Journal of the Korean Association of Oral and Maxillofacial Surgeons
- P-ISSN2234-7550
- E-ISSN2234-5930
- SCOPUS, KCI, ESCI
ISSN : 2234-7550
Vol.52 No.4
Abstract
platelet-rich fibrin (i-PRF) a growth factor–rich platelet concentrate, has emerged as a promising minimally invasive regenerative approach for papilla reconstruction. This study evaluates the clinical effectiveness of i-PRF in the management of gingival black triangles and IDP deficiencies. A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420261321819). Electronic searches of studies including human studies were performed for studies published between 2020 and 2025. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials and the JBI checklists for case reports and series. Fourteen studies met the inclusion criteria, including randomized controlled trials (RCTs), pilot studies, case series, and case reports. Most studies reported improvements in papillary height, papilla presence index, and reduction in black triangle dimensions following i-PRF therapy. Clinical outcomes were generally comparable to hyaluronic acid injections and connective tissue graft procedures, with reduced invasiveness and postoperative discomfort. i-PRF appears to be a promising minimally invasive option for managing gingival black triangles; however, larger RCTs with longer follow-up are needed to confirm long-term effectiveness.
Abstract
Objectives: This study aimed to evaluate changes in keratinized mucosa width (KMW) following an apically positioned flap (APF) during implant placement and to identify factors associated with KMW gain (KMWG). Patients and Methods: This retrospective single-center study included patients who underwent APF during implant placement. KMW was measured at baseline (BKMW), immediately after surgery (T1), and at 6 months after surgery (T2). Clinicodemographic and surgical factors were recorded, and univariable and multivariable generalized estimating equation (GEE) analyses were performed to identify factors associated with KMWG. Results: This study included 78 patients with 207 implants. The mean BKMW was 1.09±1.54 mm, the mean T1 was 4.59±2.29 mm, the mean T2 was 2.71±1.70 mm, and the mean KMWG was 1.62±1.46 mm. In univariable GEE analysis, hypertension, periodontal phenotype, BKMW, and the amount of flap displacement (AFD) were associated with KMWG (P<0.05). In multivariable GEE analysis, hypertension (estimate=0.607, P=0.012), periodontal phenotype (estimate=0.603 for thick phenotype, P=0.014), and AFD (estimate=0.221, P=0.018) were positively associated with KMWG, whereas BKMW was negatively associated with KMWG (estimate=–0.349, P<0.001). Conclusion: An increase in peri-implant KMW was observed after APF performed during implant placement. Clinicodemographic and surgical factors were associated with KMWG, suggesting that preoperative assessment may improve the predictability of peri-implant soft tissue augmentation and support surgical planning. Clinically meaningful KMWG could be achieved even with relatively limited flap extension when APF was performed using a standardized surgical approach.
Abstract
Objectives: Postoperative hemorrhage and airway obstruction remain major life-threatening complications following oral and maxillofacial surgery despite advances in surgical techniques and perioperative care. This study aimed to retrospectively characterize the clinical patterns, timing, and management of postoperative hemorrhagic and airway emergencies over a 15-year period and, based on these institutional data and a review of the literature, to propose a practical integrated framework for postoperative emergency management. Materials and Methods: A retrospective review was conducted of patients who underwent major oral and maxillofacial surgery at a university dental hospital between 2010 and 2025. Major bleeding events were defined as postoperative hemorrhage requiring reoperation or embolization, while major airway events included unplanned airway intervention or emergency tracheostomy. For airway analysis, patients undergoing malignant tumor resection were divided into an emergency tracheostomy group and an elective tracheostomy group. The Cameron scoring system was retrospectively applied. Results: Twenty patients required intervention for postoperative bleeding, with 70% of events occurring after major surgery. Five of eight orthognathic surgery patients developed hemorrhage within 72 hours postoperatively and required surgical hemostasis. Most bleeding events occurred independently of coagulation disorders. Transarterial embolization was performed in 13 patients, although only one case was directly related to emergency postoperative hemorrhage. Tracheostomy was performed in 24 patients, including 13 following oral cancer surgery. Emergency tracheostomy was most frequently required in patients with malignant tumors or severe infections. Mean Cameron scores were comparable between the emergency and elective tracheostomy groups (6.00 and 6.17, respectively). Conclusion: Postoperative hemorrhage and airway compromise remain significant complications in oral and maxillofacial surgery. Bleeding events were more closely associated with surgical extent than patient-related comorbidities. While the Cameron score may assist preoperative airway planning, postoperative clinical assessment remains essential. A structured approach incorporating bleeding control, airway protection, and selective use of embolization may improve patient safety and postoperative outcomes.
