Journal of Craniomaxillofacial Research

Evaluating Navigated and Guided Surgery in Dental Implantology: A Review

2026-02-15T07:58:52+00:00

Introduction: Navigated surgery (NS) and guided surgery (GS) are computer-assisted technologies that have enhanced precision and predictability in dental implantology. While both approaches improve outcomes over freehand placement, they differ in accuracy, efficiency, and clinical application.

Materials and Methods: This article is a narrative comparative review. We searched PubMed, Scopus, Web of Science, and the Cochrane Library (January 2020–August 2025) for studies directly comparing navigated (NS) and guided (GS) implant surgery. Eligible designs included randomized trials, cohort studies, and systematic reviews. Outcomes assessed were placement accuracy, survival, operative time, complications, and patient/clinician-reported measures. Of 130 records, 47 duplicates were removed; 11 studies were included.

Results: The 11 included studies assessed over 7,500 implants. Meta-analyses found that while NS and GS showed similar coronal and apical accuracy, NS resulted in lower angular deviation. Clinical trials confirmed that GS significantly reduced surgical time. Both techniques demonstrated high implant survival rates (exceeding 95%) with minimal complications and high clinician and patient satisfaction.

Conclusion: Both NS and GS provide accurate and reliable implant placement, each with distinct advantages. NS offers superior angular precision and intraoperative adaptability for anatomically complex cases, while GS provides greater efficiency and simplicity of workflow for routine procedures. As such, these technologies should be considered complementary tools in modern dentistry. Future research should focus on long-term outcomes, cost-effectiveness, and patient-reported measures to better inform clinical decision-making.

Comparison of the Expression of Cytokeratin 6 and 16 in Oral Lichen Planus, Oral Lichenoid Lesions with Dysplasia and Oral Squamous Cell Carcinoma

2026-02-15T07:58:51+00:00

Introduction: Oral lichen planus (OLP) and oral lichenoid lesions (OLL/OLR) are chronic inflammatory disorders of the oral mucosa with potential malignant transformation. Cytokeratins 6 and 16 (CK6, CK16) are markers of epithelial proliferation and have previously been reported to be elevated in inflammation, wound healing, and epithelial tumors. This study aimed to compare CK6 and CK16 mRNA expression across reticular OLP (ROLP), erosive OLP (EOLP), oral lichenoid lesions with dysplasia (OLR + D), oral squamous cell carcinoma (OSCC), and healthy controls.

Materials and Methods: A cross-sectional study was performed on 90 archived oral tissue specimens. mRNA expression was quantified using qRT-PCR, and data were analyzed using ΔCt, ΔΔCt, and fold-change values. Statistical comparisons were made using one-sample t-tests and one-way ANOVA.

Results: CK6 and CK16 expression were significantly altered in all lesion groups compared with controls (p < 0.001). Fold‑change analysis showed a slight decrease in CK6 expression in ROLP (0.63‑fold), followed by progressive increases in EOLP (1.59‑fold), OLR + D (1.85‑fold), and OSCC (2.33‑fold). CK16 expression increased from ROLP (1.36‑fold), EOLP (1.47‑fold), and OLR + D (2.00‑fold) to OSCC (2.72‑fold). However, no statistically significant differences were observed among the lesion groups for either gene (CK6: p = 0.840; CK16: p = 0.946).

Conclusion: CK6 and CK16 expression increases along the spectrum of oral epithelial lesions but does not reliably distinguish inflammatory, dysplastic, and malignant lesions. These cytokeratins primarily reflect generalized inflammatory and reparative processes, and their interpretation should be integrated with histopathology, clinical findings, and additional molecular markers.

Changes in the Gonial Angle Following Bimaxillary Osteotomy

2026-02-15T07:58:50+00:00

Introduction: The aim of this study was to evaluate changes in the gonial angle (GA) after bilateral sagittal split ramus osteotomy (BSSRO) combined with Le Fort I osteotomy in Class II and Class III patients, and to compare the outcomes between the two groups.

Materials and Methods: In this retrospective cohort study, 48 patients (21 Class II, 27 Class III) from Tehran University of Medical Sciences were included. All patients underwent bimaxillary osteotomy with rigid internal fixation using miniplates. Lateral cephalograms were used to measure the GA and occlusal plane angle (OPA) preoperatively, one day postoperatively, and 12 months postoperatively. Changes were analyzed using paired t-tests within groups and independent t-tests between groups. Pearson’s correlation was used to assess the relationship between GA and OPA changes.

