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Background: The surgery-first approach (SFA) in orthognathic surgery eliminates the need for pre-surgical orthodontic treatment, significantly reducing overall treatment time. However, reliance on a compromised occlusion introduces risks of condylar displacement and remodeling. This study employs artificial intelligence (AI) and deep learning to analyze condylar behavior, comparing the outcomes of SFA to the traditional surgery-late approach (SLA). Methods: A retrospective analysis was conducted on 77 patients (18 SFA and 59 SLA) treated at Perugia Hospital between 2016 and 2022. Preoperative (T0) and 12-month postoperative (T1) cone-beam computed tomography (CBCT) scans were analyzed using the 3D Slicer software and its Dental Segmentator extension, powered by a convolutional neural network (CNN). This automated approach reduced segmentation time from 7 h to 5 min. Pre- and postoperative 3D models were compared to assess linear and rotational deviations in condylar morphology, stratified via dentoskeletal classification and surgical techniques. Results: Both the SFA and SLA achieved high surgical accuracy (<2 mm linear deviation and <2° rotational deviation). The SFA and SLA exhibited similar rates of condylar surface remodeling, with minor differences in resorption and formation across dentoskeletal classifications. Mean surface changes were 0.41 mm (SFA) and 0.36 mm (SLA, p < 0.05). Conclusions: Deep learning enables rapid, precise CBCT analysis and shows promise for the early detection of condylar changes. The SFA does not increase adverse effects on condylar morphology compared to SLA, supporting its safety and efficacy when integrated with AI technologies.

Background: Temporomandibular disorders (TMDs) represent a prevalent multifactorial condition that impacts a significant portion of the global population. The objective of this study was to employ Fonseca’s questionnaire for an initial assessment of TMDs. Methods: A cross-sectional study was conducted on a sample of 250 undergraduates from the Dental School of the University of Perugia, Italy. The chi-square test, with a significance level set at p < 0.05, was used to evaluate a statistically significant relationship between TMDs and several variables such as gender, age, employed/unemployed, and physically active or not. Results: The data obtained through the questionnaire indicated that a considerable percentage of students (78%) exhibited signs consistent with TMDs. The most frequently reported signs and symptoms included psychological stress (49.6%), dental clenching and grinding (34%), joint clicking (33.6%), frequent headaches (15.2%), and neck pain (23.2%). Notably, when considering moderate to severe symptoms of TMDs, females were more significantly affected than males. Furthermore, factors such as age, employment status, and physical activity did not appear to influence the prevalence of TMDs. Conclusions: The high prevalence of TMDs identified within this young population (university students), as measured by this questionnaire (albeit warranting validation through more rigorous methodologies) underscores the necessity for the implementation of new preventive strategies that specifically address this demographic.

The main role of panoramic radiography lies in its rapid screening capability and its ability to detect and identify bone lesions, pathologies, and tooth-bearing structures. Since panoramic radiographs are widely used, they provide a good view of the jaw bones, maxillary sinus, and temporomandibular area. However, their major limitation is the reduced ability to accurately assess bone conditions, particularly in evaluating cortical integrity or identifying subtle, nondisplaced, or greenstick-type fracture lines. Other limitations include the presence of artifacts, image distortion, magnification variability, and high sensitivity to patient and film positioning, all of which can compromise image quality and diagnostic confidence. This 2D imaging method is still used worldwide, especially by dentists; however, this type of radiograph can be unpredictable due to structural superimposition and reduced ability to clearly establish, measure, and verify the precise dimensions, boundaries, and areas occupied by selected lesions. Many patients undergo panoramic imaging to assess possible mandibular fractures after trauma or following the removal of cysts, tumors, or impacted teeth. In most cases, the occurrence of a fracture without displacement can be misjudged, omitted, or underestimated. In such cases, either cone-beam computed tomography is performed or a detailed clinical examination before or during surgery, followed by intraoperative assessment, helps identify a possible fracture line, bone bending, mandibular instability, or the potential need for simultaneous prophylactic plating during dental procedures or the use of maxillomandibular fixation. This paper presents the author's own experience regarding the limitations of panoramic radiographs in estimating bone condition and detecting fracture lines. Therefore, it is essential to highlight the role of prophylactic (preventive) mandibular plating (PMP) or fixation and to clarify when it should be considered.

