The regulatory mechanisms of IGF1 in the osteogenic differentiation of canine MSMSCs via BMP2⁃Smad 1/5 signaling pathway / 口腔疾病防治

Objective@#To investigate the role of the bone morphogenetic protein 2 (BMP2)⁃Smad1/5 and p38MAPK signaling pathways in the osteogenic differentiation of MSMSCs by insulin⁃like growth factor 1 (IGF1).@* Methods @#A re⁃ combinant adenovirus (RAD) and IGF1 expressing IGF1 gene were constructed. After osteogenic induction, qRT⁃PCR and Western blot were used to detect the phosphorylation level of Smad1/5 and the expression of the BMP⁃2 protein in the BMP⁃Smad signaling pathway; immunohistochemistry was used to observe the nuclear translocation of Smad1/5; qRT⁃PCR and Western blot were used to detect IGF with Noggin and SB203580, inhibitors of the p38MAPK signaling path⁃ way 1⁃mediated osteogenic differentiation of MSMSCs@* Results@#The recombinant IGF1 adenovirus was constructed suc⁃ cessfully. MSMSCs were cultured in inductive medium after infection with different concentrations of Ad⁃IGF1, and then, the protein levels of BMP2 and p⁃Smad1/5 increased. IGF1 can also induce nuclear translocation of Smad1/5. In addition, Noggin significantly reduced the phosphorylation level of Smad1/5 and the formation of mineralized nodules in the MSMSCs. The mRNA levels of Runx2, OPN and ALP also decreased. In contrast, SB203580 decreased neither the phosphorylation level of p38 nor the mRNA expression of Runx2, OPN and ALP in the Ad⁃IGF1 MSMSCs@* Conclu⁃sion@#IGF1 can promote the osteogenic differentiation of MSMSCs via the BMP2⁃Smad1/5 signaling pathway. In con⁃ trast, IGF1 may not promote the osteogenic differentiation of MSMSCs via the p38MAPK signaling pathway.

Clinical guidelines for maxillary sinus floor elevation with sinus membrane lesions / 口腔疾病防治

@#Maxillary sinus membrane lesions have been broadly detected before implant surgery in the posterior maxilla region, resulting in uncertainty regarding maxillary sinus floor elevation surgery. In this context, we composed this commentary article based on the current literature and the clinical experience of our department. We discuss the common lesion types shown by CBCT including membrane pathological thickening, polyps/cystic lesions and air-liquid level in the sinus. Maxillary sinus floor elevation surgery can be conducted in patients with membrane thickening of 2-5 mm or with polyps/cysts of less than half of the sinus height (because the above symptoms have little influence on the outcome of surgery). Membrane thickening of more than 5 mm with ostium obstruction, antrochoanalpolyps, mucoceles and cysts of more than half of the sinus height should be carefully treated. Different treatments can be performed such as conducting elevation surgery while retaining the cyst, removing the cyst before surgery or removing the cyst during surgery based on the cyst type and size, inflammation, patency of the ostium, etc. Antibiotics-anti-inflammatory-aspiration, surgical debridement and oral lesions eliminations are generally used for treating post-operative sinusitis. Presurgical radiographic evaluation is the key to diagnosing and treating these membrane lesions. We highly advocate collaboration between our dentists and otolaryngologists on this issue.

The role of the membrane of the maxillary sinus in space osteogenesis under the sinus floor after elevation of the sinus floor / 口腔疾病防治

@#With the continuous development of maxillary sinus floor elevation technology, the osteogenesis mechanism of maxillary sinus floor elevation has always been a concern of scholars. The membrane of the maxillary sinus is an indispensable physiological structure in the process of space osteogenesis under the sinus floor after elevation of the sinus floor. In recent years, the role of the maxillary sinus floor mucosa in sinus floor space osteogenesis has been a research hotspot. Recent studies have found that the maxillary sinus floor membrane plays a role as a natural biological barrier membrane in the process of sinus floor space osteogenesis after maxillary sinus floor elevation; in addition, it has the ability to undergo osteogenesis. It has also been found that maxillary sinus membrane stem cells (MSMSCs) derived from the maxillary sinus floor membrane have characteristics of mesenchymal stem cells, which can differentiate into osteoblasts and participate in sinus floor space osteogenesis after maxillary sinus floor elevation. New studies have also found that small RNAs such as microRNAs, long noncoding RNAs and circular RNAs can regulate the osteogenic differentiation of MSMSCs, which may be important biological targets for promoting osteogenesis in the sinus floor space. In this paper, the relationship between the maxillary sinus floor mucosa and bone formation after maxillary sinus floor elevation, the barrier and osteogenic function of the maxillary sinus floor mucosa, the sources of osteoblasts involved in osteogenesis of the sinus floor space, and the molecular regulatory mechanisms of stem cells derived from maxillary sinus mucosa will be elucidated step by step.

