The biological response to peripheral nerve injury is highly intricate and comprises a synchronized sequence of cellular and molecular processes, including Wallerian degeneration, Schwann cell stimulation, macrophage-dependent debris removal, vascularization, extracellular matrix remodeling, and axonal regeneration. Successful recovery relies not only on the inherent regenerative capability of peripheral nerves but also on the reestablishment of a permissive niche facilitating neural healing. In the mandibular canal, however, regeneration may be impaired by distinct anatomical limitations. Edema, vascular inadequacy, inflammation, and fibrosis can compromise axonal regrowth and contribute to persistent neurosensory disturbance. Consequently, functional recovery after IAN injury is largely unpredictable, underscoring the need for therapeutic strategies that actively facilitate regeneration rather than merely attenuating symptoms.

Contemporary management approaches for IAN injury remain mainly supportive. Corticosteroids are mostly used during the acute phase to alleviate edema and inflammation, while microsurgical interventions, pharmacologic neuroregulators, and local anesthetics are administered in some cases. Although these strategies may mitigate secondary injury or enhance symptom control, they do not directly address the multifactorial biological signaling regulating nerve regeneration. As a result, treatment outcomes remain variable, and no universally accepted regenerative treatment has emerged for daily clinical application.

Recently, regenerative peptides have garnered attention as promising biologic regulators of tissue healing and neural regeneration. Contrary to traditional treatments that target isolated components of the injury pathway, numerous peptide-mediated agents demonstrate pleiotropic activities that affect several regenerative cascades concurrently. Preclinical studies suggest that Body Protection Compound-157 (BPC-157) may enhance cytoprotection, endothelial stability, and angiogenesis while regulating inflammatory pathways. Similarly, TB-500, a derivative of thymosin β4, has been associated with enhanced cellular migration, cytoskeletal remodeling, and tissue healing in experimental models. ARA-290 has shown tissue-protective and immunoregulatory features in preclinical and selected early clinical studies. Nonetheless, these mechanisms have not been directly shown in patients with IAN injury and should be regarded as biologically plausible hypotheses rather than established clinical mechanisms.

A recent case report published in Frontiers in Oral Health presents three clinical cases of IAN injury managed with a multimodal peptide-mediated approach comprising peptide agents, adjunctive dexamethasone, and local anesthesia. The first case involved a 38-year-old female with a prior history of Le Fort orthognathic surgery who experienced failure of a dental implant at site #30, related to cyst formation, localized bone necrosis, and abscess formation. Within 24 hours after reimplantation, she reported right-sided mandibular paresthesia. CBCT imaging revealed that the implant was placed in proximity to the IAN canal, nearly 2 mm away, without direct canal violation. The clinical findings were consistent with an indirect IAN injury, possibly associated with compression, edema, or local inflammatory responses rather than direct nerve transection.

The second case involved an 85-year-old patient who experienced failure of a dental implant at site #30. The implant was extracted utilizing a trephine bur, and the osteotomy site was grafted with platelet-rich fibrin. Within 24 hours post-surgery, the patient reported right-sided mandibular paresthesia extending from the chin to the ipsilateral oral commissure. CBCT imaging showed that the osteotomy site was in proximity to the IAN canal, around 2 mm away, with no indication of direct canal penetration. The observations indicated a compression-associated or indirect IAN injury. The third case involved a 48-year-old female who presented after extraction of a tooth and subsequent bone grafting in the right posterior mandible. Postoperatively, she reported enduring numbness on the right side of the mandible, affecting the lower lip and chin. Periapical and panoramic radiographs showed tooth-related pathology directly associated with the IAN canal before extraction, reflecting a potentially more severe injury pattern.

All three patients received weekly localized intraoral submucosal infiltrations over a period of 4 weeks, utilizing the same multimodal protocol consisting of peptide agents (ARA-290 [4 mg], TB-500 [10 mg], and BPC-157 [1 mg]) together with dexamethasone (8 mg) and bupivacaine 0.5% with 1:200,000 epinephrine (3.6 mL). Injections were precisely targeted to the affected sensory distribution. During follow-up, all three patients reported gradual enhancement in neurosensory symptoms. In the first case, the previously documented area of paresthesia had substantially decreased, with only a minor residual region of hypoesthesia (almost 3 mm) persisting inferior to the vermilion border of the lower lip. In the second case, the paresthetic region had significantly diminished in size, with only a minor residual area of diminished sensation (nearly 2 mm) persisting at the lateral aspect of the chin. In the third case, the subjective numbness had diminished by nearly 95%, with almost complete resolution of the affected region. A six-month follow-up revealed satisfactory hard tissue repair, and functional recovery was adequate to enable the placement of dental implants in the previously affected area without complications. No treatment-associated adverse events were documented in any of the three cases.

