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Background Effective management of Missing lateral incisor has remained a challenge for the clinicians. A multi-disciplinary approach involving orthodontist, restorative dental specialist, pediatric dental specialist, periodontist, oral surgeon and general dentist has proved ideal. Our aim is to review the ultimate esthetic success, and long term survival results between the orthodontic and restorative management of missing lateral incisor. Materials and methods Following the PRISMA guidelines, a systematic review of the published articles pertaining to the topic of interest was done. Searches were carried out in four different databases since February 2021 to April 2021. Results A total of 580 references were found from searches conducted in PubMed, Scopus, Cochrane and Web of Science, and 19 articles were selected and analyzed fully, after screening the title and abstract, 6 articles were included for the study. Conclusion An essential orthodontic space closure in combination with modern aesthetic prosthetic tooth replacement techniques has been reported to achieve greater success.

Oroantral communication and fistula are commonly seen complications in the field of oral and maxillofacial surgery. Oral surgeons must be familiar with the diagnosis and proper management including multiple soft and hard tissue approaches to this surgical dilemma.

Burkitt lymphoma (BL) is an aggressive form of non-Hodgkin B-cell lymphoma, with three subtypes: endemic, sporadic, and human immunodeficiency associated subtypes. Endemic BL typically involves the mandible, maxilla, and abdomen, whereas sporadic BL usually presents as an abdominal mass involving the mesenteric lymph nodes or ileocecal region, and jaw involvement is uncommon. In pediatric patients, oral BL commonly presents as facial swelling with an intraoral exophytic mass and is usually accompanied by mobile, displaced, and/or painful teeth. We report sporadic BL initially presented as orofacial manifestations in an 8-year-old boy, and conduct a mini-review. He had left facial and gingival swelling. CT revealed the lesions were located at the left anterior maxilla and the masticator muscle, and PET showed multiple lesions. An incisional biopsy of left anterior maxillary gingiva was performed, and the pathological diagnosis was BL. Oral management has been performed since initial chemotherapy, and tumor remission was achieved by chemotherapy with the B-NHL03 study regimen at our pediatric department. There was no recurrence of the tumor 5 years after chemotherapy. Dentists and oral surgeons should be aware that dental problems including floating teeth and/or alveolar bone resorption might be the first clinical manifestation of BL. Because the success of intensive treatment relies on good supportive care, oral management plays an important role to maintain oral hygiene.

Double teeth refer to two teeth that are totally or partially joined by dentin and maybe their pulps. These developmental anomalies may be the result of either gemination or fusion. This is a case of a 15-year-old Indo-Trinidadian male who presented with the fusion of a mandibular third molar with a distomolar as an incidental finding. The patient had his general dental care provided by a paediatric dentist and was referred to an oral and maxillofacial radiologist, orthodontist, and oral surgeon for consultation. A Cone-beam CT was taken to supplement the plain film periapical and orthopantomogram radiographs. It showed the three-dimensional orientation of the double molar and the extent of joining. This is the first case of fusion of a mandibular third molar to a distomolar being reported in the Caribbean.

Objective: Most tooth extractions are performed for dental reasons, but there are also nondental and nonmedical reasons for extractions; these include psychological, financial, religious, and cultural reasons as well as simply granting a patient's request. This systematic review was performed to examine the proportion and range of indications associated with tooth removal in context of dental, nondental, and medical reasons. Methods: A search conducted using PubMed, Embase, and APA PsycINFO identified 6038 studies. Three studies (4396 extractions in total) could be included for the risk of bias assessment and qualitative data synthesis. Results: The reported indications for tooth extraction on dental and medical grounds included caries with the proportion of all extractions ranging from 36.0% to 55.3%, periodontitis from 24.8% to 38.1%, trauma from 0.8% to 4.4%, periapical disease from 7.3% to 19.1%, orthodontics from 2.5% to 7.2%, and other reasons from 4.5% to 9.2%. The proportion for patient requests ranged from 3.6% to 5.9%, but specific information regarding the actual reasons for extraction could not be determined. Conclusion: The results suggest that caries and periodontitis are the most common indications for tooth extraction and that studies to reliably estimate the incidence of nondental and nonmedical motivation for extraction are lacking. Given that the final decision on performing or refusing extractions, whether it be based on dental, nondental, or nonmedical reasons, largely rests with the dentist and oral surgeon, detailed guidelines are warranted.

This article illustrates the indications and mechanism of action of core emergency medications as well as emergency medications for intravenous sedation in the oral and maxillofacial surgeon office. The recognition of medical emergencies and comprehensive knowledge of pharmaceutical medical intervention can prevent deterioration in medical emergencies. In addition, this article also reviews common dosages as well as administration techniques that should be regularly reviewed and be fundamental knowledge to the oral surgeon and staff.

Fanconi anemia is a rare disease, which is characterized by decreased production of all blood cell types. Fanconi anemia is the most common inherited form of aplastic anemia. Congenital abnormalities of the eyes, ears, and heart, malformed or absent kidney, urogenital system involvement are common. There is a delay in physical development. Intelligence in patients with Fanconi anemia is usually normal. The most serious problems associated with Fanconi anemia include the gradual development of bone marrow disorders. Many patients with Fanconi anemia develop leukemia or myelodysplastic syndrome, as well as other oncological diseases. Oral manifestations in patients with Fanconi anemia can be classified as gingivitis, periodontitis, dental caries, dental anomalies, soft tissue lesions, oral cancer, and lesions of the tongue. Patients with Fanconi anemia have increased predisposition to squamous cell carcinoma of the head and neck and oral cancer. The interdisciplinary team of medical and dental specialists must be included in the medical and dental treatment of patients with Fanconi anemia. For proper dental care of patients with Fanconi anemia, the close cooperation of dental specialists, including orthodontists, pedodontists, prosthetists, oral surgeons, as well as specialists in periodontology and oral diseases, is of particular importance.

