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The COVID-19 pandemic has altered and reshaped the delivery of oral and maxillofacial surgery (OMS) over the past few months. As the USA gradually lifts restrictions and re-opens, surgeons must adjust accordingly. Therefore, the OMS Resurgence Conference: Safely Resuming Practice with a New Normal was organized for 11 May 2020 to gather and disseminate expert opinions and recommendations for OMSs to thoughtfully resume work with efficiency and safety. This manuscript offers a summary of the highlights from the conference discussion. [ABSTRACT FROM AUTHOR]

The present study aims to identify if immunosuppression is a risk factor for the development of peri-implantitis. A retrospective cohort study design was conducted on patients presenting to the Philadelphia Veterans Affairs (VA) Medical Center for dental implant placement from 2006 to 2013. Medical encounter notes within 3 months of implant placement were used to collect information about patients' health status, including evaluations of immune system function. Implant status was assessed using dental encounter notes and radiographs from follow-up appointments at 1, 3, 5, and 10 years. Peri-implantitis was defined as radiographic evidence of change in crestal bone level, clinical evidence of bleeding on probing, with or without suppuration.1 Electronic medical records of 884 implants were retrospectively analyzed. Descriptive statistics were calculated using the SAS System (SAS Institute Version 9.4, 2002-2012, Cary, NC). The primary predictor variable was immunosuppression. The primary outcome variable was the presence of peri-implantitis. Other study variables assessed included graft at the time of implant placement, diabetes, smoking, gender, and age over 60. Descriptive, univariate, and multivariate regression analyses were performed to measure the association between predictive variables and development of peri-implantitis. Of the 884 implants placed, 205 (23.1%) developed peri-implantitis. Following a multivariate analysis that controlled for diabetes, smoking, gender, and age over 60, immunosuppression was shown to be significantly associated with an increased risk in the presence of peri-implantitis (P =.0071) when compared to implants placed in immunocompetent subjects. The data from this study show that implants placed in immunosuppressed patients were 29.78% more likely to develop peri-implantitis compared to implants placed in immunocompetent patients (OR = 2.229, 95% CI 1.243-3.996). To the best of the authors' knowledge, no existing literature has demonstrated this significant risk relationship. Following surgical implant placement, adequate function of the immune system's inflammatory response is imperative to target infections and orchestrates wound healing to allow for successful osseointegration of implants. Few studies, however, have directly investigated this nexus at a mechanistic level. In vivo studies in rabbits have indicated that titanium implant placement may up-regulate the immune system's type 2 inflammatory response to inhibit bone resorption markers and promote healing.2 Therefore, in conjunction with the authors' results, immunosuppression could play a significant role in increasing risk of peri-implantitis. Analysis of implants placed at the Philadelphia VA Medical Center revealed an important association between immunosuppression and the development of peri-implantitis. This study shows that immunosuppression may play a role in increasing the development of peri-implantitis. Along with need for further exploration regarding the pathophysiology of this relationship, additional observational and randomized controlled studies are necessary to validate the authors' findings. As implant restoration of edentulous areas is becoming the new standard of care, identification and understanding of associated risks factors are critical to ensure successful implant outcomes. [ABSTRACT FROM AUTHOR]

While opioid prescription behavior among oral and maxillofacial surgeons (OMSs) has become increasingly responsible in the past few years, the opioid misuse crisis remains a major public health challenge. There are many differences in the access to and delivery of oral and maxillofacial services in urban settings compared to rural settings. In other areas of medicine, such as primary care, opioids are more often prescribed in rural settings.1,2 This study aimed to compare opioid analgesic prescription patterns among OMSs practicing in urban and rural settings in an effort to identify avenues to further promote responsible opioid prescribing. This cross-sectional study used publicly available Medicare Provider Utilization and Payment Data from 2014 to 2018, focusing on providers labeled as OMS. Rural-Urban Commuting Area Codes (RUCA) were used to categorize each OMS as urban or rural. The outcome variables included Total Claims of Opioids (Including Refills), Mean Opioid Prescriptions Per Beneficiary, and Number of Days Supply of Opioids Per Claim. Descriptive statistics were summarized, and Wilcoxon rank-sum tests were employed to compare continuous variable means with statistical significance at P-value <.05. The study sample, from 2014-2018, consisted of mostly urban and male OMSs (Table 1). The mean number of beneficiaries per OMS varied widely, and the mean age of beneficiaries was around 70 years. The mean hierarchical condition category (HCC), used as a proxy for patient complexity, was similar between rural versus urban OMSs across all years. The mean opioid claims per provider was higher among rural OMSs across all years, with large standard deviations among both rural and urban OMSs (Table 2). However, there were no statistically significant differences in the mean opioid prescriptions per beneficiary (about 1.1-1.2). While in some years there were statistically significant differences between urban and rural OMSs in the number of days' supply per claim, the magnitude of difference was small (all periods had about 3-4 days). Finally, there were no documented instances of any long-term opioid prescriptions by any OMSs in the dataset. While rural OMSs prescribed a higher mean volume of opioid analgesics than their urban counterparts, there were no differences in mean amount of opioids prescriptions written per beneficiary. These results suggest similar opioid prescription behaviors among the majority of OMSs practicing in both rural and urban settings. However, the large standard deviation in the mean opioid claims per provider affirms previous work that have found extreme cases of opioid prescription volume among a subset of Medicare OMSs.3 Limitations of this study includes the relatively small number of rural OMSs in the dataset and its limited generalizability to prescription behaviors toward the non-elderly population. [ABSTRACT FROM AUTHOR]