Despite these promising findings, numerous alternative interpretations must be considered. Spontaneous recovery is a well-established phenomenon after minor IAN injury, especially in instances of limited axonotmesis and neuropraxia. Hence, it remains indeterminate to what extent the documented recovery was due to intervention rather than the inherent healing trajectory. Additionally, the multimodal essence of the approach impedes the detection of the contribution of any singular element. The observable advantages may stem from one agent, a subset of agents, or associations among several treatments. The likelihood of observer bias and placebo effects must also be recognized, especially since outcome evaluation depended mainly on clinical assessment and patient-documented sensory enhancements. Since this was an uncontrolled observational case series, these outcomes should not be interpreted as evidence of intervention efficacy. Spontaneous recovery, placebo effects, regression to the mean, variability in injury severity, and the simultaneous use of dexamethasone and local anesthetic all represent plausible alternative explanations for the observed clinical course.

Many limitations require recognition. The limited sample size, absence of a control group, and non-randomized treatment allocation are significant constraints. An additional limitation is the absence of standardized quantitative neurosensory evaluation. Recovery was mainly assessed using routine clinical examination, patient-reported changes in sensation, and serial photographic documentation. Objective examinations, such as validated patient-reported outcome measures, visual analog pain scores, electrophysiological studies, quantitative sensory testing, thermal discrimination, pin-prick testing, two-point discrimination, and static light-touch testing, were not obtained prospectively. Hence, the magnitude of sensory recovery cannot be objectively quantified or directly compared with other published studies using standardized neurosensory outcome measures. Another important limitation is the inability to isolate the effects of the peptide components from those of adjunctive therapy. All three patients received an identical multimodal protocol, making it impossible to determine whether the observed clinical course resulted from one agent, a combination of agents, associations among interventions, or the expected natural history of recovery. Moreover, follow-up duration was inconsistent, restricting evaluation of long-term stability. Furthermore, the long-term safety profiles, pharmacokinetics, optimal dosing approaches, and regulatory status of many peptide-mediated agents remain inadequately characterized.

Future investigations should emphasize prospective controlled trials assessing peptide-mediated regenerative approaches in patients with well-characterized IAN injuries. Longer follow-ups, imaging-dependent evaluation, quantitative sensory assessments, and standardized neurosensory outcome measures will be required to identify whether these interventions offer a significant advantage beyond traditional management and spontaneous healing. Finally, comparative studies assessing isolated versus combination peptide interventions may facilitate clarifying potential synergistic impacts and determining optimal therapeutic strategies. The present study describes three patients with IAN injury who experienced neurosensory recovery during follow-up after receiving a multimodal peptide-mediated protocol. Because of the uncontrolled observational design, lack of randomization, blinding, standardized neurosensory evaluation, and untreated controls, these findings should not be interpreted as evidence of treatment efficacy or causality. Rather, these cases represent hypothesis-generating clinical observations that support further prospective controlled trials assessing the biological rationale and potential role of regenerative peptide-mediated strategies in the management of IAN injury.

Subject of Research: Regenerative peptides as adjuncts for inferior alveolar nerve injury repair

Article Title: Case Report: Regenerative peptides for Inferior alveolar nerve injury: a narrative review with hypothesis-generating three clinical cases

Article References: Froum, S., Estrin, N., Pico, G., Yakubov, M., Ahmad, P., & LaValle, J. (2026). Case Report: Regenerative peptides for Inferior alveolar nerve injury: a narrative review with hypothesis-generating three clinical cases. Frontiers in Oral Health, 7, Article 1907109. https://doi.org/10.3389/froh.2026.1907109

Image Credits: AI Generated

DOI: 10.3389/froh.2026.1907109

Keywords: inferior alveolar nerve, regenerative peptides, BPC-157, TB-500, ARA-290, nerve regeneration, oral and maxillofacial surgery, dental implants, case report, neurosensory recovery, Case, Report

