Marius Pricop

Background/Objectives: Evidence regarding changes in oral and oropharyngeal squamous cell carcinoma (SCC) care across the COVID-19 pandemic remains limited, particularly in Eastern Europe. This study evaluated temporal changes in surgical admission volume, operative complexity, and comorbidity burden before, during, and after the pandemic at a Romanian tertiary maxillofacial center. Methods: This retrospective mixed-methods study included 248 admissions for oral and oropharyngeal SCC between 2018 and 2024. A structured administrative database was deterministically linked to narrative discharge summaries. Admissions were grouped into pre-pandemic (n = 117), pandemic (n = 93), and post-pandemic (n = 38) periods. Statistical analyses included between-period comparisons, segmented interrupted time-series analysis, and multivariable logistic regression. Qualitative thematic analysis was used to contextualize surgical and perioperative complexity. Results: Mean monthly admissions decreased from 4.9 before the pandemic to 2.6 during the pandemic and 1.6 in the post-pandemic period. Interrupted time-series analysis identified a significant declining baseline monthly trend (IRR 0.973, 95% CI 0.950–0.996; p = 0.024), without a significant immediate level change or post-onset slope change. Neck dissection increased from 23.9% before the pandemic to 39.8% during the pandemic (p = 0.045) and was independently associated with the pandemic/post-pandemic period (adjusted OR 1.87, 95% CI 1.06–3.29; p = 0.030). Qualitative findings identified recurrent codes related to surgical complexity, reconstruction, extensive nodal surgery, comorbidity burden, and perioperative management. Conclusions: Oral and oropharyngeal SCC surgical admissions showed a significant declining baseline trend between 2018 and 2024, while patients treated during and after the pandemic had higher adjusted odds of undergoing neck dissection. The findings support sustained oncological surveillance, timely referral, and multidisciplinary perioperative planning. Further multicenter studies incorporating standardized tumor–node–metastasis (TNM) staging and human papillomavirus (HPV) documentation are required to confirm these observations.

Modern prosthetic dentistry has been significantly reshaped by adhesive dentistry, CAD/CAM technologies, and advanced ceramic materials, leading to the development of minimally invasive all-ceramic restorative approaches. However, the longevity of the adhesive interface is fundamental to the long-term effectiveness of these restorations. With a focus on bond durability and clinical performance, this narrative review aims to evaluate modern adhesive strategies, tooth preparation requirements, and cementation techniques in all-ceramic minimally invasive restorations. Methods: A narrative review of the literature was performed using Google Scholar, Web of Science, and PubMed/MEDLINE databases. Publications from 2000 to 2026 were analysed. In vitro research, narrative reviews, and systematic reviews related to adhesive systems, resin cements, CAD/CAM materials, and minimally invasive prosthodontic principles were the core subjects of the research. Results: The findings indicate that material selection, surface conditioning techniques, and cementation methods have a significant impact on the clinical effectiveness of all-ceramic restorations. Retention and marginal sealing are greatly enhanced by resin-based adhesive systems. Nevertheless, hydrolytic degradation, procedure sensitivity, and substrate-related factors remain a challenge to the adhesive interface. Advances in CAD/CAM and ultra-conservative designs, like occlusal veneers and partial-coverage restorations, have increased treatment alternatives while ensuring acceptable functional and aesthetic results. Conclusions: Minimally invasive all-ceramic restorations represent a conservative and clinically effective treatment approach in modern prosthodontics. Their long-term performance is primarily dependent on adhesive interface stability and adherence to evidence-based clinical protocols. Continued developments in adhesive materials and ceramic systems are expected to improve bond durability and broaden clinical indications.

