Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse effect associated with antiresorptive therapy, particularly following tooth extraction in osteoporotic patients. This study aimed to estimate the prevalence of MRONJ after tooth extraction in individuals with osteoporosis through a systematic review and meta-analysis. Methods: A comprehensive search was conducted across three major databases (Medline, Scopus, Web of Science) up to January 2025, including observational studies reporting MRONJ following extractions in osteoporotic patients treated with antiresorptives. Pooled prevalence rates were calculated using a random-effects model, and study quality was assessed. Influence analyses as well as meta-regression were also performed. Results: Twenty-four studies were included, comprising 3784 patients and 5426 extractions. The pooled prevalence of MRONJ was 1.7% (95% confidence intervals (CI): 0.8–3.0%), with considerable heterogeneity (I² = 77%). When considering only cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) following tooth extraction in patients with osteoporosis, the estimated prevalence was 0.7% (95% CI: 0.1–1.8%), with substantial heterogeneity (I² = 61%). No individual study was identified as overly influential. Meta-regression revealed no significant associations between MRONJ prevalence and variables such as publication year, gender proportion, or extraction-to-patient ratio. Conclusions: This meta-analysis underscores the importance of vigilance in managing osteoporotic patients undergoing extractions, emphasizing the need for consistent diagnostic criteria and preventive protocols to mitigate MRONJ risk.

Background and Objectives: Severe alveolar atrophy may pose significant challenges for dental rehabilitation. Recent advances in digital planning and CAD/CAM technology have renewed the interest in patient-specific subperiosteal implants as a treatment option for anatomically challenging cases. This cohort study evaluated changes in oral health-related quality of life and patient satisfaction following rehabilitation with customized subperiosteal implants in severe alveolar atrophy. Materials and Methods: This cohort study included all consecutive adult patients with severe alveolar atrophy who underwent reconstruction with patient-specific subperiosteal implants at the Department of Oral and Maxillofacial Surgery of “Evangelismos” General Hospital, Athens, Greece, in 2025. Oral health-related quality of life was assessed using the validated OHIP-14 questionnaire preoperatively and 12 months postoperatively. Patient satisfaction was evaluated using a numerical rating scale (NRS). Secondary outcomes included postoperative complications, implant exposure, implant stability, and need for reoperation. Comparisons between baseline and 12-month scores were performed using the Wilcoxon signed-rank test. Results: Nine patients who had completed 12-month follow-up were included. Five were male, and all implants were placed in the maxilla. Significant improvement was observed in oral health-related quality of life, with the median OHIP-14 total score decreasing from 41 preoperatively to 1 at the 12-month follow-up. Patient satisfaction also improved significantly, with the median NRS total score increasing from 17 to 58. Improvements were consistent across all OHIP-14 domains and all NRS items. No major complications were recorded. One patient developed early wound dehiscence, and one patient presented with implant exposure at the anterior palate. At the final follow-up twelve months postoperatively, all implants remained clinically and radiographically stable. Conclusions: These preliminary short-term findings suggest that customized subperiosteal implants may be a promising option for selected patients with severe alveolar atrophy in whom placement of conventional endosseous implants is not feasible; however, the results should be interpreted cautiously given the very small sample size and observational design.

Outpatient parotidectomy has emerged as a potential alternative to inpatient surgery for selected patients. This systematic review and meta-analysis aimed to compare postoperative complications between outpatient and inpatient parotidectomy. A systematic search was conducted across PubMed/MedLine, Scopus, Web of Science, CENTRAL, and Google Scholar up to October 12, 2025. Observational and interventional studies comparing outpatient and inpatient parotidectomy in adults were included. Quality of studies was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95 % confidence intervals (CI) were calculated using random-effects model. Heterogeneity was quantified using I², and certainty of evidence was rated using the GRADE framework. Ten retrospective cohort studies were included. Outpatient surgery was associated with significantly lower odds of hematoma (0.36, 95 % CI: 0.17-0.77), permanent facial nerve weakness (OR = 0.10, 95 % CI: 0.06-0.17), and reoperation (OR = 0.32, 95 % CI: 0.23-0.44). No significant differences were observed for seroma, sialocele, infection, Frey's syndrome, fistula, or transient facial nerve weakness. All included studies were of moderate methodological quality, and the overall certainty of evidence was very low. Outpatient parotidectomy appears safe and feasible for selected patients, with complication rates comparable to inpatient surgery. Further prospective studies are needed to confirm these findings.

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication in patients treated with antiresorptive or antiangiogenic agents, particularly those with cancer-related comorbidities. This systematic review and meta-analysis aimed to estimate the prevalence of free flap failure in patients undergoing microvascular reconstruction for MRONJ. Methods: A comprehensive literature search was conducted across Medline/PubMed, Scopus, and Web of Science up to 30 January 2025. Inclusion criteria were observational studies involving MRONJ patients treated with free flap reconstruction. Risk of bias was assessed using the Newcastle–Ottawa Scale. The pooled prevalence of free flap failure was calculated using a random-effects model with Freeman–Tukey double arcsine transformation. Results: Twelve studies were included in the quantitative analysis. The fibula free flap was the most frequently used flap. The pooled prevalence of free flap failure was 0.1% (95% CI: 0–2.3%), with no significant associations observed in meta-regression analyses for publication year, patient age, or sex. All included studies were of moderate methodological quality. Conclusions: These findings suggest that free flap reconstruction is a reliable and effective surgical option for managing advanced MRONJ in well-resourced and specialized healthcare settings; however, limitations such as small sample sizes and heterogeneity in protocols must be considered. Further high-quality, multicenter studies are needed to evaluate long-term outcomes and refine perioperative management strategies.