• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.1
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• pp.43-48
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• 2023

The biocompatibility and durability of implant fixtures are major concerns for dentists and patients. Mechanical complications of the implant include abutment screw loosening, screw fracture, loss of implant prostheses, and implant fracture. This case report aims to describe management of a case of fixture damage that occurred after screw fracture in a tissue level, internal connection implant and microscopic evaluation of the fractured fixture. A trephine bur was used to remove the fixture, and the socket was grafted using allogeneic bone material. The failed implant was examined by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS), which revealed a fractured fixture with both normal and irregular bone patterns. The SEM and EDS results give an enlightenment of the failed fixture surface micromorphology with microfracture and contaminated chemical compositions. Noticeably, the significantly high level of gold (Au) on the implant surface and the trace amounts of Au and titanium (Ti) in the bone tissue were recorded, which might have resulted from instability and micro-movement of the implant-abutment connection over an extended period of time. Further study with larger number of patient and different types of implants is needed for further conclusion.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.2
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• pp.86-90
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• 2023

Objectives: An ectopic tooth is a rare eruption of a tooth out of the normal dental apparatus and occurs commonly with the third molar. Thus, in this study, we reported a case series of ectopic teeth in rare jaw locations and highlight the associated pathology and our experience in the surgical management. Patients and Methods: All cases of ectopic tooth managed at the Department of Oral and Maxillofacial Surgery, University of Maiduguri Teaching Hospital from January 2011 to December 2020 were reviewed. The information retrieved includes biodata, location of the ectopic tooth, signs, symptoms, type of tooth and associated pathology, surgical approach and complications. Results: Ten cases of ectopic teeth were identified over the study period. This comprised 80.0% males with a mean age was 23.3 years. The antrum and lower border of the mandible accounted for 50.0% and 40.0% of the ectopic locations, respectively. Dentigerous cyst was the most associated pathology (70%) and usually presented with pain and swelling. Surgical intervention predominantly via the intraoral route was performed if indicated. Conclusion: Ectopic teeth are rare and not always associated with pathology. A high index of suspicion and radiological investigation are necessary for diagnosis. A more extensive multi-center study is however recommended to determine the prevalence of ectopic teeth other than the third molar.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.2
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• pp.68-74
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• 2023

Objectives: Drug holidays are suggested to reduce the formation of osteonecrosis in patients under intravenous (IV) bisphosphonates (BPs) therapy. The objectives of this study are to evaluate the incidence of medication-related osteonecrosis of the jaw (MRONJ) following tooth extraction in cancer patients using IV BP, and to assess the effect of drug holiday on the development of MRONJ. Patients and Methods: A manuel search of the patient folders of Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University was undertaken to identify cancer patients who used IV BPs and had at least one tooth extraction between 2012 and 2022. Patents' age, sex, systemic condition, the type of BP used, duration of BP used, number of tooth extraction, duration of drug holiday, localization of tooth extraction and incidence of MRONJ were recorded. Results: One hundred nine teeth were removed from 57 jaws in 51 patients. All tooth extractions were performed under perioperative antibiotic prophylaxis and with primary wound closure. The incidence of MRONJ was 5.3%. Stage 1 MRONJ developed in 3 patients (only one had a drug holiday). The median duration of drug holiday was 2 months. No significant difference between the patients with and without a drug holiday and MRONJ development was found (P=0.315). The mean age of patients developed MRONJ was 40.33±8.08 years. A statistically significant difference was found between age and MRONJ development (P=0.002). Conclusion: The effect of a short-term drug holiday on the development of MRONJ may be limited because BPs remain in bone tissue for a long time. Drug holidays should be applied with the approval of an oncologist with other preventive measurements.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.2
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• pp.100-104
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• 2023

