Andrea Cicconetti

Background: Mandibular third molars (MTMs) are the most frequently impacted teeth and a common indication for oral surgery. Anatomical root variations can complicate extractions and increase intra- and postoperative risks. Methods: This narrative review analyzes the most frequent MTM root anomalies—supernumerary roots, fusion, taurodontism, C-shaped canals, hypercementosis, and apical dilacerations—focusing on their clinical implications and the diagnostic role of cone-beam computed tomography (CBCT). Results: Root anomalies markedly influence surgical complexity. Supernumerary roots and fusions may hinder elevator use and require modified sectioning. Taurodontism and hypercementosis prolong procedures and increase incomplete extraction risk. C-shaped canals and severe apical curvatures raise the likelihood of root fracture, displacement, or nerve injury. Panoramic radiographs, though common, provide limited two-dimensional detail and may underestimate anomalies. CBCT, by contrast, offers three-dimensional visualization, enhancing diagnosis, planning, and safety. Conclusions: Knowledge of MTM root anomalies, combined with selective CBCT use, is essential for optimizing surgical strategies, minimizing complications, and improving outcomes.

Background/Objectives: This study aimed to assess the long-term clinical performance of full-arch fixed restorations made of fiber-reinforced composite (FRC) supported by four ultra-short implants (4.0 × 5.0 mm) in patients with edentulous, atrophic mandibles. Methods: Ten patients were treated at Sapienza University of Rome and monitored over a 10-year period. Each case involved the placement of four plateau-design implants with a pure conometric connection and a calcium phosphate-treated surface. The final prostheses were fabricated using CAD/CAM-milled Trinia^® fiber-reinforced composite frameworks. Clinical parameters included implant and prosthesis survival, marginal bone level (MBL), peri-implant probing depth (PPD), and patient-reported outcome measures (PROMs). Results: Implant and prosthesis survival reached 100% over the 10-year follow-up. MBL data showed a minor bone gain of approximately 0.11 mm per 5 years (p < 0.0001). PPD remained stable under 3 mm, with a minimal increase of 0.16 mm over the same period (p < 0.0001). PROMs reflected sustained high patient satisfaction. No technical complications, such as chipping or framework fracture, were observed. Conclusions: Rehabilitation of the edentulous mandible with ultra-short implants and metal-free FRC prostheses proved to be a minimally invasive and long-lasting treatment option. The 10-year follow-up confirmed excellent implant and prosthetic outcomes, favorable peri-implant tissue health, and strong patient satisfaction. Nonetheless, further studies with larger sample sizes are needed to confirm these encouraging results and strengthen the clinical evidence.

Objectives: This study aimed to histologically evaluate, in humans, the orientation of collagen fibers around screw-less, Morse taper, hemispherical base abutments. Methods: This study was designed as an observational, case–control, clinical trial to evaluate the histological orientation of collagen fibers around implants. Biopsies of the peri-implant tissue were performed 8 (group A, control) or 16 (group B, test) weeks of implant uncovering, and histologically analyzed under optical microscope using Hematoxylin and Eosin, Masson, and Picro Sirius histochemical staining and a scanning electron microscope. Results: Eight patients were enrolled in this study and 16 biopsies were performed. All the biopsies were correctly analyzed. The histological examination of cross-sectional portions of the tissue taken 8 weeks after implant uncovering showed the almost complete absence of epithelial lining, while the connective tissue bundles in the superficial portion showed a lower circular pattern. The histochemical cross-section examination of the tissue taken 16 weeks after implant uncovering showed the partial presence of non-keratinizing epithelial lining at the implant site and the collagen bundles showed a greater organization, with a circumferential course around the abutment. At 8 weeks, the final histological analysis showed an average height of 1.01 mm for the keratinized epithelium, 0.83 mm for the non-keratinized epithelium, and 1.39 mm for the connective tissue. While, at 16 weeks, the values were 1.20 mm, 0.48 mm, and 1.11 mm, respectively. No statistically significant differences were found between the groups (p > 0.05). Conclusions: Histologically, there were not any differences in the height and profile of the gingiva between 8 and 16 weeks of healing after prosthesis delivery. Greater organization of the collagen fibers with a circumferential course around the abutment was found in the test group (16 weeks) compared with the control group (8 weeks).

The objective of this study is to present an uncommon case of adenomatoid odontogenic tumor (AOT) with an impacted maxillary canine, initially mimicking a follicular cyst. AOT is a rare odontogenic tumor, accounting for approximately 1% to 9% of all odontogenic tumors. It primarily occurs in the maxilla and is often associated with an unerupted permanent tooth. Follicular cysts, also known as dentigerous cysts, are benign odontogenic cysts that encase the crown of an unerupted or impacted tooth. We describe a case of AOT occurring in a 14-year-old male. Both the follicular cyst and adenomatoid odontogenic tumor (AOT) can exhibit similar clinical and radiographic presentations. It is crucial to accurately differentiate between the two to ensure appropriate treatment and prognosis.