Patient A 33-year-old man diagnosed with extranodal natural killer cell/T-cell lymphoma, nasal type (ENKTCL-NT) inducing palatal perforation was referred to the perioperative oral care support center of Tohoku University Hospital for dental care to support cancer treatment including chemotherapy and hematopoietic stem cell transplantation (HSCT). Dental review during chemotherapy revealed mucositis suspected to be caused by mucosal trauma from altered jaw function (chewing and speech) due to palatal perforation. Although the patient was already in the cleanroom, an oral appliance as well as conservative care as recommended in oral management guidelines for HSCT were used to prevent worsening of oral mucositis at subsequent HSCT including High-dose chemotherapy and total body irradiation. After HSCT, a prosthodontist fitted a palatal obturator made by a dental technician and an oral surgeon reviewed the necrotic bone and removed the sequestra according to the changes in the palate. This approach involving a multidisciplinary team including a hematologist improved the impaired oral function and minimized oral complications . Discussion ENKTCL-NT and its treatment have a significant impact on patients' oral status. Hence, it is important to provide customized dental care based on previously endorsed guidelines according to the type of disease, treatment requirements, and oral and systemic status. Conclusions This report indicated the importance of dental care with a customized plan before, during, and after HSCT for ENKTCL-NT with multidisciplinary supportive care for cancer patients to improve the impaired oral function and to minimize oral complications.

Extraction of impacted mandibular third molars is one of the most common surgical procedures performed at dental clinics; however effective training models for teaching oral surgery to dental students are limited. This study aimed to use three-dimension (3D) printing technology to develop an effective training model for impacted third molar extraction.The data for the 3D model were digitally processed using high-resolution computed tomography, and two common, but different patterns of impacted third molars were simulated using computer-aided design. Thereafter, the model was printed using the 3D-printing technology, and the efficiency of the 3D-printed model and an animal model (pig mandible) were compared using a five-point Likert scale by 35 oral surgeons in the oral surgery department and 208 students of stomatology in the internship stage.The 3D-printed model consisted of three parts: a non-replaceable part (i.e., the body of the mandible and the teeth from the left first molar to the right first molar) and two replaceable parts (i.e., the part of the ascending ramus of the mandible, as well as the second and third molars). It was covered with a layer of rubber-like material to simulate the gingiva. For the comparison between the 3D-printed and animal models, a total of 205 questionnaires were collected. Both oral surgeons and students agreed that the 3D-printed model was better than the animal model in terms of total value and the anatomy of the bone and teeth, simulating the surgical procedure (p 0.05), while the two models achieved similar results for haptic feedback of the soft tissue (p 0.05).The 3D-printed model is realistic and effective for learning impacted third molar extraction and received positive feedback from students and oral surgeons. This model can significantly improve the pre-clinical skill training of dental students.

The authors report a case of a 35-year-old man who presented with left maxillary toothache associated with left sided facial pain and a rapidly progressive loss of vision in the left eye. Clinical and radiological assessments revealed it to be an odontogenic orbital apex syndrome secondary to a vertical root fracture of a tooth. The infection was treated and controlled, postoperative follow-up showed no recurrent inflammation and the patient recovered well. However, the vision was lost permanently. Odontogenic orbital apex syndrome is a rare, aggressive disease. Once the infection spreads, it progresses rapidly, becoming a dangerous condition. To achieve better prognosis and improve survival rates, dental practitioners and oral surgeons should be aware of this distinct presentation and should have a high index of suspicion for the complication of tooth-related problems however minor they may seem.

Axenfeld–Rieger syndrome (ARS) is an extremely rare autosomal dominant disorder characterized by ocular, craniofacial, dental and periumbilical abnormalities. We present a case of a 10-year-old boy. Its awareness among oral surgeons is essential for timely diagnosis and subsequent prevention of ophthalmic and systemic complications as craniofacial and dental features constitute the early recognizable symptoms of this syndrome. Systematic ophthalmic surgeries aid in relieving vision abnormalities, while symptomatic dental treatment should be provided for masticatory and esthetic rehabilitation.

Osteo-odontokeratoprosthesis (OOKP) is a technique invented by Strampelli in 1963, in which the patient's own tooth root is used to support an optical cylinder. It uses an autologous tooth-bone-periodontal complex to mount an optical cylinder, which is stabilised by overlying autologous buccal mucosa. OOKP involves two, staged procedures done by ophthalmologists and oral surgeons, and the main contribution from the oral surgeon is during the first stage. To date we have done nine first-stage, and completed eight second-stage, OOKP operations in Japan with a mean follow-up of eight years and 11 months by modifying the original method of the oral surgery. All OOKP procedures were unilateral, and canines were selected as the donor teeth. Patients developed ocular blindness as a result of Stevens-Johnson syndrome, ocular cicatricial pemphigoid, and chemical and thermal burns to the cornea and ocular surface. All eight patients who completed the second stage have been stable, and there have been no major perioperative or postoperative oral complications. The patients' visual acuities were stable with no serious complications. Here we report the technical details of the oral contribution to OOKP.

In recent years, the practice of cosmetic surgery has expanded to include oral and maxillofacial surgeons. The groundwork for this scope-of-practice expansion was laid in part by the American Dental Association's definition change of the practice of dentistry. This change modified the scope of dentistry from the earlier "teeth and surrounding and supporting structures" to the maxillofacial area and beyond. A number of states adopted this new definition into legislation, giving practitioners the premise on which to perform cosmetic and other medical procedures on the face and potentially other parts of the body. This expansion has created legal and regulatory issues over scope and truth in advertising. The authors hypothesize that this is confused by a lack of federal guidelines and state-by-state variations in scope-of-practice laws for oral and maxillofacial surgeons.This article provides a brief overview of the key legal issues and their impact on legislation in some of the battleground states. The authors review the national distribution of scope of practice for oral and maxillofacial surgeons.The most successful path to expanded scope for dentistry has been through control of certification and credentialing. This has marginalized medicine boards from contributory oversight, thus circumventing any arguments over practice parameters. The scope-of-practice dispute is further complicated by the existence of dual-degree oral and maxillofacial surgeons.With increasing demand for cosmetic surgical interventions, establishing scope-of-practice standards for single-degreed oral and maxillofacial surgeons is critically important. As physicians, the oral and maxillofacial surgery graduates of the dual M.D./D.D.S. degree programs have no such scope-of-practice restrictions. Furthermore, if plastic surgery is to effectively argue against expanded scope of practice for oral and maxillofacial surgeons, more objective data will be necessary.

