The analysis aims at assessing the current trends in orthognathic surgery. The retrospective study covered a group of 124 patients with skeletal malocclusion treated by one team of maxillofacial surgeons at the University Hospital in Zielona Góra, Poland. Various variables were analysed, including demographic characteristics of the group, type of deformity, type of osteotomy used, order in which osteotomy was performed and duration of types of surgery. The mean age of the patients was 28 (ranging from 17 to 48, SD = 7). The group included a slightly bigger number of females (59.7%), with the dominant skeletal Class III (64.5%), and asymmetries were found in 21.8% of cases. Types of osteotomy performed during surgeries were divided as follows: LeFort I, segmental LeFort I, BSSO, BSSO with genioplasty, LeFort I with BSSO, LeFort I with BSSO and genioplasty, segmental LeFort I with BSSO, isolated genioplasty. Bimaxillary surgeries with and without genioplasty constituted the largest group of orthognathic surgeries (49.1%), and a slightly smaller percentage were one jaw surgeries (46.7%). A statistically significant correlation was found between the type of surgery and the skeletal class. In patients with skeletal Class III, bimaxillary surgeries were performed significantly more often than in patients with skeletal Class II (57.5% vs. 20.0%; p = 0.0002). The most common type of osteotomy in all surgeries was bilateral osteotomy of the mandible modo Obwegeser–Epker in combination with Le Fort I maxillary osteotomy (42.7%). The order of osteotomies in bimaxillary surgeries was mandible first in 61.3% of cases. The longest surgery was bimaxillary osteotomy with genioplasty (mean = 265 min), and the shortest surgery was isolated genioplasty (mean = 96 min). The results of the analysis show a significant differentiation between the needs of orthognathic surgery and the types of corrective osteotomy applied to the facial skeleton. Full article

Orthodontists correct dental malocclusion, but major facial skeleton deformations (skeletal malocclusion) are often subject to surgical correction. Several speech pathologies are associated with both of the occlusal anomalies mentioned above. The majority of articulation disorders and primary functions cannot be improved without skeletal correction. This study aimed to investigate the outcome of the multimodal and logopaedics treatment of Polish adults affected by skeletal malocclusion and speech-language pathology. A total of 37 adults affected by skeletal Class II and III malocclusion were included, along with the relationship between the malocclusion and speech deficiency (20 phonemes tested) in the subjects before and after surgical correction. The impact of surgery on pronunciation improvement and types of Polish phonemes most often misarticulated by Polish adults were also examined. Patients underwent combined treatment and received a full speech pathology examination. The treatment improved speech (p < 0.05), but the study did not prove that a specific surgery type was associated with pronunciation improvement. Some patients were provided with speech therapy during childhood, yet most had some minor difficulties with lip and tongue movements. Palatal, alveolar (p < 0.05), fricatives (p < 0.05), and labiodental consonant pronunciation (p < 0.05) improved. The surgical correction of malocclusion leads to better articulation of Polish consonants in adults and improves some primary functions. Full article

Vascular endothelial growth factor (VEGF)-induced angiogenesis contributes to inflammatory bone resorption in humans. Widely documented antagonists to resorption include antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs). The purpose of this study was to investigate the effect of these drugs on proangiogenic VEGF levels in periradicular lesions. Periapical tissue biopsies were obtained from 42 patients with chronic periapical periodontitis. VEGF levels were measured using a commercial ELISA kit in patients divided into groups according to treatment: no drugs (control group, n = 25), NSAIDs (n = 7), antibiotics (n = 5), and NSAIDs and antibiotics (n = 5). Reverse transcriptase (RT) reaction was performed in all the samples under analysis. Presence of VEGFA and VEGFB gene expression was assessed using reverse-transcription-polymerase chain reaction (RT-PCR). ELISA analysis indicated that average VEGF levels in tissue samples of patients treated with NSAIDs (6.097 ± 1.930 ng/mL), antibiotics (5.661 ± 2.395 ng/mL), and NSAIDs and antibiotics (7.142 ± 2.601 ng/mL) were significantly lower than in samples of control patients (10.432 ± 4.257 ng/mL, ANOVA p = 0.008). The RT-PCR did not reveal VEGFA gene expression in any of the 42 samples. VEGFB gene expression was found in 26 of 42 samples (69.1%). The use of NSAIDs or antibiotics in patients with exacerbated chronic periodontitis decreases VEGF levels in periapical tissues. Pharmacotherapy may minimize the effects of VEGF on apical periodontitis progression in that way. Full article