The study, published in Frontiers in Oral Health, examined patients treated between December 2020 and November 2025 at the Department of Integrated Therapies in Otolaryngology. Of 165 consecutive patients evaluated for suspected sinonasal disease, 111 had sinusitis without any foreign body, 6 carried a maxillary foreign body without sinusitis, and 48 presented the combination that formed the core of the analysis: odontogenic maxillary sinusitis accompanied by a foreign object in the sinus. The male-to-female ratio in the overall cohort was almost exactly even, at 1.01, and 129 of the patients suffered the chronic form of the disease, defined by symptoms persisting for more than three months, while 26 presented acutely.

Odontogenic sinusitis, as the condition is known, occupies a distinctive position in sinus pathology. Under the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 classification, it is categorized as a secondary chronic rhinosinusitis, a localized disease with an anatomically unilateral distribution. The dominant mechanism is periapical or periodontal infection arising from a maxillary posterior tooth, in which inflammatory exudate erodes through the bone separating the dental apex from the sinus floor and drains into the cavity. Periapical lesions account for roughly 73 percent of cases, oroantral fistulae for 23 percent, and retained teeth for 4 percent, according to figures cited in the literature. The disease develops unilaterally in over 90 percent of cases, and between 85 and 90 percent of patients experience symptoms on the same side as the dental problem.

Recognizing the condition remains a diagnostic challenge. The most frequent complaints are facial pain or pressure, postnasal drip, nasal obstruction, and unilateral purulent discharge often accompanied by a foul odor or taste, yet dental pain is frequently absent, which can steer clinicians away from the true cause. Computed tomography typically shows partial to complete opacification of the maxillary sinus in 70 to 100 percent of cases, but dental pathology is reportedly overlooked in 60 to 70 percent of scans by radiologists unless a targeted dental assessment is performed. This blind spot is precisely why the Roman team insists on a multidisciplinary diagnostic pathway: preoperative CT scans were independently reviewed by at least three specialists, a radiologist, an otolaryngologist, and an oral surgeon, while endoscopic findings were evaluated jointly by at least two specialists before any surgical decision was made.

The foreign bodies themselves vary widely in composition and origin. Tooth roots, root canal filling materials, fractured tooth fragments, dental implants, and impression substances can all enter the sinus through apical migration, traumatic manipulation during dental procedures, or an oroantral fistula. Dental implants deserve particular attention. Accidental displacement usually occurs intraoperatively, linked to excessive site preparation, insufficient primary stability, or inadequate planning, but delayed migration years after placement has also been documented, potentially driven by peri-implantitis or bone resorption from improper occlusal load distribution. Resorption of the alveolar ridge combined with progressive pneumatization of the sinus reduces the available bone height in the posterior maxilla, which is both a major predisposing factor for displacement and a contraindication to implant placement in that region.

The surgical toolkit described in the paper centers on three routes of access. The nasal approach, an endoscopic middle meatal antrostomy, involves removing the uncinate process and enlarging the natural sinus ostium to clear diseased mucus while preserving healthy mucosa and its basement membrane, thereby maintaining mucociliary function; the widened opening can also serve as the corridor for foreign body extraction, though the proximity of the orbit and infraorbital nerve demands considerable expertise. The oral approach is a modified mini Caldwell-Luc procedure, in which a full-thickness mucoperiosteal flap is elevated over the canine fossa, a bony window is created in the anterior sinus wall, and the Schneiderian membrane is incised to access the cavity; the antrostomy typically exceeds 3 to 4 millimeters to admit a pediatric endoscope. This modification reduces the facial swelling and paresthesia associated with the traditional Caldwell-Luc operation and speeds recovery. Where an oroantral communication or fistula exists and the foreign body is small enough, the fistulous tract itself can serve as the removal route, after which the defect is closed with local flaps for small to medium gaps of 5 to 8 millimeters, or with cortico-cancellous grafts covered by resorbable collagen membranes, sometimes reinforced with a heterologous cortical lamina, for larger defects.

