Allogeneic Fibrin Clot for Odontogenic/Cementogenic Differentiation of Human Dental Mesenchymal Stem Cells

BACKGROUND@#Fetal bovine serum is widely used as a growth supplement for cell culture medium; however, animalbornepathogens increase the risk of transmitting infectious agents. Platelet-rich fibrin is recently considered as a successfulalternative but leukocytes present limits to its allogeneic feasibility. The aim of this study was to explore the effects ofallogeneic fibrin clot (AFC) without leukocytes on inducing odontogenic/cementogenic differentiation of human dentalpulp stem cells (hDPSCs) and human periodontal ligament stem cells (hPDLSCs) in vitro and in vivo. @*METHODS@#AFC was prepared by high-speed centrifugation and leukocytes were almost removed, and AFC serum wasobtained through three freeze–thaw cycles. hDPSCs and hPDLSCs were treated with AFC serum to investigate theodontogenic or cementogenic associated markers by real-time polymerase chain reaction. hDPSCs were treated with AFCserum and placed inside of dentin canal, hPDLSCs were treated with AFC serum to wrap outside of dentin, the mixture wasthen transplanted into the subcutaneous of nude mice for 12 weeks. @*RESULTS@#AFC serum exhibited enough growth factors and cytokines to induce odontogenic/cementogenic differentiationof hDPSCs and hPDLSCs in vitro. Furthermore, AFC seurum could induce hDPSCs to differentiate into odontoblastslikecells and pulp-like tissues, and hPDLSCs to regenerate cementum-like tissues. @*CONCLUSION@#AFC could be an alternative safe source with growth factors for the expansion of human dental mesenchymalstem cells (hDMSCs).

Quantification of three-dimensional facial asymmetry for diagnosis and postoperative evaluation of orthognathic surgery / 대한악안면성형재건외과학회지

Background@#To evaluate the facial asymmetry, three-dimensional computed tomography (3D-CT) has been used widely. This study proposed a method to quantify facial asymmetry based on 3D-CT. @*Methods@#The normal standard group consisted of twenty-five male subjects who had a balanced face and normal occlusion. Five anatomical landmarks were selected as reference points and ten anatomical landmarks were selected as measurement points to evaluate facial asymmetry. The formula of facial asymmetry index was designed by using the distances between the landmarks. The index value on a specific landmark indicated zero when the landmarks were located on the three-dimensional symmetric position. As the asymmetry of landmarks increased, the value of facial asymmetry index increased. For ten anatomical landmarks, the mean value of facial asymmetry index on each landmark was obtained in the normal standard group. Facial asymmetry index was applied to the patients who had undergone orthognathic surgery. Preoperative facial asymmetry and postoperative improvement were evaluated. @*Results@#The reference facial asymmetry index on each landmark in the normal standard group was from 1.77 to 3.38. A polygonal chart was drawn to visualize the degree of asymmetry. In three patients who had undergone orthognathic surgery, it was checked that the method of facial asymmetry index showed the preoperative facial asymmetry and the postoperative improvement well. @*Conclusions@#The current new facial asymmetry index could efficiently quantify the degree of facial asymmetry from 3D-CT. This method could be used as an evaluation standard for facial asymmetry analysis.

Allogeneic Fibrin Clot for Odontogenic/Cementogenic Differentiation of Human Dental Mesenchymal Stem Cells

BACKGROUND@#Fetal bovine serum is widely used as a growth supplement for cell culture medium; however, animalbornepathogens increase the risk of transmitting infectious agents. Platelet-rich fibrin is recently considered as a successfulalternative but leukocytes present limits to its allogeneic feasibility. The aim of this study was to explore the effects ofallogeneic fibrin clot (AFC) without leukocytes on inducing odontogenic/cementogenic differentiation of human dentalpulp stem cells (hDPSCs) and human periodontal ligament stem cells (hPDLSCs) in vitro and in vivo. @*METHODS@#AFC was prepared by high-speed centrifugation and leukocytes were almost removed, and AFC serum wasobtained through three freeze–thaw cycles. hDPSCs and hPDLSCs were treated with AFC serum to investigate theodontogenic or cementogenic associated markers by real-time polymerase chain reaction. hDPSCs were treated with AFCserum and placed inside of dentin canal, hPDLSCs were treated with AFC serum to wrap outside of dentin, the mixture wasthen transplanted into the subcutaneous of nude mice for 12 weeks. @*RESULTS@#AFC serum exhibited enough growth factors and cytokines to induce odontogenic/cementogenic differentiationof hDPSCs and hPDLSCs in vitro. Furthermore, AFC seurum could induce hDPSCs to differentiate into odontoblastslikecells and pulp-like tissues, and hPDLSCs to regenerate cementum-like tissues. @*CONCLUSION@#AFC could be an alternative safe source with growth factors for the expansion of human dental mesenchymalstem cells (hDMSCs).