Background: Medication-Related Osteonecrosis of the Jaws (MRONJ) is a serious complication of antiresorptive therapy. The aim of the study was to assess the level of knowledge and awareness regarding MRONJ among Polish dentists and students of dentistry. Methods: The online self-administered questionnaire was sent out electronically among dentists in Poland and dentistry students of the Medical University of Gdansk. The results obtained were statistically analyzed. The results were considered statistically significant if the condition p ≤ 0.05 was met. Results: A total of 203 respondents participated in this survey. A total of 94.6% of them declared knowledge of the term MRONJ. However, the length of bisphosphonates persistence in the body was known to 51.5% of participants, while the knowledge of oral and maxillofacial surgeons concerning this topic was significantly higher (87.0%). Conclusion: Dental and maxillofacial surgeons presented the highest level of knowledge about MRONJ. The remaining groups did not differ in their knowledge. It must be noted that the knowledge of the students was similar to that of dentists. A better level of knowledge by dentists could contribute to a decline of the occurrence of the disease in future. Theoretical and practical initiatives should be promoted to improve the knowledge about MRONJ. Full article

Treating oncologic patients remains a challenge for surgeons aiming to provide patients with safe margins of resection while maintaining the highest possible quality of life. The latter, in the case of malignancies, requires using sophisticated methods of reconstruction. Thus, we present a case of a 75-year-old patient treated in our department with a rare neoplasm in the region of the temporomandibular joint—a myxofibrosarcoma that was mimicking an inflammatory lesion. The patient underwent two surgeries—firstly alloplasty of the TMJ due to the suspicion of an inflammatory lesion, lately extended to the resection of glenoid fossa and subtemporal fossa contents when the mandible was reconstructed using UHMW-PE (ultra-high molecular weight polyethylene). The patient was also referred for adjuvant radiotherapy and has remained disease-free for over 96 months with very good aesthetics and function of the mandible. The presented case highlights not only the need for increased oncologic awareness but also the possible use of UHMW-PE as a reconstruction material in the broad resection of the maxillofacial region. Full article

Open reduction and internal fixation (ORIF) is becoming increasingly common in treatment of the condylar process, including mandible head fractures. This approach significantly improves the results in terms of anatomical reduction of bone fragments, and shortens the treatment time, allowing for early functional recovery. The success of ORIF is largely determined by the stability of the osteosynthesis. The stabilization effect depends on the screw type and length of the plate used, in addition to the diameter and length of the screws used. The aim of this study was to determine the largest possible screw length that can be used in ORIF of the mandibular condyle considering the variable bone thickness. A total of 500 condyles were examined using computer tomography (CT)-based 3D models in Caucasians. For all models, three measurements were made in the frontal projection in places typical for the stabilization of osteosynthesis plates in the fractures of the condylar process: the base, the top, and the sigmoid notch. In addition, one measurement of the mandible head was made in the place of the greatest width. The results showed that 8 mm screws should be used in the region of the condylar base as the longest anatomically justified screw, whereas in the area of a sigmoid notch only 1.5–2 mm screws should be used. Measurements in the area of the neck top revealed statistically significant differences in the measurements between the sex of patients, with average differences below 1 mm (p < 0.05). In this area, the maximal length of the screw was found to be 10 mm. In mandibular head fractures, the use of long screws is extremely important due to the desired effect of fragment compression. Statistically significant differences were found in the measurement results between women and men. The maximal screw length for bicortical fixation was found to be 22 mm in men and 20 mm in women. In post-traumatic patients, the ability to obtain a clear measurement is often limited by a deformed anatomy. Taking into account the fact that the fracture stability is influenced by both the plate length and the length of the fixation screws, an assessment of the standard measurement values in a cohort group will improve the quality of the surgical fixations of the fractures. Full article

