Background: Since the novel coronavirus disease (COVID-19) outbreak, the cases of COVID-19 co-infections have been increasingly reported worldwide. Mucormycosis, an opportunistic fungal infection caused by members of the Mucorales order, had been frequently isolated in severely and critically ill COVID-19 patients. Methods: Initially, the anamnestic, clinical, and paraclinical features of seven COVID-19-associated mucormycosis (CAM) cases from Egypt were thoroughly reported. Subsequently, an extensive review of the literature was carried out to describe the characteristics of CAM cases globally, aiming to explore the potential risk factors of mortality in CAM patients. Results: Out of the seven reported patients in the case series, five (71.4%) were males, six (85.7%) had diabetes mellitus, and three (42.9%) had cardiovascular disease. All patients exhibited various forms of facial deformities under the computed tomography scanning, and two of them tested positive for Mucorales using the polymerase chain reaction (PCR) testing. Liposomal amphotericin B (LAmB) was prescribed to all cases, and none of them died until the end of the follow-up. On reviewing the literature, 191 cases were reported worldwide, of which 74.4% were males, 83.2% were from low-middle income countries, and 51.4% were aged 55 years old or below. Diabetes mellitus (79.1%), chronic hypertension (30%), and renal disease/failure (13.6%) were the most common medical comorbidities, while steroids (64.5%) were the most frequently prescribed medication for COVID-19, followed by Remdesivir (18.2%), antibiotics (12.7%), and Tocilizumab (5.5%). Conclusions: As the majority of the included studies were observational studies, the obtained evidence needs to be interpreted carefully. Diabetes, steroids, and Remdesivir were not associated with increased mortality risk, thus confirming that steroids used to manage severe and critical COVID-19 patients should not be discontinued. Lung involvement, bilateral manifestation, and Rhizopus isolation were associated with increased mortality risk, thus confirming that proactive screening is imperative, especially for critically ill patients. Finally, surgical management and antimycotic medications, e.g., amphotericin B and posaconazole, were associated with decreased mortality risk, thus confirming their effectiveness.

Purpose The recent coronavirus disease (COVID-19) pandemic mainly affects the respiratory system; however, several oral and maxillofacial post-COVID-19 complications have also been observed. This series reports the growing number of osteonecrosis cases associated with post-COVID-19 patients. Materials and methods This is a retrospective, multi-center case series that reports cases with maxillary osteonecrosis after various periods of SARS-CoV-2 infection in the period between January and August 2021 based on the PROCESS guidelines. Results Twelve cases were reported with post-COVID-19 manifestation of spontaneous osteonecrosis of the maxillary jaw. Five patients were hospitalized during COVID-19 management and all of the twelve cases had at least one systematic Co-morbidity, and undertake corticosteroids prescription based on the COVID-19 disease treatment protocol. The mean onset of osteonecrosis symptoms appearance was 5.5 ± 2.43 weeks calculated from the day of the negative PCR test. The management was successfully done through surgical debridement and pre and post-operative antibiotics. No anti-fungal medications were prescribed as the fungal culture and the histopathological report were negative. Conclusion Post-COVID-related osteonecrosis of the jaw (PC-RONJ) could be now considered as one of the potential post-COVID-19 oral and maxillofacial complications that occurs unprovokedly and mainly in the maxilla.

Objective Myofascial pain syndrome with trigger points is the most common cause of nonodontogenic pain. Although injection of the trigger points is the most effective pain reduction treatment, many patients exhibit recurrence after a short period. Therefore, the aim of the current study was to evaluate the clinical efficacy of magnesium sulfate injections in the treatment of the masseter muscle trigger points when compared to saline injections. Material and method This study randomly (1:1) assigned 180 patients to one of two treatment groups based on whether their trigger points were injected with 2 ml of saline or magnesium sulfate. Pain scores, maximum mouth opening (MMO), and quality of life were measured at the pre-injection and 1, 3, and 6 months post-injection. Results The pain scores were significantly higher in the saline group during all follow-up assessments, whereas the MMO was significantly higher in the magnesium sulfate group up to 3 months of follow-up (p < 0.001). However, the difference in MMO ceased to be statistically significant after 6 months of follow-up (p = 0.121). Additionally, the patient’s quality of life score was significantly higher in the magnesium sulfate group compared to the saline group (p < 0.001). Conclusion Injection of magnesium sulfate is an effective treatment measure for myofascial trigger points. However, further studies with a proper design addressing the limitations of the current study are necessary. ClinicalTrials: org (ID: NCT04742140) 5/2/2021.

Objective: The aim of the study was to evaluate the efficiency of temporomandibular joint arthrocentesis with ozonated water versus ringer lactate in treatment of anterior disc displacement without reduction (closed lock) and to evaluate the effect of both procedures on the level of interleukin-6 (IL-6) in the joint space. Patients and methods: Forty patients with bilateral anterior disc displacement without reduction were included in the study. Patients were randomly allocated into 2 groups. Group I performed arthrocentesis using ozonated water while group II underwent the same procedure using sodium ringer lactate. Clinical evaluation of the patients was done preoperative, immediately ostoperative, at 1 week and 1, 3 and 6 months postoperatively. The pain was assessed using visual analog scales. Maximal mouth opening (MMO) was recorded at each follow-up visit. Synovial fluid sample was collected to detect the level of IL-6, preoperative, immediately postoperative and at six months postoperative Results: Both groups showed improvement in clinical parameters. Concerning maximal mouth opening, there was no statistically significant difference between the two groups pre-operatively, after 1 week as well as after 1 month. After 3 months and 6 months, Group I showed statistically significant higher mean MMO than Group II. the pain score assessment showed no statistical significant difference between the two groups pre-operatively. Through all other periods, Group I showed statistically significantly lower mean VAS scores than Group II. The interleukin-6 levels showed no statistically significant difference between the two groups pre-operatively. Immediately post-operative as well as after 6 months, Group I showed statistically significantly lower mean IL-6 level than Group II. Conclusion: Arthrocentesis using ozonated water proved to have superior results in treatment of TMJ anterior disc displacement without reduction. Interleukin-6 level in the TMJ synovial fluid has direct correlation with the dysfunction symptoms.

Objectives: The aim of the study was to evaluate the accuracy of surgical templates for guided implant surgery using 3D printing. Patients & Methods: Twenty-four patients were examined for implant placement. Each implant site was planned virtually and a 3D printed surgical guide was constructed. The implant had been installed using the 3D printed surgical guide. Postoperative CBCT was performed, and the images were superimposed on the virtual planning images. The amount of coronal, apical, and angular deviation was calculated. Results: A total of 48 implants were placed in 24 patients. Elven patients were completely edentulous while the other 13 patients where partially edentulous. Mean angular deviation of the implants placed in partially and completely edentulous patients 4.1±0.1 and 3.3±0.78 degrees respectively. While the mean deviation coronally was 1.5±0.3 and 1.1±0.5 mm in partially and completely edentulous patients respectively. The deviation at the apical portion showed a mean 2.1±0.3 and 2.2±0.5 mm in implants placed in partially and completely edentulous patients. Statistical significant difference between the partially and completely edentulous arches where found in coronal and angular deviation while the apical deviation showed no significant difference. Conclusion: A high accuracy in implant placement can be achieved using 3D printed surgical guide.