Dritan Turhani

Background/Objectives: Maxillary sinus floor augmentation (MSFA) via the lateral approach is a well-established procedure for prosthetic rehabilitation of atrophic posterior maxillae. However, late complications are often nonspecific, with an incompletely understood aetiology. We evaluated patients with atypical late complications post-MSFA with bovine xenohybrid bone substitute NaturesQue SemOss B (BEGO GmbH, Bremen, Germany), describing their presentation, management, and outcomes. Methods: This retrospective, complication-selected clinical case series examined 47 patients who underwent lateral window MSFA with this graft from September 2020 to March 2023 in a single university department. Twelve complication cases were identified during the study period. Atypical late complications were defined as graft-associated clinical and/or radiological adverse outcomes, excluding peri-implantitis, that first manifested > 6 mo postoperatively. Baseline characteristics, perioperative findings, conservative and surgical management (including graft removal and reaugmentation), histology, and follow-up were assessed. Results: Twelve complication cases were identified among 47 patients treated during the study period. Seven experienced implant loss; seven, partial or complete lack of graft osseointegration; six, pain; and seven, signs of sinus infection. Histological analysis (6/12) revealed lymphocytes, plasma cells, and fibroblastic changes without detectable macrophages. No intraoperative complications were observed. Conclusions: Atypical late complications affected 25.5% of the patients. Despite comprehensive clinical, radiological, and histological assessments, the aetiology remained unclear, and the findings did not indicate a peri-implantitis-type infection; we hypothesised impaired early phase wound healing These patients were amenable to repeat augmentation post-non-osseointegrated graft removal, although larger studies are required.

Background/Objectives: The aetiology of facial clefts remains incompletely understood, and ionising radiation has been discussed as a potential exogenous factor. This review investigated the epidemiology of cleft lip and/or palate (CL/P) in Germany in relation to the Chernobyl NPP accident. Methods: A systematic literature search was conducted using MEDLINE, LIVIVO, and the Cochrane Library, supplemented by additional searches. OHAT risk-of-bias domains were applied to the included studies. Results: In total, 276 potentially relevant records were identified, of which six were included. Studies from Bavaria and the former German Democratic Republic reported regional associations between increased CL/P prevalence and the Chernobyl NPP accident. None of the included studies assessed radiation exposure at the individual level; exposure assessment was regional or ecological. Conclusions: Associations were reported in some more heavily contaminated regions, whereas no statistically significant differences were found in regions affected by lower levels of fallout. One study reported an estimated additional regional exposure of 1.2 mGy in the most heavily contaminated areas. This estimate does not substitute for individual dosimetry and should be interpreted cautiously. Experimental and other sources cited in the review discuss malformation effects at doses of at least 50 mGy. Given the heterogeneous study designs, ecological exposure assessment, inadequate control of confounding, and very low certainty of evidence, the available data do not support establishing a causal relationship between Chernobyl-related exposure and CL/P in Germany.

Introduction and importance: Internal tooth resorption is a rare, inflammation-mediated pathological process that is most often detected incidentally. Third molars appear to be disproportionately affected, possibly due to their anatomical and developmental characteristics. Reports comparing internal resorption of third molars in situ and after autologous transplantation remain scarce. Presentation of the case: This case series presents two uncommon clinical scenarios involving internal resorption of third molars. The first case describes simultaneous internal resorption affecting three third molars in situ without any identifiable triggering factors. The second case reports very late-onset internal resorption of a transplanted third molar, occurring nineteen years after successful autologous transplantation with long-term functional survival. Clinical discussion: The presented cases support the hypothesis of an intrinsic vulnerability in third molars to pulpal resorptive processes. Large pulp chambers, thin dentinal walls, delayed eruption, chronic low-grade inflammation, and cumulative biological stressors may contribute to odontoclastic activation. While autologous third molar transplantation can provide excellent long-term outcomes, late complications such as internal resorption may still arise after prolonged asymptomatic periods. Conclusion: Third molars may be particularly susceptible to internal resorption, both in situ and following transplantation. Although autologous transplantation is a reliable long-term treatment option, lifelong clinical and radiographic follow-up is essential to detect late-onset internal resorptive processes.

