Journal of the Korean Association of Oral and Maxillofacial Surgeons
- P-ISSN2234-7550
- E-ISSN2234-5930
- SCOPUS, KCI, ESCI
ISSN : 2234-7550
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e-SubmissionVol.51 No.6
Abstract
With a rapidly aging population and increasing use of antiresorptive agents, medication-related osteonecrosis of the jaw (MRONJ) represents a growing clinical challenge worldwide. To address the need for tailored clinical guidance, a multidisciplinary task force was convened. Five Korean academic societies—the Korean Society for Bone and Mineral Research, the Korean Association of Oral and Maxillofacial Surgeons, the Korean Association of Maxillofacial Plastic and Reconstructive Surgeons, the Korean Society of Osteoporosis, and the Korean Endocrine Society—collaborated to develop this position statement. The consensus was formulated through comprehensive reviews of literature, combined with three rounds of formal surveys to consolidate expert opinion on controversial topics. This position paper provides evidence-based clinical guidelines for the prevention, diagnosis, and management of MRONJ tailored to the Korean healthcare environment. The diagnostic criteria affirm the standard definition but add a provision for diagnosis based on clinical or radiographic evidence of necrotic bone, even if the traditional 8-week timeframe has not been met. The committee advocates for retaining Stage 0 in the staging system to emphasize early detection and preventive intervention. Key recommendations include prescriptive, drug-specific guidelines for prophylactic drug holidays (e.g., a 2-month pause for oral bisphosphonates; timing surgery 3-4 months after the last denosumab injection) to minimize MRONJ risk from dental procedures. This statement also provides a clear framework for therapeutic drug holidays in established MRONJ, carefully balancing the need for jaw healing against systemic fracture risk. For treatment, this statement advocates for early and active surgical intervention across all MRONJ stages, supported by evidence of superior long-term outcomes compared to conservative management. This position statement offers a unique, evidence-based Korean clinical practice guideline for managing MRONJ. It is intended to standardize care, reduce clinical confusion, and ultimately improve patient outcomes by providing a clear framework for decision-making.
Abstract
Temporomandibular joint disorders (TMDs) comprise multifactorial conditions involving pain, joint noises, and restricted mandibular motion. Prolotherapy, involving intra-articular or periarticular injection of proliferative agents such as hypertonic dextrose or polydeoxyribonucleotide (PDRN), has recently gained attention as a regenerative therapy for refractory TMDs. This review summarizes current evidence and biological mechanisms underlying prolotherapy in temporomandibular joint (TMJ) disorders. Literature searches identified clinical and experimental studies evaluating efficacy, safety, and treatment protocols. Prolotherapy promotes fibroblast activation, collagen synthesis, and ligamentous stabilization. Dextrose remains the most validated proliferant, while PDRN provides comparable efficacy with less discomfort and shorter treatment intervals. Clinical data consistently show reduced pain and improved maximum mouth opening across chronic and degenerative TMJ cases, with preliminary imaging evidence of subchondral bone remodeling. Reported adverse events are minimal and transient. Prolotherapy appears to be a regenerative approach that may be regarded as one of the conservative treatment modalities for TMDs. Further controlled studies are needed to validate its long-term clinical and structural outcomes.