Abstract
Hardware exposure after mandibular reconstruction poses significant management challenges. Incomplete removal of reconstruction plates and screws may compromise stability, particularly when osseointegration prevents screw retrieval. A patient who underwent mandibular resection for odontogenic keratocyst with non-vascularized fibular reconstruction developed exposure of the fixation plate. During revision surgery, exposed screws were removed, but several screws remained firmly integrated within the reconstructed bone and could not be retrieved. To prevent destabilization, the plate was retained with the remaining screws, while polymethyl methacrylate (PMMA) bone cement was adapted in the vacant screw sites to restore stability. Postoperative healing was uneventful, and the reconstruction plate remained stable. This report highlights the novel use of PMMA bone cement as a salvage method for plate stabilization in maxillofacial reconstruction, adapting a material widely established in orthopedic surgery for craniomaxillofacial application.
Abstract
Comminuted mandibular fractures (CMFs) associated with panfacial trauma are challenging because restoration of skeletal continuity does not necessarily re-establish functional occlusion or facial form. We report a staged multidisciplinary rehabilitation in a 34-year-old man who sustained severe craniofacial injuries in an industrial explosion, including a CMF, multiple midfacial fractures, and extensive anterior maxillary destruction. Initial treatment consisted of hemorrhage control, top-down open reduction and internal fixation, and simultaneous orbital floor reconstruction. Because severe mandibular comminution and fragment interference prevented safe restoration of the mandibular arch and occlusion, stable skeletal fixation was prioritized and the potential need for delayed correction was recognized intraoperatively. After osseous union, persistent mandibular arch discrepancy and malocclusion were reassessed, and definitive corrective surgery was planned using right sagittal split ramus osteotomy and anterior mandibular vertical osteotomy. Subsequent rehabilitation included rhinoplasty, anterior maxillary reconstruction with an autogenous mandibular body block bone graft, implant placement, and prosthetic treatment. The staged approach achieved clinically acceptable occlusion, satisfactory masticatory function, and improved facial symmetry. This case suggests that delayed corrective surgery after skeletal healing can provide a practical pathway when immediate occlusal restoration is unsafe during primary fixation.
Abstract
Temporomandibular joint (TMJ) internal derangement frequently leads to orofacial pain, joint dysfunction, and limited mandibular movement. Conservative treatment is first, but arthrocentesis may help refractory cases. This case report describes one year of conservative therapy and arthrocentesis with intra-articular hyaluronic acid (HA) and 12.5% dextrose. A 21-year-old woman had right-sided preauricular pain, joint clicking, and intermittent locking for one year. Clinical and magnetic resonance imaging findings confirmed anterior disc displacement with reduction and intermittent locking with osteoarthritis of the right TMJ. After 8 months of physiotherapy, pharmacotherapy, occlusal splint, and diet modification, maximum mouth opening improved from 13 to 36 mm, but symptoms persisted. Two arthrocentesis sessions with prolotherapy were performed: one with HA alone, followed by HA and 12.5% dextrose. At 4-month follow-up, function was restored, symptoms resolved, and joint clicking disappeared. Arthrocentesis with intra-articular HA and 12.5% dextrose relieved pain, improved mouth opening, and restored function in refractory TMJ internal derangement. This case highlights the value of a staged, minimally invasive strategy, though larger controlled studies are needed to validate its efficacy and to standardize treatment protocols. A stepwise approach, from conservative therapy to arthrocentesis with intra-articular HA and 12.5% dextrose, can effectively manage TMJ internal derangement.