The coronavirus pandemic has become a huge global challenge medically, economically and psychologically. The COVID-19 pandemic shows that the population can experience general psychological distress. The sanitary regime in dental offices and lack of vaccine for coronavirus may have an impact on the level of dental anxiety among patients undergoing oral surgery procedures. A clinical study was conducted between November 2019 and September 2020. A total of 175 patients (n = 175) were enrolled in the research. The aim of the study was to assess the attitude of patients towards the new situation related to the reduced availability of dental offices providing oral surgery procedures. The level of anxiety associated with surgical intervention was measured using a self-made COVID-19 questionnaire and the MDAS scale. The ED-5Q questionnaire and EQ-VAS scale were also used in this research. The study showed that 21.9% of respondents presented with increased anxiety about a dental visit compared with the time before the pandemic. This epidemiological situation has led to an overwhelming increase in moderate dental anxiety (M: 11.4) among patients undergoing oral surgery procedures. The quality of patients&rsquo, health (EQ-VAS) related to the impact of the coronavirus pandemic and the quarantine decreased by 10 percentage points. Oral surgeons should be prepared for more anxious patients in dental offices during the pandemic.

Introduction: The Wiedemann-Rautenstrauch syndrome (WRS) is a rare progeroid syndrome with an autosomal recessive pattern of inheritance. The main clinical features include severe intrauterine and postnatal growth failure, distinctive facial appearance, hydrocephaly, prominent scalp veins, absence of subcutaneous fat, sparse hair of the scalp, eyebrows, and eyelashes, generalized lipoatrophy, psychomotor delay, progressive neurological deterioration, and short life expectancy. Natal teeth and micrognathia are reported as the oral manifestations of this syndrome. Case Presentation: Here is the report of a 6.5-year-old female patient with clinical signs of WRS referred to the Department of Periodontology of Shiraz School of Dentistry with the chief complaint of toothache and gingival hyperplasia. Carious teeth were extracted, and excess gingival tissue was removed through a surgical procedure under general anesthesia. The patient was the first case with a concomitant severe anterior open bite. Conclusions: Therapies for WRS are symptomatic, requiring the coordinated efforts of a team of specialists. Dentists and oral surgeons can be recruited by pediatricians and family physicians to improve the quality of life of such patients.

Household isolation measures to reduce coronavirus transmission during the COVID-19 pandemic have resulted in increased risk of domestic violence and abuse (DVA). DVA physical injury most frequently involves the face. Dentists, dental care professionals, oral surgeons and oral and maxillofacial surgeons all have a critical part to play in identifying patients experiencing DVA, who present with dental and facial injury, and in making referrals to specialist agencies. This paper describes how to ask questions about DVA sensitively and how to make an appropriate referral. Early intervention and referral to a DVA advocate can prevent an abusive situation becoming worse with more intense violence. It can save lives.

Confusion exists around the terms 'Oral Surgeon' and 'Oral and Maxillofacial Surgeon'. Historical terms and international differences have added to this confusion. Recently, the University of Sydney has begun to offer a Doctor of Clinical Dentistry in Oral Surgery to graduate dentists. With this new dental specialty entering the Australian workforce, distinction must be made between their role and the role of Oral and Maxillofacial Surgeons to facilitate effective referral pathways. A cross sectional survey of 3rd and 4th year dental students was distributed in June 2019. Students were queried with regards to their perception of the scope of practice of Oral Surgeons and Oral and Maxillofacial Surgeons as well as their knowledge of the training pathways and level of interest in pursuing either pathway. A total of 85% of students responded. Responses indicated a general awareness of the increased scope of practice of Oral and Maxillofacial Surgeons with some exceptions. No significant difference was seen between third and fourth year responses. Knowledge of both training pathways was lacking. Further education is required with regards to the scope of practice of both specialties. A lack of exposure to Oral and Maxillofacial Surgery during the undergraduate years may be partly to blame. Consideration should be given to the renaming of Oral Surgery to Surgical Dentistry.

Introduction:\ud Dental implants are a popular option for replacing missing teeth. When searching for information regarding dental implants, patients may first look to their dental practice website. The aim of this study was to assess the variance of patient information provided regarding implant complications on dental implant practice websites.\ud \ud Materials and methods: \ud Inclusion criteria for this study were dental practices within the Greater Glasgow & Clyde health board and practices with an active website. Completeness was assessed using a six-point score based on the British Association of Oral Surgeons ‘Information for patients’ leaflet and Association of Dental Implantology ‘Considering dental implants? – A patient’s guide to dental implant treatment’ leaflet.\ud \ud Results: \ud In total, 90.7% (n = 107) of practices provided accessible implant information on their websites. However, only 37.3% (n = 44) mentioned one or more specified dental implant complications. Pain/discomfort was the most frequently stated complication (n = 41/118); implant failure was only mentioned by 19 practices (16%). The mean number of complications mentioned by the 118 practices offering dental implants was 1.1.\ud \ud Discussion: \ud As implant dentistry grows, there may be concerns over patient expectations. To overcome lack of quality assurance on the internet, dentists can provide factual information on their websites. They should be aware of their duty to provide material that is accurate, honest, informative and not potentially misleading.

