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Introduction: The purpose of this European multicenter study was to describe the general characteristics and risk factors of MRONJ lesions as well as their clinical diagnosis and management at different European Oral and Maxillofacial Surgery centers, in order to minimize selections biases and provide information about the epidemiology, etiopathogenesis, and the current trends in the treatment of MRONJ across Europe., Materials and Methods: The following data were registered for each patient: gender; age at MRONJ diagnosis; past medical history; indication for antiresorptive or antiangiogenic therapy; type of antiresorptive medication; local risk factor for MRONJ; MRONJ Stage; anatomic location and symptoms; treatment; surgical complications; recurrence., Results: A total of 537 patients (375 females, 162 males) with MRONJ were included. Statistically significant associations were found between patients with metastatic bone disease and recurrences (P < 0.0005) and between advanced MRONJ stages (stages 2 and 3) and recurrences (P < 0.005). Statistically significant associations were also found between male gender and recurrences (P < 0.05), and between MRONJ maxillary sites and recurrences (P < 0.0000005)., Conclusions: A longer mean duration of antiresorptive medications before MRONJ onset was observed in patients affected by osteoporosis, whereas a shorter mean duration was observed in all metastatic bone cancer patients, and in particular in those affected by prostate cancer with bone metastases or multiple myeloma. Surgery plays an important role for the management of MRONJ lesions., Competing Interests: Declaration of competing interest No competing interest, (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Chondrosarcoma is among the most common primary bone tumors in adults. In the mandible, chondrosarcoma is a very uncommon malignant cartilage-producing tumor. This case report shows how virtual planning combined with other digital technologies may improve masticatory function rehabilitation in patients with enlarged mandibular chondrosarcoma. The present study reports a case of a 52-year-old male patient who was initially diagnosed with a mandible chondroma, which was successfully excised with no evidence of malignant transformation. Nevertheless, the patient's symptoms recurred after 10 years, and a subsequent diagnosis of mandible chondrosarcoma was established, prompting the need for subtotal mandible resection and reconstruction with a fibula-free flap. Following a healing period, the patient underwent dental implant surgery to restore the mandibular dental arch, which was performed utilizing computer-aided design and computer-aided manufacturing technology, with fully guided implant placement facilitated by virtual planning. In this case report, the implant position data merging process is described from the digital impression and control model to ensure optimal passive fit of the full-arch zirconia prosthesis and discuss the importance of occlusal adjustments to avoid technical and biological complications. Virtual planning and digital technologies are crucial for the effective management of mandibular defects, allowing for accurate treatment and complete restoration of mandibular function. Their use leads to improved patient outcomes and quality of life. As technology advances, their importance in treating complex medical conditions is only expected to grow., (© 2023 by the American College of Prosthodontists.)

Purpose: A retrospective 17-year review of the epidemiology, microbiological aspects, and treatment of patients hospitalized for non-odontogenic maxillofacial infections., Methods: A retrospective study reviewed 4040 medical records of patients hospitalized at Vilnius University Hospital Zalgiris Clinic during the period of 2003 to 2019. The following data were collected: patient sociodemographic characteristics, length of hospitalization, sources of infection, affected anatomical regions, treatment modalities, microbiological findings, and sensitivity to antibiotics., Results: The mean (sd) annual incidence of non-odontogenic maxillofacial infections over the past 17 years was 237 (49) cases, and the mean (sd) hospital stay was 7.3 (4.5) days. The male-to-female ratio was 1.9:1, while the mean (sd) patient age was 42.1 (19.0) years. The need for an additional incision and the involvement of multiple anatomical regions were the strongest predictors of longer hospitalization. A total of 139 microorganism species were identified, with Bacteroides, Prevotella, and Staphylococcus showing the highest resistance to penicillin., Conclusions: Longer hospital stays were associated with older age (≥ 65 years), smoking, systemic diseases, type of treatment, involvement of multiple anatomical regions, and the need for additional surgery. Most of the cultured microorganisms were Staphylococcus species., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Hand hygiene plays a significant role in infection control, yet it is performed correctly only 40% of the time. The daily use of soap, disinfectants and gloves can also affect hand skin health. Periodical educational interventions regarding hand hygiene can improve infection control., Objectives: The current study aimed to identify the existing hand hygiene practices applied by dental personnel, to evaluate knowledge about infection control, to determine the adverse effects of hand hygiene on the skin, and to assess the effectiveness of the educational interventions concerning these topics., Material and Methods: This study was carried out at the Vilnius University Hospital Žalgiris Clinic, Lithuania. At the 1st stage, data was collected by using a self-administered questionnaire. At the 2nd stage, dental personnel underwent an educational intervention and the surveys were redistributed to determine any changes in the level of knowledge., Results: In most cases, dental workers performed hand hygiene when it was needed. The proper method was selected by 53.4% on average. The main mistakes were the excessive use of soap and only occasional use of a disinfectant. The reported hand skin side effects included dryness (68.8%) and fissures (37.5%). Only half (50.5%) of the staff regularly used emollients. After the educational intervention, there was a 24.9% improvement in hand hygiene compliance., Conclusions: The correct procedure for hand hygiene was reported by half of the participants. Washing hands with soap was the preferable choice, while alcohol-based hand rub (ABHR) was avoided. Skin problems were reported by more than 70% of the respondents. Training had a positive impact on the hand hygiene knowledge of the dental personnel.

