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Journal of the Korean Association of Oral and Maxillofacial Surgeons

Vol.49 No.3

Joo-Young Park(Seoul National University, Seoul, Korea) pp.105-106 https://doi.org/10.5125/jkaoms.2023.49.3.105
Mrunalini Ramanathan(Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan) ; Rie Sonoyama-Osako(Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan) ; Yukiho Shimamura(Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan) ; Taro Okui(Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan) ; Takahiro Kanno(Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Japan) pp.107-113 https://doi.org/10.5125/jkaoms.2023.49.3.107
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Abstract

Bimaxillary transverse width discrepancies are commonly encountered among patients with dentofacial deformities. Skeletal discrepancies should be diagnosed and managed appropriately with possible surgical corrections. Transverse width deficiencies can present in varieties of combinations involving the maxilla and mandible. We observed that in a significant proportion of cases, the maxilla is normal, and the mandible showed deficiency in the transverse dimension after pre-surgical orthodontics. We designed novel osteotomy techniques to enhance mandibular transverse width correction, as well as simultaneous genioplasty. Chin repositioning along any plane is applicable concomitant with mandibular midline arch widening. When there is a requirement for larger widening, gonial angle reduction may be necessary. This technical note focuses on key points in management of patients with transversely deficient mandible and the factors affecting the outcome and stability. Further research on the maximum amount of stable widening will be conducted. We believe that developing evidence-based additional modifications to existing conventional surgical procedures can aid precise correction of complex dentofacial deformities.

Pitchaya Aneksomboonpol(Department of Conservative Dentistry and Prosthodontics, Faculty of Dentistry, Srinakharinwirot University) ; Basel Mahardawi(Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University) ; Pheeradej Na Nan(The Engineering Institute of Thailand under H.M. The King’s Patronage) ; Palawat Laoharungpisit(Department of General Dentistry, Faculty of Dentistry, Srinakharinwirot University) ; Thongnard Kumchai(Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi University, Bangkok, Thailand) ; Natthamet Wongsirichat(Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi University, Bangkok, Thailand) ; Napapa Aimjirakul(Department of Conservative Dentistry and Prosthodontics, Faculty of Dentistry, Srinakharinwirot University) pp.114-124 https://doi.org/10.5125/jkaoms.2023.49.3.114
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Abstract

Dental implants have been utilized for many years to treat individuals with missing teeth. To optimize the long-term success rate of such implants, new designs, surfaces, and materials have been analyzed. It is important for the clinician to have a background in the field of implant surface design, to be familiar with the strengths and limitations of the available options, and to be aware of the alterations in surface structure that may occur following installation. This article provides a detailed review of the structure and the surface characteristics of dental implants, the modifications of implant surface, as well as the methods of evaluating implant surface structure. Moreover, it provides information concerning the structural changes that may take place at the time of dental implant placement. It is important for clinicians to be aware of such changes to plan and execute implant procedures with the highest possible success and implant survival rates.

Anita Pradhan(Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Sciences, Bareilly, India) ; Preeti Bhattacharya(Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Sciences, Bareilly, India) ; Shivani Singh(Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Sciences, Bareilly, India) ; Anil Kumar Chandna(Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Sciences, Bareilly, India) ; Ankur Gupta(Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Sciences, Bareilly, India) ; Ravi Bhandari(Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Sciences, Bareilly, India) pp.125-134 https://doi.org/10.5125/jkaoms.2023.49.3.125
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Abstract