Autogenous bone grafts from the mandibular ramus are a known source of inadequate bone volume scenarios of the residual alveolar ridge. However, the conventional block-type harvesting technique cannot prevent bone marrow invasion, which can cause postoperative complications such as pain, swelling, and inferior alveolar nerve injury. This study aims to suggest a complication-free harvesting technique and present the results of bone grafting and donor sites. One patient received two dental implants with a complication-free harvesting technique that involves creation of ditching holes with a 1 mm round bur. Sagittal, coronal, and axial osteotomies produced grid-type cortical squares using a micro-saw and a round bur to confirm the cortical thickness. The grid-type cortical bone was harvested from the occlusal aspect, and the harvesting was extended through an additional osteotomy on the exposed and remaining cortical bone to prevent bone marrow invasion. The patient did not suffer postoperative severe pain, swelling, or numbness. After 15 months, the harvested site exhibited new cortical bone lining, and the grafted area had healed to a cortico-cancellous complex with functional loading of the implants. Our technique, grid-type cortical bone harvesting without bone marrow invasion, allowed application of autogenous bone without bone marrow invasion to achieve acceptable bone healing of the dental implants and to regenerate the harvested cortical bone.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.2
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• pp.61-67
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• 2023

This systematic review aimed to analyze the clinicopathological profile and relevant prognostic factors of head and neck rhabdomyosarcoma in pediatric patients. The search was carried out in the electronic search portals PubMed, Lilacs, Embase, Scopus, and Web of Science. The search yielded studies that were then analyzed regarding study topic, data extraction, and risk of bias using the STROBE (Strengthening the Reporting of Observational Studies) guidelines. Finally, three studies were included for qualitative analysis. Most of the cases involved embryonic and alveolar rhabdomyosarcoma. Expression of MYOD1 was highly correlated with diagnosis of spindle cell/sclerosing rhabdomyosarcoma, which appears to have a poor prognosis in children. Furthermore, tumor size <5 cm and absence of metastasis accompanied by complete resection and administration of adjuvant therapies such as chemotherapy and radiotherapy favored a better prognosis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.1
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• pp.50-58
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• 2022

Objectives: Osteoarthritis (OA) is the most prevalent and disabling joint disease in the world. Temporomandibular joint (TMJ) exercise is a widely used treatment and could be a beneficial and long-term tool for treating TMJ OA. The present study aims to evaluate the effects of therapeutic exercise in the conservative treatment of TMJ OA. Materials and Methods: A single-group experimental pre-post test was performed. We included patients who met the diagnostic criteria for TMJ OA. Outcome variables were pain intensity (visual analogue scale), functionality (Helkimo index), and structural changes (ultrasound). Follow-up periods were at months 1, 3, and 6. The intervention included a home-based program with thermotherapy, manual therapy, and therapeutic exercise during the entire follow-up period. Results: We included 15 patients and 26 joints, all women with a median age of 57 years (range, 49-62 years). Median change in pain intensity on joint palpation, mouth opening, and at rest at the first month was 47.5 mm, 51 mm, and 60 mm, respectively, and 48 mm, 49.5 mm, and 42.5 mm, at six months (P=0.001). The Helkimo index showed significant improvement in medians from baseline severe dysfunction (17 points) to minimal dysfunction at three and six months (2 points) (P=0.001). Ultrasound showed improved disc position. Conclusion: This study demonstrated significant improvements in pain, function, and joint disc position and represents a valuable tool for the long-term treatment of patients with TMJ OA.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.1
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• pp.21-32
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• 2022

Objectives: Inferior alveolar nerve block (IANB) is commonly used for mandibular dentoalveolar surgery. The objective of this study was to evaluate and compare the effectiveness of coadministration of dexamethasone (4 mg/mL) or adrenaline (0.01 mg/mL) as an adjuvant with lignocaine 2% in IANB during third molar surgery (TMS). Patients and Methods: This double-blind, randomized controlled trial was conducted between March and August 2020. The investigators screened patients needing elective TMS under local anesthesia. Based on strict inclusion and exclusion criteria, patients were enrolled in this study. These patients were assigned randomly into two study groups: dexamethasone group (DXN) or adrenaline group (ADN). Outcome variables were postoperative edema, trismus, visual analogue scale (VAS), perioperative analgesia, onset time, and duration of IANB. Results: Eighty-three patients were enrolled in this study, of whom 23 (27.7%) were eliminated or excluded during follow-up. This study thus included data from 60 samples. Mean age was 32.28±11.74 years, including 28 females (46.7%) in the ADN (16 patients, 57.1%) and DXN (12 patients, 42.9%) groups. The duration of action for DXN (mean±standard deviation [SD], 4:02:07±0:34:01 hours; standard error [SE], 0:06:00 hours; log-rank P=0.001) and for ADN (mean±SD, 1:58:34±0:24:52 hours; SE, 0:04:42 hours; log-rank P=0.001) were found. Similarly, time at which 1st analgesic consume and total number of nonsteroidal antiinflammatory drugs need to rescue postoperative analgesia was found statistically significant between study groups (t (58)=-11.95; confidence interval, -2:25:41 to -1:43:53; P=0.001). Early-hours VAS was also significantly different between the study groups. Conclusion: A single injection of dexamethasone prolongs the duration of action of lignocaine 2% IANB. Additionally, it can be used in cases where adrenaline is contraindicated.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.1
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• pp.41-49
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• 2022