Digital design of functional surgery for odontogenic cyst intruding into maxillary sinus / Desenho digital de cirurgia funcional para cisto odontogênico intrusivo em seio maxilar

Abstract Introduction Traditional Caldwell-Luc approach needs modifications for odontogenic cysts intruding into the maxillary sinus, to preserve sinus mucosa and bony contour. Recently, digital technology has been widely applied to the field of maxillofacial surgery, guiding the surgical plan and improving its accuracy. Objective This study attempted to present and evaluate the functional surgery of odontogenic cysts intruding into the maxillary sinus using a computer-assisted pre-surgical design. Methods Consecutive patients with odontogenic cysts intruding into the posterior part of the maxillary sinus were enrolled. Method I "Bony wall reimplantation method" was performed for large lesions exceeding the zygomatic alveolar crest but without apparent bone destruction of the anterior wall of the sinus, while Method II "bone removal method" was more convenient for small lesions near to the zygomatic alveolar crest. The gap was filled with a pedicled buccal fat pad after lesion removal and all cases were without inferior meatal antrostomy. Results A total of 45 cases were included in the study. 22 were operated using method I while 23 were operated with method II. Operations were completed in 20 min. Pain disappeared in 3.62 days on average, and swelling 6.47 days. Nasal bleeding occurred in 8 patients lasting 1-3 days. Suppurative inflammation was observed in 1 patient, and infection occurred after bone reposition. Other repositioned free bony wall was without resorption in CT images. Conclusions Sinus mucosa and bony wall should be conserved. Preoperative digital design can guide osteotomy effectively during the surgery. Bone reposition is not suitable for suppurative inflammation. The pedicled buccal fat pad is enough for drainage and inferior meatal antrostomy is not necessary.

Resumo Introdução A abordagem tradicional de Caldwell-Luc precisa de modificações para os cistos odontogênicos que se introduzem no seio maxilar, para preservar a mucosa sinusal e o contorno ósseo. Recentemente, a tecnologia digital tem sido amplamente aplicada ao campo da cirurgia maxilofacial, orienta o plano cirúrgico e melhora sua precisão. Objetivo Esse estudo teve como objetivo apresentar e avaliar a cirurgia funcional de cistos odontogênicos intrusivos no seio maxilar utilizando um desenho pré-cirúrgico assistido por computador. Método Foram recrutados pacientes consecutivos com cistos odontogênicos intrusivos na parte posterior do seio maxilar. O método I, "método de reimplante de parede óssea", foi feito em lesões grandes que excediam a crista zigomático-alveolar, mas sem destruição óssea aparente da parede anterior do seio, enquanto o método II, "método de remoção óssea", foi mais conveniente para pequenas lesões próximas à crista zigomático-alveolar. O espaço foi preenchido com um retalho pediculado do corpo adiposo bucal após a remoção da lesão e todos os casos foram feitos sem antrostomia meatal inferior. Resultados Um total de 45 casos foram incluídos no estudo. Vinte e dois foram submetidos à cirurgia utilizando-se o método I, enquanto que 23 foram submetidos ao método II. As operações foram concluídas em 20 minutos. A dor desapareceu em média após 3,62 dias, e o edema, depois de 6,47 dias. Hemorragia nasal ocorreu em 8 pacientes com duração de 1 a 3 dias. Processo supurativa foi observado em 1 paciente ocorrendo após a reposição óssea. Outros retalhos reposicionados livres da parede óssea não mostraram reabsorção em imagens de TC. Conclusões A mucosa sinusal e a parede óssea devem ser preservadas; o desenho digital pré-operatório pode orientar a osteotomia de forma eficaz durante a cirurgia; a reposição óssea não é adequada em processos supurativos. O retalho pediculado de corpo adiposo bucal é suficiente para a drenagem e antrostomia meatal inferior não é necessária.

Caracterización anatomoclínica de elevaciones sinusales en pacientes implantológicos / Anatomo-clinical characterization of sinus elevations in implatologic patients

