Background

Sodium hypochlorite solutions have been an important adjunct in root canal treatment for over 60 years. In Iran, many individuals work in dentistry under the title of ‘experimental dentist’. These individuals lack formal academic education in dentistry and, with limited practical knowledge, they pose a risk to the health of many citizens. In many instances, these dentists fill anaesthetic cartridges with NaOCl for use in root canal irrigation. Occasionally, these cartridges containing NaOCl are mistakenly injected into the patient instead of anaesthetic, causing significant damage.

Method

In June 2022, a 33-year-old male patient was referred to a maxillofacial surgery clinic following an accidental injection of NaOCl, which was intended to be a local anaesthetic solution. Upon examination, complications including ecchymosis, haematoma, swelling, oedema, necrosis and sensory neurovascular defects were observed.

Results

According to the grading scale, the injuries were considered moderate. After a thorough examination, a vestibular incision was made in the affected area. The patient was prescribed Vitamin B1, Vitamin E 400, Coenzyme Q10 capsules, Bromelain capsules at a dose of 500, Ibuprofen 400 mg pain reliever, Amoxicillin and Metronidazole oral antibiotics, Dexamethasone 8 mg ampoule and Hydrocortisone 100 mg ampoule. The patient returned to a normal and stable condition after 10 days.

Conclusion

Vestibular incision and Vitamin B1, Vitamin E 400, Coenzyme Q10 capsules, Bromelain capsules at a dose of 500, Ibuprofen 400 mg pain reliever, Amoxicillin and Metronidazole oral antibiotics, Dexamethasone 8 mg ampoule and Hydrocortisone 100 mg ampoule will drain the hematoma, improve nerve damage and repair the damaged area due to NaOCl that was accidentally injected.

Background

Oroantral communication (OAC) and fistulas (OAF) are pathological openings between the maxillary sinus and the oral cavity. Traditional closure methods, such as buccal or palatal flaps, are effective but can cause postoperative discomfort and tissue loss. Platelet-Rich Fibrin (PRF), has emerged as a minimally invasive alternative, promoting angiogenesis and tissue healing through the sustained release of growth factors. This study aimed to review the current evidence on the effectiveness of Platelet Rich Fibrin in the management of oroantral communications and oroantral fistulas.

Methods

A study protocol was developed in accordance with the Preferred Reporting Guideline for Overviews of Reviews (PRIOR) and registered on the International Prospective Register of Systematic Reviews (PROSPERO) under Registration No. CRD 420251027772. Furthermore, the reporting of the present systematic review was performed based on the PRISMA checklist.

Results

Our search strategy yielded 220 articles from five electronic databases. Of these, 82 were duplicate studies, leaving 138 unique records, which were screened independently by two authors for eligibility. 120 studies were excluded based on title and abstract screening. The remaining 18 full-text articles were assessed for eligibility. 15 studies were excluded as they did not meet the inclusion criteria. Finally, a total of three systematic reviews met the criteria for inclusion and were critically reviewed.

Conclusions

This systematic review of systematic reviews highlights the consistent effectiveness of platelet-rich fibrin (PRF) in the closure of oroantral communications and fistulas, with reported success rates between 90% and 100%. PRF enhanced healing, reduced complications, and improved patient comfort, particularly when used as an adjunct to surgical flaps in larger defects. PRF appears to be a reliable and biologically advantageous material; nevertheless higher-level studies are needed to confirm its comparative effectiveness and guide clinical protocols.

Background

Orthognathic surgery is a surgical procedure to correct dentofacial deformities, improving function and facial aesthetics.

Method

This case report highlights the use of the short split sagittal osteotomy (SSSO), a modified technique proposed by Posnick, in treating a 32-year-old female patient presenting with retrognathia (Class II skeletal pattern) and obstructive sleep apnea.