Results: The mean reduction in GA at 12 months was 2.81° (±2.89°) in Class II and 3.81° (±2.60°) in Class III patients. The mean relapse (increase) in GA from the first postoperative day to 12 months was 1.57° (±1.60°) in Class II and 2.00° (±1.41°) in Class III patients. No statistically significant difference was found between the two groups for the magnitude of GA change or relapse (p > 0.05). Furthermore, no significant correlation was found between the amount of GA change and OPA change within either group (p > 0.05).

Conclusion: Bimaxillary osteotomy with rigid fixation resulted in a significant reduction of the gonial angle in both Class II and Class III patients. Although the magnitude of change and relapse was numerically greater in Class III patients, the difference was not statistically significant. The occlusal plane angle changed in a similar direction but was not strongly correlated with the gonial angle change.

The Effect of Mouthwash Containing Chitosan/Zinc Oxide Nanoparticles on Surface Hardness and Color Change of Bleached Enamel

2026-02-15T07:58:49+00:00

Introduction: This study compared the effects of mouthwashes containing chitosan/zinc oxide nanoparticles, 0.2% chlorhexidine, 1.5% hydrogen peroxide (Colgate), and distilled water on the color and microhardness of bleached enamel.

Materials and Methods: Sixty bovine incisors were randomly divided into four groups (n = 15). After polishing and tea staining for six days, baseline color and microhardness were recorded using the CIELAB system and Vickers test. The enamel surfaces were bleached three times with 40% hydrogen peroxide. After ten days, measurements were repeated. The bleached samples were then immersed in 5 ml of each mouthwash twice daily for 14 days. The synthetic mouthwash contained 1% chitosan and 500 µg/ml zinc oxide nanoparticles. Color and microhardness were re-evaluated, and data were analyzed using the Kruskal–Wallis and post-hoc tests (α = 0.05).

Results: Significant color differences were observed between the mouthwash groups and water (p < 0.05), with no significant difference between chlorhexidine and the nanoparticle mouthwash. Both the nanoparticle and Colgate mouthwashes similarly increased enamel microhardness, while chlorhexidine caused a slight decrease.

Conclusion: Mouthwash containing chitosan and zinc oxide nanoparticles improved bleached enamel microhardness without affecting color stability compared to 0.2% chlorhexidine.

Radiographic Features of the Gubernaculum Tract in Impacted Teeth

2026-02-15T07:58:48+00:00

Introduction: The gubernaculum tract (GT) is a fibrous canal extending from the dental follicle to the alveolar crest, playing a crucial role in tooth eruption. This structure is not visible on conventional radiographs but can be reliably detected using cone-beam computed tomography (CBCT). This study aimed to evaluate the radiographic characteristics of the GT in impacted teeth using CBCT imaging.

Materials and Methods: In this cross-sectional study, CBCT scans of 85 patients (41 males, 44 females) with impacted teeth, referred to Mashhad Dental School between December 2020 and December 2022, were evaluated. The mean age was 21.4 ± 11.06 years (range: 8–48 years). The presence, dimensions, morphology, and attachment patterns of the GT were assessed in coronal and sagittal planes. Data were analyzed using Chi-square and Mann-Whitney U tests (α = 0.05).

Results: The GT was detectable in 36.7% of impacted teeth, with significantly higher visibility in males (P = 0.015). Canines were the most commonly affected teeth. The most frequent causes of impaction were abnormal eruption angle and tooth displacement. The GT most commonly showed central attachment in mesio-distal (64%) and bucco-lingual (76%) dimensions and occlusal attachment in the occluso-cervical direction (52%). Rectangular morphology was predominant (57%). Mean GT length and width were approximately 3.1–3.3 mm in both planes.

Conclusion: CBCT enables detailed visualization of the gubernaculum tract in impacted teeth. The presence and characteristics of the GT may serve as predictive indicators for eruption disturbances and assist in treatment planning decisions.

The Effect of Dried Fruits Consumption on Dental Plaque pH

2026-02-15T07:58:47+00:00

Introduction: In this randomized controlled clinical trial, we evaluated the effect of three dried fruits (date, raisin, and apricot) in comparison to 40% sucrose and sorbitol solutions (as positive and negative controls, respectively) on the pH of dental plaque.