Introducción: Las elevaciones del seno maxilar traen consigo modificaciones anatómicas, que pueden influir en su funcionabilidad. Objetivo: Caracterizar clínica y anatómicamente las elevaciones sinusales realizadas y su repercusión en el éxito de los implantes posicionados. Material y Método: Se realizó un estudio descriptivo, prospectivo en 56 pacientes sometidos a elevaciones sinusales en el período comprendido desde enero 2013-enero 2015 con criterios de inclusión debidamente establecidos, en la Facultad de Estomatología Raúl González Sánchez. Cada paciente se sometió a interrogatorio, examen clínico y al análisis ortopantomográfico previo al tratamiento, y a los 6, 12, 18 y 24 meses de la intervención. Se analizaron las variables edad, sexo, distribución topográfica, técnica quirúrgica implementada, material de relleno, altura sinusal, nivel óseo y complicaciones. Resultados: Predominaron pacientes del sexo femenino (60,7 por ciento), con edades comprendidas entre 30-39 años (60,7 por ciento). La tasa total de éxito a 2 años de implantación dental fue 92,1 por ciento. La reducción final en altura sinusal promedio en técnica de ventana lateral fue la mayor (10,1 mm). La mejor relación altura injerto-longitud de implante se obtuvo con beta fosfato tricálcico (1,66). La perforación de membrana menor de 5mm fue la complicación transoperatoria más registrada (28,6 por ciento). Conclusiones: La técnica de ventana lateral exhibe mejores resultados en la reducción de la altura sinusal. El relleno con betafosfato tricálcico muestra mejor relación altura de injerto-longitud del implante. Los resultados de reducción en altura se mantienen estables tras 12 meses y la perforación de membrana sinusal es la complicación más usual(AU)

Introduction: Elevations of the maxillary sinus lead to anatomical modifications, which can influence on its function. Objective: To characterize sinus elevations from the clinical and anatomical point of view, and comment on their impact on the success of positioned implants. Material and Method: A descriptive prospective study was conducted in 56 patients who underwent sinus elevations with very well established inclusion criteria in Raúl González Sánchez Faculty of Odontology from January 2013 to January 2015. Each patient was interviewed, and submitted to a clinical exam. Also, an orthopantomography analysis was made before treatment, and 6, 12, 18, and 24 months after the intervention. Variables such as age, sex, topographic distribution, implemented surgical technique, padding material, sinus height, bone level, and complications were analyzed. Results:Female patients predominated (60,7 percent), aging from 30-39 years (60,7 percent). The overall success rate at 2 years following implantation was 92,1 percent. The final reduction of average sinus height with the lateral window technique was the highest (10,1 mm). The best relationship in terms of height and length of graft was obtained with beta-tricalcium phosphate (1,66). Membrane perforation smaller than 5mm was the most recorded intraoperative complication (28,6 percent). Conclusions: The lateral window technique exhibits better results in the reduction of sinus height. Padding with beta-tricalcium phosphate shows a better relationship in terms of height and length of graft. The results in height reduction are stable after 12 months, and sinus membrane perforation is the most common complication(AU)

Culture and identification of the osteogenic properties of beagle maxillary sinus membrane stem cells / 口腔疾病防治

Objective@#To investigate the osteogenic properties of maxillary sinus membrane stem cells (MSMSCs). @*Methods @#Beagle maxillary sinus mucosa was collected, immunomagnetic bead method was applied for isolation of CD146+ cells, and MSMSCs were harvested and cultured from the canine maxillary sinus floor mucosa. The levels of the cell surface antigens CD44, CD146, and CD34 were determined at passage one by flow cytometry. Cells at passage one were cultured in basal medium and osteogenic inductive medium. Real-time PCR, immunohistochemical staining, alkaline phosphatase activity, alizarin red staining and Von Kossa staining were used to investigate the osteogenic properties in vitro. @*Results@#The canine MSMSCs were cultured successfully. The results of flow cytometry were positive for CD146 and CD44 expression but negative for CD34 expression. The relative mRNA expression of runt-related transcription factor 2 (RUNX2) (t = 14.44,P < 0.001), osteopontin (OPN) (t = 7.85,P = 0.001) and alkaline phosphatase alkaline phosphatase (t = 14.27,P < 0.001) was apparently higher in the osteoinductive medium group than in the basal medium group, the differences in relative mRNA expression between the groups were significant. The protein levels of RUNX2 and OPN increased in the osteoinductive medium group. The alkaline phosphatase activity of the MSMSCs increased when the cells were cultured in osteoinductive medium; the activity increased to a level that was significantly higher than that in basal medium, particularly at days 3 (t = 8.79, P < 0.001), 7 (t = 9.75,P < 0.001), 14 (t = 12.14,P < 0.001), 21 (t = 19.62,P < 0.001) and 28 (t = 17.53,P < 0.001). Obvious mineralized nodules were observed by alizarin red staining or Von Kossa staining.@*Conclusion @#Maxillary sinus membrane stem cells exhibit osteogenic ability.

