Tomasz Wach

Aim: The aim of this review was to highlight the ongoing challenge of medication-related osteonecrosis of the jaw (MRONJ) in everyday clinical practice. Materials and Methods: This review was conducted following a structured narrative approach, utilizing PubMed as the primary research database. The following keywords and their combinations with Boolean operators (AND, OR) were used: MRONJ, osteonecrosis, bisphosphonates, bone density conservation agents, denosumab. The literature search spanned publications from 2003 to April 2025, corresponding to the first description of bisphosphonate-related osteonecrosis of the jaw by Marx and subsequent evolution of the diagnostic and therapeutic concepts.The final set of 32 articles were reviewed and synthesized narratively. Conclusions: Management strategies are examined across disease stages, from conservative measures and pharmacologic interventions to surgical resection and reconstruction. Emerging therapies, including teriparatide, hyperbaric oxygen, platelet-rich preparations, and cryosurgery, show promise as adjunctive treatments. Prevention remains paramount, emphasizing pre-treatment dental evaluation, patient education, and interprofessional collaboration.

Background: Pediatric craniofacial fractures are difficult to assess on computed tomography (CT) because growth-related anatomy and subtle fracture patterns can obscure clinically relevant findings. We evaluated a lightweight 2.5D deep-learning approach after expansion of an earlier 63-examination pilot. Methods: The retrospective cohort comprised 209 fully anonymized pediatric craniofacial CT examinations from 209 unique patients, with exactly one examination per patient (103 fracture-positive and 106 fracture-negative). The center contributions were Katowice (n = 135), Olsztyn (n = 34), and Lodz (n = 40). Central axial, coronal, and sagittal reconstructions were stacked as a three-channel input to an ImageNet-initialized ResNet-18. The historical experiment retained a stratified 146/63 training/development–validation split. Reviewer-requested post hoc analyses comprised descriptive calibration, controlled retraining without vertical flipping, three repetitions of five-fold cross-validation, input and initialization ablations, and leave-one-center-out testing. Results: On the 63-examination development-validation subset, AUROC was 0.934 (95% CI 0.862–0.989) and AUPRC was 0.938 (95% CI 0.878–0.987). Repeated five-fold cross-validation yielded mean AUROC 0.899 (SD 0.033) and AUPRC 0.891 (SD 0.040). Leave-one-center-out AUROC varied from 0.604 (SD 0.025) for Katowice to 0.793 (SD 0.097) for Lodz; the Olsztyn holdout permitted sensitivity-only assessment. Conclusions: The original split and repeated cross-validation support an internal feasibility signal, but the post hoc center-held-out results show that performance was not uniformly transportable across institutions. The findings do not establish external validity or clinical utility.

Background/Objectives: Dental implants are a predictable treatment modality for missing teeth, and the crown emergence angle may affect peri-implant tissue health. This study evaluated the influence of crown emergence angle on marginal bone loss (MBL) and the corticalization index (CI) at 3-month and 5-year follow-ups, considering restoration type and implant location. Methods: Records from 155 patients treated with MIS implants were analyzed retrospectively. The primary outcome was marginal bone loss (MBL) at 60 months after loading; secondary/exploratory outcomes included MBL at 3 months and the Corticalization Index (CI) at 3 and 60 months. Three prosthodontic restorations were included: single crowns, splinted crowns, and bridges. Intraoral radiographs were used to measure crown emergence angle, MBL, and CI. Results: Recorded emergence profile was 32° ± 10°. Marginal bone loss increased over time but did not differ significantly among restoration groups. No significant relationship was found between emergence angle and MBL for single crowns (p = 0.369) or splinted crowns (p = 0.176). For bridges, a weak but statistically significant relationship was observed (p = 0.042). CI increased over time in all groups, without significant differences by restoration type. Restoration type was significantly associated with anterior/posterior implant location (p = 0.0004): single crowns predominated anteriorly, whereas splinted crowns and bridges were more frequent posteriorly. No significant association was found for maxilla versus mandible (p = 0.077). Conclusions: Within the limitations of this retrospective radiographic analysis, no clinically meaningful association was observed between emergence angle and MBL for single or splinted crowns. For bridges, the observed association was statistically significant but weak and should be interpreted cautiously. Other biological, biomechanical, and systemic factors may play a greater role in peri-implant tissue stability than emergence angle alone.