What distinguishes the Roman algorithm is its explicit integration of three variables that previous flowcharts treated more loosely: the status of the ostiomeatal complex, the size and position of the foreign body, and the presence or absence of an oroantral defect. The decision logic runs roughly as follows. In patients without ostiomeatal obstruction and without an oroantral defect, foreign bodies smaller than 1 to 2 centimeters are approached nasally if they sit superiorly or adhere to the sinus roof, and orally via the mini Caldwell-Luc if they lie inferiorly or are embedded in inflammatory tissue in the deep recesses; bodies larger than 2 centimeters require an endoscopically assisted lateral approach. In patients without sinusitis but with an oroantral fistula, the fistular route is preferred when the foreign body fits through the tract, with simultaneous fistula closure. When odontogenic sinusitis is present, signaled by ostiomeatal complex obstruction, the calculus shifts decisively toward combined surgery: small foreign bodies without a fistula are managed with a combined or purely nasal approach, large ones demand a simultaneous endoscopic and lateral procedure, and the coexistence of a fistula adds a fistular step for closure after nasal removal. For tiny foreign bodies under 1 to 2 millimeters, the team even endorses a wait-and-see policy when clinically appropriate, sparing the patient an operation altogether.

The outcomes lend the algorithm considerable weight. Among the 48 patients with sinusitis and a foreign body, 32, or 67 percent, underwent the combined oral and nasal approach in a single operative session, 12, or 25 percent, were treated orally alone, and 4, or 8.33 percent, nasally alone. Complete removal of the foreign body and complete resolution of symptoms were achieved in all cases, with no major complications and no revision surgeries over a mean follow-up of six months and a minimum of three. Within the broader cohort, ostiomeatal complex obstruction was observed in 77 cases, and 73 patients carried an oroantral defect alongside the foreign body. Under Felisati’s classification, 8 cases were pre-implantological complications, 37 were implantological complications, and 115 were classical complications, reflecting how heavily dental procedures and implant surgery feature in the origins of this disease.

The findings align with a growing international consensus that odontogenic sinusitis is best managed jointly by otolaryngologists and oral surgeons. Felisati and colleagues previously reported a 98.8 percent success rate across a prospective series of 257 patients using a cause-specific algorithm, while a prospective study by Kocum and colleagues found that a one-stage combined ENT and dental approach was used in 94 percent of 364 patients with a 97 percent success rate. The Roman team acknowledges the limitations of its own design: the analysis is descriptive rather than comparative, no formal statistical superiority testing was performed given the small size of subgroups such as the four nasal-only patients, and follow-up relied on clinical symptom resolution rather than systematic radiologic assessment or patient-reported outcome measures. Even so, the authors argue that the relatively large number of patients with maxillary sinus foreign bodies and the consistent application of a predefined algorithm make the results directly applicable to routine practice.

The broader message for patients and clinicians alike is that a displaced dental material in the maxillary sinus is rarely a trivial finding. Surgical removal is recommended when the foreign material causes or contributes to sinusitis, and the choice of route, nasal, oral, fistular, or a simultaneous combination of these, should be dictated by the anatomy of each case rather than by habit or specialty allegiance. As the authors put it in their conclusion, the simultaneous combined approach overcomes the anatomical and technical limitations of each individual access, providing wider visualization and more comprehensive access to the sinus cavity, reducing the risk of recurrence or complications, and representing, in their view, a new frontier in the management of foreign bodies in patients suffering from odontogenic sinusitis. Larger prospective and multicenter studies will be needed to confirm which patient subgroups benefit most, but for now the Rome algorithm offers one of the most detailed roadmaps available for a problem that sits, quite literally, at the intersection of two surgical disciplines.

Subject of Research: Surgical management of maxillary sinus foreign bodies in odontogenic sinusitis using a multidisciplinary treatment algorithm

Article Title: Maxillary foreign body management in odontogenic sinusitis: an algorithm based on a single centre experience

Article References: Sabatino, L., Lopez, M. A., Valentini, M., Mattaroccia, M., Iafrati, F., Di Giovanni, S., Moffa, A., & Casale, M. (2026). Maxillary foreign body management in odontogenic sinusitis: an algorithm based on a single centre experience. Frontiers in Oral Health, 7, Article 1945885. https://doi.org/10.3389/froh.2026.1945885

Image Credits: AI Generated

DOI: 10.3389/froh.2026.1945885

Keywords: odontogenic sinusitis, maxillary sinus, foreign body, dental implants, middle meatal antrostomy, Caldwell-Luc, oroantral fistula, endoscopic sinus surgery, multidisciplinary surgery, ostiomeatal complex, treatment algorithm, oral and maxillofacial surgery