Materials and Methods: 20 healthy dental students were requested to stop their oral hygiene 24 hours before and also avoid eating and drinking 2.5 hours before each session for five sessions. At each session, initial pH was measured using a pH meter electrode. Then, 20 grams of the randomly selected food was chewed, spread in the mouth, and swallowed after 5 minutes. The pH of the dental plaque was measured 1, 5, 10, 20, and 30 minutes after consumption. Data were analyzed using repeated-measure ANOVA (p < 0.05).

Results: Following consumption of date, raisins, and apricots, the plaque pH loss was significantly higher than that of sorbitol at both 1,5 minutes (p < 0.05), but there was no significant difference between these groups in comparison to sucrose in these intervals (P > 0.05). Comparison of pH changes after 10, 20, and 30 minutes did not show statistically significant differences between any of the groups (P > 0.05). In the sucrose and apricot groups, pH significantly decreased compared to its initial pH (P = 0.006 and P < 0.0001, respectively), but there was no significant difference in date, raisins, and sorbitol (P < 0.05).

Conclusion: The results indicated that date, raisin, and apricot could reduce dental plaque pH similar to sucrose and significantly higher than sorbitol. However, no significant difference was observed in reducing plaque pH at different time intervals between other dried fruits.

Evaluation of miR-155 Expression in Peripheral Blood Samples of COPD Patients

2026-02-15T07:58:46+00:00

Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible chronic inflammatory disorder characterized by the increased recruitment of monocytes, lymphocytes, and neutrophils. Beyond the lungs, COPD is associated with systemic inflammation, skeletal complications such as osteoporosis, and poor oral and periodontal health, all of which are clinically relevant in oral and maxillofacial practice. This study aims to investigate the changes in miR-155 expression in the peripheral blood of COPD patients compared to healthy individuals.

Materials and Methods: In this descriptive-cross-sectional study, 35 peripheral blood samples from COPD patients and 35 peripheral blood samples from healthy individuals were collected. RNA extraction was immediately performed, followed by Real-Time PCR to assess the changes in miR-155 expression.

Results: The miR-155 biomarker was positive in the peripheral blood of 25 out of 35 patients. In the group of healthy individuals, this biomarker was positive in 6 out of 35 cases. Statistical analysis of the positivity rate of this biomarker between the patient group and the healthy group showed a significant difference. Based on the findings of this study, the expression of miR-155 is increased in COPD patients compared to healthy individuals.

Conclusion: The miR-155 biomarker could potentially play an important role in the identification and diagnosis of COPD in patients. Given the growing evidence that COPD-related systemic and oral inflammation adversely affects periodontal status, jawbone health, and perioperative risk in oral and maxillofacial surgery, circulating miR-155 may also serve as a useful adjunct biomarker for risk stratification and multidisciplinary management of COPD patients in craniomaxillofacial settings. However, further studies are recommended.

Minimally Invasive Titanium Tacks-assisted Soft Tissue Stabilization for Lingual Flap Fixation and Vestibulo-Lingual Sulcoplasty

2026-02-15T07:58:45+00:00

Introduction: In general, most countries have a rising life expectancy and an aging population. This may lead to a need for more complicated oral rehabilitation based on dental implants. The vestibular depth, either on the buccal or lingual side of the edentulous ridge, is a crucial factor in the planning of dental implant therapy. Due to the existence of lingual anatomic features, the rebuilding of the lingual sulcus may be regarded as a more difficult procedure. A severe atrophic ridge of the mandible might be considered one of the most challenging clinical situations, which may lead to inadequate lingual sulcus depth. To increase the depth of the lingual sulcus, several methods were proposed; however, the present case describes a novel surgical approach using bone tacks to address the problem.

Materials and Methods: At the second stage of implant surgery, an inadequacy of keratinized tissue was observed in the buccal and lingual regions. To solve this problem, a flap was created with the keratinized tissue positioned mostly on the lingual side. A free gingival graft taken from the palatal area was used in the accordion approach for soft tissue management on the buccal side. For lingual side management, all existing keratinized tissue was apically fixed via a sharp dissection and two minimally invasive bone Tacks.

Results: A 10-month follow-up after vestibulo-lingual sulcoplasty showed a significant improvement in lingual (4 mm) and buccal (6 mm) vestibular depth when compared to the baseline measurements.

Conclusion: The tack-assisted soft tissue stabilization (TASS) technique showed the potential to surpass conventional suturing methods in lingual flap fixation, owing to its minimally invasive approach. This technique offers stable flap fixation, surgical convenience, efficiency, and the preservation of keratinized gingiva around the implants.