This multicenter study aimed at comparing different techniques of lip and nose repair with or without NAM and primary anterior rhinoplasty in pre-adolescent children. Patients with unilateral clefts of lip, alveolus, and palate who had undergone cleft lip and nose repair were evaluated in a prospective three-centre study using standardized monochromatic, cropped photographs. Four cleft surgeons evaluated the aesthetics of the central part of the face when the patients had reached age ten years. Seventy-six sets of photographs out of 87 patients were evaluated. The overall ratings of lips and noses did not differ much between centres. However, noses of centres 1 (mean 0.74; SD 0.57) and 2 (mean 0.76; SD 0.60) had been rated better than centre 3 (mean 1.32; SD 0.78; p = 0.0078), especially "Deformation of upper part of nostril rim or poor position of alar cartilage". Centre 3 had produced better looking scars (mean 0.33; SD 0.48); p = 0.0036. Within the limitations of the study it seems that NAM and primary anterior rhinoplasty including postoperative nasal stents should be performed whenever possible in order to achieve a favorable shape of the nose and to reduce the need for secondary corrective surgery., Competing Interests: Declaration of competing interest There is no conflict of interest whatsoever. Some little money, however, was granted from the German Academic Exchange Service in order to ease the financial burden of travelling to one or the other centre for the yearly meetings., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

This case control study measured early crestal bone changes around subcrestally placed platform-switched implants surrounded by thin soft tissue and compared them with regular, matching-platform implants placed in a supracrestal position and surrounded by thick soft tissue. Sixty-six patients received two-piece internal hex dental implants. Control group patients (n = 33) received implants that had a horizontally matching implant-abutment connection and were placed approximately 0.5 to 1 mm supracrestally. Test group patients (n = 33) received platform-switched implants that were placed about 1.5 mm subcrestally. Clinical examinations were conducted, intraoral radiographs were taken, and statistical analysis was performed. After 2 months, the mean bone loss was 0.2 mm (SD: 0.22 mm; range: 0.1 to 1.2 mm) in the control group and -0.69 mm (SD: 0.65 mm; range: 0 to 2.6 mm) in the test group; this difference was found to be statistically significant (P < .05). After 1 year, mean bone loss was 0.28 mm (SD: 0.36 mm; range: 0.1 to 1.63 mm) in the control group and -0.6 mm (SD: 0.55 mm; range: 0.05 to 1.8 mm) in the test group. Platform-switched implants placed in a subcrestal position in vertically thin soft tissues showed statistically significantly more bone loss than non-platform-switched implants placed supracrestally with vertically thick tissues.