The study, led by Tariq Ahmad and Muslim Khan of Khyber College of Dentistry in Peshawar, together with Brekhna Jamil of the Institute of Health Professions Education at Khyber Medical University and Muhammad Shahzad of Khyber Medical University and Zarqa University in Jordan, focused on postgraduate residents enrolled in training programmes overseen by the College of Physicians and Surgeons Pakistan. Oral and maxillofacial surgery is a demanding specialty that bridges dentistry and medicine, requiring trainees to master everything from complex dentoalveolar procedures to the management of facial trauma, tumours and reconstructive surgery. Yet the researchers noted that the learning experiences of these residents, and the factors that help or hinder their development, had received surprisingly little systematic attention, particularly in low- and middle-income countries where most of the world’s surgical training actually takes place.

The methodological choice is what makes the study distinctive. Rather than relying on retrospective interviews, which are notoriously vulnerable to memory bias and to what participants think researchers want to hear, the team used the audio-diary technique described in the Association for Medical Education in Europe’s Guide No. 144. Each resident recorded three reflective audio diaries capturing their experiences close to the moment they occurred. This approach, grounded in experiential learning theory associated with David Kolb and in the sociocultural ideas of Lev Vygotsky, allows researchers to capture learning as it unfolds in real time, including the emotional texture of clinical work that formal assessments rarely register. The diaries were then transcribed verbatim and subjected to thematic analysis, a qualitative method that identifies recurring patterns of meaning across the corpus of narratives.

The central finding is that workplace learning in this surgical setting is a multifaceted process shaped principally by three forces: clinical exposure, collaboration, and a supportive organisational environment. Clinical exposure emerged as the engine of learning, with residents describing how hands-on encounters with patients, from routine third molar extractions under local anaesthesia to major oncological resections, provided the raw material from which surgical competence is built. This aligns with decades of research on informal workplace learning, notably Michael Eraut’s work showing that much professional knowledge is acquired incidentally, through participation rather than instruction. But exposure alone was not enough. The residents’ accounts repeatedly emphasised that learning deepened when it was embedded in collaborative practice, where colleagues discussed cases, shared techniques and debriefed after difficult procedures.

The study identified a clear set of enablers that residents said made their learning possible. The overall work environment came first: hospitals where the atmosphere encouraged questions and permitted supervised autonomy transformed routine service work into educational opportunity. Supervisor support was another decisive factor. When consultants took time to explain the reasoning behind a surgical decision, demonstrated techniques step by step, or gradually entrusted residents with greater responsibility, trainees reported accelerated growth in both skill and confidence. This resonates strongly with the international literature on entrustment, including studies showing that faculty willingness to grant autonomy in the operating room is one of the strongest predictors of resident development. Peer support formed a third pillar, with senior residents functioning as what Vygotskian theory would call more knowledgeable others, scaffolding juniors through procedures just beyond their independent capability.

Perhaps most strikingly, the residents highlighted the availability of learning resources and support staff as a critical enabler, a finding that carries particular weight in resource-constrained health systems. Adequate nursing assistance, functioning equipment, access to journals and simulation facilities, and sufficient staffing to allow time for teaching all shaped whether a clinical day became a learning day or merely a shift to be survived. The researchers frame these findings within the concept of self-regulated learning, the process by which trainees set goals, monitor their own performance and adjust strategies. Self-regulation, the literature suggests, flourishes only when the workplace provides the psychological safety and material conditions that make deliberate practice possible. In surgical education, where the stakes of error are measured in patient harm, the environment is not a backdrop to learning but an active ingredient in it.

Against these enablers, the diaries recorded a darker catalogue of barriers. Excessive workload was the most frequently cited obstacle. Residents described rosters so demanding that fatigue eroded both their capacity to absorb teaching and their motivation to reflect on cases. This finding echoes a growing global literature on burnout among postgraduate medical trainees, including a systematic review published in CMAJ Open reporting substantial prevalence of burnout worldwide, and earlier Pakistani studies documenting burnout among surgical residents in the country’s public hospitals. The second major barrier was the lack of support staff, which forced residents to divert energy from learning into administrative and menial tasks, a phenomenon well documented in workplace-based studies from other lower-middle-income settings. The third barrier, fear of unexpected outcomes, deserves particular attention: residents described how anxiety about complications, and about the professional and emotional consequences of adverse events, made them hesitant to take on cases that would stretch their abilities.