Results

The patient underwent bimaxillary advancement with counterclockwise rotation and genioplasty, planned virtually via Dolphin 3D software. The surgical approach aimed to optimise occlusal function, airway space, and facial harmony while minimising potential complications. The SSSO technique, characterised by a low and short medial cut anterior to the lingula, was chosen for its advantages in reducing surgical trauma, nerve injury risk, and operative time. The patient expressed satisfaction with both functional and aesthetic results.

Conclusion

Literature review supports the efficacy and safety of the SSSO, citing lower rates of unfavourable splits, reduced neurosensory deficits, and reliable stability when proper fixation is applied. This case reinforces the potential of the SSSO as a viable alternative to the traditional bilateral sagittal split osteotomy (BSSO), especially in less complex mandibular corrections. Selection of surgical techniques should remain individualised, guided by patient anatomy, surgeon experience, and the specific goals of treatment.

Background

Cleft lip and palate (CLP) is the most prevalent craniofacial malformation, frequently associated with maxillary hypoplasia, velopharyngeal dysfunction and aesthetic alterations that compromise quality of life. Among surgical strategies, orthognathic surgery (OS) and distraction osteogenesis (DO) remain the most widely applied techniques for correction of maxillary deficiencies in CLP patients.

Objective

This literature review focuses on analysing and synthesising the current evidence on the most commonly used OS and DO techniques in patients with CLP, highlighting their indications, results and limitations.

Methods

A systematic search was conducted in PubMed, Scopus, Cochrane Library and Taylor and Francis, including clinical studies, systematic reviews and meta-analyses published in the last 15 years.

Results

OS provides immediate correction of moderate maxillofacial deformities and improves occlusion and facial harmony, but carries a considerable risk of relapse and velopharyngeal dysfunction. In contrast, DO enables gradual skeletal advancement with superior long-term stability and better soft tissue adaptation, though it requires prolonged treatment and tolerance to distraction devices. Recent evidence indicates that hybrid and segmental distraction techniques may further enhance stability and reduce complications.

Conclusion

The choice between OS and DO should be individualised according to the severity of maxillary hypoplasia, patient age, and functional-aesthetic objectives. While OS remains effective for moderate corrections, DO demonstrates advantages in severe cases. Multicenter studies with standardised protocols are needed to strengthen long-term evidence and optimise surgical decision-making in CLP management.

RESUMEN

La fisura labio-palatina (FLP) es la malformación craneofacial más frecuente, asociada a hipoplasia maxilar, disfunción velofaríngea y alteraciones estéticas que comprometen la calidad de vida. Entre las estrategias quirúrgicas disponibles, la cirugía ortognática (CO) y la distracción osteogénica (DO) son las técnicas más empleadas para la corrección de las deficiencias maxilares en pacientes con FLP.

Objetivo

Analizar y sintetizar la evidencia actual sobre las técnicas de CO y DO más utilizadas en pacientes con FLP, destacando sus indicaciones, resultados y limitaciones.

Métodos

Se realizó una búsqueda sistemática en PubMed, Scopus, Cochrane Library y Taylor & Francis, incluyendo estudios clínicos, revisiones sistemáticas y metaanálisis publicados en los últimos 15 años.

Resultados

La CO permite una corrección inmediata de deformidades moderadas y mejora la oclusión y la armonía facial, aunque presenta un riesgo considerable de recidiva y alteraciones velofaríngeas. En contraste, la DO posibilita un avance esquelético progresivo con mayor estabilidad a largo plazo y mejor adaptación de los tejidos blandos, aunque requiere un proceso prolongado y tolerancia al uso de dispositivos de distracción. La evidencia reciente sugiere que las técnicas híbridas y segmentarias pueden optimizar la estabilidad y disminuir las complicaciones.

Conclusión

La elección entre CO y DO debe individualizarse según la severidad de la hipoplasia maxilar, la edad del paciente y los objetivos funcionales y estéticos. Mientras la CO resulta eficaz en correcciones moderadas, la DO ofrece ventajas en casos severos. Se requieren estudios multicéntricos con protocolos estandarizados para fortalecer la evidencia a largo plazo y optimizar la toma de decisiones quirúrgicas en el manejo de la FLP.