Background: In everyday practice, we observed an increased number of complications with a xeno-hybrid bovine graft in challenging cases, prompting a systematic review of timing strategies and the impact of the operator. Objective: To compare early safety and rehabilitation timelines for immediate versus delayed implant placement after alveolar ridge procedures with a xeno-hybrid bovine graft, and to examine operator-level effects. Materials and Methods: Single center retrospective cohort (Danube Private University, Krems, Austria; January 2021–October 2023). Consecutive patients undergoing alveolar ridge preservation (ARP) or reconstruction (ARR; conservative protocol without meshes or rigid frameworks) with a xeno-hybrid bovine graft and subsequent implant were included. Strata: ARP, ARR, ARP with immediate implant placement (ARP+II), ARR with immediate implant placement (ARR+II). Primary endpoint: early implant loss < 12 months after the index surgery. Secondary endpoints: days to implant exposure and days to definitive prosthesis. Results: We analyzed 158 coded interventions (ARP 33; ARR 16; ARP+II 32; ARR+II 77). Early implant loss was uncommon (7/158; 4.4%) and occurred only with immediate implant placement (ARP+II 6.3%; ARR+II 6.5%); no early failures occurred in delayed strata. Immediate implant placement accelerated rehabilitation (exposure: 358/364 vs. 144/162 days; prosthesis: 406/419 vs. 196/204 days; both p < 0.0001). After adjustment for treatment base, timing, and age, no independent operator level effect on early loss was detected. Conclusions: In this university cohort using a xeno-hybrid bovine graft, early implant loss was rare and confined to immediate implant placement, which nonetheless shortened the pathway to exposure and restoration by ~5–7 months. Differences across providers were explained by case selection and protocol choice after adjustment. Clinical Significance: With appropriate case selection and surgical execution, immediate implant placement after ARP/ARR can reduce treatment time by ~5–7 months without a clear increase in early failure within the limits of this cohort; treatment protocol and case triage are the main levers of early outcome.

Background/Objectives: Cone beam computed tomography (CBCT) is vital in endodontics but suffers from beam-hardening artifacts caused by metallic restorations, which can obscure diagnostic details. This study evaluated a novel patient positioning protocol—a controlled head tilt—designed to mitigate these artifacts by moving contralateral metallic structures outside the primary X-ray path in small field of view (FoV) CBCTs. Methods: Using a skull phantom with metallic restorations CBCT scans were acquired in three positions: standard alignment, a 12° tilt toward the region of interest (ROI), and a 12° tilt to the opposite side. Fifty experienced dentists, blinded to the protocol, subjectively compared image quality and artifact severity between the tilted and reference images. Results: The tilt away from the ROI was rated as providing better image quality significantly more often than the tilt towards the side of the ROI (442 of 585 non-tied comparisons; p < 0.001). A complementary rater-clustered GEE analysis adjusted for slide confirmed higher odds of “better” ratings under head tilt away from the ROI for image quality (OR = 4.16, 95% CI 3.12–5.56) and artefacts (OR = 2.87, 95% CI 1.93–4.26). An individual head tilt significantly improves subjective small-FoV CBCT image quality, most evidently in the longitudinal plane, by reducing artifact interference from contralateral metals, and should be considered a practical strategy for clinical use, and may serve as a practical chairside strategy, pending clinical validation.

Objective: This retrospective study investigated the relationship between the timing of single-tooth implant-supported restorations—including the interval from tooth extraction and socket preservation to implant placement and final prosthetic restoration—and the severity of periapical inflammation, as classified by the Dental Apical Inflammation Score (DAIS). Methods: A total of 87 patients were included (DAIS 1: 8; DAIS 2: 14; DAIS 3: 1; DAIS 4: 64). Procedural intervals (extraction, socket preservation, implant placement, and prosthetic restoration) were analyzed alongside histological assessment of periapical inflammation. Clinical parameters such as tooth location, endodontic treatment status, patient age, and sex were examined using ANOVA, chi-square tests, and Pearson’s correlation analysis. Results: An effective sample size of N = 86 (excluding the single DAIS 3 case) was included in the parametric analysis. No significant differences in procedural timing were found across DAIS groups for the intervals between extraction and implant placement (F(2, 83) = 0.338, p = 0.714) or restoration (F(2, 83) = 1.016, p = 0.367). Tukey’s HSD post hoc analysis showed no pairwise group differences. Histological diagnosis was not significantly associated with DAIS (χ²(6) = 7.00, p = 0.321), though small subgroup sizes warrant interpretive caution. A significant association was identified between DAIS score and tooth location (χ²(3) = 11.79, p = 0.008). Patient age showed a weak but significant positive correlation with DAIS (r = 0.222, p = 0.039). No significant associations were found for endodontic status (χ²(3) = 2.54, p = 0.468) or sex (χ²(3) = 2.63, p = 0.452). Histological assessment revealed that most specimens represented radicular cysts with varying proportions of acute and chronic inflammatory infiltrates, consistent with the DAIS classification. Conclusions: Procedural timing did not significantly differ between DAIS groups. However, the observed associations with tooth location and patient age may warrant further investigation into their potential relevance for treatment planning. These findings suggest that implant timing may not need to be substantially modified according to DAIS severity alone, but that anatomical site and patient age should be considered during clinical decision-making.