The coronectomy technique is an alternative to conventional impacted tooth removal which aims to reduce the risk of damage to the inferior alveolar nerve (IAN). The technique is usually performed by senior oral surgeons or residents in training. Herein, patients were treated in a single service, in which coronectomy was performed by an undergraduate dental student on partially erupted lower third molars. A prospective analysis was performed on 21 individuals submitted to a total of 35 coronectomies. Clinical and radiographic follow-up was performed for at least 12 months. Overall, healing was within normal limits, without major complications and without permanent IAN injury. However, one case showed temporary IAN paraesthesia resolved within a month and two required repetitions of coronectomy due to the remaining enamel, but with a good final result. Root migration was observed in all cases, but no other surgery was required. Coronectomy may be an important option for treating partially erupted teeth in close nerve relationships, which could also be performed by trained undergraduate dental students. This series is interesting because it can encourage oral and maxillofacial surgeons to train undergraduate students and to stimulate their attraction and passion for surgery.

Rationale: Tooth extraction is a common dental surgical procedure. There is a possibility that various complications often occur during third molar tooth extractions. Patient concerns: The authors report herein 2 cases of migration of a high-speed dental hand-piece bur during mandibular third molar extraction—one case with the iatrogenic foreign body migrating into the mandibular body and another case with the iatrogenic foreign body migrating into the floor of mouth are reported. Diagnosis: The patient was diagnosed with the iatrogenic foreign body associated with mandibular third molar extraction by imaging examinations. Interventions: The authors performed elective surgery to remove the foreign body under general anesthesia in Case 1, and performed emergency surgery to remove the foreign body under local anesthesia in Case 2. Outcomes: The foreign bodies were removed, and complete removal of the foreign bodies was confirmed by postoperative x-ray examination. The patients’ postoperative courses were uneventful. Lessons: The selection of adequate surgical procedures and instruments will prevent the occurrence of iatrogenic foreign bodies. If migration accidents occur, their positions should first be confirmed by imaging examinations. Dentists and/or oral surgeons should perform removal operations considering the degree of emergency based on the results of imaging examinations.

Objectives To establish current implant practice among university and hospital restorative dental specialists in the United Kingdom (UK) and Ireland and their opinions relating to criteria for implant treatment.Materials and methods An online questionnaire was distributed to 150 university and hospital restorative dental specialists in the UK and Ireland.Results The response rate was 27%. Twenty-nine (70%) respondents provided implant treatment, of which 76% and 100% placed and restored implants respectively. In addition, 79% worked with oral surgeons or oral and maxillofacial surgeons as part of the implant team. Hypodontia and malignancy were cited as the main groups that qualified for NHS dental implant treatment. Irradiation, smoking and bisphosphonates were considered the most important medical factors in patient selection for implant placement, while untreated periodontitis, poor oral hygiene and uncontrolled caries were the most important dental factors.Conclusions The majority of responding university and hospital restorative dental specialists within the UK and Ireland provide dental implant treatment and undertake a multidisciplinary approach where necessary. There is variation in the number of patients treated with implants by each respondent annually. The main patient groups that receive priority for NHS dental implant treatment are malignancy and hypodontia. Otherwise, there is general agreement about the factors considered important when selecting patients for implant treatment on the NHS and this aligns to the Royal College of Surgeons guidelines on selecting patients for the provision of dental implants.

There exist many dental surgery such as orthognathic surgery and an implant operation. Jaw deformity is one of the dental diseases such as an abnormality of occlusion and facial distortion in the shape. To treat jaw deformity, the osteotomy is carried out by human hands. However, drilling a jawbone accurately by oral surgeons is difficult. Recently, surgical robots are attracting attention in the medical field. The researches of surgery supporting systems have been carried out. They have possibilities to avoid unexpected accidents in the surgery, a hands shake and so on. The improvement of the minimally invasive surgery can be expected, thanks to robotic technology. The purpose of this research is the design and development of master-slave dentistry and oral surgery assisting robot. By implementing acceleration based bilateral control, haptic information can be communicated. Moreover, the proposed robot has the serial-parallel hybrid mechanism that can obtain the advantages of a serial mechanism and a parallel mechanism. In this paper, the mechanism of the proposed robot is explained and the performance of the proposed robot is validated by experiments.

Introduction: Odontogenic keratocysts (OKCs) are frequent, aggressive lesions with a strong tendency to recur, particularly in their para-keratinized majority form. Although they are mainly non-syndromic, these lesions are found in a large majority of patients with Gorlin syndrome. Thus, multiple forms are almost always associated with this syndrome and require investigation to prevent the risk of various cancers. Non-syndromic multiple forms are exceptional. Observation: A 20-year-old patient presented with dual localization of maxillary and left mandibular OKC at consultation. Under general anesthesia, excision of the lesions and extraction of the impacted wisdom teeth 28 and 38 were performed. The patient showed no clinical sign of Gorlin syndrome. Discussion: The OKC or epidermoid cyst is derived from the dental lamina or its remnants and from the basal part of the oral epithelium and represents between 10 and 20% of all cystic lesions in the maxillae. Its peak of incidence is between the second and fourth decade (or earlier in case of association with basal cell necrosis). OKC occurs mainly in the mandible and preferentially at the Ramus, where its frequency can reach 70% depending on the series. Conclusion: The management of OKC by oral surgeons must be conducted in a multidisciplinary setting in close collaboration with dermatologists, geneticists, and anatomic pathologists. Due to the strong recidivating character of OKCs, patient monitoring is essential.

Cleidocranial dysostosis is a rare genetic disorder that manifests various abnormalities in bone and dental development. Affected individuals show varying degrees of skeletal, dental, and craniofacial abnormalities. Among its many pathognomonic features, hypoplastic maxilla, depressed midface, mandibular prognathism, and multiple retained deciduous teeth and impacted supernumerary teeth may be treated by collaboration between an oral surgeon and an orthodontist. Herein, we report a successfully treated case of a Korean male adult patient, who was diagnosed with cleidocranial dysostosis, by careful planning and execution of combined orthodontic and surgical treatments consisting of a series of dental extractions of multiple retained deciduous teeth and impacted supernumerary teeth, window opening, button bonding and orthodontic traction of impacted permanent teeth, pre-surgical orthodontic treatment, and orthognathic surgery involving Le Fort I osteotomy, bilateral sagittal split osteotomy, malar augmentation, and partial glossectomy. The treatment resulted in notable esthetic and functional improvements and patient satisfaction.

