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Background Conventional plate osteosynthesis is the corner stone for management of displaced parasymphyseal mandibular fractures that necessitate open reduction and internal fixation (ORIF). Yet, the conventional workflow is labor-intensive, time consuming and limited by variable reduction accuracy as it relies solely on surgeon experience. Recently, various novel computer-guided techniques have been introduced for mandibular fracture repair, hiring surgical guides of diverse designs and strategies. These techniques served as a substitute for the conventional treatment modalities, offering improved precision, speed and reproducibility. Therefore, this randomized controlled trial (RCT) compares the overall precision of this distinct complete computer-guided virtual surgical planning (VSP) protocol as a whole, employing screw-holes locator and custom-made plates versus the conventional workflow for parasymphyseal mandibular fracture repair. Methods Twenty-six cases presented with uncomminuted parasymphyseal mandibular fracture were enrolled and randomized into two groups. The interventional group underwent ORIF utilizing a screw-hole locator and custom-made plates, while the control group utilized ready-made mini-plates for ORIF. In both groups, virtual surgical planning of the fractured mandible was accomplished, creating a virtual reduced model by Mimics software aided by preoperative computer tomography (CT) scan. Then, three-dimensional model derived from the postoperative CT scan was superimposed onto the VSP reduced model. Linear deviations between predefined dental and bony landmarks to established anatomical planes were measured and underwent statistical analysis. Results The actual postoperative mandibular model in the computer-guided group demonstrated negligible deviation from the VSP model. While the conventional group revealed considerably greater deviation. The average deviation of the bony landmarks was 0.044 ± 0.14 mm for the intervention group versus 0.69 ± 0.5 mm for the control group ( p  < 0.001). The average deviation of the dental landmarks was 0.04 ± 0.13 mm for the intervention group versus 0.47 ± 0.33 mm for the control group ( p  < 0.001). The average surgical time of the intervention group was 1.46 ± 0.18 h versus 1.80 ± 0.34 h for the control group ( p  = 0.004), with the intergroup difference being statistically significant. Conclusions The integration of screw-holes locator and patient-specific implants (PSI) have improved anatomical reduction precision, facilitated reestablishment of the patient’s native occlusion and ensured more standardized reproducible outcomes, especially beneficial for less experienced surgeons. Trial registration The study is a randomized control trial, registered at ClinicalTrials.gov Protocol Registration and Results System Receipt, NCT05647460, Data: 2022–12-05.

Background Several treatment modalities have been reported in the management of mandibular fractures using an alternative computer-guided approach through the utilization of different designs of guiding devices. However, these computer-guided methods do not always guarantee accurate anatomical bone reduction. This study aimed to assess the reduction precision of the computer-guided mandibular fracture and internal fixation using screw holes locating surgical guide, as presented earlier in the orthognathic surgery field in various studies to be applied in the field of mandibular traumatology, comparing it with the conventional approach. Methods Twenty-six patients with Brown Class III mandibular fracture, defined by a single fracture line involving the body, parasymphysis or symphysis regions, were randomly assigned to two groups for open reduction and internal fixation. The study group underwent reduction and fixation using patient-specific screw-hole locating guide and pre-bent titanium miniplates, whereas the control group received conventional reduction and fixation with intraoperatively adapted titanium miniplates. Virtual reduction of the fractured mandible was performed in all cases of both groups utilizing CT scan and mimics software. Then, the actual postoperative mandibular model was superimposed over the virtually operated mandibular model based on predefined reference points and plans to obtain dental and bony linear measurements. The recorded measures were statistically analysed. Results The actual postoperative mandibular model in the computer-guided group showed minimal deviation from the virtual mandibular model. While the deviation of the actual post operative model in the conventional group from the virtual model was higher, the difference in deviation between the two groups was statistically significant. The mean bony deviation was 0.09 ± 0.29 mm in the computer-guided group, versus 0.70 ± 0.33 mm in the control group p  < 0.001. The mean dental deviation was 0.05 ± 0.16 mm in the computer-guided group versus 0.56 ± 0.32 mm in the control group p  < 0.001.The mean operative time of the computer-guided group(1.49 ± 0.19)(hours) was significantly shorter than the mean operative time of control group (1.82 ± 0.37)(hours) which is statistically significant p  < 0.001. Conclusions The use of screw-hole locating guide and pre-bent plates enhanced surgical accuracy and efficiency. It also highlighted how patient-specific design can reduce dependence on surgeon experience and standardized outcomes in complex mandibular fractures. Trial registration The study is registered at ClinicalTrials.gov Protocol Registration and Results System Receipt, ID: NCT05444829.