Introduction: Mesiodens are the most common supernumerary teeth, but rare anatomical variants such as multiple formations or ectopic eruption into the nasal cavity are scarcely reported. Their management remains controversial, particularly in asymptomatic patients. Case presentation: We present two exceptional cases. The first involves a 56-year-old male with two fully developed, conical mesiodens located palatally between the central incisors, discovered incidentally and managed conservatively. The second case concerns a 16-year-old male with a mesiodens protruding into the nasal cavity, detected due to delayed eruption of the upper central incisors. In both cases, patients were asymptomatic, and a watchful waiting strategy with clinical and radiological follow-up was chosen. Discussion: Cone bean computer tomography (CBCT) played a crucial role in diagnosis and treatment planning, allowing for detailed assessment of root development, anatomical relationships, and exclusion of complications. Literature supports surgical extraction in symptomatic cases; however, a conservative approach may be safe and appropriate in selected asymptomatic patients. Conclusion: These cases highlight the importance of individualized, patient-centered decision-making in managing rare mesiodens presentations. Conservative management combined with CBCT-based monitoring can be a viable alternative to surgery when clinical symptoms are absent. Highlights:

Background: Maxillary sinus floor augmentation (MSFA) is commonly used to increase posterior maxillary bone volume prior to implant placement. Although generally successful, late complications can impact long-term outcomes. The purpose of the study was to estimate the incidence and timing of atypical late complications following (MSFA) using bovine xenohybrid bone grafts. The study also aimed to evaluate whether preoperative bone volume is associated with the risk of complications. Methods: This retrospective cohort study was conducted at the Center of Oral and Maxillofacial Surgery, Danube Private University, Krems-Stein, Austria, and included patients who underwent MSFA with bovine xenohybrid bone grafts and either simultaneous or staged implant placement between January 2020 and December 2023. Preoperative bone volume of the posterior maxilla measured via cone beam computed tomography (CBCT) in the planned implant insertion position. The primary endpoint was the time (days) from MSFA to the occurrence of a graft-related complication (defined as atypical if occurring more than 6 months after MSFA and not related to peri-implantitis) The covariates included subjects’ age, sex, the quantity of graft used for MSFA, timing of dental implant insertion (simultaneous vs. staged) and implant dimensions. Kaplan–Meier analysis and Cox proportional hazards regression were used to evaluate time-to-event data. Only one graft site per patient was analyzed. Results: Atypical complications occurred in 9 out of 47 patients (19.1%), with an average time to onset of 645 days. In a multivariable analysis, a lower preoperative bone volume was found to be an independent predictor of an increased risk of complications (hazard ratio [HR]: 0.972; 95% confidence interval [CI]: 0.925–1.021; p = 0.252). However, the quantity of graft used for MSFA was not found to be a predictor (p = 0.46). Conclusions: Within the limitations of a retrospective study, reduced native bone volume appears to increase the risk of atypical late complications following MSFA with bovine xenohybrid grafts. This makes closer clinical and radiologic follow-up of patients over a longer period very necessary.

Introduction: Persistent cutaneous fistulas of dental origin without intraoral symptoms can be diagnostically challenging, particularly when first assessed by non-dental clinicians. These fistulas are frequently misdiagnosed and inappropriately treated before the underlying dental cause is identified. Case presentation: We report the case of a 65-year-old female patient with a persistent submental fistula that had been unsuccessfully treated by several medical disciplines over several months. Initial conservative and surgical approaches failed to resolve the lesion. Dental examination revealed a periapical radiolucency associated with tooth 32, and subsequent CT imaging confirmed a cortical disruption suggestive of a fistulous tract. Surgical extraction of the affected tooth and excision of the inflammatory tissue resulted in resolution of the infection. Histopathology confirmed a chronically inflamed, partially cystic lesion. Secondary scar correction was performed for aesthetic reasons. Discussion: This case highlights the importance of including odontogenic causes in the differential diagnosis of chronic cutaneous facial lesions. Early dental imaging and interdisciplinary collaboration are essential for correct diagnosis and effective treatment. Psychological comorbidities and patient-related barriers, such as dental phobia, may further complicate management and delay recovery. Conclusion: Persistent extraoral fistulas in the chin region should prompt a thorough dental evaluation. Appropriate radiographic imaging and timely surgical management can prevent unnecessary treatment and long-term complications. Increased awareness among non-dental clinicians is essential to avoid misdiagnosis. Highlights: