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.3
Abstract
Platelet-rich fibrin (PRF), a second-generation platelet concentrate, has emerged as a promising autologous biomaterial in regenerative medicine. Unlike platelet-rich plasma (PRP), PRF is prepared without anticoagulants or biochemical additives, allowing natural platelet activation and fibrin polymerization. This process generates a three-dimensional fibrin matrix containing concentrated platelets, leukocytes, cytokines, and growth factors that collectively support tissue regeneration. Owing to these regenerative properties, PRF has been increasingly applied in oral and maxillofacial surgery. Despite its widespread clinical use, the precise biological mechanisms underlying PRF-mediated bone regeneration remain incompletely understood. PRF functions not only as a reservoir for growth factors, but also as a dynamic immunomodulatory scaffold that regulates inflammation, angiogenesis, cellular migration, and osteogenic differentiation. Recent evidence further suggests that leukocytes, fibrin architecture, cytokine networks, and osteoimmunological interactions within PRF play critical roles in coordinating tissue regeneration. This scoping review aims to summarize the current understanding of the biological mechanisms and regenerative potential of PRF in bone healing and oral and maxillofacial reconstruction. Particular emphasis is placed on the interplay between growth factor release, fibrin matrix structure, immune modulation, and cellular signaling pathways involved in osteogenesis. Furthermore, recent advances, limitations, and future perspectives regarding PRF optimization and clinical applications are discussed.
Abstract
Objectives: Jawbone defects following cystectomy for cysts of the jaw may cause postoperative complications such as pathological fractures and secondary infections. Therefore, different bone-grafting procedures have been developed. Novel cotton-like bone graft material composed of β-tricalcium phosphate, poly-L-lactic acid, and polyglycolic acid (β-TCP/PLLA/PGA) has handling properties, three-dimensional shapeability, and bone forming ability, and has potential clinical utility for bone formation. However, no studies have evaluated the clinical outcomes of the novel β-TCP/PLLA/PGA in patients of oral and maxillofacial surgery. Thus, we evaluated the usefulness of β-TCP/PLLA/PGA in bone formation within jawbone defects following cystectomy. Patients and Methods: 28 patients (19 males and 9 females; mean age: 47.5 years) who visited the Department of Oral and Maxillofacial Surgery, Shimane University Hospital, between November 2022 and April 2024 were included. They underwent cystectomy for cysts of the jaw (maxilla or mandible) and were grafted with β-TCP/PLLA/PGA. All excised cyst were submitted for histopathological examination. Patient demographics, clinical data, and computed tomography (CT) images were retrospectively evaluated to assess the defect dimensions, CT values, and bone continuity of the jawbone defects. Data on postoperative complications were obtained from medical records. Results: Among the 28 cystic lesions (6 maxillary and 22 mandibular jaw cases), 27 were odontogenic cysts (26 odontogenic cysts and 1 orthokeratinized odontogenic cyst), and 1 was a non-odontogenic cyst (nasopalatine duct cyst). Both long- and short-axis lengths of the jawbone defect revealed a significant decrease at 6 months postoperatively compared with the preoperative and 1-month postoperative values. The CT values were significantly increased from 1 month to 6 months postoperatively (P<0.05). At 6 months postoperatively, 39.3% of the patients achieved full bone continuity. No serious adverse events were observed. Conclusion: β-TCP/PLLA/PGA demonstrated excellent handling characteristics and clinical safety as a novel cotton-like bone graft material for jawbone defects following cystectomy.
Abstract
Dental extractions are among the most frequently performed procedures in dentistry. While anatomical, behavioral, and access-related factors are known to influence extraction outcomes, the role of racial and ethnic characteristics in shaping extraction techniques, preferences, and disparities has not been synthesized. This scoping review aimed to explore and map the existing evidence on how racial, ethnic factors influence dental tooth extraction. A search was conducted across PubMed, Scopus, Google Scholar using a combination of MeSH terms and keywords related to dental extraction, race, ethnicity, anatomy, and sociocultural behavior. The review followed PRISMA-ScR guidelines. A total of 15 studies were included, encompassing anthropological, clinical, forensic, public health perspectives. The review identified key racial anatomical traits (e.g., root morphology, dental arch form, bone density) that affect extraction difficulty, particularly among Caucasoid, Mongoloid, and Negroid populations. Ethnic and cultural factors—health beliefs, care-seeking behavior, and access disparities—played a role in extraction timing and technique. Provider bias, lack of diversity within the dental workforce emerged as contributing factors to inequitable care delivery. Integrating this understanding into dental education, clinical guidelines can support equitable, culturally competent care. Further research is warranted to bridge anatomical evidence with behavioral and structural determinants of extraction disparities.
Abstract
The presence of a mandibular osseous defect significantly complicates revision orthognathic surgery by increasing the risk of unfavorable fractures and inferior alveolar nerve (IAN) injury. In such instances, the high oblique sagittal split osteotomy (HOSSO) serves as a strategic alternative to the conventional bilateral sagittal split osteotomy. We report a case involving a 31-year-old Chinese female presenting with skeletal relapse twelve years after the primary bimaxillary surgery. Preoperative imaging identified a 1.5×1.5 cm circular osseous defect in the right mandibular body, communicating with the IAN canal. To bypass the defect site, a unilateral HOSSO was performed on the right mandible, while a standard sagittal split ramus osteotomy was utilized on the left. Postoperative clinical and radiographic evaluations at six months demonstrated satisfactory facial profile improvement and stable occlusion, with absence of neurosensory deficits or unfavorable fractures. This case underscores the importance of thorough preoperative radiographic assessment and suggests that HOSSO is a safe, effective technique for bypassing localized mandibular body pathology, particularly during revision procedures.
Abstract
Tumours involving the bones of maxillofacial region requires elaborate surgical skills and experience for managing the complexity. Treatment planning majorly depends on the extent of bone involvement, type of erosion and involvement of para mandibular soft tissue. Pertaining to mandible in this paper, marginal and segmental mandibulectomies are the predominant options which are oncologically safe practices done by surgeons. Here we report a case of a patient, who was treated with technique of reverse marginal mandibulectomy. He had a unique presentation of tumour abutting the lower border of mandible with the erosion limited to the outer cortex along with a huge extra nodal growth. This sparsely used technique was performed post neoadjuvant chemotherapy followed by microvascular reconstruction. We intend to draw attention to this hermetic technique as an oncological safe and reliable alternative for a specific group of patients.
Abstract
Existing classification systems for isolated zygomatic arch fractures have substantially advanced clinical management of this injury pattern. However, atypical fracture configurations that do not conform to established subtypes are occasionally encountered in clinical practice. This technical note describes an unusual V-shaped outward displacement fracture of the zygomatic arch and proposes its recognition as a novel subtype within the recently described modified classification system for zygomatic arch fractures. A patient presenting following a motor vehicle accident exhibited an isolated zygomatic arch fracture with outward (lateral) displacement of arch fragments, forming a distinctive V-shaped configuration. Unlike conventional zygomatic arch fractures, which characteristically produce trismus through coronoid process impingement, this variant preserved mouth opening and manifested primarily as an aesthetic deformity. Management considerations for this pattern differ from standard approaches applied to conventional subtypes. The described fracture pattern is clinically and biomechanically distinct from the seven subtypes currently enumerated in the modified classification. Incorporation of this variant as a new subtype would enhance the comprehensiveness and clinical utility of the classification, enabling more accurate diagnosis and tailored surgical planning for atypical isolated zygomatic arch fractures.