Tommaso Lombardi

Background: Solitary bone cysts (SBCs) are non‐epithelialized intraosseous cavities that predominantly affect the posterior mandible of children and young adults. Their occurrence in the anterior mandible is uncommon, and available data remain limited. Aim: This study aimed to systematically review the available literature on SBCs of the anterior mandible, synthesizing epidemiological, clinical, radiological and surgical findings. In addition, two well‐documented clinical cases are presented to illustrate the diagnostic challenges and therapeutic outcomes associated with this uncommon yet clinically relevant entity, emphasizing the importance of a cautious and structured diagnostic approach. Methods: A systematic literature search was conducted in PubMed, Embase and Web of Science databases in accordance with PRISMA guidelines. Studies reporting SBCs exclusively located in the anterior mandible were included. Data extraction focused on patient demographics, clinical presentation, lesion localization, radiographic characteristics, treatment modalities and follow‐up outcomes. Results: Twenty articles published between 1990 and 2026 were included and two documented clinical cases have been added, comprising 56 individual cases. The mean age at diagnosis was 16.8 years (range: 9–41 years), with a slight female predominance. Most lesions were asymptomatic and incidentally discovered. Lesion localization was specified in 24 cases, while laterality was not reported in 32 cases. Radiographically, all lesions were described as unilocular radiolucency, although detailed radiographic features were not available in 16 cases. Surgical exploration with curettage was performed in all cases, except in one study of 14 cases where the treatment is not specified. Follow‐up outcomes were reported in 21 cases, all demonstrating complete clinical and radiographic resolution. No recurrences were observed. Conclusion: SBCs of the anterior mandible primarily affect young patients and show an excellent prognosis following surgical exploration with curettage.

A 66-year-old female patient was referred to the oral surgery unit for the enucleation of a radicular cyst centered at the apex of the necrotic tooth 12. Initial panoramic and intraoral periapical radiographs suggested a persistent periapical cystic lesion despite previous root canal treatment. However, cone-beam computed tomography (CBCT) revealed the coexistence of two distinct lesions within the same anatomical region: a periapical lesion associated with tooth 12, radiographically suggestive of a radicular cyst, and a second well-defined lesion centered within the nasopalatine canal, consistent with a nasopalatine duct cyst and not detectable on conventional radiographs. This unusual association represented a significant diagnostic challenge, as the clinical and two-dimensional radiographic findings initially suggested a single persistent endodontic lesion. Surgical enucleation of both lesions was performed. Histopathological examination confirmed the diagnosis of a nasopalatine duct cyst for the lesion located within the incisive canal, whereas the periapical lesion was confirmed as a radicular cyst. Postoperative follow-up at 10 days, 3 months, 6 months, and 1 year demonstrated satisfactory healing without recurrence or complications. This case highlights the diagnostic value of CBCT in the identification of coexisting odontogenic and non-odontogenic lesions of the anterior maxilla, particularly when conventional radiography is insufficient to distinguish separate pathologies.

Background/Objectives : Hyalinizing clear cell carcinoma (HCCC) and clear cell odontogenic carcinoma (CCOC) are rare clear cell neoplasms with overlapping histopathological features. This study aimed to compare their clinicopathological characteristics, particularly in anatomically challenging sites such as the palate and maxilla. Methods: Three analyses were performed. First, an unpublished series of five HCCC and three CCOC cases was evaluated for diagnostic histopathological features. Second, a PRISMA-ScR-guided literature review of 58 HCCCs and 45 CCOCs restricted to tumours arising in intraoral minor salivary glands, major salivary glands and gnathic bones published between 2000 and 2025 was conducted using PubMed. Third, a sub-analysis compared palatal HCCC and maxillary CCOC (25 vs. 14 cases), integrating literature and unpublished cases. Results: The case series and overall literature review showed that HCCC and CCOC predominantly occurred in adults (mean age, case series: 50.8 years; literature: 56.33 years for HCCC and 61 vs. 54.11 years for CCOC) with a female predilection (case series: 60%; literature: 68%) and generally exhibited clinically indolent behaviour. The site of occurrence, soft tissue (HCCC) versus intraosseous location (CCOC), was the principal distinguishing feature. No marked differences were observed between the two tumours in either the overall literature analysis or the site-specific sub-analysis. However, CCOC at maxillary/palatal sites presented with a higher number of larger lesions and higher number of cases with nodal metastasis compared with HCCC, most probably indicating delayed clinical detection rather than intrinsic aggressiveness of CCOC. Histopathological overlap was considerable; however, diffuse dense hyalinization (4/5), focal glandular differentiation (2/5), mucous-secreting cells (4/5) and salivary gland association (5/5) favoured HCCC, whereas patchy hyalinization (3/3), larger tumour lobules (3/3) and peripheral palisading (2/3) favoured CCOC. Conclusions: HCCC and CCOC demonstrate clinicopathological similarities and shared EWSR1 rearrangement, supporting a close biological relationship. The considerable overlap between these tumours support the hypothesis that CCOC may represent the intraosseous counterpart of HCCC and highlight the importance of integrated clinicopathological assessment and further clarification in future WHO classifications.