Diagnostic analysis of vertical orbital dystopia and canthal tilt for surgical correction

Objectives@#We sought to identify a clinically useful method of analyzing orbital dystopia to aid in diagnosis and treatment planning and to quantify vertical discrepancies in eye level and variations in canthal tilt in Koreans. @*Patients and Methods@#In 76 Korean patients with a mean age of 23.12 years, mean differences in the level of the pupils, lateral canthi, medial canthi, and canthal tilt were measured. The difference in pupil level was calculated from the perpendicular lines drawn from the midpupil area of each eye to the midline of the face to determine the amount of skeletal discrepancy of the eye. Soft tissue discrepancies were determined according to the vertical difference between the lines drawn from the lateral or medial canthus of each eye perpendicular to the midline of the face. The canthal tilt was determined from the inclination of a line connecting the lateral and medial canthi, then classified as class I, II, or III. @*Results@#Mean differences in pupil level, medial canthi, and lateral canthi were 1.57±1.10 mm, 1.14±1.07 mm, and 2.03±1.64 mm, respectively. The mean degree of canthal tilt were 8.45°±3.53° for the right side and 8.42°±3.81° for the left side. No study participants presented with class III canthal tilt. The mean canthal tilt values for those with class I tilt were 3.21°±1.68° for the right side and 3.18°±1.63° for the left side, while, for those who had class II tilt, the values were 9.60°±3.66° for the right side and 9.54°±2.99° for the left side. @*Conclusion@#The presented diagnostic method of orbital dystopia can be used to effectively establish a treatment plan that takes into consideration the patient’s skeletal and soft-tissue discrepancies.

Diagnostic analysis of vertical orbital dystopia and canthal tilt for surgical correction

Objectives@#We sought to identify a clinically useful method of analyzing orbital dystopia to aid in diagnosis and treatment planning and to quantify vertical discrepancies in eye level and variations in canthal tilt in Koreans. @*Patients and Methods@#In 76 Korean patients with a mean age of 23.12 years, mean differences in the level of the pupils, lateral canthi, medial canthi, and canthal tilt were measured. The difference in pupil level was calculated from the perpendicular lines drawn from the midpupil area of each eye to the midline of the face to determine the amount of skeletal discrepancy of the eye. Soft tissue discrepancies were determined according to the vertical difference between the lines drawn from the lateral or medial canthus of each eye perpendicular to the midline of the face. The canthal tilt was determined from the inclination of a line connecting the lateral and medial canthi, then classified as class I, II, or III. @*Results@#Mean differences in pupil level, medial canthi, and lateral canthi were 1.57±1.10 mm, 1.14±1.07 mm, and 2.03±1.64 mm, respectively. The mean degree of canthal tilt were 8.45°±3.53° for the right side and 8.42°±3.81° for the left side. No study participants presented with class III canthal tilt. The mean canthal tilt values for those with class I tilt were 3.21°±1.68° for the right side and 3.18°±1.63° for the left side, while, for those who had class II tilt, the values were 9.60°±3.66° for the right side and 9.54°±2.99° for the left side. @*Conclusion@#The presented diagnostic method of orbital dystopia can be used to effectively establish a treatment plan that takes into consideration the patient’s skeletal and soft-tissue discrepancies.

The treatment of obstructive sleep apnea patient using extended uvulopalatal flap: a case report

The uvulopalatal flap (UPF) technique is a modification of uvulopalatopharyngoplasty (UPPP) for the surgical treatment of obstructive sleep apnea. In the UPF technique, an uvulopalatal flap is fabricated and sutured to the residual mucosa of the soft palate to expand the antero-posterior dimensions of the oropharyngeal inlet. In the extended uvulopalatal flap (EUPF) technique, an incision at the tonsillar fossa is added to the classical UPF technique followed by the removal of mucosa and submucosal adipose tissue for additional expansion of the lateral dimension. The EUPF technique is more conservative and reversible than UPPP. Therefore, complications, such as velopharyngeal insufficiency, dysphagia, dryness, nasopharyngeal stenosis and postoperative pain, are reduced. In the following case report, the patient was diagnosed with obstructive sleep apnea and treated with the EUPF technique. The patient's total respiratory disturbance events per hour (RDI) was decreased to 15.4, the O2 saturation during the sleep was increased, and the excessive daytime sleepiness had disappeared after the surgery without complications. The authors report this case with a review of the relevant literature.