The zoonotic parasite Dirofilaria repens has spread toward north in Europe, and cases of autochthonous dirofilariosis caused by D. repens have emerged in the Baltic countries Estonia, Latvia, and Lithuania. We conducted a review on the emergence of dirofilariosis in humans and domestic dogs in these three countries in northeastern Europe. Based on the available literature and reports, the first finding in the Baltic countries was made in Latvia in 2008, followed by the first in Lithuania in 2010, and the first in Estonia in 2012. In all three countries, further findings were reported soon after the first reports. By the end of 2019, autochthonous human D. repens infections had been described from Latvia and Lithuania, and autochthonous canine D. repens infections had been described from all three Baltic countries. While no epidemiological studies estimating prevalence or incidence of the human infections have been published from the three countries, a substantial proportion of investigated dogs have tested positive for microfilariae in studies performed in Latvia and Lithuania. Dirofilariosis is an emerging zoonosis in northern Europe, and the summarized data confirm that D. repens has become established and endemic in the Baltic countries. The available data do not provide a good overview of the situation, and further epidemiological studies are needed. Awareness about the recently emerged zoonotic parasite should be increased among medical doctors, veterinarians, and the general public. Managing this zoonotic infection is a public health challenge that needs to be addressed using a One Health approach. Investigating the spread of D. repens in the Baltic countries could be useful for better preparedness for the anticipated further spread to the Nordic countries.

Purpose: To identify the prevalence and determinants of dental trauma in permanent anterior teeth among 11- to 13-year-old schoolchildren, to compare self-reported dental trauma rates with clinical examination trauma rates, and to examine mouthguard use among children engaged in contact sports., Materials and Methods: A probability sampling scheme was used to recruit schools, with all 6th grade children in the selected schools invited to participate. A total of 2621 caregiver consent forms were sent, of which 807 were returned (31%). Caregivers were asked four trauma-related questions. Clinical examinations included assessment of dental trauma experience (trauma index with five severity codes), lip competence and incisal overjet. Child- and tooth-level analyses were performed., Results: Clinical evidence of dental trauma was found in 52% of participants, 13% self-reported dental trauma, and 7% of children did not remember the occurrence of any trauma. The two most frequently self-reported reasons of dental injury were falls or collisions with objects (63%) and sport/leisure activities (32%). Nearly half of the more severe dental injuries did not receive the necessary treatments. One-third of schoolchildren participated in contact sport activities, but only 3% always used mouthguards. There was a substantial difference between the clinical and self-reported findings. Logistic regression analyses revealed no statistically significant associations between dental trauma experience and the potential determinants studied: gender, lip coverage and overjet., Conclusion: In this study, traumatic dental injuries were observed with 52% prevalence. A substantial discrepancy between self-reported and clinical findings was observed.