Abstract
Objectives: Pediatric and adolescent oral and maxillofacial trauma and infections differ significantly from adults in anatomy, development, and immunity, making diagnosis and treatment challenging. This study retrospectively evaluated the etiology, clinical features, and management of oral and maxillofacial trauma and infections among patients aged 3 to 15 years. Materials and Methods: A retrospective review was conducted of 824 pediatric and adolescent patients who presented to the emergency department of Pusan National University Yangsan Hospital from January 2022 to December 2024. Patients were categorized based on chief complaints into trauma, infection, or other conditions. Primary analyses focused on trauma and infections, and secondary analyses included etiology, diagnosis, treatment, and outcomes. Results: Trauma accounted for 742 cases (90.0%) and infections for 44 cases (5.3%). Boys (65.7%) outnumbered girls (34.3%), and school-aged children (6-11 years) were most frequently affected (56.5%). Lacerations (49.2%) and abrasions (34.1%) were the most common traumas, followed by dental trauma (31.0%) and facial fractures (5.0%). Among fractures, the mandibular condyle (35.1%) was most commonly involved. Most fractures were managed non-surgically (54.0%), while 30.0% required surgery. Infections were mainly odontogenic abscesses (44.7%), cellulitis (36.4%), and sialadenitis (15.9%). Abscesses were treated with incision and drainage (57.1%) or antibiotics (19.1%), with 23.8% requiring hospitalization. Conclusion: Trauma was the most frequent emergency cause in pediatric and adolescent patients, particularly among school-aged boys. Most cases were successfully managed with appropriate treatment. Early diagnosis and timely intervention are essential for favorable outcomes in pediatric maxillofacial emergencies.
Abstract
Objectives: The use of titanium platelet-rich fibrin (T-PRF) as a sustained drug delivery system (SDDS) has been limited. Hence present study aimed to evaluate the antimicrobial efficacy, drug kinetics and growth factor release of T-PRF injected with amoxicillin+clavulanic acid (amoxiclav gel), metronidazole (MTZ) and neem (NE) gels separately. Materials and Methods: 12 Healthy volunteers were recruited for this in vitro analysis. Drug kinetics were monitored at 0, 2, 24, 48, and 72 hours. Antimicrobial efficacy was assessed at 48 hours post inoculation in culture plates and growth factor release was measured at 3, 7 and 10 days. Kruskal– Wallis test, Dunn’s Post hoc test, Bonferroni’s correction and Mann–Whitney U test were used to compare the drug release over time frames, inhibition zone diameters (IZDs) and growth factor release were expressed in (mean and standard deviations) millimetres, pico g/mL and nano g/mL. Results: In terms of drug kinetics, both T-PRF clots and collagen sponges when injected with antibiotic/ herbal gels individually there was a sustained drug release up to 72 hours and there was a greater release observed in collagen sponge. IZDs were recorded for T-PRF injected with amoxiclav/MTZ/ NE gel for anti-microbial efficacy. Growth factor release was also observed for T-PRF plain and T-PRF injected with gels, with levels were numerically higher in T-PRF plain. Conclusion: Within the limitations of the study T-PRF demonstrated sustained drug release with superior antibacterial activity. Growth factor release was not compromised, aiding in the preservation of regenerative capacity. Therefore, T-PRF can be used as a SDDS.
Abstract
Objectives: Leukocyte platelet-rich fibrin (L-PRF) has garnered attention due to its biocompatibility, low cost, and regenerative potential. This paper presents a clinical case series demonstrating the versatility and effectiveness of L-PRF in oral and maxillofacial surgery. Patients and Methods: This case series comprised six patients who underwent comprehensive clinical and imaging evaluations and were recommended for oral surgery interventions using L-PRF. The cases include venipuncture, L-PRF preparation, and its clinical applications. Results: In Patient 1, an oroantral communication was closed using an L‑PRF membrane and vestibular flap, achieving satisfactory soft‑tissue healing. Patient 2 underwent a maxillary sinus lift with bone graft material and L‑PRF membranes (replacing collagen membranes) to reduce cost and enhance bone regeneration. In Patients 3 to 5 (all systemically compromised), post‑extraction placement of an L‑PRF plug and membranes prevented complications and preserved the alveolar ridge for future rehabilitation. Finally, Patients 6 and 7, both with recurrent pericoronitis of partially erupted lower third molars, received extractions followed by L‑PRF plug and membrane placement, with uneventful healing in all cases. The findings reinforce the growing body of evidence supporting the benefits of L-PRF in oral and maxillofacial surgery. Conclusion: L-PRF represents a promising, biocompatible tool in clinical practice, offering significant advantages for patient recovery and surgical outcomes.