Role of miR-27a in the osteogenic differentiation of beagle maxillary sinus membrane stem cells / 口腔疾病防治

Objective@#To detect the expression level of miR-27a during the osteogenic differentiation of beagle maxillary sinus membrane stem cells (MSMSCs) and explore the role of miR-27a in the osteogenic differentiation of MSMSCs.@*Methods@#Beagle MSMSCs were cultured in vitro. The expression level of miR-27a was detected via RT-PCR after an osteogenic inductive culture was prepared. The mRNA expression levels of Runx2 and OPN were examined via RT-PCR, and the protein expression levels of Runx2 and OPN were examined via Western blot after the cells were transfected with pre-miR-27a or anti-miR-27a. Finally, osteoprogenitor cells transfected with pre-miR-27a were composited with Bio-Oss particles and subcutaneously implanted into nude mice to form ectopic bone formation models, and then the inhibition of bone formation from miR-27a was observed in vivo. @*Results@#The expression level of miR-27a in the beagle MSMSCs decreased after osteogenic inductive culturing. The relative miR-27a levels were significantly decreased at day 1 (t=3.795, P=0.023), day 3 (t=4.493, P=0.011), day 7 (t=11.591, P < 0.001), day 14 (t=12.542, P < 0.001), and day 21 (t=5.621, P=0.008) compared with day 0. In addition, the expression levels of Runx2 mRNA (t=4.923, P=0.007) and protein (t=4.425, P=0.008) were reduced after the cells were transfected with pre-miR-27a. The expression levels OPN mRNA (t=5.253, P=0.006) and protein (t=5.132, P=0.006) were also reduced. In contrast, the mRNA expression levels of Runx2 (t=3.925, P=0.013) and OPN (t=3.712, P=0.019) were increased after the cells were transfected with anti-miR-27a, and bone formation was observed after the subcutaneous implantation of beagle MSMSCs composited with Bio-Oss in nude mice. Nevertheless, ectopic bone formation was inhibited by pre-miR-27a-transfected beagle MSMSCs composited with Bio-Oss (t=7.219, P=0.0020). @* Conclusion @# MiR-27a negatively regulates the osteogenic differentiation of MSMSCs.

Evaluation of clinical outcomes of implants placed into the maxillary sinus with a perforated sinus membrane: a retrospective study / 대한악안면성형재건외과학회지

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of implants that were placed within the maxillary sinus that has a perforated sinus membrane by the lateral window approach. METHODS: We examined the medical records of the patients who had implants placed within the maxillary sinus that has a perforated sinus membrane by the lateral approach at the Department of Oral and Maxillofacial Surgery of Chonnam National University Dental Hospital from January 2009 to December 2015. There were 41 patients (male:female = 28:13). The mean age of patients was 57.2 ± 7.2 years at the time of operation (range, 20–76 years). The mean follow-up duration was 2.1 years (range, 0.5–5 years) after implant placement. Regarding the method of sinus elevation, only the lateral approach was included in this study. RESULTS: Ninety-nine implants were placed in 41 patients whose sinus membranes were perforated during lateral approach. The perforated sinus membranes were repaired with a resorbable collagen membrane. Simultaneous implant placements with sinus bone grafting were performed in 37 patients, whereas delayed placements were done in four patients. The average residual bone height was 3.4 ± 2.0 mm in cases of simultaneous implant placement and 0.6 ± 0.9 mm in cases of delayed placement. Maxillary bone graft with implant placement, performed on the patients with a perforated maxillary sinus membrane did not fail, and the cumulative implant survival rate was 100%. CONCLUSIONS: In patients with perforations of the sinus mucosa, sinus elevation and implant placement are possible regardless of the location and size of membrane perforation. Repair using resorbable collagen membrane is a predictable and reliable technique.

EFFECT OF SHORT ADMINISTRATION BISPHOSPHONATE TO PERIOSTEUM AND SINUS MEMBRANE AFTER ILIAC BONE GRAFT INTO MAXILLARY SINUS IN RABBIT

Survival rate of implant placement in the maxilla treated with sinus elevation by the lateral approach: A retrospective study / 대한치주과학회지

PURPOSE: Osseointegration of implants in patients with pneumatized maxillary sinuses is difficult to achieve due to the deficiency of available bone in the posterior maxilla after loss of teeth. Maxillary sinus elevation is a method to overcome this problem. In this study, we evaluated the implant survival rate and the relationship between implant survival in patients with sinus elevation by the lateral approach. MATERIALS AND METHODS: A total of 48 patients were consecutively treated with sinus elevation by the lateral approach between February 2003 & August 2006 at the dental hospital of Chonbuk National university. A total of 113 implants were placed. The mean healing period was 7.1 months and implants were placed after a mean period of 5.6 months. The mean observation period was 21.8 months. RESULTS: Out of the 113 implants placed, fifteen failed, resulting in a survival rate of 86.7%, 18 cases of sinus membrane perforation were observed out of 65 sinuses treated. 33 implants were placed in a perforated site and 10 failed, representing a 60.7% implant survival. 80 implants were placed in a nonperforated site and 5 failed, representing a 92.6% implant survival. CONCLUSIONS: Implant placement with sinus elevation is an acceptable treatment for short term Results. Sinus membrane perforation and postoperative complications, however, may have an effect on implant failure.