Objectives This study aims to evaluate the quality and quantity of gained and maintained bone width after Ridge splitting utilizing autogenic bone wedge versus mixed bone particles for horizontal ridge augmentation in the anterior aesthetic zone. Materials and methods This randomized clinical trial included 20 patients with horizontally deficient anterior maxillary alveolar ridges. Patients were divided equally into two groups. Group I received an autogenous bone wedge harvested from the chin area to be placed intercotically after ridge splitting (intervention group). Group II received mixed bone particles of autogenic and xenogeneic bone placed intercortically after ridge splitting (control group). Radiographic assessment of gained and maintained alveolar bone width at three vertical levels was performed using CBCT at three-time intervals (preoperative, immediate postoperative, and 6 months postoperative). Histologic and histomorphometric analysis of core biopsy harvested immediately before implant placement was also performed to assess bone quality and % of newly formed bone area using H&E and Mansons trichrome stains. Collected data were conducted for statistical analysis. Results The outcome of the studied grafts showed a significant increase of the immediate postoperative bone width in the control group more than the intervention group, with a mean difference from the preoperative bone width (2.17 ± 1.10) mm for the control group and only (1.44 ± 0.66) for the intervention group. In contrast, the 6-month postoperative bone width was decreased in both groups with a mean difference from the immediate postoperative bone width (1.21 ± 0.54) in the control group (p-value < 0.001) compared to only (0.41 ± 0.50) in the intervention group (p value = 0.135); this statistical data revealed that the bone wedge technique of the intervention group helped to maintain the gained bone width more than the packed bone particles of the control group. Moreover, the intervention group showed higher value and quality of newly formed mature bone with well-formed havarsian canals than the control group, which showed lower bone quality of osteoid and fibrous tissue with remnants of xenogenic bone particles microscopically. Conclusions The two-stage ridge-splitting procedure using an interposition bone wedge is an effective method for horizontal ridge augmentation in the horizontally deficient anterior maxilla. Clinical relevance The two-stage Ridge splitting with an inter-positional bone wedge ensures better bone width maintenance and quality. Trial registration The study was registered on ClinicalTrials.gov on 24/07/2024 under the registry number “NCT06529653”. It adhered to the Declaration of Helsinki on medical research ethics and received approval from the Institutional Research Ethics Committee of the Faculty of Dentistry, Cairo University (IRB number: 161022).

Purpose Surgical removal of intra-bony calcific benign lesions is technically challenging regarding its accessibility, proximity to vital structures, and deteriorating effect on the remaining bony structures. Methods Computer-guided buccal cortical plate separation was performed for ten patients using patient-specific osteotomy locating guides and pre-bent plates. The guide was designed to outline the osteotomy, the buccal cortical plate was separated, the lesion was removed, and finally, the pre-bent plates were used to fix the separated cortex. Results Surgical procedures were uneventful for all patients, operation time was 39.5 ± 13.01 min, postoperative pain decreased within the follow-up time intervals, and there was a statistical significant difference between the time intervals ( P value < 0.001). Edema and trismus were acceptable. One case showed nerve affection which resolved after 4 weeks. Conclusion Computer-guided buccal cortical plate separation for removal of intra-bony calcified benign lesions provides a promising approach, especially for inexperienced surgeons. Trial registration ClinicalTrials.gov NCT05329974 . Registered on 6 April 2022—retrospectively registered.