Background

Upadacitinib is a Janus kinase (JAK) inhibitor, part of a class of medications that modulate immune system signalling. These drugs are commonly used to manage inflammatory conditions such as rheumatoid arthritis and ulcerative colitis by reducing inflammation and pain.

Methods

To our knowledge, we report the first documented case of spontaneous osteonecrosis of the jaw associated with upadacitinib.

Results

In this report, we explore the drug's mechanism of action and its potential role in the pathogenesis of medication-related osteonecrosis of the jaw (MRONJ).

Conclusion

Though rare, upadacitinib should be added to the growing list of drugs implicated in MRONJ.

Background

Odontogenic orbital cellulitis (OOC) is a rare but serious complication of dental infections, accounting for 2%–5% of all orbital cellulitis cases. It can be life-threatening if not promptly diagnosed and managed, particularly in vulnerable populations such as pregnant women. This case report discusses the complex management of OOC with deep neck space involvement in a Gravida 5 para 4 female at 27 weeks of gestation—an exceptionally rare scenario with only isolated cases reported worldwide.

Case Presentation

A 28-year-old pregnant female presented with right periorbital swelling, pus discharge and signs of orbital involvement following extraction of the right maxillary and mandibular third molars. Clinical examination revealed orbital oedema, limited ocular movements and purulent discharge from the extraction site. MRI revealed multiple abscesses extending into the parapharyngeal, masseteric and orbital spaces. Surgical intervention under local anaesthesia involved incision and drainage of the buccal, retromolar and orbital abscesses, along with the placement of drains. Post-operative care included IV antibiotics and multidisciplinary monitoring by maxillofacial and ophthalmology teams.

Conclusion

Odontogenic orbital cellulitis during pregnancy presents unique diagnostic and therapeutic challenges. Prompt recognition, appropriate imaging, surgical drainage, antibiotic therapy and multidisciplinary coordination are essential for favourable maternal and foetal outcomes.

Background

In 1971, the World Health Organisation concluded the term Adenomatoid Odontogenic Tumour (AOT). This tumour accounts for approximately 2%–7% of all odontogenic tumours. AOTs commonly present in the younger demographic with a 2:1 female predisposition. The maxilla is more commonly affected. AOTs are categorised into follicular, extrafollicular and peripheral variants, respectively. Patients are usually asymptomatic with evidence of expansion of the cortical bone. AOTs are slow-growing and well-encapsulated with enucleation and curettage being the treatment modality accepted amongst the literature.

Methods

A 15-year-old female was referred to the oral surgery department at Edinburgh Dental Institute with a 6–7-month history of an asymptomatic swelling adjacent to tooth 22. On clinical assessment, there was a firm labial swelling adjacent to tooth 22. Radiographic assessment highlighted the presence of a unilocular radiolucency with a corticated margin distal to the root surface of tooth 22 with expansion, thinning and perforation of the buccal cortical bone. Diagnosis suggested a benign odontogenic lesion: an odontogenic keratocyst, lateral periodontal cyst or lateral radicular cyst.

Results

Management involved enucleation for histopathological assessment. This confirmed an intraosseous AOT with complete excision. Clinical and radiographic review highlighted complete mucosal healing with evidence of bony infiltration and no recurrence.

Conclusion

This case highlighted the effective management of an intraosseous AOT with enucleation and curettage.

Background

This study aimed to review the current high-quality evidence on piezoelectric vs. conventional hand-piece in third molar surgery: a systematic review of systematic reviews.

Methods

A study protocol was developed in accordance with the Preferred Reporting Guideline for Overviews of Reviews (PRIOR) and registered on the International Prospective Register of Systematic Reviews (PROSPERO) under Registration No. CRD42024549962. Furthermore, the reporting of the present systematic review was performed based on the PRISMA checklist.