Multiple impacted permanent teeth is a rare finding and often associated with systemic diseases or some rare syndromes. This article reports two Iranian cases with multiple impacted teeth without systemic disease or syndromes. The first patient, a 17-year-old male, had 18 unerupted teeth and 9 unerupted supernumerary teeth. The second patient, a 16-year-old female, had 14 unerupted teeth. In these cases, an interdisciplinary approach between orthodontist, oral surgeon and prosthodontist is required to achieve optimum facial aesthetics and functional occlusion.

A variety of techniques have been documented for the recovery of bone loss in areas where rehabilitation with dental implants is planned. The loss of teeth is followed by the loss of height and thickness of the bone too, precluding the installation of dental implants. The premature bone loss in this region can also cause pneumatization of the maxillary sinuses. So, the corrections of these defects are a real challenge for dentists and oral surgeons. The technique of segmental osteotomy with bone interposition graft has proven to be a viable option to solve this problem. This clinical case report describes the successful application of the technique in the treatment of decreased vertical dimension in the posterior area of the maxilla, where 7 months later 4 dental implants were installed. Two dental implants of 13 mm, and two dental implants of 11 mm, demonstrating success with bone height that was achieved in the case, making the use of this technique very sustainable in bone loss of posterior area of the maxilla with pneumatized maxillary sinuses.

Bifid mandibular canal is a variation of the normal anatomy. Such anomalies can result in difficult anesthesia while performing surgeries of the posterior mandible under local anesthesia. Moreover there is a high chance of damaging the neurovascular bundle leading to complications. Here we present a case of a bifid mandibular canal which posed difficulty in achieving appropriate anesthesia. The inferior alveolar nerve is of special interest for maxillofacial and oral surgeons. Its relation with mandibular third molar plays an important role while performing disimpaction surgery, in cases of bilateral sagittal split osteotomy, prosthesis placement in resorbed ridges, mandibular trauma procedures, and may be traumatized by penetration of the implant drill.

Early detection of oral squamous cell carcinoma (OSCC) is a challenge for oral surgeons, as clinical features are not always classical. Cytopathological assays can help identify alterations at the cellular level. This article reports a case of OSCC in a young male adult without exposure to classical risk factors. The histopathological examination showed a micro invasive carcinoma invading the connective tissue. Cytopathological results showed a higher percentage of cells in deeper epithelial layers; the cytomorphometric examination revealed a nuclear/cytoplasmic ratio of 0.14; the mean number of Nucleolar Organiser Regions which have a high affinity for silver (AgNOR) per nucleus was 2.86, and the mean percentage of nuclei with >2 AgNOR was 58%. The micronucleus test found 3 micronucleated cells and several metanuclear aberrations. These findings support the hypothesis that cytological examination is an important tool to identify early changes in oral smears and thus help in the early clinical detection of suspicious malignant oral lesions that should be more rigorously followed.

Here, we report a case of fatal bleeding in conjunction with mandibular medicationrelated osteonecrosis of the jaw (MRONJ). A 75-year-old Japanese man was referred to our department with osteonecrosis of the jaw due to bisphosphonate (BP) for multiple bone metastases from prostate cancer. Aggressive surgical intervention was ruled out due to a poor prognosis in terms of life expectancy. Death occurred due to hemorrhagic shock resulting from massive oral bleeding caused by necrosis of the mandible. Numerous reports have suggested that jaw necrosis is induced not only by BP, but also RANKL antibody, steroids, and molecularly-targeted agents. This suggests that the number of cases of MRONJ is likely to increase among elderly patients in whom general health is already poor. The American Association of Oral and Maxillofacial Surgery recommends aggressive treatment only in cases of stage 3 disease. Therefore, such a therapeutic strategy may only be available for cases of jaw necrosis in which the general health status of the patient is otherwise good. To prevent a life-threatening outcome in cases of MRONJ, physicians, who are responsible for determining the drug strategy, should cooperate with oral surgeons in determining the best therapeutic strategy.

Given the popularity of dental implants, determining their prognosis is an integral component of dental practice. An accurate prognosis is crucial to development of an appropriate treatment plan and may require alterations as overall status or the status of implants or natural teeth change. The importance of an established set of factors for determining implant prognosis would be highlighted in dentist-patient communication and in interdisciplinary collaboration. The main objective of the proposed prognostication system is short- and long-term success of dental implants. The aim of this study was to review evidence-based prognostic factors including surgical, peri-implant, prosthetic, and overall considerations in implant dentistry and to propose a new prognostication system. A blind survey was taken by 67 prosthodontists, periodontists, and oral surgeons at three dental schools to assess the importance of each consideration based on clinical experience and available evidence. The results supported incorporation of the comprehensive review of evidence-based prognostic factors into the proposed dynamic system for dental implant prognostication.

Objective: To assess the referral patterns of General Dental Practitioners (GDPs) and Pediatric Dentists (PDs) when faced with a range of Pediatric-Oral Surgery (POS) cases. Material and Methods: Eighty-two dentists treating children [51.2% GDPs (n=42) and 48.8% PDs (n=40)] were shown clinical photographs or radiographs of twelve common POS cases. Opinions on whether to “manage it yourself”, “refer to a/another pediatric dentist”, “refer to an oral surgeon (OS)”, “refer to a multidisciplinary clinic (MDC)”, or “do nothing” were sought. Statistical analysis was carried out using SPSS software with Chi-square test (p≤0.05). Results: Both GDPs and PDs reported significantly higher referrals to OS of: 1) lower lip mucoceles (50%, 52.5% respectively), 2) exposure of impacted maxillary canine (64%, 51.3%) and 3) dento-alveolar trauma cases (73.8%, 65%). A majority of GDPs and PDs reported self-managing of: 1) removal of multiple deciduous carious teeth (81%, 97.5%), 2) odontogenic infections with facial swelling (57.1%, 92.5%), 3) removal of ankylosed submerged primary molars (66.7%, 95%) and 4) dental trauma (71.4%, 100%). PDs reported self-managing primary herpetic gingivostomatitis (PHGS, 95%) compared to 45.2% of GDPs. GDP referral of PHGS to the PDs was 42.9%. There were no significant differences between both groups regarding removal of a mesiodens, release of a tongue-tie, a labial frenectomy, or a lip laceration, but the majority would refer to oral surgeons in these cases. Conclusion: Whilst United Arab Emirates dentists sampled referred some pediatric-oral surgery cases to oral surgeons, general dental practitioners were reluctant to refer pediatric-oral surgery cases to pediatric dentists, preferring to self-manage them.