Background and Objectives: The SARS-CoV-2 pandemic disrupted oral and maxillofacial surgery (OMS) services worldwide because of the high aerosol-generating nature of head-and-neck procedures, restricted access to elective dental care, and systemic reallocation of hospital resources. Continuous longitudinal multi-year data covering both the pandemic and the post-pandemic phases from regional Romanian (and more broadly central and southeastern European) emergency centers remain scarce. We aimed to quantify the impact of the pandemic on OMS activity in a large Romanian regional referral center and to evaluate post-pandemic resilience. Materials and Methods: We conducted a retrospective single-center study of all inpatient admissions to the OMS Clinic of a tertiary emergency hospital in western Romania between 1 January 2018 and 31 December 2024. Three periods were pre-specified: pre-pandemic (2018–2019), pandemic (2020–2022) and post-pandemic (2023–2024). A Newey–West segmented interrupted-time-series (ITS) regression and a negative-binomial monthly count model with Fourier seasonality were fitted; length of hospital stay was further analyzed with a multivariable gamma-log generalized linear model adjusted for age, sex, county, primary ICD-10 chapter and total ICD-10 codes. Variables analyzed included case volume, demographics, primary and secondary ICD-10 diagnoses, length of hospital stay (LOS), case complexity (total ICD-10 codes per admission) and in-hospital mortality. Results: A total of 11,628 inpatient admissions corresponding to 8084 unique patients (56.5% male; mean age 52.2 ± 19.2 years) were analyzed. Compared with the pre-pandemic baseline (mean 2037 admissions/year), annual volume dropped by 45.1% in 2020, 44.0% in 2021 and 32.3% in 2022, with a nadir of −76% during the first state of emergency (April 2020; n = 34 admissions). Recovery was rapid; 2024 exceeded the pre-pandemic baseline by +10.1% on raw counts and by +16.2% on admissions per 100,000 catchment population using year-specific INS denominators. The segmented ITS regression confirmed an immediate level drop of −114.2 admissions/month in March 2020 (95% CI −133.1 to −95.3; p < 0.001) and a positive post-intervention slope of +2.06 admissions/month (95% CI 1.23–2.88; p < 0.001), with observed monthly volume returning to the counterfactual projection by October 2023. The case mix shifted significantly (χ² = 406.9, p < 0.0001); elective benign neoplasm admissions were reduced from 7.2% to 2.0%, while neoplasms of uncertain behavior nearly doubled from 15.7% to 27.5%. Case complexity increased during the pandemic (mean ICD codes 4.08 ± 2.42 vs. 3.44 ± 2.30; p < 0.001); after exclusion of administrative codes (whole Z chapter and U07.x), the difference attenuated to 3.34 vs. 3.17 codes (still p < 0.001 by Kruskal–Wallis), indicating that the largest portion of the unadjusted increase was driven by the new mandatory pre-admission SARS-CoV-2 screening code Z11.5 rather than true clinical complexity. Notably, the clinically interpretable proxy R63.3 (feeding difficulty) independently rose from 41.5% to 53.1%. The crude median LOS did not differ between the pre-pandemic and pandemic periods (3.07 vs. 3.06 d; p = 0.19) and dropped significantly post-pandemic (2.22 d; p < 0.001); however, after multivariable adjustment for case mix, age, sex, county and code count, the LOS was 15.7% shorter during the pandemic (adjusted ratio 0.84, 95% CI 0.82–0.87; p < 0.001) and 22.8% shorter post-pandemic (adjusted ratio 0.77, 95% CI 0.75–0.80; p < 0.001) relative to baseline. Conclusions: The pandemic caused a severe but transient contraction of OMS activity accompanied by increased case complexity and a marked shift away from elective surgery. Inpatient volume returned to and exceeded the pre-pandemic baseline by 2024. These results support the value of standing pandemic-preparedness protocols, sustained access to preventive dental care, and integrated tele-triage pathways for future public-health crises.

