The main objectives of this article are to help surgeons understand some important factors that influence surgical performance, and provide them with some advice to improve their surgical skills. Progression of surgical skill through novice-expert continuum and factors that influence thisprogression are discussed. One of these influential factors is the surgeon’s stress resilience. Scientific evidence regarding physiologic processes that underlie stress resilience and the effectiveness of psychological tools to improve this innate characteristic is reviewed. The impact of self-esteemand the importance of deliberate practice on achieving higher levels of surgical performance arealso discussed. Innate characteristics are not rigid and can be improved by a variety of psychological tools including mental practice and self-talk. Stress management training programs and courses would be beneficial for surgeons with limited stress latitude and resilience. Deliberate practice is a powerful and efficient strategy to improve surgical performance.Key words: Deliberate practice; Dexterity; Expert; Stress; Surgical performance; Surgical skill.

Introduction: The aim of this study was to assess Tongue Squamous Cell Carcinoma (TSCC) patients’ outcome and compare that to their matched pair counterparts of salivary gland adenoid cystic carcinoma (SGACC) patients.Materials and Methods: A population-based cohort study was conducted using SEER data. From a database of 2019 patients, treated from 2004 to 2012. We matched individuals withtongue SCC to those who have ACC of salivary gland. Matches were made for gender, age and treatment modalities. We compared their 5-year survival, rate of local, regional and distant failures.Results: We identified 1716 patients with TSCC and 313 cases with SGACC. Median follow up time was 2.07 years. The frequency of SGACC was significantly high in female likewise the frequencyof TSCC in males (p≤0.001). SGACC tumor was more likely to be detected at an advanced stage (p≤0.001). The most often affected subsites in the TSCC tumor were the tongue (C02.9)(24.5%) and in SGACC tumor were the minor salivary gland (42.5%). There was a significant (P≤0.001) difference in overall survival in favor of female with SGACC and the combined-therapygroup over the TSCC patients belong to the same group. The Kaplan–Meier estimates of overall survival at five years were 58% in the TSCC patients and 87% in the SGACC group.Conclusion: It is important for the clinicians be aware of the invasive nature of oral malignancies especially TSCC and SGACC. These lesions are associated with high recurrence rate and distant metastasis and poor prognosis. Early detection may enhance the survival rate of the patients. The overall survival is lower in TSCC than SGACC and the death rate is higher in these kinds of tumors.Key words: Diagnostics, Salivary glands, Cancer and pre-cancer, Squamous cell carcinoma.

Introduction: Among many techniques advocated for the horizontally deficient alveolar ridges, ridge split technique has many advantages.Materials and Methods: Here, the main treatment management strategy of the horizontally collapsed ridges, the ridge split approach, is discussed in detail according to our new ridge widthclassification, with the goal of assisting an operator in choosing the proper bone augmentation technique.Results: Success rate was more than 97 percent with using our protocol in treatment of cases in this study.Conclusion: Choice of the technique is dependent ultimately on operator experience and surgical comfort. The ridge split has many advantages, including lack of donor site morbidity and graft stability over time.Key words: Ridge-split, Alveolar ridge.

Introduction: This study aimed to compare the primary stability of implants inserted conventionally with those inserted following sinus lift plus bone graft.Materials and Methods: The data consisted of periotest scores from 12 patients (7 women, 5 men, mean age of 47.8±10.4) and 24 implants. Each patient had 1 implant which was insertedconventionally and another using sinus lift (lateral window) and bone graft, therefore, each patient rolled as control as well as case group for him/herself. Eight patients had surgery on the right side and other 4 on the left side. After 4 months of surgery, primary stability was measured by periotest at 3 points. Radiographs also were served to evaluate success rate of each technique. The patientswere collected from a private clinic during 8 months. Mann-Whitney U test was served for analysis; P-value less than 0.05 was considered as statistically significant.Results: The difference between diameters and lengths of implants between case and control group was insignificant (p>0.05). The mean score of periotest for case and control group was -2.73±1.52 and -4.31 ±1.99 respectively. Although the primary stability was higher in the control group and Mann-Whitney U analysis showed a significant difference (p<0.05), but as both scores were negative, primary stability was acceptable in the case group as well.Conclusion: Despite the lower primary stability of implants inserted in regions with a sinus lift and graft, the technique is acceptable and clinically efficient.Key words: Implant, Sinus lift, Graft, Primary stability.

Introduction: Postoperative complications such as swelling, pain, and trismus after surgery of the impacted lower third molars are the main concerns of surgeons. Many authors claim thatthe use of a drain could help control these unpleasent events. The purpose of this study was to evaluate the effect of the use of a surgical drain to control the swelling in impacted lower thirdmolar surgery.Materials and Methods: We had 100 patients of both genders with bilateral impacted lower third molars in comparable positions and with the same degree of surgical difficulty in thisstudy. Both impacted molars were removed in the same session using a surgical drain on one side and without it in the other side. The postoperative swelling was evaluated at 48 hours and 7 days.Results: In the group in which the drain was used, the control of the swelling variable was statistically significant at 48 hours (P = .001) in comparison with the group in which the drain was notused. However, it was not statistically significant at 7 days (P=1.00).Conclusion: The use of the drain helps to control swelling in the acute phase of postoperation.Key words: Surgical drain, Mandibular third molar surgery, Impacted tooth, Postoperative complication.

This study represents a case of extensive perforating internal root resorption in tooth 7 in 22-yearold female, with a history of trauma in the anterior segment of maxilla in childhood. Diagnosiswas made by clinical manifestation, intraoral periapical radiograph and cone beam computed tomography (CBCT). CBCT has superior diagnostic accuracy that results in better management ofcomplicated cases. Due to hemorrhage from the perforation site into the canal, and inability to dry the canal space surgical approach was employed to seal the resorptive defect. Clinical and radiographicexamination revealed a successful outcome six months after treatment.Key words: Internal Resorption, cone beam computed tomography, surgical management.

Neurofibromatosis is associated with various degrees of soft tissue and hard tissue involvement; among which tumor-related face ptosis is the main reason for serial exitional treatment. This case report demonstrates usage of analyzing mirror images technique for exact examination of abnormalities affecting one side of the face. The patient was a 48-year-old woman, diagnosed with VonRecklinghausen’s disease with numerous surgeries in the past, who was seeking surgical treatment for the mass on the left side of her face and modifying deformity.Materials and Methods: The procedure began with producing a 3D scan of patient’s face by a high quality laser scanner and the scanner data were transferred to relevant softwares andthen the postsurgical changes were applied to the patient’ face. Thereafter, using engineering and graphical softwares such as CATIA and SolidWorks, the necessary surgical molds were designed. In the next steps, the molds were built using a 3D scanner several sizes. During surgery, the templateswere first placed on the patient’s face in each phase and debulking was achieved based on the relevant template so that favorable amount of debulking was finally reached using these surgical guides.Conclusion: The simultaneous application of 3D surface laser scanner technology and reconstruction of the affected side based on the healthy side and analyzing the information obtainedfrom this reconstruction, make an objective assessment over the precise prediction of the abnormal soft tissue volume, pre- intra- and post-operatively which leads to improved results.Key words: Neurofibromatosis; 3D modeling; virtual surgery.