There is no publication concerning tongue-tie (TT) in adults, surprisingly. It is generally known that TT is mainly diagnosed in newborns and infants. It seems unlikely that TT does not cause functional disorders in adults, especially considering that TT has been present in organism since childhood. Thus, there is insufficient information about the influence of TT on adults′ speech production. The purpose of this study was the functional evaluation of lingual frenotomy on tongue mobility and speech in the adult Polish population. Methods: Methods were based on visual observation and examination of the oral cavity accompanied by visual and auditory examination of articulation. Χ² test, Kruskal–Wallis, analysis of variance (ANOVA), and Student’s t-test were used for statistical analyses. Conclusions: Tongue-tie is a serious condition in adults. Implementing surgical procedures to treat it improves the tongue′s mobility in every direction and improves speech clarity. The frenotomy should be implemented in patients suffering from malocclusion because the equilibrium of all the face muscles and skeleton is often disturbed and may lead to unstable functional effects of orthodontic and orthognathic treatment. Full article

Soluble urokinase-type plasminogen activator receptor (suPAR) is a marker of immune activation and reflects a more distinct aspect of inflammation than C-reactive protein (CRP) does. The study concerns a clinically silent state of the immune system expressed by the level of suPAR, which could affect the occurrence of complications (non-life threatening) after scheduled procedures. The purpose was the evaluation of suPAR predictive value in minor maxillofacial surgery complication incidents. Eighty patients were tested for suPAR, CRP and a series of basic laboratory serum tests on 1 day before surgery. Complications of orthognathic and minor injuries treatments were reported. The suPAR level, expressed as a measure independent of the patient’s age (Index of Body Inflammation, IBI), was analyzed. The protein level was also assessed on postoperative day 3. Basic statistical analysis did not reveal any relevant dependence between suPAR (or IBI) and occurrence of minor complications. The application of factor analysis, artificial neural network and inclusion of chlorides, glycaemia, alanine transaminase (ALT), albumin and hemoglobin levels allowed to indicate the suPAR/IBI ranges associated with an increased risk of minor postoperative complications. Concluding, it seems that, in the current state of the knowledge, the monitoring of pre-operational suPAR level solely does not include sufficient predictive information for the occurrence of minor complications after maxillofacial surgery. The suPAR/IBI level should be combined with other patient characteristics to predict healing complications. Full article

Extended postoperative mandibular reconstructions due to orofacial disease involving the temporomandibular joint (TMJ) in immature patients remain a challenge as a result of ongoing growth, which is usually affected by the disease and treatment. Current reconstructive techniques based fully on alloplastic total joint replacement fail to meet fully the anatomical and functional requirements for the masticatory system and speech development. Fourteen children aged 12.6 ± 2.6 with tumors or congenital deformities affecting the mandible and TMJ were included in the study. Radical surgical treatment according to our own protocol was performed through microvascular anastomotic flap reconstruction of the soft tissues and bones, together with total TMJ custom replacements. Follow-up lasted 2–6 years. During the follow-up, increases in the mandible body (13% growth) and ramus (12% growth) were observed, both of which were related (p < 0.001). This is the first report concerning the immediate reconstruction of the mandible with ramus and total TMJ in children and adolescents that combines a free vascularized graft and total individual prosthesis of the TMJ. The presented technique enabled optimal function of the TMJ, growth of the mandible, and further rehabilitation of the patients. The technique was demonstrated to be safe, reliable, and provide good functional and cosmetic outcomes. Full article

Background: The serum suPAR level is affected in humans by it increases with age. Therefore it makes difficult interpretation and any comparison of age varied groups. The aim of this study is to find simple way to age independent presentation of suPAR serum level for maxillofacial surgery purpose. Methods: In generally healthy patients from 15 to 59 y.o. suPAR level was tested in serum before orthognathic or minor traumatologic procedures. Five ways to make the suPAR serum level assessment independent of age are proposed. Results: One way of making suPAR levels independent of age led to the result with the same statistical distribution as in the raw suPAR serum material and this distribution is the normal. Conclusion: The simple way for suPAR serum level analysis without its dependence on patient age is calculation of the index of body inflammation understood as square root of squared suPAR serum level divided by logarithm of patient age to base 10. Full article