Background English language anxiety (ELA) is a prevalent phenomenon in language education. It is one of the most commonly investigated non-linguistic variables in studies of language learning. Accordingly, numerous studies have paid great attention to the factors leading to FLA. Methods As instruments of ELA have not been subjected to a rigorous test of item response theory (IRT), this study conducted such analysis using the Rasch rating scale model. ELAS scale developed using classical testing theory (CTT), which consists of 32 items measuring four sub-scales (listening, speaking, reading and writing anxiety), was analysed using IRT. WINSTEPS software and SPSS version 26 were used to examine the psychometric properties, sex differential item functioning (DIF) and Rasch analysis of the ELAS in the Egyptian context. A total of 604 participants were recruited for data collection. Results The main findings indicated that the scale yielded a good approximation of Rasch assumptions and appears to be a valid and reliable tool. DIF was computed using the Mantel–Haenszel (MH) method and Welch’s t-test, which indicated that no sex bias was detected for any item of the ELAS. Conclusions This paper presents a promising ELA instrument characterized by adequate validity, reliability and objectivity in addition to potential for precise use in comparison between males and females because it is invariant across sex.

Background Eating problems are prevalent among children with autism spectrum disorder (ASD). The Brief Autism Mealtime Behaviors Inventory (BAMBI) has great potential for helping physicians quickly detect feeding issues in autistic children. This study aimed to evaluate feeding behavioral problems and their correlation to ASD severity among children with ASD using the BAMBI and Childhood Autism Rating Scale (CARS). This cross-sectional study enrolled 52 Egyptian children with an ASD. An Arabic version of BAMBI was administered to the parents of these children. Data about the participants’ sociodemographics as well as BAMBI and CARS were collected. Results Our main findings revealed that limited food variety features, such as preferring crunchy food or only sweet foods, were significant problems (57.7% and 52%). The means of the BAMBI and the CARS were 48.11 ± 12.2 and 39.9 ± 9.8, respectively. Living in rural areas, having limited income, elementary education of mothers, unemployed fathers, low birth weight, and neonatal care unit admission, were significantly associated with the BAMBI scale. Children with more severe ASD have a limited variety of behavior during eating than the minimal and moderate ASD groups ( p  = 0.01 and 0.03, respectively). A statistically positive correlation was observed between the BAMBI and CARS ( r  = 0.4 and p  = 0.02). Conclusions Using the BAMBI scale, Egyptian children with more severe ASD were found to have limited food selectivity. The BAMBI scale was significantly correlated with the CARS, suggesting that the BAMBI may be an effective measure of the severity in autistic children.

Objective Complex mandibular anatomy including rolled-out inferior mandibular border, thin rami with cortically adherent inferior alveolar nerve (IAN) complicate the application of the current mandibular osteotomies. This study aims to introduce an intraoral Inverted-L Ramus Osteotomy (ILRO) modified with IAN lateralization and intra-canal osteotomy for management of complex mandibular anatomical variations during mandibular setback surgery. Patients and Methods This prospective study included 20 skeletal class III patients (mean age: 21.6 ± 3.3 years) with complex mandibular anatomy indicated for mandibular setback surgery (mean setback: 6.05 ± 1.1 mm). Preoperative CBCT imaging, digital planning, and fabrication of cutting / drilling guides were performed. Surgery involved mandibular setback through the application of the ILRO modified with nerve lateralization and intra-canal osteotomy. IAN function evaluated preoperatively at intervals up to one year postoperatively. Data on bad splits and surgical duration were also analyzed. Results The mean surgical duration was 2.26 ± 0.21 h, with bilateral IAN exposure completed in 11 ± 3.2 min per side. All 40 osteotomy sites were separated without bad splits. Neurosensory deficits were observed in 90% of patients at two months, decreasing to 35% at six months and 5% at one year. Conclusion The introduced osteotomy overcomes the limitations of the traditional mandibular osteotomies in dealing with mandibular complex anatomy with adequate IAN protection and split segments integrity during mandibular setback surgery. Clinical relevance The introduced osteotomy provides a safe alternative to the current mandibular osteotomies utilized in mandibular setback surgery.