The range of possible inflammatory changes in the oral cavity and in the maxillary and mandibular bones may present with diverse patterns and characteristics in both clinical and radiological evaluation. In most cases, a standard radiological examination, such as dental panoramic radiograph (DPR), has significant limitations in assessing early or complex bone changes associated with chronic bone inflammation. Advanced imaging with multidetector computed tomography or cone-beam computed tomography (MDCT or CBCT) can improve lesion characterization and surgical planning when a detailed evaluation of tooth-bearing structures, tooth apices, cortical plates, and cancellous bone is required. Such imaging allows more detailed assessment of alterations in medullary bone morphology and architecture, as well as identification of possible periosteal reactions adjacent to chronic bone inflammation. Osteomyelitis of the jaws comprises a heterogeneous group of inflammatory bone disorders characterized by variable clinical presentations and a broad spectrum of radiological appearances. Depending on disease chronicity, host factors, and microbial burden, mandibular osteomyelitis may mimic odontogenic tumors, fibro-osseous lesions, or malignant bone pathologies. Quite often, dental treatment affects bone status and condition, leading to unwanted events such as bone inflammation. Imaging plays a central role in diagnosis; however, radiographic findings are often nonspecific, particularly in early or chronic stages. Each case of osteomyelitis underscores the importance of correlating imaging findings with clinical history and highlights the role of repeated imaging in distinguishing inflammatory bone disease from aggressive jaw lesions. This study aims to characterize diverse patterns of chronic mandibular osteomyelitis associated with various prior treatment modalities using CBCT. By presenting a series of illustrative cases from heterogeneous clinical settings, the authors highlight the nonspecific radiographic features and diagnostic challenges inherent in chronic bone inflammation. The focus remains on the interpretation of complex imaging findings rather than a comparative analysis of technical protocols.

Pediatric odontogenic tumors are rare but are frequently overlooked because they often mimic simple cysts on routine radiographic examinations. The radiographic appearance on panoramic imaging and cone-beam computed tomography (CBCT) frequently does not correlate with the true biological nature of these lesions. On CBCT, classic odontogenic tumors often demonstrate mixed radiolucent–radiopaque patterns with ill-defined borders, internal calcifications, septations, or other structural features. The diagnostic challenge arises when an odontogenic tumor mimics a unilateral, well-defined radiolucent area or a cystic lesion with clear borders and no associated tooth displacement, erosion, root resorption, or cortical bone dehiscence. Panoramic radiography has inherent diagnostic limitations but remains widely used for routine dental screening. CBCT provides enhanced three-dimensional assessment and improves diagnostic accuracy in the evaluation of jaw lesions. A marked increase in dental follicle diameter necessitates differentiation between cystic transformation, inflammatory processes, and other odontogenic pathologies. Cortical swelling and bone asymmetry warrant careful evaluation. In this context, an atypical cyst-like lesion detected on routine panoramic radiography prompted a needle aspiration biopsy, which revealed a dry tap and suggested a solid lesion. This prompted CBCT evaluation. Two juvenile cases are presented in which clinical findings, panoramic radiography, and CBCT provided discordant diagnostic impressions of cystic-appearing lesions with well-defined borders and bone expansion. These cases illustrate a diagnostic pathway in which imaging demonstrates a cyst-like appearance with benign radiological features, fine-needle aspiration biopsy reveals the absence of cystic fluid, and histopathology confirms that radiology alone cannot reliably distinguish true cysts from solid odontogenic tumors in pediatric patients.

Background Free flap monitoring techniques still rely on gold standard methods such as skin color evaluation, temperature, and puncture tests that are time-consuming, discontinuous, and prone to human error. Near-Infrared Spectroscopy represents a continuous, non-invasive technique that aims to avoid subjective errors by detecting early stages of vascular compromise, providing enough time for successful salvage surgery. Methods This retrospective study includes 56 patients undergoing microvascular reconstruction and 24-h NIRS monitoring. All other patients without detailed MAP charts were excluded. The NIRS system used was the HemoSphere-ForeSight by Edwards Lifesciences; this platform enabled the detection of StO2 values and their integration with real-time intra-arterial catheter-detected MAP values. Data were recorded by an adhesive sensor, chosen according to the height and width of the flap. Results Forty-seven (83%) patients showed a positive correlation between MAP and StO2 data (ρs > 0.450, p  < 0.0001), validating the theory that MAP values positively correlate with flap perfusion, tissue oxygenation, and survival rate. Nine patients did not show a direct correlation between MAP and StO2 data; their values were influenced by vasopressors or psychophysical conditions during their admission to the Intensive Care Unit (ICU) after surgery. Conclusions Comparing MAP and StO2 values, their trend charts play a crucial role in flap monitoring, contributing to the best possible survival rate outcome and, if necessary, leading to micro-anastomosis checks and eventual flap salvage surgery. MAP data analysis should, indeed, be considered in future guidelines for free flap monitoring techniques. Level of Evidence: Level III, diagnostic study.