Achieving the coverage of multiple adjacent gingival recessions (MAGRs) in a single surgical procedure poses a major clinical challenge. The gold standard procedure involves the collection of autogenous connective tissue from the palatal mucosa. In case of reduced palatal tissue thickness, augmentation using a collagen sponge can be performed. The aim of this study was to compare the treatment outcome of MAGR coverage by a coronally advanced flap (CAF) along with a connective tissue graft (CTG) harvested from augmented or nonaugmented palatal mucous membrane. Thirty-five patients with 148 MAGRs were enrolled in the study. The recessions were covered with CTGs collected from 26 augmented- (test group) and from 24 nonaugmented (control group) palatal donor sites followed by a CAF. Clinical parameters were measured at baseline, 6, 12 and 24 months after intervention. Clinical results for both, the test and the control group were steady and similar with the exception of buccal gingival thickness (BGT₁). After 24 months, statistically greater BGT₁ and complete root coverage (CRC) was observed in the test group. The augmented CTG+CAF method achieves good and predictable clinical results in the coverage of MAGRs. It leads to the increase of gingival thickness in comparison to the nonaugmented intervention. Full article

Background: Smoking tobacco significantly affects the biology of periodontal tissues and contributes to the increased risk of peri-implant diseases. The aim of the study was to investigate whether smoking cigarettes affects the primary and secondary stability of maxillary dental implants, inserted into fresh sockets immediately after extraction. Methods: The study was conducted on 164 patients between the ages of 27–71 years old. 67 individuals smoked more than 20 cigarettes daily and 97 were non-smokers. 190 immediate implants were inserted in the maxilla. Immediate implantations were performed with simultaneous augmentation of the socket with xenogenic bone grafting material. In the posterior region, implants were inserted into the palatal alveolus. The stability of the implants was measured using Insertion Torque Value (ITV) and two types of devices: Periotest (PT) and Osstell (ISQ). Marginal bone loss was evaluated on cone beam computed tomography scans. Results: In an aesthetic area, the PT values at 6 months post-implantation were higher for smokers than non-smokers (p < 0.05), respectively. The ISQ values were significantly lower in smokers compared to non-smokers at 6 months post-implantation (p = 0.0226), respectively. In the posterior region PT values were higher in smokers both on the day of implantation (p = 0.0179), 6 months after surgery (p = 0.0003) as well as 24 months after surgery (p < 0.0001), as compared to non-smokers, respectively. Smokers revealed lower ISQ values than non-smokers (p = 0.0047) on the day of implantation, as well as 6 months after implantation (p = 0.0002), respectively. There were no significant differences in marginal bone loss after 18 months of loading between smokers and non-smokers in the aesthetic, as well as posterior regions (p > 0.05). ITV measurements were lower in smokers than non-smokers in the aesthetic (16.3 vs. 17.5 Ncm) and posterior area (16.8 vs. 17.9 Ncm). Conclusions: This study indicate that smoking cigarettes has a negative effect on the stability of immediate implants in the maxilla. Primary stability of immediate implants may be lower in the posterior area of the maxilla in smokers when compared to non-smokers, which may eliminate smokers from immediate implants in this region. Secondary stability of immediate implants may be lower in both the aesthetic and posterior areas in smokers compared to non-smokers, which may encourage the postponement of final crowns delivery at 6 months post op and the extension of the occlusaly temporary crowns use in some smoker cases. Full article

