The aim of this review is to discuss the requirements for effective irrigation of the root canal system and its role in treatment outcome. A review of the literature regarding irrigants, methods of irrigation and regimens was undertaken. It indicates that irrigation is comprised of a multitude of factors, and that effective irrigant delivery and agitation achieves mechanical, chemical and microbiological functions, which are prerequisites for obtaining a clean canal system. However, most studies are ex vivo and assess intermediate outcome values rather than treatment success. Additionally, there is an absence of high-level evidence evaluating the effect of irrigation on the outcome of root canal treatment. Therefore, citing irrigation as a significant factor that affects root canal treatment success cannot be done. This highlights the need to further investigate the prognostic value of irrigation on root canal treatment success.

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Dentofacial deformities (DFD) and obstructive sleep apnea (OSA) are two entities which can be intricately related and require complex management. It can be argued that in the subset of patients in which these two entities overlap and require intervention, an orthognathic surgery first approach (SFA) should be considered a primary treatment modality. With respect to isolated dentofacifal deformities undergoing orthognathic surgery first, the literature and cases completed by the authors resulted in an overall decrease in orthodontic treatment time, on average one year. This is in comparison to the average orthodontic treatment length in those who undergo orthognathic surgery after completion or near completion of orthodontic treatment. In addition, advantages of this treatment modality are immediate resolution of the dentofacial deformity and easier decompensation of the malocclusion after surgery. In relation to OSA, it is known that orthognathic surgery can decrease the apnea-hypopnea index (AHI) in the range of 50-90% resulting in improvement or resolution of symptoms in approximately 90% of patients. Therefore, in the subset of patients with both OSA and DFD requiring intervention and who undergo surgery first intervention, assessing both objective and subjective outcomes (i.e., improvement in AHI, length of treatment, patient satisfaction and QOL) can be utilized to further evaluate the value in this approach as a primary treatment modality.

Fibular free flap reconstruction remains the workhorse of postmandibulectomy reconstruction. Dental implantation to support a dental prosthesis is a sought-after outcome when the area of resection involves tooth-bearing zones. Chronic perisoft tissue pedicle hyperplasia with secondary infection leading to gradual bone loss is a simple complication to manage in the general population, but it becomes a serious issue in the fibula mandibular reconstruction patient in that it can lead to pathological fracture of the fibula. A case of a patient with a near fracture of his fibula mandibular reconstruction, and its management via a minimally invasive approach is presented.