Introduction: Odontogenic sinusitis (ODS) is an underrecognized cause of maxillary sinus inflammation and is frequently associated with dental, periodontal, endodontic, and iatrogenic factors. Accurate identification of the odontogenic source is essential for appropriate treatment planning. Cone-beam computed tomography (CBCT) allows detailed evaluation of the maxillary sinus, adjacent teeth, alveolar bone, and periodontal structures, and may improve the radiologic differentiation of ODS. Materials and Methods: This retrospective observational study analyzed radiologic data from patients evaluated and treated by the authors for suspected odontogenic sinusitis between 2019 and 2026. The final study group included 85 patients with CBCT-based evidence of odontogenic pathology affecting the maxillary sinus. CBCT scans were reviewed to identify tooth-related and treatment-related etiologic factors associated with ODS. Based on the radiologic findings, the authors developed a CBCT-based classification of odontogenic etiologies and proposed an imaging-guided management algorithm. Results: CBCT identified a broad spectrum of odontogenic factors associated with maxillary sinus disease. The most relevant radiologic patterns included endodontic and periapical pathology, periodontal or combined endo-periodontal disease, post-extraction inflammatory changes, odontogenic cysts, oro-antral communication or fistula, retained roots or teeth, displaced endodontic materials, and grafting or implant-related complications. These findings were organized into 16 radiologic categories reflecting the principal etiologic pathways of ODS. The proposed classification facilitated correlation between radiologic presentation and the recommended dental, surgical, and otolaryngologic treatment approach. Conclusions: CBCT is a valuable imaging modality for identifying odontogenic causes of maxillary sinus inflammation and provides more precise diagnostic information than conventional radiography alone. A structured CBCT-based evaluation may improve etiologic diagnosis, support multidisciplinary decision-making, and help guide individualized management of patients with ODS.

Background and Clinical Significance: Vascular lesions of the face, particularly arteriovenous malformations (AVM) and mixed hemangiomas (MH), pose significant diagnostic and therapeutic challenges because of their complex anatomy, unpredictable behavior, and high risk of bleeding. Surgical planning should be individualized and often requires a staged approach with meticulous interdisciplinary coordination to ensure patient safety. The presence of a concomitant odontogenic infection further complicates management, as local inflammation may exacerbate vascular instability and increase the risk of life-threatening complications. Local inflammation and infection might cause some life-threatening conditions, especially when an abscess occurs in the area of any vascular lesion. Ensuring that the oral cavity is free from potential odontogenic infections is a particularly important issue in many complex cases, especially in patients treated for oral, head, and neck cancer or in those with other coexisting morbidities affecting the oral and facial regions. Case Presentation: A 72-year-old man was referred for management of a severe odontogenic infection associated with an extensive facial vascular lesion. The patient’s medical history was significant for arterial hypertension and chronic liver dysfunction (CLD) of unclear etiology. Complete blood testing, including coagulation assessment and liver ultrasonography, was performed, with no contraindication to surgery identified. The scope of odontogenic-related infections was scheduled for simultaneous removal during initial surgery. Preparation for surgery included the local application of sclerotherapy agents. Conclusions: Quite often, a routine panoramic radiograph can help in assessing the status of bone and dentition to undertake all necessary treatment. Severe odontogenic disease, including multiple retained roots, periapical infections, and odontogenic cystic lesions in the context of poor oral hygiene, may lead to the occurrence of possible inflammation. In case of any vascular lesion, a careful diagnostic and therapeutic strategy is needed. This case report highlights that maintaining an infection-free oral environment is a critical component of care in patients with complex facial MH and should be regarded as an essential element of overall treatment planning.

Background: Dental care for non-cooperative patients is a major clinical and organizational challenge, particularly in individuals with intellectual or neurodevelopmental disabilities and in patients with severe dental anxiety or phobia. When behavioral techniques are insufficient, conscious or deep sedation or general anesthesia may be required, but practical guidance on selection and care pathways remains fragmented. Methods: We combined a retrospective observational analysis from a single Italian academic center with a narrative review of the international literature. Forty-one sedation-assisted dental sessions were included. Demographics, indication for non-cooperation, sedation regimens, procedures, completion rates, and adverse events were descriptively analyzed. Results: The cohort included pediatric and adult patients; non-cooperation was mainly related to disability/neurodevelopmental conditions or severe dental phobia. Benzodiazepine-based oral or intravenous sedation, sometimes combined with low-dose propofol, enabled completion of all planned procedures without major adverse events or conversion to general anesthesia. The literature supports general anesthesia for profound non-cooperation or extensive treatment needs, but availability and waiting lists limit access; sedation is effective for selected cases with appropriate organizational support. Conclusions: An individualized stepped-care model integrating behavioral management, sedation, general anesthesia, and structured preventive recall may optimize access and outcomes within the Italian context and strengthen long-term post-treatment attendance.