Background: COVID-19 is primarily a respiratory disease, but increasing evidence suggests possible oral and maxillofacial complications. This study presents a case series of post-COVID maxillary osteonecrosis (PC-RONJ) cases from western Romania and explores the possible association between SARS-CoV-2 infection, its treatment, and this complication. Methods: We conducted a multicenter retrospective case series of two patients with recent PCR-confirmed SARS-CoV-2 infection who subsequently developed maxillary osteonecrosis (ONC) between 2021 and 2023. Clinical examination, CT imaging (including 3D reconstructions), and ENT assessment were used to assess the severity of the disease. All medical records were reviewed to identify comorbidities, details of COVID-19 treatment, and the appearance of maxillofacial symptoms. Results: Both patients had been hospitalized for severe COVID-19 and treated according to the national protocol with systemic corticosteroids, oxygen therapy, anticoagulation, and antivirals. CT scans revealed marked osteolytic destruction of the maxilla and maxillary sinus walls, with extension toward adjacent facial bones. Microbiological analysis revealed a complex polymicrobial profile, including Gram-positive and Gram-negative bacteria as well as opportunistic fungal species, consistent with a chronic biofilm-associated infectious process. Patients received surgical treatment, followed by local care and, in both cases, prosthetic rehabilitation with maxillary obturators, which improved speech, chewing, and oral function. Conclusions: This case series suggests a possible association between severe COVID-19, its treatment, and subsequent maxillary osteonecrosis in susceptible patients; however, the small number of cases precludes causal inference. To our knowledge, this is the first Romanian report describing such cases in patients without prior antiresorptive therapy. These findings highlight the need for careful use of systemic corticosteroids and vigilant post-recovery monitoring of maxillofacial complications. Further studies are required to clarify the underlying mechanisms and risk factors.

Background and Objectives: Osteonecrosis of the jaw (ONJ) occurring after infection with SARS-CoV-2 has emerged as an increasingly reported complication in the post-COVID-19 era. Post-COVID-19 osteonecrosis of the jaw (PC-ONJ) has been described in association with both COVID-19-associated mucormycosis (CAM) and non-fungal phenotypes. This narrative review aims to synthesize and critically analyze the available evidence regarding terminology and classification, epidemiology and risk factors, pathophysiological mechanisms, clinical and imaging characteristics, diagnostic challenges, and management strategies relevant to oral and maxillofacial surgery practice. Materials and Methods: An extensive literature search was conducted in the PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and Google Scholar databases. The search targeted peer-reviewed publications published between 2020 and 2025, reflecting the post-pandemic emergence of this clinical spectrum. Original studies, systematic and narrative reviews, multicenter case series, consensus guidelines, and well-documented case reports were considered. Results: Available data, largely derived from case reports and small series, demonstrate a predominance of maxillary involvement and frequent association with diabetes mellitus and systemic corticosteroid therapy. Proposed mechanisms include COVID-19-associated endothelial dysfunction, microvascular thrombosis, immune dysregulation, metabolic imbalance, and treatment-related effects. Clinically, patients may present with persistent orofacial pain, tooth mobility, exposed or probeable bone, and frequent sinonasal extension, with symptoms sometimes preceding bone exposure. Diagnostic challenges arise from the overlap with medication-related osteonecrosis of the jaw (MRONJ), osteoradionecrosis (ORN), and chronic osteomyelitis. Imaging is essential for assessing disease extent but remains insufficient for etiologic differentiation, making histopathological examination and targeted microbiological investigations necessary, particularly to exclude invasive fungal infection. Conclusions: Management must be etiology-driven. CAM requires urgent antifungal therapy combined with surgical debridement, whereas non-fungal forms are generally managed with conservative surgery and appropriate antimicrobial stewardship. Standardized diagnostic criteria and prospective multicenter studies are needed to reduce nosological ambiguity and optimize clinical decision-making in this emerging post-viral condition.

Maxillary sinus (MS) floor elevation using the lateral window approach is a predictable technique for bone augmentation in the posterior maxilla. However,

Background: Medication-related osteonecrosis of the jaw (MRONJ) is a grave complication in patients with cancer treated with antiresorptive agents, particularly after invasive dental procedures. Identifying reliable clinical factors to assess MRONJ risk remains a clinical challenge. Methods: The retrospective observational study comprised 61 oncologic patients undergoing dental extractions during antiresorptive therapy. Preoperative serum levels of 25-hydroxyvitamin D and β-C-terminal telopeptide cross-link (β-CTx), along with relevant clinical variables, were measured. The analyses included comparative tests, multivariate logistic regression to detect independent predictors of MRONJ, and ROC curve analysis to assess the model’s predictive performance. Results: MRONJ was diagnosed in 18 patients (29.5%). Low preoperative vitamin D levels were significantly associated with MRONJ and remained an independent predictor in the multivariate analysis (OR = 8.74, p = 0.005). The mandibular extraction site was also identified as a significant risk factor (OR = 7.94, p = 0.007). In contrast, β-CTX levels, age, sex, cancer type, and the number of extracted teeth did not show a significant link to MRONJ development in this cohort. The comprehensive multivariate model demonstrated good discrimination capacity (AUC = 0.806). Conclusions: Preoperative vitamin D deficiency is an important independent predictor of MRONJ after dental extractions in patients with cancer receiving antiresorptive agents. Integrating metabolic biomarkers and clinical variables into predictive models may improve risk assessment and support the development of more effective preoperative prevention strategies.