Dental implant placement has evolved from conventional freehand techniques toward digitally guided workflows integrating cone-beam computed tomography (CBCT), computer-aided design/computer-aided manufacturing (CAD/CAM), and dynamic navigation systems. Although guided surgery improves positional accuracy, its clinical relevance compared with freehand placement remains debated. This narrative review, based on a systematic and structured literature search following predefined selection criteria, analyzes studies published between 2000 and 2025 comparing guided and freehand implant placement regarding accuracy, survival, complications, biological outcomes, and workflow efficiency. Searches of PubMed/MEDLINE, Embase, and Web of Science identified 40 eligible human clinical studies for qualitative synthesis. Guided placement consistently demonstrated greater positional accuracy, with angular deviations of approximately 2–4° versus 5–9° for freehand placement and linear deviations reduced by about 1 mm. Nevertheless, implant survival rates were high and comparable for both techniques, generally exceeding 95% across short- and medium-term follow-up. Overall complication rates were low; guided approaches reduced anatomical risk and improved prosthetic predictability in complex or multi-implant cases, while freehand placement allowed greater intraoperative flexibility and tactile feedback, potentially optimizing primary stability in variable bone conditions. Marginal bone loss and peri-implant tissue outcomes were similar between approaches. Guided workflows required additional planning time and costs but enhanced reproducibility in complex rehabilitations. Guided and freehand implant placement should therefore be considered complementary strategies, with optimal outcomes depending on case selection, surgical expertise, and the balanced integration of digital technologies into contemporary implant practice.

Background: Misdiagnosis on radiographic examination is a significant risk for dentists and medical practitioners. This review focuses on an anatomical variation of the maxillary sinus that can mimic a radicular (periapical) cyst. Knowledge of morphological variations, their prevalence, and the radiographic criteria distinguishing these variations from true lesions is essential to ensure accurate diagnosis and appropriate treatment and to prevent unnecessary or potentially harmful interventions. Objective: The aim of this study was to perform a systematic literature search of published cases and to present a clinical case illustrating a specific maxillary sinus variant, an enlarged sinus with a prominent alveolar recess that can mimic a periapical cyst on radiographs. Methods: After defining specific MeSH terms, a systematic literature search was conducted across three databases: Web of Science, PubMed, and Embase. Relevant articles reporting on enlarged maxillary sinuses with alveolar recesses resembling radicular cysts were identified and analyzed. Results: Four articles describing the presence of an enlarged maxillary sinus with an alveolar recess resembling a periapical cyst were extracted from the literature. Conclusion: Knowledge gaps regarding the alveolar recess of the maxillary sinus remain in the literature and should be addressed to avoid misdiagnosis. The findings also underscore the importance of three‐dimensional imaging, such as CT or CBCT, for accurate detection of this anatomical variant.

Emerging artificial intelligence (AI) and robotic surgical technologies have the potential to influence digital implant dentistry substantially. As a narrative review, and building on the foundations outlined in Part I, which described current digital tools and workflows alongside their persistent interface-related limitations, this second part examines how AI and robotics may overcome these barriers. This synthesis is based on peer-reviewed literature published between 2020 and 2025, identified through searches in PubMed, Scopus, and Web of Science. Current evidence suggests that AI-based approaches, including rule-based systems, traditional machine learning, and deep learning, may achieve expert-level performance in diagnostic imaging, multimodal data registration, virtual patient model generation, implant planning, prosthetic design, and digital smile design. These methods offer substantial improvements in efficiency, reproducibility, and accuracy while reducing reliance on manual data handling across software, datasets, and workflow interfaces. In parallel, robotic-assisted implant surgery has advanced from surgeon-guided systems to semi-autonomous and fully autonomous platforms, with the potential to provide enhanced surgical precision and reduce operator dependency compared with conventional static or dynamic navigation. Several of these technologies have already reached early stages of clinical deployment, although important challenges remain regarding interoperability, standardization, validation, and the continuing need for human oversight. Together, these innovations may enable the gradual convergence of digital technologies, real-time-assisted, unified, end-to-end implant prosthodontic workflows, and gradual automation, while acknowledging that full automation remains a longer-term prospect. By synthesizing current evidence and proof-of-concept applications, this review aims to provide clinicians with a comprehensive overview of the AI and robotics toolkit relevant to implant dentistry and to outline both the opportunities and remaining limitations of these disruptive technologies as the field progresses towards seamless, fully integrated treatment pathways.