Introduction: In complex clinical conditions when physiological bone regeneration is insufficient, there is a need to develop synthetic material-based scaffolds. The morphologic properties of porous scaffolds are of crucial importance. The dimensional accuracy of 3D printed scaffolds can be affected by a variety of factors., Materials and Methods: Three groups of 3D printed scaffolds were investigated: PLA1 (pure polylactic acid) printed with an FDM Ultimaker Original printer, PLA2 and composite PLA/hydroxyapatite (PLA/HAp) scaffolds printed with a Pharaoh XD 20. PLA/HAp filament was created with hot-melt extrusion (HME) equipment. The morphology of the prepared scaffolds was investigated with SEM, micro-CT and superimposition techniques, gravimetric and liquid displacement methods., Results: Layer heights of PLA1 scaffolds varied the most. PLA1 scaffold volume statistically significantly differed from PLA2 (p < 0.001) and PLA/HAp (p < 0.01) groups. Filament composition had no effect on the volumes of the scaffolds printed with the Pharaoh XD 20 printer (p > 0.05). The total porosity of printed PLA/HAp scaffolds deviated the least from the original STL model., Conclusions: This study showed that PLA/10% HAp filament fabricated with HME and printed with FFF 3D printer produced equal or even better accuracy of printed scaffolds than scaffolds printed with pure PLA filament. Further research is needed to analyze the effect of HAp on 3D scaffold morphology, accuracy, mechanical and biologic properties., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to simulate low dose paediatric head CT images with different noise levels corresponding to various tube current time product values and assess simulated image suitability in non-syndromic craniosynostosis diagnostics., Method: 29 paediatric patients who underwent head CT examinations for cranial deformity were enrolled in the study. The low dose CT images, corresponding to 120 kV and 120 mAs, 100 mAs, 80 mAs, 50 mAs and 13 mAs settings, were synthesised by adding noise to original data. Three researchers evaluated suitability for diagnostics of original and simulated images by using questionnaire assessing image suitability., Result: 174 separate cases (containing 1 axial and 1 3D image) were evaluated. Percentage of images evaluated as suitable for diagnosis were 98.9% on original images, 100% on 120 mAs, 100% on 100 mAs, 97.1% on 80 mAs, 96.6% on 50 mAs and 96% on 13 mAs., Conclusions: Images registered with 120 kV 13 mAs can be used to diagnose non-syndromic craniosynostosis with statistically same accuracy as with standard protocol and correspond to decrease of effective dose from 4.98 mSv to 0.33 mSv (median values)., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background/aims: In Lithuania, dental trauma cases are often treated by general dentists, but it is unknown whether their age, self-evaluation of trauma knowledge and practice location can predict their actual knowledge and management of trauma cases. The aim of this study was to evaluate whether these factors can be used to predict the actual knowledge and management of trauma cases., Methods: A 2-part questionnaire included 17 multiple-choice questions about practitioners' demographics, their self-evaluated knowledge and how frequently they treated traumatized permanent teeth as well as 13 clinical scenarios reflecting a variety of clinical trauma cases and their complications. A total of 980 randomly selected general dentists, representing 5 Lithuanian counties, participated in the study., Results: The response rate was 59.4% (n = 582). Overall, 82.3% of general dentists reported that they treated only a few dental trauma cases and 14.4% chose to refer their patients; 55.1% of dentists considered their dental traumatology knowledge to be sufficient but incomplete and 34.0% self-evaluated their knowledge as insufficient. The most knowledge (based on self-evaluation) was reported by the younger dentists (≤50 years; P = .004). The mean correct knowledge score was 7.6 ± 2.2 of the 13 clinical scenarios. Both bivariate and multivariate analyses showed that greater trauma-related knowledge was associated with a younger age. Better knowledge was observed amongst the dentists who self-evaluated their own knowledge as sufficient or as comprehensive., Conclusion: Lithuanian general dentists have insufficient dental traumatology knowledge. Better knowledge was observed amongst younger dentists (≤50 years)., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: To analyze treatment modalities and results in patients with severe odontogenic maxillofacial infections during a 10-y period., Methods: Medical records of 1,077 patients hospitalized because of severe odontogenic maxillofacial infections during 2003-2012 were reviewed. The sample consisted of the records that matched inclusion criteria. For each patient the following data were collected: Age, gender, presence of systemic diseases, length of hospital stay, causal tooth, location of inflammation, treatment, results of bacteriologic sampling, and anti-bacterial susceptibility., Results: Male to female ratio was 1.4:1. Two or more anatomic spaces were involved in 42.9% of cases, 37.3% of which involved the floor of the mouth. Penicillin in combination with gentamicin or metronidazole was prescribed in 69% of cases. Sixty-two different micro-organism species were identified with predominance of Streptococcus haemolyticus (42.9%). The microbial analysis showed the highest susceptibility of predominant micro-organisms to penicillin was 76.9% and the highest resistance was to metronidazole (27.9%)., Conclusions: The frequency of odontogenic maxillofacial infection remained almost unchanged during a 10-y period. Single-space infections were more common (57.1%) than infections involving two or more spaces. Susceptibility to penicillin remains relatively high; therefore, penicillin can remain part of the armamentarium for treatment of odontogenic maxillofacial infections.