Background: Stabilization of luxated, avulsed, and root-fractured teeth is a part of the dental trauma treatment. The aim of the study was to assess the power chain and its comparison with two commonly used splinting materials. Methods: The evaluated splints were a wire-composite splint (WCS) with a diameter of 0.5 mm, a titanium trauma splint (TTS), and a power chain-composite splint (PCS). The splints were all fixed to the labial surfaces of permanent maxillary incisors in 10 human volunteers. The following parameters were measured: tooth mobility with Periotest before and after the splint application and removal, Aproximal Plaque Index (API), Sulcus Bleeding Index (SBI), and time needed to apply and to remove the splint. Each volunteer was also given a visual analogue scale (VAS) questionnaire to assess his/her subjective attitudes to splint materials. Results: The PCS was the most flexible material as it had the lowest horizontal Periotest values. For the two other methods, horizontal splint effects were similar and were also low. The PCS was the fastest to apply and remove and was also the most aesthetic splint. Conclusion: In this experimental study among volunteers, all three tested materials were found suitable for splinting the PCS has some advantages worth it to be further evaluated clinically in trauma patients. Full article

The analysis aimed at studying stresses reduced according to Huber’s hypothesis and displacement patterns at selected sites of the facial skeleton using a tooth-borne appliance in surgically assisted rapid maxillary expansion. Five different variants of osteotomy of the midface and a variant without surgical intervention were compared to determine the best model for making an incision in the maxilla. The finite element analysis (FEA) was used for the study. Five osteotomy variants and a variant without osteotomy were modelled using a tooth-borne appliance on a facial skeleton model of a 23-year-old woman with skeletal malocclusion. The finite element mesh was constructed based on the geometry imported into the ANSYS 15.0 (Swanson Analysis System of USA) software, in which calculations were performed using the finite element analysis. Stress distributions and displacement patterns along the X, Y and Z axes are presented for each osteotomy variant with the expansion of the tooth-borne appliance at a level of 0.5 mm. As a result of the analysis it was found that osteotomy of the palatal suture in conjunction with Le Fort I osteotomy has the biggest impact on the course of maxillary expansion. If no osteotomy is performed, an increase in stresses reduced according to Huber occurs in the entire facial skeleton with a simultaneous absence of maxillary expansion. Full article

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a condition that is becoming more common in the everyday practice of both dental and maxillofacial surgeons. Materials and methods: This paper aims to provide a comprehensive and easy to read by clinicians presentation of comprehensive, accessible, and up-to-date data on MRONJ. The individual chapters focus on the etiology, epidemiology, diagnosis, prevention, treatment, and recurrence of MRONJ. Results and discussion: It has been observed over the years that among drugs that increase the risk of the disease, apart from bisphosphonates, angiogenesis inhibitors and anti-RANKL monoclonal antibodies should also be included. A thorough physical and subjective examination, periodic correction of dental prostheses, and an adequate preparation for even the simplest of procedures in the oral cavity area can prevent or minimize the risk of MRONJ. Conclusions: It is extremely difficult to treat once it occurs and oftentimes is a recurring problem that leads to a multitude of symptoms that gradually decrease the quality of a patient’s life. Full article

Background: Shots from commonly available non-gunpowder weapons are a significant cause of facial injuries, especially in pediatric patients. A consequence of such trauma may be the placement of a projectile within the maxillary sinus, which is a therapeutic need with no guidelines for foreign body removal. The purpose of this paper is to discuss the etiology, epidemiology, diagnosis, treatment and prognosis of such cases. Materials and methods: Any cases describing the presence of airgun pellets within the maxillary sinus were included. Animal patients and non-English cases were excluded. The final search using the PubMed, BASE and Google Scholar engines was made on 13 November 2021. The JBI Critical Appraisal Checklist for Case Reports was used to assess the risk of bias. The collected data are presented in tabular form and were subjected to a comparative assessment. Results: In total, reports of seven cases of lead airgun projectiles in the maxillary sinuses were identified, qualified and analyzed. There were no cases of lead intoxication. The bullets were removed by open surgery in the form of antrostomy of the maxillary sinus or with the use of an endoscope. In none of the described cases were complications observed during surgery or postoperative observation. Discussion: This systematic review was based on case reports that differed significantly in quality. The location of the lead foreign body within the maxillary sinuses may be considered favorable over other craniofacial gunshots. The risk of lead intoxication does exist, but such a location of the bullets does not favor it. The removal of projectiles from the maxillary sinuses appears to be easily achievable and does not predispose one to complications. Full article