Objective Osteogenesis imperfecta is a rare inherited skeletal disease known to be associated with oral problems. In the present study, we investigated the oral condition of Japanese patients with osteogenesis imperfecta using a nationwide survey. Subject and methods A total of 534 clinics were surveyed by questionnaire, including 69 clinics registered to train paediatric dentists and 465 registered to train oral surgeons, to determine the number of osteogenesis imperfecta cases and the clinical dental findings of each case. Cases in the authors' clinic were also investigated. Results Dentinogenesis imperfecta was found in 64% of the total 110 cases of osteogenesis imperfecta, most commonly in type III and IV osteogenesis imperfecta. The most common malocclusion was mandibular protrusion or anterior cross-bite, followed by open bite. Approximately 40% of all patients with osteogenesis imperfecta taking bisphosphonates underwent primary tooth extraction because of eruption disturbances with no complications. Conclusions The main oral problem associated with osteogenesis imperfecta is dentinogenesis imperfecta. Treatment with bisphosphonates does not need to be interrupted when ectopically placed primary teeth are extracted to allow replacement by permanent successors. Periodic oral health management is recommended for patients with osteogenesis imperfecta, especially those with dentinogenesis imperfecta.

Dogs have bad breath. But when Montana sheep rancher Katy Harjes noticed her collie, Hoshi, had particularly bad breath and facial swelling, she was concerned that the symptoms might be a sign of something serious. She was right; ten-year-old Hoshi had squamous cell carcinoma, a common type of oral tumor found in dogs. The cancer had not metastasized, but the damage was extensive enough that part of Hoshi's lower jaw needed to be removed. Luckily, Hoshi was a suitable candidate for a stateof-the-art bone regrowth procedure developed by Frank Verstraete, B.V.Sc, Dr.Med.Vet., M.Med.Vet., and Boaz Arzi, D.V.M., oral surgeons at the University of California (UC), Davis, School of Veterinary Medicine. Consequently, Katy and Hoshi embarked on a 15-hour road trip to California.

The aim of this study was to assess oral cancer awareness among dentists who attended 101st FDI World Dental Congress, Istanbul, Turkey. Among 170 dentists who agreed to participate, there were 13 oral surgeons, 6 restorative dentists, 4 endodontists, 4 orthodontists, 6 periodontists, 5 pedodontists, and 14 prosthodontists. Knowledge of oral cancer risk factors and diagnosis procedures, dentists’ attitude towards oral cancers, management practice regarding oral cancer, and oral cancer information sources were assessed using 25 questions. The data were analyzed with IBM SPSS Statistics 22.0 program. Among 170 participant dentists, there were 69 (40.6%) male dentists and 101 (59.4%) female dentists. Largest number of them identified tobacco (98.8%) and alcohol usage (91.2%), prior oral cancer lesions (95.3%), viral infections (90.0%), UV exposure (86.5%), and betel quid chewing (80.6%), and lower numbers reported older age (56.5%) and low consumption of fruit and vegetables (52.4%). Oral medicine specialists scored marginally higher in indicating erythroplakia and leukoplakia most likely to be precancerous and squamous cell carcinoma as the most common form of oral cancer (p

Odontogenic foci can rarely cause intracranial infection. Hematogenous spread is considered to be the most important pathophysiological mechanism of intracranial infection of odontogenic origin. To investigate the oral origin of intracranial infections, oral surgeons should understand the underlying mechanisms by which oral bacteria spread to the central nervous system. However, there have been very few reports of intracranial infection resulting from odontogenic infection. The authors report the cases of a 64-year-old man, a 68-year-old man, and a 64-year-old woman whose brain abscesses perhaps have arisen from odontogenic foci, because other sources of intracranial infection such as endocarditis and maxillary sinusitis were not found. Bacteriological examination of brain abscess specimens identified Staphylococcus aureus in case 1, Streptococcus constellatus, Fusobacterium nucleatum, and Parvimonas micra in case 2, and Lactobacillus catenaformis, Porphyromonas gingivalis, and Fusobacterium nucleatum in case 3. All suspected causal teeth had no obvious signs of acute inflammation in 3 cases. Oral surgeons should understand these characteristics of odontogenic brain abscess, in which the potentially causal odontogenic foci often lack acute symptoms. If other origins of infection are not found, it would be better to eliminate the potentially causal odontogenic foci for improvement of oral hygiene, however, the decision making criteria to eliminate suspected causal teeth is needed to be elucidated.

Introduction: Ewing's sarcoma is a primary malignant bone tumor that affects children and young adults. In rare cases, it affects the bones of the face. The diagnosis is difficult because signs are non-specific. Positive diagnosis is based on a cytogenetic examination showing a specific translocation of the EWS gene. Treatment involves a sequence including chemotherapy, oncological surgery and radiotherapy. Observation: The case presented is that of a 4-year old girl initially sent for suspicion of dental cellulitis. On clinical examination, she had recent mandibular dental mobility and a gingival mucosa swelling. Signs of bone lysis interesting the mandibular symphysis was observed on the orthopantomogram. She had no pain or symptoms indicating neoplasia. This atypical situation led to a bone biopsy who revealed the diagnostic of mandibular Ewing's sarcoma. A suitable medical care in a specialized unit was able to be started without delay. Discussion: The literature reports other cases also wrongly diagnosed as an infectious pathology of dental origin. Conclusion: This case shows that the diagnosis of mandibular Ewing's sarcoma must be evoked in front of any atypical mandibular lesion of the child, regardless of his age or sex. Physicians and dental surgeons specialized in oral surgery are then in the foreground to help establish early diagnosis and ensure rapid management by limiting the functional and aesthetic sequelae related to localization.