Introduction: Medication-related osteonecrosis of the jaws (MRONJ) is a severe side effect of antiresorptive or antiangiogenic therapy that manifests as an exposed bone, accompanied by clinical signs of infection, persisting for more than 8 weeks, without history of radiation therapy or metastases to the jaws. The aim of the study was to present first MRONJ cases in Lithuania and review trends in the modern research literature on the subject., Materials and Methods: We retrospectively reviewed patient charts with a diagnosis of "Inflammatory conditions of the jaws" treated in Vilnius University Hospital Žalgiris Clinic, Department of maxillofacial surgery in 2007-2014. Patients diagnosed with MRONJ were selected for the study. Demographic data, characteristics of the disease and treatment modalities were analysed., Results: Nine cases (five male and four female) of MRONJ were analysed. The mean patient age was 69±7,9 years. Predominant primary malignancy was prostate cancer. Osteonecrotic lesions were located both in maxilla and mandible. In all cases we started with a conservative treatment first. After the antibiotic therapy with or without sequestrectomy, the condition of all patients stabilized and improved to stage I MRONJ., Conclusion: MRONJ is a disturbing condition resulting in a severely worsened quality of life in the affected patients. This is the first case series of successfully treated patients suffering from stage II or III MRONJ in the Baltic States. A more comprehensive understanding of MRONJ will hopefully allow clinicians to enhance accuracy in risk assessment and forecast positive and negative outcomes of antiresorptive or antiangiogenic therapy.

Background and Objective: The prevalence and etiology of midfacial fractures varies among countries. Until now, knowledge about such type of injuries in the region of the Baltic countries was rather scarce. The purpose of the study was to analyze the prevalence, etiology and localization of midfacial fractures treated at the Vilnius University Hospital Žalgiris Clinic, Vilnius, Lithuania., Materials and Methods: The medical records of patients treated for midfacial fractures during the period January 2005 to December 2010 were analyzed for gender, age distribution, frequency and type of injury, cause of fractures, consciousness status and alcohol abuse during trauma., Results: The records of 799 patients were analyzed. The male-to-female ratio was 4.4:1. The mean age of the patients was 33.16±14.0 years (min 1, max 87). As much as 68.8% of injuries were zygomatic fractures, 27.9% were maxillary, and 3.3% were isolated orbital floor fractures. The most frequent causes for injury were interpersonal violence (64%), followed by falls (16.3%) and traffic accidents (8.3%). Most midfacial fractures (65.3%) occurred between April and October (P<0.05), on weekends (58.2%; P<0.05) and at night (62.0%; P<0.05). In 14%, trauma reports indicated the abuse of alcohol. More often such persons received more than one midfacial bone fracture (P<0.05) concurrently., Conclusions: This study revealed that the main cause of midfacial fractures was assault. Male patients, aged 15-34 years, more often sustain midfacial fractures. Preventive health care programs should seek measures in the reduction of aggression and violence in close future involving family, school and community institutions., (Copyright © 2015 Lithuanian University of Health Sciences. Production and hosting by Elsevier Urban & Partner Sp. z o.o. All rights reserved.)

OBJECTIVES. To evaluate the perpendicularity of the line connecting external auditive meatus to the midsagital plane and the palatal suture as a midsagittal symmetry reference line. Setting and Sample Population - 62 randomly chosen human skulls from osteological collection (Vilnius University). MATERIAL AND METHODS. The skulls were photographed (Nikon 40 D, Nikkor lens 50 mm) from basal, frontobasal and frontal views. Photos were analysed with Adobe Photoshop CS5 (Adobe). The first line connected frontal points of external auditive meatus and the angle to the midsagittal plane was measured. The second line (the palatal suture) was compared to the median sagittal plane. Data was analysed with SPSS 17 (IBM). RESULTS. The mean value for the angles of the line between the external auditive meatus and the midsagittal plane in basal views was 90.12° (SD=1.48°) and in frontobasal 90.36° (SD=2.25°). No statistically significant differences were found between groups of age and sex. The inter-rater agreement for evaluation of the adequacy of palatal suture with the midsagital plane was high (Cohen's Kappa 0.702 (p<0.05)) as well as the coincidence of both lines in basal and frontobasal views (90.3% and 85.5% respectively). CONCLUSION. Considering the limits of this study the angle between external auditive meatus and midsagital skull plane has a characteristic fluctuating asymmetry. The congruence of palatal suture and midsagital plane is debatable.

