This literature review examines the literature on surgical management of ameloblastoma and keratocystic odontogenic tumours (KCOT). KCOT represent 3 % - 11 % of all the cystic lesions in the jaws and ameloblastoma 11 % of the odontogenic tumours. Treatment involves removal of the tumours by means of enucleation, curettage, marsupialization or resection. The first three can be combined with each other or with the adjunctive therapies: applications of Carnoy´s solution or cryotherapy. The aim of this literature review is to evaluate the risk of complications correlated to different surgical techniques for removal of KCOT or ameloblastoma. A search was performed in PubMed based on our keywords (Marsupialization, decompression, fenestration, enukleation, KCOT, OKC, KOT, keratocystic odontogenic tumor, odontogenic keratocyst, ameloblastoma, outcome, follow-up, relapse, prognosis, recurrence). The data was managed with Excel.  Twenty articles met our criteria: 12 articles reported KCOT in 667 patients and 8 articles reported 191 patients concerning Ameloblastoma. The articles almost exclusively presented the risk of recurrence for different treatment modalities. Subsequently the results mainly contain recurrence rates for different surgical techniques. 412 KCOT patients received enucleation alone and 92 recurred, resulting in a recurrence rate of 22.3 %. 91 patients with ameloblastoma received resection and four recurred, resulting in a recurrence rate of 4.4 %. This review fails to identify any reliable evidence on recurrence rates in relation to treatment modalities for KCOT and ameloblastoma. Further prospective controlled clinical trials are essential to address this important issue.

ABSTRACT   Background Removal of mandibular third molars can be associated with postoperative complications. Coronectomy with partial removal of the crown, is described as an alternative surgical method when risks for post-operative complications are substantial.  Aim  The aim of this study was to evaluate risk factors for post-operative complications after coronectomy.   Materials and Methods Fifty-six patients (26 men/30 women, median age 51 years) were operated with coronectomy of mandibular third molars. Risk factors were identified from medical records and radiographic examinations. Post-operative complications lasting over 14 days were registered.   Results  Fifty percent of the patients had a post-operative complication with significant higher risk for complications for patients over 51 years (p = 0.016). The most common complications were pain from surgical site and local infection. Three patients were registered with affected sensory function. Root migration was registered in 16 patients. Gender, comorbidity, medication, tobacco use, cause of referral (bacterial/other causes) or angulation of the third molar did not affect the risk for complications. Conclusion  The results indicate that coronectomy is an appropriate surgical technique when the risks for postoperative complications are significant, although a high level of short-term complications has been observed.

Additive manufacturing (AM) has enabled the possibility for the hospitals to become their own implant producers developing implants that are tailored to patient’s anatomy. Despite the enormous potential of custom-made implants there are challenges that complicate the implementation of them into clinical practice. The aim of this research is to (1) identify the main driving forces and barriers for the delivery of custom-made implants; (2) explore staff stakeholder views and practices related to the implementation of AM in surgery for the development of custom-made implants; (3) formulate recommendations on how to cope with the implementation challenges. The research method was an explorative qualitative study consisted of a literature review on the challenges of custom-made implants in clinical applications coupled with the collection and inductive analysis of empirical data. The empirical study was based on ten semi-structured interviews conducted among both domestic and international hospital managers medical doctors and research engineers. The consolidated framework for implementation research (CFIR) was utilized for data collection. Using the five domains of CFIR, the following results were obtained: (1) Characteristics of individuals: Most research participants indicated a positive attitude towards the innovation expressing self-efficacy to its use; (2) Intervention characteristics: Custom-made implants were perceived to have a relative advantage in surgical practice due to their high degree of observability and geometrical adaptability providing increased surgical quality, perfect patient fit and better understanding of pathologies. However, high implementation costs, low degree of trialability and high degree of complexity in the development process were regarded as drawbacks of the innovation; (3) Outer setting: the regulatory uncertainty and lack of reimbursement limit the accessibility of custom-made implants to low income populations; (4) Inner setting: scarcity of resources, staff resistance to change, insufficient management support, communication difficulties, limited access to educational materials and training opportunities as well as lack of time and innovative capacity were regarded by the majority of participants as implementation barriers; (5) Process: central for the success of implementation is the need for a coherent implementation plan and evaluation process as well as the engagement of key stakeholders such as hospital managers, payers, regulatory and implementation advisors. This dissertation proffers a deeper understanding of the implementation issues related to custom-made implants and offers preliminary recommendations on how to cope with implementation impediments through the use of Rogers diffusion of innovation coupled with concepts from the field of organizational change and innovation management including Clayton’s disruptive innovation.