Background: Osteoporosis is a prevalent condition characterized by low bone mass and altered microarchitecture, increasing fracture risk. Early detection remains challenging, as conventional methods such as DXA are limited to specialized settings and often detect disease only after a fracture. Radiomics and three-dimensional (3D) imaging techniques, such as CBCT, may provide novel approaches for assessing bone quality. Methods: This pilot study analyzed 68 CBCT scans from adult patients (41 females, 27 males; mean age 57 years). Three-dimensional regions of interest (ROIs) were delineated in seven maxillofacial and mandibular sites (total 309 ROIs). Radiomic texture features were extracted and compared with corresponding T-scores from DXA measurements. Additionally, synthetic 3D reference phantoms with controlled variations in density, trabecular connectivity, and structural anisotropy were generated to evaluate the sensitivity of texture features to microarchitectural changes. Results: Several radiomic features, including GLCM-, ARM-, and Gradient-derived parameters, demonstrated consistent monotonic trends correlating with bone density and microstructural deterioration. Differences in feature values were observed across healthy, osteopenic, osteoporotic, and advanced osteoporotic states. Reference phantoms confirmed that the observed trends were attributable to structural differences rather than imaging variability. Features such as Sum Variance and Correlation exhibited potential as early indicators of microarchitectural degradation. Conclusions: Three-dimensional CBCT texture analysis may provide a non-invasive, supplementary tool for assessing bone quality and detecting early osteopenic changes. Further studies with larger cohorts are warranted to validate radiomic markers and develop predictive indices for osteoporosis screening.

Background. Since there is no ideal classification of mandibular condyle fractures, there have been several attempts to make this issue clearer for clinicians as well as facilitating communication. In 2018, new classification including improved arrangement of the reference lines was introduced. The aim of the study is to present a two-center evaluation of the effect of different classification types on the reported incidence of mandibular condyle fractures in a five times larger research sample than previously. Materials and methods. Two classification types were validated using a series of 431 cases from Ukrainian and Polish databases. Information was obtained from clinical notes and computed tomography scans of each patient using a standardized data collection form, then statistical analysis was performed. Results. It was noted that the difference between classifications result varied more in Ukraine than in Poland (p < 0.01); thus, Ukrainian data may be more susceptible to AO & SORG & IBRA classification complexities. In Poland, 2018 Kozakiewicz scheme is probably better recognizable, whilst in Ukraine it may significantly improve the representation of mandibular neck fractures in epidemiological descriptions. Conclusions. At the moment, both the AO & SORG & IBRA and Kozakiewicz classifications are equally effective, but the meaning of an established diagnosis is slightly different in each of them due to localization of reference lines.

Background: Head and neck squamous cell carcinoma (HNSCC) remains the seventh most common cancer worldwide, characterized by late-stage diagnosis and poor 5-year survival rates. Oral squamous cell carcinoma (OSCC) is the most prevalent subtype. The identification of robust diagnostic, prognostic, and predictive markers is essential for personalized treatment monitoring. Methods: Following PRISMA and PICO standards, we conducted a comprehensive review of studies published over the past 10 years across PubMed/MEDLINE, Scopus, and Web of Science. The selection process was facilitated by AI-powered tools (Rayyan QCRI), and study quality was assessed using NOS or QUIPS. Results: 34 articles (including meta-analyses and original trials) were identified. Established clinical markers, such as p16-positivity (HR ≈ 0.55) and PD-L1 (CPS), remain significant. However, the molecular landscape is expanding to include high-risk lncRNA signatures (HR ≈ 2.50), immune checkpoints such as TIGIT (HR ≈ 1.85), and genomic alterations, including IL-10 promoter polymorphisms. We highlight that epigenetic silencing of p16 affects only about 25% of patients, while metabolic regulators (e.g., GLUT-1) and protein markers (e.g., MASPIN) offer critical predictive value for therapy response. Conclusions: The diagnostic and predictive paradigm is shifting toward a multi-omic approach that integrates DNA, RNA, proteins, and metabolic indicators. Future clinical use will rely on AI-driven multimarker panels and non-invasive liquid biopsies to enable real-time monitoring and de-escalation of treatment strategies.

Background: Marginal bone loss (MBL) is a condition leading to implant loss and treatment failure. MBL is one of the main complications in dental implantology. The aim of this research is to show the method that can predict bone loss around implants and protect patients from implant loss. Methods: A total of 1026 intraoral standardized radiographs of dental implants were included in this study. A total of 2052 peri-implant jawbone image samples were analyzed in MaZda 4.6 software. A new scale was calculated and described. MBL was measured, and groups of patients were compared. Results: After 3 months of functional loading, the Corticalization Index (CI) was calculated to be 210.70 ± 149.78 and increased after 60 months to 277.88 ± 198.78. In the 60-month observation, MBL was 0.85 mm ± 1.29 mm, and it has been noted that low MBL is associated with CI lower than 300, high MBL with CI higher than 500, and critical high MBL appeared when CI was higher than 1200. Conclusions: Authors created a new scale, and research showed that the specified CI in our scale may predict MBL around dental implants with a five-year forecast horizon. It allows us to implement specific treatment and protect implants from loss.