Objectives: The aim of the study was to quantify and compare craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders (TMDs). Materials and Methods: A total of 126 adult subjects were categorized into two groups (63 with a TMDs and 63 without a TMDs), based on detection of symptoms using the Temporomandibular Joint Disorder-Diagnostic Index (TMD-DI) questionnaire. Posteroanterior cephalograms of each subject were traced manually and 17 linear and angular measurements were analyzed. Craniofacial asymmetry was quantified by calculating the asymmetry index (AI) of bilateral parameters for both groups. Results: Intra- and intergroup comparisons were analyzed using independent t -test and Mann–Whitney U test, respectively, with a P<0.05 considered statistically significant. An AI for each linear and angular bilateral parameter was calculated; higher asymmetry was found in TMD-positive patients compared with TMD-negative patients. An intergroup comparison of AIs found highly significant differences for the parameters of antegonial notch to horizontal plane distance, jugular point to horizontal plane distance, antegonial notch to menton distance, antegonial notch to vertical plane distance, condylion to vertical plane distance, and angle formed by vertical plane, O point and antegonial notch. Significant deviation of the menton distance from the facial midline was also evident. Conclusion: Greater facial asymmetry was seen in the TMD-positive group compared with the TMD-negative group. The mandibular region was characterized by asymmetries of greater magnitude compared with the maxilla. Patients with facial asymmetry often require management of temporomandibular joint (TMJ) pathology to achieve a stable, functional, and esthetic result. Ignoring the TMJ during treatment or failing to provide proper management of the TMJ and performing only orthognathic surgery may result in worsening of TMJ-associated symptoms (jaw dysfunction and pain) and re-occurrence of asymmetry and malocclusion. Assessments of facial asymmetry should take into account TMJ disorders to improve diagnostic accuracy and treatment outcomes.

Da Woon Kwack(Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea) ; Sung Min Park(Department of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University, Cheonan, Korea) pp.135-141 https://doi.org/10.5125/jkaoms.2023.49.3.135
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Abstract

Objectives: This study aimed to develop and validate machine learning (ML) models using H2O-AutoML, an automated ML program, for predicting medication-related osteonecrosis of the jaw (MRONJ) in patients with osteoporosis undergoing tooth extraction or implantation. Patients and Methods: We conducted a retrospective chart review of 340 patients who visited Dankook University Dental Hospital between January 2019 and June 2022 who met the following inclusion criteria: female, age ≥55 years, osteoporosis treated with antiresorptive therapy, and recent dental extraction or implantation. We considered medication administration and duration, demographics, and systemic factors (age and medical history). Local factors, such as surgical method, number of operated teeth, and operation area, were also included. Six algorithms were used to generate the MRONJ prediction model. Results: Gradient boosting demonstrated the best diagnostic accuracy, with an area under the receiver operating characteristic curve (AUC) of 0.8283. Validation with the test dataset yielded a stable AUC of 0.7526. Variable importance analysis identified duration of medication as the most important variable, followed by age, number of teeth operated, and operation site. Conclusion: ML models can help predict MRONJ occurrence in patients with osteoporosis undergoing tooth extraction or implantation based on questionnaire data acquired at the first visit.

Mi Hyun Seo(Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea) ; Mi Young Eo(Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea) ; Kezia Rachellea Mustakim(Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea) ; Buyanbileg Sodnom-Ish(Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea) ; Hoon Myoung(Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea) ; Soung Min Kim(Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea) pp.142-147 https://doi.org/10.5125/jkaoms.2023.49.3.142
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Abstract

Objectives: As medical history before surgery is often based on patient reporting, there is the possibility that patients intentionally hide underlying diseases or that dentists cannot recognize abnormal health states. Therefore, more professional and reliable treatment processes are needed under the Korean dental specialist system. The purpose of this study was to elucidate the necessity of a preoperative blood testing routine prior to office-based surgery under local anesthesia. Patients and Methods: Preoperative blood lab data for 5,022 patients from January 2018 to December 2019 were assembled. Study participants were those who underwent extraction or implant surgery under local anesthesia at Seoul National University Dental Hospital. Preoperative blood tests included complete blood count (CBC), blood chemistry, serum electrolyte, serology, and blood coagulation data. Values outside of the normal range were considered an “abnormality,” and the percentage of abnormalities among the total number of patients was calculated. Patients were divided into two groups based on the presence of underlying disease. The rates of abnormalities in the blood tests were compared between groups. Chi-square tests were performed to compare data from the two groups, and P<0.05 was considered statistically significant. Results: The percentages of males and females in the study were 48.0% and 52.0%, respectively. Of all patients, 17.0% (Group B) reported known systemic disease, while 83.0% (Group A) reported no specific medical history. There were significant differences between Groups A and B in CBC, coagulation panel, electrolytes, and chemistry panel (P<0.05). In Group A, the results of blood tests that required a change in procedure were identified even though the proportion was very small. Conclusion: Preoperative blood tests for office-based surgery can detect underlying medical conditions that are difficult to identify from patient history alone and can prevent unexpected sequelae. In addition, such tests can result in a more professional treatment process and build patient confidence in the dentist.

