocortical iliac block bone grafts. The collaborative workflow resulted in optimized surgical guide design, reduced planning iterations, and improved surgical precision. Conclusions: The established surgeon–bioengineer collaborative protocol enhances the efficiency and accuracy of computer-assisted mandibular reconstruction while making advanced surgical planning techniques more accessible. While initial results are promising, future studies with larger patient cohorts and extended follow-up periods are needed to fully validate the protocol’s long-term benefits and broader applicability. Full article