This fear finding connects to one of the most important tensions in surgical training worldwide: the balance between patient safety and trainee autonomy. Research on trust in clinical education, including work by Hauer, Ten Cate and colleagues, has shown that supervisors calibrate the independence they grant based on perceived trainee competence, and that trainees in turn regulate their own participation based on their confidence and their reading of the supervisor’s trust. When fear of complications dominates, this delicate feedback loop can freeze, producing residents who remain passive observers far longer than their abilities warrant. The Pakistani study suggests that in settings with limited support staff and high patient volumes, this dynamic may be amplified, making structured supervision and psychological support after adverse events not luxuries but prerequisites for effective training.

The authors argue that understanding these enablers and barriers has direct practical value for the organisations that run postgraduate residency programmes in oral and maxillofacial surgery. By mapping where learning flourishes and where it stalls, programme directors can design more supportive and structured clinical training: protecting teaching time within heavy workloads, ensuring adequate staffing so residents are not consumed by non-educational tasks, training supervisors in feedback and entrustment, and building systems that help residents process complications constructively rather than through fear. The audio-diary method itself, the team suggests, could be adopted more widely, both as a research tool and as a reflective practice instrument for trainees, since recording regular reflections is known to deepen metacognition and professional identity formation.

The study’s significance extends well beyond one specialty or one country. With the global health workforce facing projected shortfalls of millions of workers by 2030, according to analyses in BMJ Global Health, most surgical training in the coming decades will happen in exactly the kind of resource-limited environments this study examined. Understanding how residents learn in those environments, and what institutions can do to multiply the enablers and dismantle the barriers, is therefore a matter of global health equity as much as educational theory. The voices captured in these thirty-three audio diaries, recorded between a resident and a recorder in the quiet after a long clinical day, offer a reminder that the making of a surgeon is a social and organisational achievement, not merely an individual one, and that every hospital, through its culture and its choices, is either building surgeons or wearing them down.

Subject of Research: Workplace-based clinical learning experiences of oral and maxillofacial surgery residents in Pakistan

Article Title: Exploring clinical workplace learning among oral and maxillofacial surgery residents: a qualitative audio diary study

Article References: Ahmad, T., Jamil, B., Khan, M., & Shahzad, M. (2026). Exploring clinical workplace learning among oral and maxillofacial surgery residents: a qualitative audio diary study. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 144. https://doi.org/10.1007/s44186-026-00549-9

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00549-9

Keywords: oral and maxillofacial surgery, surgical education, workplace learning, audio diaries, residency training, qualitative research, supervision, burnout, self-regulated learning, Pakistan, medical education, clinical exposure

Researchers led by Yu Zhang and Wei Cui of the Fourth Military Medical University in Xi’an, working with colleagues at Xi’an Medical University, distributed a cross-sectional questionnaire to all 109 public institutions approved by China’s Ministry of Education to offer undergraduate dentistry programs between 2021 and 2023. The questionnaire was adapted from validated frameworks used in the United Kingdom, reviewed by five subject-matter experts and pilot-tested before deployment. Forty-nine institutions returned valid responses, a participation rate of 45 percent, but the sample carried considerable weight: it included all 28 institutions holding an official discipline ranking of C-minus or above in the most recent national evaluation, and it spanned all seven major geographic regions of China.

The structural findings show a remarkable degree of consensus on how the subject is delivered. Nearly all responding institutions, 47 of 49 or 95.92 percent, teach dentoalveolar surgery not as a standalone course but embedded within a broader oral and maxillofacial surgery curriculum. Three-quarters of schools, 75.51 percent, schedule the material in the fourth academic year, positioning it after students have completed foundational biomedical coursework and general dental training but before graduation and clinical licensure.

Beneath that structural agreement, however, lies substantial variability in time commitment. For both theoretical and practical instruction, the most commonly reported duration was 10 to 20 hours, yet the actual range was dramatic: theory teaching ranged from as little as 4 hours to as many as 36 hours, while practical teaching spanned from 4 hours to more than 36 hours. That means a student at one Chinese dental school might receive nine times the hands-on surgical instruction of a peer at another institution, a disparity with potential implications for entry-level competence in procedures that carry real risks of nerve injury, fracture and infection.