Advances in digital dental technologies have transformed implant therapy from analog, stepwise processes into advanced, data-driven workflows spanning diagnosis, planning, surgery, and prosthetic delivery. Contemporary digital implantology integrates multiple techniques, tools, and multimodal datasets into comprehensive diagnostic models and treatment workflows, enhancing implant placement accuracy, procedural efficiency, patient experience, and interdisciplinary coordination. However, integration remains constrained by fragmented datasets, diverse software platforms, and parallel surgical and prosthetic streams. These interfaces often require manual user intervention to convert, process, and align data, thereby increasing the risk of data loss, artifact generation, misalignment, and error accumulation, which may impact implant and prosthetic restorative outcomes. Similarly, implant and prosthetic planning steps continue to rely on subjective, non-standardized user input, requiring advanced experience and training. This narrative review synthesizes current evidence and technical developments in digital implant dentistry based on literature searches in PubMed, Scopus, and Web of Science, with emphasis on publications from 2010 onward, prioritizing systematic reviews, randomized clinical trials, and technical reports focusing on key technological innovations. It presents the current state of the art in digital implantology and identifies major workflow interfaces that constrain seamless, end-to-end integration. This part I summarizes contemporary tools and approaches in digital implant technology. In contrast, Part II of this series will address the emerging roles of artificial intelligence and robotics in overcoming these limitations and advancing toward fully integrated digital implant prosthodontic workflows. Overall, current digital implant workflows are clinically reliable and are equivalent to, or often superior to, conventional approaches in terms of efficiency and accuracy. Nevertheless, their full potential remains limited by persistent software, data, and process interface barriers.

Background/Objectives: Oral focal mucinosis (OFM) and solitary cutaneous focal mucinosis (SCFM) are rare, benign lesions characterized by localized mucin deposition in the stromal connective tissue. While both share similar histological features, they occur in distinct anatomical sites and clinical contexts and have not been directly compared in the literature. Method: This study presents a case series of 39 OFM cases diagnosed over 25 years, supplemented by a literature review of previously reported OFM cases, and compares the combined data with published cases of SCFM. The literature-based analysis included 116 OFM cases published in four articles and 138 cases of SCFM published in five articles. Demographic and clinical data were extracted and analyzed, including age, sex, lesion location, size, duration, symptoms, clinical impression, treatment, and recurrence. Results: The mean age of OFM patients was 41 years, with a slight female predominance, most commonly affecting the gingiva. SCFM cases were more common in males, with a higher mean age of 52 years and frequent occurrence on the extremities and trunk. Both lesions were predominantly asymptomatic and managed by conservative excision. Due to its rare occurrence and nonspecific clinical presentation, both entities were frequently clinically misdiagnosed. Conclusions: In conclusion, this is the first study to directly compare OFM with SCFM and represents the largest series of OFM reported to date. The study provides new comparative insights into SCFM and OFM, highlighting differences in age, gender, lesion site, size, and symptomatology. SCFM predominantly affects older males on the extremities, whereas OFM occurs in younger females, mainly in the gingiva, with larger, sometimes symptomatic lesions, and with a very low recurrence rate.

Peri-implant diseases are plaque-associated pathologic condition characterized by the inflammatory process affecting hard and soft tissues around endosseous dental implants. These frequent complications are the result of an imbalance between the host response and bacterial challenge, which may affect the peri-implant mucosa “mucositis” or also involve the supporting bone “peri-implantitis”. Clinical aspects/signs of peri-implant diseases should be detected at each recall visit as well as swelling, erythema, bleeding on probing and suppuration. Moreover, many risk factors are involved in the development of peri-implant disease and most patients may have multiple risk factors including smoking, substance use disorders, socio-economic status, mental health disorders, old age and poor home dental care. In addition, iatrogenic, local, systemic, type of prosthesis and implant site-specific factors have been involved in the development of such complication. Clinicians must be aware of and recognizes the importance of such risk factors in order to manage them appropriately. This chapter aims to provide clinicians with an up-to-date understanding of peri-implant disease.

Background: Venous malformation, formerly designated as cavernous hemangioma, is a rare vascular lesion characterized by significant endothelial cells proliferation, predominantly affecting young females. Diagnosis is challenging due to its low incidence and variety of clinical, radiological, and histological presentations. Objectives: The aim was to review the current scientific understanding of maxillary venous malformation based on the available literature and present an additional rare case of venous malformation of the upper maxilla. Methods: A systematic review was conducted across PubMed, Google Scholar, and Embase databases for studies published between January 1990 and April 2025. Inclusion criteria encompassed meta-analyses, systematic reviews, randomized controlled trials, non-randomized controlled trials, cohort studies, and case reports describing cavernous hemangiomas and venous malformation of the maxilla. All clinical and radiological characteristics were considered. Results: Out of 10,021 studies identified through our database search, 22 met the inclusion criteria, describing 28 (29 with our case) clinical cases of maxillary venous malformation. Conclusions: Maxillary venous malformation presents complex and varied clinical and radiological aspects, which are crucial for preoperative assessment and management. Appropriate measures may be necessary to prevent bleeding complications during lesion removal. To the best of our knowledge, this is the first comprehensive review on venous malformation of the maxilla. In addition, we report an unusual case identified incidentally during implant planning and successfully removed through isolated bone augmentation.