The mandibular anterior lingual depression is an uncommon anatomical variant. It is difficult to be detected in conventional 2D plain radiographs representing a diagnostic challenge. In this report, we describe a patient who presented to the dental clinic for the extraction of impacted third molars. Upon cone beam computed tomography (CBCT) examination of the mandible, it was incidentally noted that he had bilateral anterior lingual depressions in his mandible. The presence of anterior lingual depressions is uncommon and to be found bilateral is rare. This bone topography represents a challenge for the oral surgeon during implant placement with an increased risk of complications. The incidental finding was documented in the patient's dental record for future implications in case an implant placement was needed.

Antiresorptive drugs (ARDs), such as bisphosphonates or denosumab, that prevent bone resorption are widely used in patients with osteoporosis or with cancer that has metastasized to the bones. Although osteonecrosis of the jaw (ONJ) is a well-documented complication of ARD use, the benefits ARDs outweigh the complication. Thus, research has focused on finding ways to prevent or reduce the risk of developing ONJ. Dentists, as part of a multi-professional team, have a critical role in preventing ONJ. However, many dentists tend to hesitate to provide dental care to patients with ONJ, or tend to think that it is a problem to be dealt with by oral surgeons. This review gives an overview of ARD-related ONJ and provides the guidelines for dental care in patients taking ARDs to lower the risk of developing ONJ.

The esthetic component is critical for the successful outcome and patients’ satisfaction regarding the implant-prosthetic therapy. The esthetic outcome success depends mostly on the optimization of the algorithms specific to the pro-implant and implant stage as well as to the designing and technological execution of the future prosthetic restoration. A proper planning of optimal facial esthetics must involve a multidisciplinary approach with inclusion of periodontists, orthodontists, oral surgeons and implantology specialists. The dental practitioner must consider various factors that influence the esthetic outcome (tooth position, root position of the adjacent teeth, biotype of the periodontium, tooth shape, smile line, implant site anatomy, implant positioning). Also, some factors (anatomical limits of the implant site, periodontal status, occlusal parameters), which can alter the final esthetic result, must be assessed prior to planning the esthetic parameters of the future prosthetic restoration. The esthetic outcome can be improved by using new digital technologies based on software applications for assessment of clinical and biological indices of the prosthetic field, virtual planning of implants positioning and design projection of future prosthetic restoration.

An oral surgeon who removed the wrong tooth and then misled the patient and attempted to influence a nurse’s testimony during a subsequent trust investigation has been suspended from the UK medical register for eight months. Michael Winston, who is qualified in both medicine and dentistry, works as an associate specialist in oral surgery one day a week at Liverpool University Dental Hospital. He is also a locum consultant oral surgeon at Blackpool Teaching Hospitals. In January 2016 at the Liverpool hospital he removed a molar that was not in the patient’s plan for removal. Although he realised his error before the patient left, Winston failed to tell her, and she left unaware that a …

Introduction:Squamous cell carcinoma of the oral cavity is the most common cause of mandibular defect. The functional and aesthetic impacts of this surgery must be considered. The number of mandibular resections depends on the TNM classification of the tumor. Mandibular reconstruction by a fibula free flap has become the gold standard. Unfortunately, not all mandibular resections are rehabilitated. The purpose of this study is to evaluate oral rehabilitation after mandibular resection in patients with squamous cell carcinoma.Materials and methods:A retrospective study was conducted to evaluate oral rehabilitations according to the type of surgical resection and reconstruction. The secondary evaluation criteria were type of rehabilitation, implant success rate, post-radiotherapy delay, rehabilitation success rate, and causes of non-rehabilitation.Results:The study included 157 patients with mandibular resection. Of the patients, 26.7 percent received oral rehabilitation. All rehabilitation with implants was functional. The main causes of non-rehabilitation were death or recurrences related to the progression of the disease, postoperative anatomical difficulties, and cost of oral rehabilitation.Conclusion:Oral rehabilitation after mandibular resection surgery is insufficient. A rehabilitation unit including a maxillofacial surgeon, oral surgeon, and dentist is essential. Implementation of the unit should be considered as soon as possible. The cost of rehabilitation should not be a limiting factor.

Introduction : Surgical techniques for wisdom tooth extraction are very well described and codified in the literature. As far as standard approaches are concerned, oral surgeons enjoy a wide array of therapeutics and methods to remove impacted third molars. However, conventional intra-oral first path is not suitable when it comes to atypical inclusion and/or limited access. Observation : This paper illustrates extreme situations where the intra-oral armamentarium shows its weaknesses: first, two cases where modified submandibular access was successfully used to remove deeply impacted lower third molars; and 1 case where Lefort I osteotomy was achieved to remove a maxillary third molar projected into the pterygo-maxillary fossa. Discussion : The extra-oral surgical approach for dental extraction is very rare and in most cases the classical intra-oral approach dominates. However, when intra-oral surgery of the pterygo-maxillary fossa is impossible by the conventional endobuccal method, appropriate extra-oral approaches might be useful. Conclusion: Rarely, atypical surgical approaches may be used for removal of ectopic third molars.

This is a randomized, multi-center, open-label, phase III study to evaluate the efficacy of professional oral care in preventing oral mucositis induced by everolimus in postmenopausal estrogen receptor-positive metastatic breast cancer. Patients will be randomized into professional oral care and control groups (1:1 ratio). All patients will receive everolimus with exemestane and will continue everolimus until disease progression. In the professional oral care group, patients will receive teeth surface cleaning, scaling and tongue cleaning before starting everolimus, and will continue to receive professional oral care weekly from oral surgeons throughout the 8 week treatment. In the control group, patients will brush their own teeth and gargle with 0.9% sodium chloride solution or water. The primary endpoint is the incidence of all grades of oral mucositis. Target accrual is 200 patients with a two-sided type I error rate of 5% and 80% power to detect 25% risk reduction.