Massive Pediatric Mandibular Ewing’s Sarcoma Presenting with Life-Threatening Airway Obstruction: A Case Report

2026-02-15T07:58:44+00:00

Introduction: Ewing’s sarcoma is a rare and aggressive malignant small round-cell tumor that typically arises in the long bones and pelvis, with only 1–2% of cases involving the maxillofacial skeleton. Mandibular presentation is exceptionally uncommon and presents diagnostic and therapeutic challenges. This study reports a clinical case and includes a focused literature review. A 9-year-old girl presented with a large mandibular mass associated with airway compromise and recurrent intraoral bleeding. Clinical, radiological, and histopathological examinations were performed. The patient underwent urgent tracheostomy, near-total mandibulectomy with a lip-split incision and 2 cm margins, followed by immediate titanium plate reconstruction. Postoperative care included adjuvant multiagent chemotherapy. A literature review of cases reported between 1988 and 2025 was conducted for comparison. Surgery achieved complete tumor resection with immediate stabilization of the airway and mandibular continuity. Postoperative histopathology confirmed the diagnosis of Ewing’s sarcoma with clear margins. The patient recovered with stable airway function and initiated adjuvant chemotherapy. Review of published cases demonstrated variability in presentation, management, and survival outcomes. A summary of comparative mandibular cases is presented in Table 1. Pediatric mandibular Ewing’s sarcoma is rare but may present with airway emergencies. Early recognition, multidisciplinary planning, and prompt surgical intervention with airway protection are critical for favorable outcomes.

Long-Standing Pleomorphic Adenoma on a Female’s Palate: A Case Report

2026-02-15T07:58:43+00:00

This case report elucidates the significant oncologic risk associated with long-standing pleomorphic adenoma (PA), wherein the cumulative risk of malignant transformation to carcinoma ex pleomorphic adenoma (CXPA) escalates over time. It details the management of a 46-year-old female with a 25-year history of a palatal mass, which exhibited recent rapid growth—a key clinical warning sign. Diagnosis was confirmed via incisional biopsy following clinical and cone-beam computed tomography assessment, which revealed bony erosion. The patient was successfully treated with complete surgical excision, with final histopathology confirming a benign PA. The case underscores a critical clinical dilemma: delayed intervention for PA inadvertently heightens malignancy risk and complicates management. Consequently, this report strongly advocates for prompt diagnosis and definitive surgical excision upon initial detection of PA to preempt transformation and mitigate the profound prognostic implications of CXPA.

Successful Autotransplantation of a Mandibular Third Molar: A Case Report

2026-02-15T07:58:41+00:00

Tooth autotransplantation serves as a viable treatment option for replacing non-restorable teeth, particularly in young patients. This case report details the successful autotransplantation of a mandibular third molar to replace a severely damaged right second mandibular molar in a 21-year-old female. Following atraumatic extraction and meticulous handling to minimize extraoral time, the donor tooth was transplanted into the recipient site with optimal endodontic treatment and stabilization through a semirigid splint. One-year post-operation, the transplanted tooth exhibited normal occlusion, physiological mobility, and no signs of complications such as root resorption or ankylosis. This case underscores the importance of careful patient selection, surgical precision, and post-operative care in achieving successful outcomes in tooth autotransplantation, reaffirming its role as a valuable treatment modality in contemporary dentistry.

Parotid Sialolithiasis without Classical Clinical or Imaging Features: A Case Report

2026-02-15T07:58:40+00:00

Sialolithiasis of the parotid gland is an uncommon occurrence, accounting for only 10–20% of all salivary calculi. This report describes an unusual case of parotid sialolithiasis in a 42-year-old female who presented with a soft, tender, and ill-defined swelling on the left side of the face persisting for one year. Clinical examination showed no notable extraoral or intraoral swelling. Magnetic resonance imaging revealed an intensely enhancing lesion anterior to the left masseter region, suggestive of a soft tissue neoplasm such as lipoma, fibroma, or hemangioma. Histopathological examination aided in the identification of sialolith within the excretory duct, accompanied by extensive destruction of the serous acini by chronic lymphoplasmacytic infiltrate, aiding in the diagnosis. This case underscores the diagnostic challenge posed by parotid sialoliths lacking classical symptoms and the absence of its detection in diagnostic imaging.