The content itself follows an internationally recognizable core. Institutions consistently reported covering tooth extraction, local anesthesia, the extraction of impacted mandibular third molars, and the management of post-extraction healing and complications. These are the bread-and-butter procedures of general dental practice, and their prominence reflects the reality that most graduates will perform them daily rather than pursue surgical specialization.

Where the survey offers its most actionable insights is in the details of practical training pathways. Thirty institutions, 61.22 percent, described a progressive training sequence that moves students from instrument familiarization, through phantom-head simulation on artificial jaw models, to supervised peer-to-peer practice of local anesthesia injections. This staged approach mirrors competency-based models advocated in dental education literature, allowing students to build psychomotor skills incrementally before touching a patient. Yet simulation for more complex procedures lagged considerably: only 53.06 percent of schools provided simulation training for the surgical removal of impacted mandibular third molars, 42.86 percent for root or fractured-root removal, and just 36.73 percent for the extraction of other impacted teeth. These are precisely the procedures where inexperienced operators face the steepest learning curves and the highest complication rates.

Digital teaching tools present a similar picture of uneven adoption. Videos were nearly universal, used by 95.92 percent of institutions, and animations were employed by 79.59 percent, reflecting how inexpensive and easily deployed these passive formats have become. Interactive virtual programs, by contrast, were reported by only 24.49 percent of schools. The distinction matters educationally: passive media support observation and conceptual understanding, while interactive simulation platforms provide deliberate practice with feedback, the mechanism most strongly associated with skill acquisition in the surgical education literature.

Pedagogical innovation shows a clear hierarchy as well. Problem-based learning was the most widely adopted active-learning method, reported by 71.43 percent of institutions, followed by case-based learning at 42.86 percent and flipped-classroom teaching at 34.69 percent. These approaches ask students to reason through clinical scenarios before or instead of receiving didactic lectures, and their growing footprint suggests Chinese dental educators are engaging with international trends in health-professions education, even if penetration remains incomplete.

Assessment practices reveal perhaps the most significant gap between theory and practice in Chinese dentoalveolar surgery education. Summative theoretical examinations were nearly universal at 95.92 percent, confirming that knowledge acquisition is rigorously tested. But practical skills assessment was implemented at only 59.18 percent of institutions, and phantom-head assessment, in which students demonstrate operative technique on simulation models, at just 48.98 percent. In other words, at roughly half of Chinese dental schools, a student could complete the surgical component of their degree without ever being formally examined on their ability to perform the procedures they studied.

The authors conclude that undergraduate dentoalveolar surgery education in China has an established framework centered on tooth extraction and local anesthesia, with broad use of practical and digital teaching methods, but that marked variation persists in teaching hours, complex-procedure simulation, interactive digital tools and practical assessment. They suggest that future curriculum development may consider competency-guided learning objectives, strengthened simulation and case-based training, and more comprehensive assessment strategies, while cautioning that the educational effectiveness of such reforms requires empirical evaluation. For a country graduating thousands of dentists annually into a health system where tooth extraction remains one of the most commonly performed surgical procedures, the findings offer a data-driven baseline for national conversations about standardization, and a reminder that what happens in the simulation laboratory may matter as much as what happens in the lecture hall.

Subject of Research: Curriculum structure, simulation training and assessment in undergraduate dentoalveolar surgery education across Chinese dental schools

Article Title: Dentoalveolar surgery education in Chinese undergraduate dental schools: a national survey of curriculum structure, simulation training and assessment

Article References: Zhang, Y., Cui, W., Hu, K., Mo, J., He, F., Wang, Y., Wang, J., Zhang, W., Zhang, Z., Wang, Y., & Xue, Y. (2026). Dentoalveolar surgery education in Chinese undergraduate dental schools: a national survey of curriculum structure, simulation training and assessment. BMC Medical Education. https://doi.org/10.1186/s12909-026-10374-9

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10374-9

Keywords: dentoalveolar surgery, dental education, undergraduate curriculum, simulation training, tooth extraction, local anesthesia, China, BMC Medical Education, problem-based learning, phantom head, assessment, oral and maxillofacial surgery