Objectives: We compared changes in fractal dimension (FD) and grayscale value (GSV) of peri-implant alveolar bone on digital panoramic radiography (DPR) and cone-beam computed tomography (CBCT) immediately after implant surgery and 12 months postoperative. Materials and Methods: In this retrospective study, 16 patients who received posterior mandibular area dental implants with CBCT scans taken about 2 weeks after implantation and one year after implantation were analyzed. A region of interest was selected for each patient. FDs and GSVs were evaluated immediately after implant surgery and at 12-month follow-up to examine the functional loading of the implants. Results: There were no significant differences between DPR and CBCT measurements of FD values (P>0.05). No significant differences were observed between FD values and GSVs calculated after implant surgery and at the 12-month follow-up (P>0.05). GSVs were not correlated with FD values (P>0.05). Conclusion: The DPR and reconstructed panoramic CBCT images exhibit similar image quality for the assessment of FD. There were no changes in FD values or GSVs of the peri-implant trabecular bone structure at the 12-month postoperative evaluation of the functional loading of the implant in comparison to values immediately after implantation. GSVs representing bone mass do not align with FD values that predict bone microstructural parameters. Therefore, GSVs and FDs should be considered different parameters for assessing bone quality.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.3
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• pp.163-168
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• 2023

An oroantral fistula (OAF) or oroantral communication (OAC) is an opening between the oral cavity and the maxillary sinus. If left untreated, these openings may cause chronic maxillary sinusitis. Although small defects (diameter <5 mm) may close spontaneously, larger communications require surgical intervention. Various studies have been conducted on OAC closure using a platelet-rich fibrin (PRF) membrane; most of these prior studies have involved simple direct application of PRF clots. This study introduces a new "double-barrier technique" using PRF for closure of an OAF involving sinus mucosal lifting and closure. The PRF material is inserted into the prepared maxillary sinus space, and the buccal advancement flap covers the oral side. This technique was successfully used to treat two patients with chronic OAF in the posterior maxillary region after implant removal or tooth extraction. The use of a PRF membrane in a double-barrier technique may have advantages in soft-tissue healing and could enable easy closure of chronic OAF with minimal trauma.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.6
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• pp.324-331
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• 2023

Objectives: The purpose of this study was to evaluate the outcomes of implants placed in horizontally augmented alveolar ridges using porcine bone grafts and to investigate the long-term stability of the porcine bone grafts. Materials and Methods: A retrospective analysis was conducted on 49 sites that underwent horizontal ridge augmentation using porcine bone grafts and implant placement with a follow-up period longer than 5 years. Furthermore, additional analysis was conducted on 24 sites where porcine bone grafts were used exclusively for horizontal ridge augmentation and implant placement. Results: The mean follow-up period after prosthesis loading was 67.5 months, with a mean marginal bone loss of 0.23 mm at 1 year and a cumulative mean marginal bone loss of 0.40 mm over the entire follow-up period. Of the 49 implants, 2 were lost and 3 did not meet the success criteria, resulting in a survival rate of 95.9% and a success rate of 89.8%. In 24 sites, the mean marginal bone loss was 0.23 mm at 1 year and 0.41 mm at 65.8 months, with 100% survival and success rates. Conclusion: Porcine bone grafts can be successfully used in horizontal ridge augmentation for implant placement in cases of ridges with insufficient horizontal width.