Jeong-Kui Ku(Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea) ; Dawool Han(Department of Oral Pathology, Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea) ; Jong-Ki Huh(Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry) ; Jae-Young Kim(Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry) pp.148-151 https://doi.org/10.5125/jkaoms.2023.49.3.148
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Abstract

Schwannomas are benign tumors originating from myelinating cells constituting nerve sheaths but rarely contain cellular elements of the nerve. The authors encountered a 47-year-old female patient with a schwannoma on the anterior mandibular ramus arising from the buccal nerve, measuring 3 cm×4 cm. Surgical resection was performed with preservation of the buccal nerve via microsurgical dissection. After one month, the sensory function of the buccal nerve was recovered without complications.

Sang Min Lee(Department of Oral and Maxillofacial Surgery, School of Dentistry, Jeonbuk National University) ; Dae Ho Leem(Department of Oral and Maxillofacial Surgery, School of Dentistry, Jeonbuk National University) pp.152-156 https://doi.org/10.5125/jkaoms.2023.49.3.152
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Abstract

Plexiform neurofibroma is a rare benign tumor and a special subtype of neurofibromatosis 1. This report is a literature review with a case of patient with facial hemorrhage observed at the site of neurofibroma removal in the right lower face due to minor trauma. Through PubMed search, using terms ((facial hematoma) OR (facial bleeding)) AND (neurofibromatosis), 86 articles were identified, and five related articles (six patients) were finally selected. Of the six patients, two had previously undergone embolization. However, as a result, all patients received open surgery to remove hematomas. The hemostatic methods mentioned were vascular ligation (five patients), hypotensive anesthesia (two patients), and postoperative blood transfusion (four patients). In conclusion, spontaneous or minimally traumatic bleeding is possible in neurofibromatosis patients. In most cases, it can be resolved by vascular ligation under hypotensive anesthesia. Optionally, prior embolization and supplementary tissue adhesive may be used.

Abdullah Alsoghier(Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia) pp.157-162 https://doi.org/10.5125/jkaoms.2023.49.3.157
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Abstract

Elongated styloid syndrome (ESS) can present with myriad symptoms that mimic common features of orofacial pain, such as temporomandibular joint disorders (TMJDs), often causing a challenge and delay in diagnosis. We report the case of a 52-year-old male with a three-year history of non-painful clicking during jaw movement initially diagnosed as TMJD-related internal derangement. The patient presented with a history of annoying jaw sounds for three years, described as a popping sound without bilateral clicking or crepitation. Tinnitus and progressive hearing loss were observed in the right ear, and a hearing aid was recommended by an otolaryngologist. The patient was initially diagnosed with TMJD and managed accordingly; nevertheless, his symptoms persisted. Imaging revealed prominent bilateral styloid process elongation that exceeded the recognized cut-off level of >30 mm for elongation. The patient was informed of his diagnosis and its treatment but opted only for further swallowing and auditory assessments of his ear and nose symptoms. Clinicians should consider including ESS as a differential diagnosis in patients presenting with non-specific chronic orofacial symptoms for timely diagnosis and favorable clinical outcomes.

Jae-Woong Jung(Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University College of Dentistry, Seoul, Korea) ; Sung ok Hong(Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University College of Dentistry, Seoul, Korea) ; Eun-Jee Lee(Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University College of Dentistry, Seoul, Korea) ; Ra-Yeon Kim(Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University College of Dentistry, Seoul, Korea) ; Yu-Jin Jee(Department of Oral and Maxillofacial Surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University College of Dentistry, Seoul, Korea) pp.163-168 https://doi.org/10.5125/jkaoms.2023.49.3.163
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Abstract

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