Pilomatrixoma is a benign skin adnexal tumor arising from the hair-follicle matrix. While typically small and slowly growing, rare “giant” variants (>5 cm)—especially in the cervical region—may clinically and radiologically mimic malignant masses, posing a significant diagnostic challenge. We report a case of a 29-year-old male presenting with a solitary, firm, subcutaneous mass (~6 cm) in the left anterior cervical region, which enlarged rapidly over 6 months without pain or systemic symptoms. Contrast-enhanced CT revealed a well-defined, heterogeneous subcutaneous lesion without muscular or vascular invasion. Core needle biopsy (CNB) supported a diagnosis of pilomatrixoma. The mass was completely excised under IV sedation and local anesthesia. Histopathology confirmed classic pilomatrixoma features (basaloid cells, shadow cells, foreign-body giant cell reaction). At one-year follow-up the patient was disease-free, and scar outcome was excellent. This case underscores the importance of including giant pilomatrixoma in the differential diagnosis of large cervical soft-tissue masses. Histopathological examination remains essential for definitive diagnosis, while CNB can guide preoperative planning. Complete surgical excision yields excellent outcomes with minimal morbidity, avoiding overtreatment for suspected malignancy.

Background and Objectives: Odontogenic infections are common emergencies in oral and maxillofacial surgery. They are typically polymicrobial, with aerobes guiding initial empirical therapy. However, regional data on their microbiology and resistance patterns in Romania are limited. This study aimed to characterize the aerobic microbial profile of odontogenic infections in Southwestern Romania and assess the antimicrobial susceptibility of isolated pathogens. Materials and Methods: A prospective observational study was conducted over 12 months at a tertiary referral hospital. Pus samples collected intraoperatively were cultured aerobically. Bacterial identification used biochemical methods and the VITEK 2 system. Antimicrobial susceptibility was determined by disk diffusion and automated MIC testing, interpreted according to EUCAST v13.0 (2023). Results: Of 110 patients, 96 (87.3%) yielded positive aerobic cultures, producing 97 isolates. Streptococcus spp. were predominant (49.5%), followed by coagulase-negative staphylococci (24.7%), Staphylococcus aureus (14.4%), Enterobacterales (7.2%), and Pseudomonas aeruginosa (3.1%). Streptococcus spp. remained susceptible to penicillin G (82.3%), amoxicillin–clavulanate (76.4%), and clindamycin (70.5%), but only 55.0% to erythromycin. Most S. aureus isolates were methicillin-susceptible (92.9%), while coagulase-negative staphylococci showed high methicillin resistance (59.3%) yet full susceptibility to linezolid, vancomycin, and teicoplanin. Enterobacterales were resistant to ampicillin (90%) and amoxicillin–clavulanate (65%) but remained susceptible to ceftriaxone (80%) and ciprofloxacin (85%). P. aeruginosa isolates were fully susceptible to piperacillin–tazobactam, ceftazidime, cefepime, and meropenem. Conclusions: This study provides regional data on aerobic pathogens in odontogenic infections. High resistance to penicillin and macrolides limits empirical use. Amoxicillin–clavulanate and clindamycin retain moderate activity, while glycopeptides, linezolid, and carbapenems preserved full efficacy. Surgical drainage remains central to management, and antibiotic therapy should be guided by local susceptibility patterns. These data provide baseline information to inform empirical therapy and stewardship efforts and highlight the need for multicenter studies including anaerobic and molecular analyses.