Objective The primary goals for alveolar cleft grafting are to gain and maintain bone in the cleft area that provides continuity for the maxillary segments, allowing the stability of the maxilla and building the bony foundation for the erupting cleft teeth and closure of the oronasal communication. The current study compared the effectiveness of the double iliac corticocancellous bone blocks technique versus the particulate autogenous spongy bone graft from the anterior iliac crest in alveolar cleft grafting in the mixed dentition stage. Patients and methods The current randomized clinical study included 18 patients with unilateral alveolar clefts. They were divided into two equal groups according to the technique used for grafting; group (1) included nine patients in whom grafting with double iliac corticocancellous bone blocks with cancellous bone particulates in between was used (study group), and group (2) included nine patients in whom conventional cancellous particulate bone grafting from anterior iliac crest was used (Control group). Results Nine months postoperatively, the study group showed superior results regarding graft width, height, and volume compared to the control group in the current study. Conclusion Regarding the graft success factors represented by the maintained graft labio-palatal width, graft height, and total graft volume, the technique of double iliac corticocancellous bone blocks was markedly effective in reconstructing alveolar clefts when compared with the conventional grafting technique that utilized cancellous particulate bone alone from the anterior iliac crest. Clinical relevance. The double iliac corticocancellous bone blocks technique maintained the grafted bone volume, width, and height.

ObjectiveThe essential concern of alveolar cleft grafting in patients of cleft lip and palate at the mixed dentition phase is to gain bone within the cleft area that provides closure of the oronasal communication with continuous and stable maxilla for future cleft teeth eruption or implantation. This study aimed to compare the effectiveness of mineralized plasmatic matrix (MPM) versus cancellous bone particles harvested from anterior iliac crest in secondary alveolar cleft grafting.Patients and methodsThis prospective randomized controlled trial was conducted on ten patients with unilateral complete alveolar cleft requiring cleft reconstruction. Patients were randomly divided into two equal groups; group (1) included 5 patients who received particulate cancellous bone derived from anterior iliac crest (control group) and group (2) included 5 patients who received MPM graft prepared from cancellous bone derived from anterior iliac crest (study group). All patients received CBCT preoperatively, immediately postoperatively and after 6 months. On the CBCT, graft’s volume, labio-palatal width, and height were measured and compared.ResultsThe outcome of the studied patients 6 months postoperatively showed that the control group had significant decrease in the graft volume, labio-palatal width, and height compared to the study group.ConclusionMPM allowed for the integration of bone graft particles inside a fibrin network, which offers positional stability of the bone particles, thus preserving their shape with subsequent “in situ” immobilization of the graft components. This conclusion was reflected positively in terms of maintained graft volume, width, and height compared to that of the control group.Clinical relevanceMPM allowed for maintenance of grafted ridge volume, width, and height.

Hyperphosphatemic familial tumoral calcinosis (HFTC) is a rare autosomal recessive disorder characterized by ectopic calcifications in periarticular soft tissues due to mutations in genes such as GALNT3, FGF23, or KL, leading to FGF23 deficiency or resistance and subsequent hyperphosphatemia. This study describes a 12-year-old girl from Jazan, Saudi Arabia, who presented with progressive right hip pain and swelling, initially managed as an infection. Imaging revealed periarticular calcifications, and laboratory tests confirmed hyperphosphatemia with normal calcium and parathyroid hormone levels. Genetic testing identified a homozygous pathogenic variant in GALNT3, confirming HFTC type 1. Recurrence occurred 1.5 years later in the right elbow, with similar radiographic findings. Further evaluation via CT demonstrated basal ganglia and parotid gland calcifications, highlighting systemic involvement. Management included complete surgical resection of calcific deposits, followed by acetazolamide (500 mg twice daily) and a low-phosphorus diet. Over one year of multidisciplinary follow-up, no recurrence was observed. Histopathology revealed microcalcifications with a giant cell reaction, consistent with HFTC. HFTC's diagnosis relies on clinical, biochemical (hyperphosphatemia), and radiological findings (multilobulated periarticular calcifications), supplemented by genetic testing. Treatment involves phosphate-lowering strategies (dietary restriction, phosphate binders, acetazolamide) and surgical excision for symptomatic lesions. This study underscores the importance of early recognition, genetic confirmation, and a multidisciplinary approach to prevent complications and recurrence.