Objectives: If teeth are missing, super-eruption of teeth in the opposing arch can occur in the area and can change the occlusal plane. When missing teeth are replaced with implants, the oral surgeon must determine whether or not the super-erupted teeth need to be treated in order to normalize the occlusal plane. In this study, we evaluated the clinical prognosis of dentition after implant placement and prosthetic treatment were completed in an occlusal plane altered by super-erupted teeth in the opposing arch without additional treatment of the super-erupted teeth. Materials and Methods: Twenty-two patients (9 males, 13 females) were treated with implants and prosthetics without addressing the super-erupted opposing dentition from April 2004 to August 2012 at Seoul National University Bundang Hospital. A total of 33 implants were placed. Values of crestal bone loss, survival rates, and surgical and prosthetic complications for an average of 29.6 months after prosthetic loading were recorded. Results: In one case, the cover screw was exposed after implant surgery. The mean crestal bone loss was 0.09±0.30 mm. Of the 33 implants, 31 survived, a survival rate of 93.94%. A prosthetic complication occurred in one case but functioned well after correction. Conclusion: Favorable clinical results from prosthetic complications, crestal bone loss, and implant survival rates were exhibited in implants next to a super-erupted opposing tooth.

Background Extra-oral drainage of odontogenic abscesses is commonly performed by oral and maxillofacial surgeons. It is a potentially hazardous and expensive procedure, but in selected cases can be carried out under local anaesthetic, avoiding some of the risks and costs associated with general anaesthesia. Aim To evaluate the management options for odontogenic abscesses. Method A review of the literature with respect to radiological, anaesthetic and surgical techniques that facilitate extra-oral incision and drainage under local anaesthetic. Results A case series demonstrates the value of imaging, the Vazirani–Akinosi mandibular nerve block, a specific forcep technique and local anaesthetic extra-oral drainage of the submandibular space. Conclusions Oral surgeons can utilise their specialist knowledge of head and neck anatomy, local anaesthetic technique, surgical skills and specialist equipment to deliver quick and definitive treatment for odontogenic abscesses. To our knowledge, extra-oral incision and drainage of dental abscesses is not regularly carried out under local anaesthetic. However, if removal of the causative tooth and abscess drainage can be undertaken under local anaesthetic, the risks and costs of general anaesthesia can be avoided.

Orofacial infections following dental extractions are a common referral to an oral and maxillofacial department as an emergency, especially when combined with swelling and limited mouth opening. The case presented demonstrates a rare complication of chronic suppurative osteomyelitis with bilateral pathological fractures of the mandible, which occurred following a staged dental clearance. CPD/Clinical Relevance: Dental extractions are one of the most common treatments carried out by oral surgeons and general dental practitioners. This case highlights a rare but encountered complication of routine oral surgery and demonstrates when it is necessary to make an immediate referral to the local oral and maxillofacial surgery unit.

Advancement genioplasty is a versatile procedure able to address both functional and cosmetic issues. It is commonly performed by oral surgeons and less so by facial plastic and plastic surgeons, presumably because of its inherent risks.To present our technique for advancement genioplasty and our aesthetic and functional outcomes.A retrospective review was conducted of the medical records of 126 patients who had undergone advancement genioplasty with our modified technique in a private practice setting from September 1997, through September 2014. Our analysis was performed between January and March 2015.Description of technique and evaluation of complication rates, improvement in sleep apnea symptoms, and patient satisfaction.The 126 patients had a mean age of 39.8 years. There were 81 male and 45 female patients. The overall complication rate was 6.3% (8 of the 126 patients). Complications included plate extrusion in 2 patients, infection in 2 patients, mental nerve injury in 3 patients, and tooth root injury in 1 patient. Patients were satisfied with the aesthetic result of the procedure, which also produced an improvement in obstructive sleep apnea in 82 of 89 (92%) patients with sleep apnea.Advancement genioplasty is a valuable tool that can address both functional and aesthetic issues. The technique presented here allows safe, reliable, and effective execution of the procedure.3.

A tooth normally erupts when half to three-quarters of its final root length has developed. Tooth impaction is usually diagnosed well after this period and is generally asymptomatic. It is principally for this reason that patients seek treatment later than optimal. Tooth impaction is a common problem in daily orthodontic practice and, in most cases, it is recognized by chance in a routine dental examination. Therefore, it is very important that dental practitioners are aware of this condition, since early detection and intervention may help to prevent many harmful complications. The treatment of impacted teeth requires multidisciplinary cooperation between orthodontists, oral surgeons and sometimes periodontists. Orthodontic treatment and surgical exposure of impacted teeth are performed in order to bring the impacted tooth into the line of the arch. The treatment is long, more complicated and challenging. This article presents an overview of the prevalence, etiology, diagnosis, treatment and complications associated with the management of impacted teeth.

The importance of the position of the lingual nerve in the oral cavity cannot be understated for dentists and oral surgeons. Therefore, the location of the lingual nerve with various positions of the tongue is important. However, most dental and medical students are taught oral cadaveric anatomy where tissues are fixed. Therefore, the focus of this article is to demonstrate how the lingual nerve moves based on tongue movement in fresh tissues and how this is important for dentists and oral surgeons. Clin. Anat. 30:467-469, 2017. © 2017 Wiley Periodicals, Inc.

Spindle cell squamous carcinoma (SpCC) is an exceedingly rare variant of squamous cell carcinoma with unique clinicopathological characteristics. SpCC is an aggressive and rapidly progressive neoplasm, and increased awareness for dentists, oral surgeons, and head and neck specialists should aid diagnosis and prompt treatment. We present a case of SpCC in the anterior maxilla of an 84-year-old female which displayed rapid growth.