Results

Our search strategy yielded 1720 articles. Of these, 213 were duplicate studies, and 364 studies were screened independently reviewed by two authors for eligibility. Of these, 349 were excluded based on the title and abstract. 15 articles were assessed for eligibility, eight studies were excluded as they did not meet the inclusion criteria. Finally, a total of seven systematic reviews met the criteria for inclusion, and they were critically reviewed.

Conclusions

Piezoelectric hand-pieces reduce postoperative pain, swelling, and trismus, with fewer complications like paresthesia and dry socket. Although evidence on analgesic use is mixed, they offer a better overall postoperative experience. Clinicians may favour their use in complex cases where soft tissue preservation is critical. High-quality RCTs are needed to address current evidence heterogeneity and guide clinical practice.

Background

Facial nerve injury is a common complication of trauma, crush injuries, basilar skull fractures, resections of the head and neck, and nerve compression caused by tumour growth, which results in permanent functional deficits and facial paralysis. Maxillofacial surgical procedures account for 40% of iatrogenic injuries. These include parotid surgeries and temporomandibular joint replacement, which revolve around the facial nerve, making it susceptible to damage. In addition to the functional issues, the psychosocial quality of life is significantly affected by facial asymmetry. Treating facial paresis in the early post-traumatic period with a multidisciplinary approach is important for accelerating the recovery process. Various treatment modalities such as thermal heat, acupuncture therapy, medical management with steroids, electrical stimulation, facial massage and facial strapping are important in assisting the healing process. Nimodipine, a calcium channel blocker, works as a selective cerebral vasodilator to minimise morbidity and mortality in patients with subarachnoid haemorrhage. It is hypothesised to protect neurons and smooth muscle cells against axonal swelling due to calcium overload. Nimodipine may enhance the flow of oxygen and nutrients to damaged neurons, thereby minimising cell death. In animal investigations and clinical studies, it has exhibited good preservation of facial nerve function when administered prophylactically with a speedy recovery of function.

Aim

To assess the outcome of nimodipine administration in the management of facial paresis following segmental resection of a tumour in the mandible.

Materials and Methods

Patient was prescribed tablet nimodipine 60 mg QID (Four Times a Day) for 8 weeks with periodic follow-up and reviews for evaluation of her symptoms

Results

There were significant improvements in the patient's symptoms during the time period, bringing her condition to nearly HB (House-Brackmann) Grade I.

Conclusions

Significant functional recovery of the injured facial nerve was observed. Nimodipine can be considered for the treatment of facial nerve paresis induced by surgical trauma. Further prospective clinical studies are recommended to generate more evidence.

Aim

The COVID-19 pandemic caused a shift in the use of Filtering Facepiece Respirators (FFRs) from disposal to reuse. This cross-sectional study aimed to assess whether this practice reflected a broader change in attitude toward sustainability.

Materials and Methods

An online questionnaire was distributed via email to 105 oral surgery programmes between November 2020 and April 2022. The survey compared practices before and during the COVID-19 pandemic lockdown, assessed the impact of these practices on disease transmission and evaluated the attitudes of oral surgeons toward FFR reuse.

Results

The average clinic-days/week had decreased (p = 0.016), and 70% of clinics had treated < 40 patients/week (p < 0.001) (response rate = 20%). The number of Aerosol-Producing Procedures (APPs) had decreased to < 10/week for 60% (p = 0.006) of clinics. Extended use, reuse and limited reuse were adopted by 45%, 25%, and 30% of clinics, respectively, and did not affect the number of surgeons or patients contracting COVID-19 (p = 0.735, p = 1.000 and p = 0.534, respectively). Forty-five percent had used alternatives to N95. The majority of the responders believed that FFR reuse “should not be used only at the time of crisis”, “may also be used when no shortage exists”, “should be sought before trying to obtain foreign FFRs”, “should become routine practice with defined standards” and “has the potential to decrease healthcare costs.”

Conclusion

This study provides evidence in support of following the guidelines and their potential for infection control but, more importantly, highlights a paradigm shift among the American academic oral and maxillofacial surgery outpatient clinics toward a more sustainable approach to FFR use beyond the pandemic.