Up to now, many various techniques have been proposed for the repair of complete unilateral cleft lip. The aim of this study was to compare late results of three different surgical techniques (C. Tennison, R. Millard, and J. Olekas) used for the repair of complete unilateral cleft lip and to analyze their advantages and disadvantages. Material and METHODS. Sixty-six patients with nonsyndromic complete unilateral cleft lip, alveolus, and palate were examined. For 19 patients (28.8%), cleft lip repair was performed using the Tennison technique; for 20 patients (30.3%), Millard technique; and for 27 patients (40.9%), Olekas technique. Results were assessed by score, which was given by analyzing standardized photographs of nasolabial triangles. For the assessment, the modified scale according to Mortier and Anastassov was used. Separate anatomical elements - red lip, white lip, scars, and nose - were assessed. RESULTS. The best appearance of the red lip and white lip was found after the Tennison technique. Scars and nose looked the best after Olekas cheiloplasty. There were no significant differences in the evaluation of red lip and nose appearance comparing all three analyzed surgical techniques (P>0.05). Tennison technique showed significantly better results in the appearance of the white lip (P<0.05); the appearance of scars was significantly better after the Olekas repair (P<0.001). CONCLUSIONS. Height of white lip and symmetry of the Cupid's bow were better restored by using the Tennison technique. The physiological configuration of the white lip and less visible scars were achieved by using the Olekas technique. All techniques were equal in red lip and nose formations.

Unlabelled: The transmission of blood-borne viruses in dental offices is a potential hazard to patients and dental staff. The aim of the study was to clarify the current situation regarding hepatitis B virus vaccination, percutaneous injuries among members of the Lithuanian dental community., Material and Methods: A confidential, self administered questionnaire was send to all 2235 Lithuanian general dental practitioners. The questionnaire collected data on sociodemographic characteristics, practice time, working place and environment, hepatitis B virus (HBV) vaccination, history of hepatitis B infection, and needlestick and sharp instruments injury (NSII)., Results: Overall response rate was 64.7% (87.4% of them were women; 64.1% were working in five major cities of Lithuania and 60.8% in private clinics. Mean age of respondents was 44.8 (range 23 - 74 years). As much as 95.3% dentists expressed concern about the risk of cross-infection from patients to themselves and their dental assistants. Respondents reported: complete immunization against HBV (35.9%); previous hepatitis infection (4.3%); needlestick and sharp instruments injury (78.5%); collecting medical history about HBV from patients (30.9%)., Conclusions: Despite a high risk of needlestick and sharp instruments injury in the dental practice as well as high risk of HBV infection and the existence of strong rules and recommendations for routine HBV vaccination, vaccine coverage among Lithuanian dentists cannot be assumed to be adequate. Further continuing education programs and stronger control measures might be suggested.

Objectives: To analyze clinical data of patients treated for mouth floor cellulitis during 2003-2006 years at the Department of Maxillofacial Surgery, Vilnius University Hospital Zalgiris Clinic and to compare the results with existing data., Material and Methods: Patient's gender, age, social insurance, demographic profile, preference of first visit, previous treatment, origin of inflammation, symptoms of disease, treatment protocol and outcomes were evaluated from 240 clinical records., Results: The male-female ratio was 1.3:1. The mean age of patients was 43.18+/-7.56 years. 65% of patients were from urban. 47% of patients were employed, 15% retirees, 22% unemployed, 10% children, 2% students and 4% handicapped people. In 65% of cases primary diagnosis was incorrect. Majority of patients appealed to doctor on the first five days from the beginning of the disease. 93.7% of mouth floor cellulites were odontogenic origin. In 32.9% of the patients at the time of first examination the extension of inflammation into parapharyngeal, pterygomandibular spaces or neck together with mouth floor cellulitis was diagnosed. In 1.7% (in 4 out of 240) of cases infection extended into the neck and parapharyngeal spaces despite treatment. In 2% (in 5 out of 240) of cases infection extended to mediastinum., Conclusions: Despite the aggressive treatment serious complications still are possible. Delayed treatment procedures might determine poor prognosis.