Abstract
Objectives: To report the clinical and functional outcomes of patients undergoing total temporomandibular joint (TMJ) replacement with customized prostheses. Materials and Methods: Six female patients treated between 2018 and 2024 for advanced TMJ pathology—severe osteoarthritis (n=5) or condylar osteochondroma (n=1)—were included. All underwent unilateral total joint replacement using customized prostheses planned with cone-beam computed tomography and magnetic resonance imaging. Interincisal mouth opening (IMO), pain (visual analog scale), jaw function (JF), and dietary intake (DI), assessed through a Likert-type psychometric scale, were recorded preoperatively and during a minimum follow-up of 24 months. Results: All patients showed postoperative improvement. Median JF decreased from 6.5 to 3.5, DI from 8 to 1.5, and pain from 7 to 2. Postoperative IMO averaged 32 to 33 mm. One patient required revision for screw displacement without long-term functional compromise. Conclusion: Customized TMJ prostheses proved safe and effective, demonstrating consistent improvements in pain, mandibular function, and dietary capacity in patients with severe joint disease. This approach represents a reliable therapeutic option when combined with individualized surgical planning.
Abstract
This study presents a modified upper eyelid approach incorporating a lateral canthotomy to improve surgical access in complex fronto-orbital fractures. A 69-year-old male patient with no comorbidities was admitted to the regional hospital of Rancagua with a left fronto-orbital-zygomatic fracture. Surgery was performed under general anesthesia using an upper eyelid incision combined with a lateral canthotomy to enhance exposure of the fracture site. Reduction and osteosynthesis of the lateral orbital wall and part of the frontal bone were successfully achieved without complications. The modified approach provided wide and direct access to the affected areas, particularly beneficial in cases with comminuted fractures requiring the placement of multiple osteosynthesis elements. The lateral canthotomy significantly expanded the surgical field, facilitating accurate reconstruction. Additionally, the eyelid incision, placed along the natural palpebral crease, offered excellent aesthetic results with a nearly imperceptible scar. This technique proves to be a valuable option for the management of complex fronto-orbital injuries, combining effective exposure with favorable cosmetic outcomes. It is especially useful in extended fractures where optimal visualization is critical for successful repair. The upper eyelid approach with lateral canthotomy thus stands out as a reliable and aesthetically conscious alternative for orbital fracture surgery.
Abstract
In the field of mandibular reconstruction, multiple treatment options and surgical approaches are available. Most techniques require extensive incisions across the face and neck to visualize, resect and reconstruct large mandibular defects. These approaches are associated with greater aesthetic compromise and an increased risk of injury to neurovascular structures. The aim of the present study is to introduce alternative facial approaches using tunneled dissection techniques, which allow for the resection and reconstruction of extensive mandibular defects involving the body, ramus, and temporomandibular joint.
Abstract
Mandibular prognathism is a well-known skeletal discrepancy with varying prevalence rates demographically. Patients with severe prognathism may experience difficulties speaking and chewing food as well as problems with psychosocial adjustment, indicating the need for surgical correction. In cases of single-stage larger mandibular setbacks, complications such as reduction in the pharyngeal airway and instability can be encountered. Therefore, two-stage orthognathic surgery could be recommended. Two patients (17-year-old female and 16-year-old female) reported with large mandibular antero-posterior discrepancies. Surgical correction was performed in two stages. In the first stage, a mandibular setback was performed with an anterior mandibular body osteotomy using Dingman’s technique with a modified step osteotomy, as it provides an increased surface area of contact between the osteotomized segments to achieve better stability. Osteofixation was done using locking titanium miniplates. A year after orthodontic decompensation at the second stage, maxillary advancement using Le Fort I osteotomy and bilateral sagittal split osteotomy for mandibular setback were performed and fixed with unsintered hydroxyapatite/poly-L-lactic acid plates and screws. The post-operative course was followed by post-surgical orthodontics. It can be concluded that a harmonized facial profile with good outcome in terms of skeletal stability, airway dimensions and occlusion were achieved with patient satisfaction.