Kei-Ichiro Miura

Purpose Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by recurrent upper airway obstruction during sleep and associated with important systemic health risks. Oral appliance (OA) therapy, particularly mandibular advancement devices (MADs), is an established treatment option for patients with mild to moderate OSA and for those who are unable to tolerate continuous positive airway pressure. However, in patients with dental implants, prosthodontic and biomechanical factors may influence the indication, design, retention, and safety of OA therapy. Therefore, the purpose of this review was to examine the existing literature on OA therapy in patients with OSA who have dental implants. Methods Scopus and PubMed were searched on April 2, 2026, for English-language articles published during the predefined 20-year period from January 1, 2006, through December 31, 2025. Eligible studies described patients with OSA whose dental implants or implant-supported prostheses influenced OA therapy. Data were synthesized descriptively. Results Of 36 records, four studies were included: two case reports, one case series, and one finite element analysis. Most patients were edentulous. Reported approaches included implant-retained mandibular advancement appliances, overdentures worn during sleep, and biomechanical evaluation of implant-supported OAs. Benefits included improved retention and favorable sleep-related outcomes, whereas mucosal discomfort and limited long-term safety data remained concerns. Conclusion Evidence remains sparse, but implant-assisted OA therapy may be feasible in carefully selected patients, especially edentulous individuals with poor conventional OA retention.

Kuroda H, et al. J Dent Anesth Pain Med. 2026 ;26:e5. https://doi.org/10.17245/jdapm.2026.26.109

Sanuki T, et al. J Dent Anesth Pain Med. 2026 ;26:e4. https://doi.org/10.17245/jdapm.2026.26.045

Primary intraosseous carcinoma (PIOC) is a rare malignant tumor of the jaw, often diagnosed as odontogenic cysts or osteomyelitis. We report a case of a 53-year-old woman who was initially diagnosed with mandibular osteomyelitis resulting from pericoronitis of the left lower third molar. The patient underwent tooth extraction under general anesthesia, and the granulation tissue from the extraction socket was sent for histopathological evaluation, revealing moderately differentiated squamous cell carcinoma. Postoperative imaging revealed significant bone resorption, invasion of the mandibular canal, and proximity to a left submandibular lymph node. Based on these findings, the patient was diagnosed with PIOC and subsequently underwent left-sided neck dissection, hemi-mandibulectomy, and reconstructive surgery. Histopathological examination confirmed the diagnosis of PIOC, with no evidence of metastatic lymph nodes. The patient has remained disease-free for seven years and four months postoperatively. PIOC is believed to originate from odontogenic cysts and is often detected at advanced stages due to its intraosseous location. Diagnosis is based on the absence of continuity with the oral mucosa, absence of metastatic oral tumor, and presence of squamous cell carcinoma. Early diagnosis and treatment are crucial for improving patient prognosis and quality of life. This case underscores the importance of considering malignancy in cases of destructive bone resorption and highlights the importance of timely biopsy in preventing delayed treatment.

Background: The maxilla is surrounded by complex anatomical structures, including the nasal cavity, maxillary sinus, zygomatic process, cranial base, mandible, and masticatory muscle space. Therefore, when maxillary squamous cell carcinoma (SCC) is close to or invades these structures, determining clear surgical margins becomes challenging, making complete resection difficult. This study aimed to evaluate factors related to primary recurrence, cervical lymph node recurrence, distant metastasis, and prognosis of primary maxillary SCC at the Department of Oral and Maxillofacial Surgery, Nagasaki University Hospital. Methodology: Patients with SCC of the maxillary gingiva or hard palate treated at a single institute between 2008 and 2022 were reviewed. Age, sex, performance status, primary site, T stage, N stage, pathological N stage, histological differentiation, mode of invasion, lymphatic invasion, vascular invasion, perineural invasion, margin status, extranodal extension, treatment method, and outcome were reviewed. Factors related to survival and local recurrence were analyzed by Cox regression. Results: A total of 61 patients were enrolled. The five-year overall survival (OS) and disease-specific survival (DSS) rates were 74.4% and 83.3%, respectively. Univariate analysis revealed that performance status, T stage, mode of invasion, pathological N stage, lymphatic invasion, vascular invasion, perineural invasion, extranodal extension, and local recurrence were significantly associated with OS and DSS. Local recurrence was observed in 14 of 61 patients (23.0%), all of which had T4 tumors. Finally, 12 patients had uncontrolled primary tumors, while only two had uncontrolled cervical metastases. Margin status did not significantly affect survival and local recurrence. Conclusions: While uncontrolled disease was observed in 14 cT4 cases, no local recurrence occurred in cT1-T3 cases. Histological factors, not margin status, were key prognostic indicators, suggesting the need to re-evaluate treatment strategies for T4 and high-grade tumors.