Background/Objectives: Children’s unique physiological and behavioral needs require individualized treatment planning. It seems reasonable to investigate treatment options for recurrent temporomandibular joint (TMJ) dislocation and assess their outcomes. This review was conducted with the purpose of identifying recent therapeutic approaches for TMJ dislocation in pediatric patients and evaluating their effectiveness. Methods: Searches were conducted on 21 September 2025, using BASE, PubMed, and Scopus. The review included studies with measurable outcomes, published between 2000 and 2025, that focused on patients under the age of 18 with recurrent TMJ dislocation. Studies with unclear diagnoses or undefined treatment methods were excluded. Risk of bias was evaluated using the Joanna Briggs Institute’s critical appraisal tool. The results were tabulated. Results: Based on the inclusion criteria, nine studies were included: one case-control study, three case series, and five case reports. Invasive treatment methods applied in pediatric patients were reported in two of those. Minimally invasive and conservative treatment methods were most frequently described, with botulinum toxin injections being the most commonly reported minimally invasive approach. Conclusions: Research revealed that conservative and minimally invasive methods are preferred in pediatric patients’ treatment. Due to the heterogeneity and limited number of available literature, consistent conclusions regarding the effectiveness of different treatment methods for recurrent TMJ dislocation in children could not be drawn. This study received no funding. PROSPERO ID number: CRD420251139493.

Background: An adequate OSCC macroscopic resection margin (MRM) is essential for effective treatment. This study analyzed the effects of formalin fixation (FF) on the MRM. Material and Methods: A total of 42 patients were enrolled in this study. Tumors from the floor of the mouth (FOM; n = 23), the tongue (TC; n = 10), and the maxilla (MT; n = 9) were studied. A 3D scanner was used to create virtual models, and further analysis was conducted according to the established protocol. Results: The most significant shrinkage was observed in the TC (MRM n = 121; Med. = 1.5 mm; p val. = 7.05 × 10⁻¹⁸), with a maximum shrinkage of 28%. For the FOM (n = 262; Med. = 0.8 mm; p val. = 6.76 × 10⁻¹⁸), the greatest MRM shrinkage was 26%. In the MT group (n = 91; Med. = 0.9 mm; p val. = 2.69 × 10⁻⁹), the shrinkage was 18.7%. Among MRMs >8 mm (n = 159), FF led to 58.5% of them shrinking to ≤8 mm, resulting in a false decrease in the safe MRM (p val. = 1.11 × 10⁻²⁷). Overall, the average shrinkage for all specimens was μ= 2.57 mm (p val. = 8.89 × 10⁻¹⁰) alongside and μ= 2.35 mm (p val. = 4.09 × 10⁻⁶) across. The tumors themselves showed minimal changes: μ= 0.69 mm (p val. = 9.73 × 10⁻³) alongside and μ= 0.8 mm (p val. = 2.52 × 10⁻⁷) across. Conclusion: Formalin fixation (FF) caused the shrinkage of the OSCC MRM, particularly in tongue cancers. Even after proper surgical excision in the postoperative results, the number of normal MRMs was underestimated. This should be considered when interpreting the results of surgical treatment. However, FF had a minimal impact on the overall shrinkage of the tumors themselves.

Objectives: This review aimed to gather and summarize the existing information on the clinical application of allogeneic umbilical and placental derivatives in the treatment of temporomandibular joint disorders. Methods: Research on the impact of the use of umbilical and placental derivatives on reducing pain and improving mobility in the temporomandibular joint was included in the article. Medical databases, including ACM, BASE, Cochrane, Scopus, Google Scholar, ClinicalTrials.gov, and PubMed, were searched. The final search was conducted on 20 October 2024. Results: Out of the 43 records found, 5 were considered eligible for further analysis and showed that the use of placental and umbilical derivatives has the greatest potential in the treatment of ankylosis. The intra-articular administration of these tissues into the TMJ brings beneficial results, but they are similar to other, parallel methods, such as PRP or corticosteroids. Conclusions: The studies discussed may guide researchers in expanding clinical trials, particularly by including more patients with TMDs, and have promising potential in ankylotic disorders, where amniotic membrane use has shown clear benefits.