The aim of this study was to assess the methodical protection of the lingual nerve via the use of a standardized step-by-step procedure in the surgical extraction of the lower third molar. A 5-year retrospective analysis of surgical third molar surgery conducted by third-year oral surgery specialty program students was performed in the oral surgery department of Policlinico Umberto I in Rome, from 2017 to 2022. All surgeries were carried out using a standardized step-by-step procedure to protect the lingual flap during the surgery. Every patient underwent a review on the initial postoperative day, and subsequently, one week after the surgery, coinciding with the removal of the sutures. During each postoperative visit, thorough examinations were conducted to assess any sensory nerve impairment of the inferior alveolar, lingual, or mylohyoid nerves. None of the cases reported postsurgical lingual nerve injury; there was zero incidence of lingual nerve paresthesia or dysesthesia. The systematic application of lingual flap protection proved to be an effective and reproducible approach for the surgical removal of lower third molars without raising the risk of lingual nerve sensory impairment, regardless of the operator’s experience.

Background: The aim of this study was to identify variations in the origins of the anterior branches of the external carotid artery (ECA) and to propose an update of the current classification. Methods: The study included 100 carotids arteries from fifty human donors. Classification of anterior branches of external carotid artery was performed according to Vaz’quez et al. (2009). Results: The configuration origins of anterior branches were found as follows: Type I, 82%; Type II, 1%; Type III, 16%. No Type IV was observed. The study identified seven subgroups of anterior branch variations in the external carotid artery. The most frequently observed variations were Subtype Ia in 40% (n = 20) of cases on the right side and Subtype Ib in 38% (n = 19) on the left side. In addition, a rare and previously unclassified configuration was observed in a 72-year-old male donor, where the carotid artery was pentafurcated on the left side. Conclusions: In conclusion, the presence of anatomical variants not previously included in the anterior external carotid artery branching classifications supports the consideration of a revision to the present classification system.

The aim of the study is to review the literature to observe studies that evaluate the extent of the thermal effect of different laser wavelengths on the histological evaluation of oral soft tissue biopsies. An electronic search for published studies was performed on the PubMed and Scopus databases between July 2020 and November 2022. After the selection process, all the included studies were subjected to quality assessment and data extraction processes. A total of 28 studies met the eligibility criteria. The most studied laser was the carbon dioxide (CO₂) laser, followed by the diode laser 940 nm–980 nm. Six studies were focused on each of the Erbium-doped Yttrium Aluminium Garnet (Er:YAG), Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) lasers, and diode lasers of 808 nm and 445 nm. Three studies were for the Potassium Titanyl Phosphate (KTP) laser, and four studies were for the Erbium, Chromium-doped Yttrium, Scandium, Gallium, and Garnet (Er,Cr:YSGG) laser. The quality and bias assessment revealed that almost all the animal studies were at a low risk of bias (RoB) in the considered domains of the used assessment tool except the allocation concealment domain in the selection bias and the blinding domain in the performance bias, where these domains were awarded an unclear or high score in almost all the included animal studies. For clinical studies, the range of the total RoB score in the comparative studies was 14 to 23, while in the non-comparative studies, it was 11 to 15. Almost all the studies concluded that the thermal effect of different laser wavelengths did not hinder the histological diagnosis. This literature review showed some observations. The thermal effect occurred with different wavelengths and parameters and what should be done is to minimize it by better adjusting the laser parameters. The extension of margins during the collection of laser oral biopsies and the use of laser only in non-suspicious lesions are recommended because of the difficulty of the histopathologist to assess the extension and grade of dysplasia at the surgical margins. The comparison of the thermal effect between different studies was impossible due to the presence of methodological heterogeneity.

Detailed knowledge about the normal anatomy and its variations is a necessity in good clinical and surgical practice. The case we are reporting here shows a rare configuration origin of the superior thyroid, lingual and facial arteries arising directly from a pentafurcated common carotid artery. A fresh frozen latex-infiltrated cadaver was dissected. The superior thyroid artery, the lingual artery and the facial artery were found to be directly detached from the common carotid artery as terminations of the five terminal rami variations. The current classifications of anatomical variants are discussed in detail in relation to this case.

(1) Background: The anatomical variations of neurovascular canals that are encountered in oral surgery are often overlooked by anatomy textbooks or provided with insufficient information. The aim of this study is to analyze the most common variations, describing their morphology, prevalence and clinical implications. (2) Methods: A review of published literature from the 20th century onwards was performed using the PubMed electronic database as well as anatomical textbooks. The variations being investigated were: retromolar canal (RMC) and foramen (RMF), accessory mental foramen (AMF), midline (MLF) and lateral (MLF) lingual foramina and canalis sinuosus (CS). (3) Results: Anatomical variants of neurovascular canals and foramina have a significant incidence and important clinical implications in the most common oral surgery procedures such as third molar extraction, bone harvesting and implantology. (4) Conclusions: Knowledge of these variables is highly important both for students to have a more accurate anatomical awareness and for professional surgeons to be able to provide better diagnoses and prevent complications during oral surgery techniques.