Retrospective study on the bisphosphonate-related osteonecrosis of jaw

INTRODUCTION: The incidence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) has increased gradually in patients who have undergone surgical treatment for osteomyelitis. In this study, a retrospective analysis of BRONJ patients was carried out using the data of osteomyelitis patients treated surgically. MATERIALS AND METHODS: Osteomyelitis patients, who underwent curettage, sequestrectomy, saucerization or decortications, and partial mandibulectomy at Seoul National University Dental Hospital from 2004 to 2010 were enrolled in this study. The patients were classified and categorized into two groups based on the surgical records and progress notes. One group comprised of patients with osteomyelitis and osteoporosis, and the other group included patients with osteomyelitis only. The epidemiological data of the BRONJ patients was analyzed to identify any trend in the incidence of BRONJ in osteomyelitis patients. RESULTS: Among 200 patients who underwent surgical intervention for osteomyelitis, 64 (32.0%) were identified as having osteoporosis as the underlying disease. In these 64 patients, more than 81.3% had been prescribed bisphosphonates. Females were far more affected by BRONJ than males. The incidence of BRONJ also increased with age. The posterior part of the mandible was affected more frequently by BRONJ. CONCLUSION: Although the availability of potent antibiotics and increased oral hygiene care can reduce the overall incidence of osteomyelitis, BRONJ can increase the total incidence. To prevent BRONJ, it is recommended that an oral examination be performed before prescribing bisphosphonates. Moreover, the patients should be educated about the potential risks of dental procedures that might be causal factors for BRONJ. Furthermore, patient swho take bisphosphonates for the treatment of osteoporosis should undergo periodic follow up oral examinations to prevent BRONJ.

Gorham-Stout Disease of the Mandible: A Case Report

Clinical study of surgical treatments for snoring and obstructive sleep apnea

PURPOSE: Clinical study to evaluate the efficacy and the safety of various surgical treatments in snoring and obstructive sleep apnea. METHODS AND MATERIALS: We performed surgical treatments such as radiofrequency ablation, uvulopalatopharyngoplasty(UPPP) with tonsillectomy, uvulopalatopharyngoplasty with advancement genioplasty, orthognathic surgery(maxillomandibluar advancement), distraction osteogenesis device insertion. Diagnosis was performed with clinical examination, polysomnography, lateral cephalometric and computed tomography. 62(M : F = 45 :17 , mean age 41.5, mean follow-up 4 weeks) patients underwent radiofrequency ablation and 7(M : F = 5 : 2, mean age 38.9, mean follow-up 19months)patients experienced uvulopalatopharyngoplasty with tonsillectomy. Uvulopalatophayngoplasty with advancement genioplasty was performed for 3 (M : F = 2: 1, mean age 30.2 , mean follow-up 14 months)patients. The last 3(M : F = 2 : 1, mean age 21.5 , mean follow-up 24 months)patients was treated with orthognathic surgery including distraction device insertion. The results was evaluated by questionnaires, polysomnography, investigation of complications. RESULTS: Of the patients treated with radiofrequency ablation, 95% reported improvement of their symptom. 100% improvement was reported in patients treated with UPPP with tonsillectomy and UPPP with advancement genioplasty. The two of three patients who underwent orthognathic surgery showed the satisfactory of treatments. Dryness of mouth was the most common complication during short period in radiofrequency ablation and UPPP with tonsillectomy. Relapse complication was not found in any surgical treatments. CONCLUSION: Treatment for snoring and OSA is determined by severity degree of the physiologic derangements, predominant type of apnea and obstructive site. Accuracy diagnosis should be performed prior to treatment for satisfactory treatment result. This study demonstrates feasibility, safety and efficacy of surgical treatments in snoring and OSA.

Lemierre syndrome: A case report

Abscesses are common in the oral and maxillofacial area. However, secondary thrombosis of the internal jugular vein accompanying the primary abscess is rare. In 1936, Andre Lemeierre studied 20 patients who showed an initial oropharyngeal infection, septicemia, internal jugular vein thrombosis, and secondary spread of the infection, and after then this condition Lemierre syndrome. Clinically, these patients present with tonsilitis lasting several days, continuous fever, and cervical pain. In the past, ligation and excision of the internal jugular vein was often performed. Current therapeutic modality for this condition is appropriate antibiotic prescription and surgical drainage of abscess. This case report presents a patient who showed symptoms of Lemierre syndrome, initiated as an oropharyngeal infection then developed thrombosis of the internal jugular vein. This patient was admitted into Seoul National University Dental Hospital. In addition to routine antibiotic therapy, surgical incision and drainage of the infection site was performed. Without ligation or excision, the thrombosed IJV disappeared eventually. As the Lemierre syndrome is not a common disease, this case report and review of the literature would be useful regarding a treatment of patients with Lemierre syndrome.

Location of the descending palatine artery in relation to the Le Fort I osteotomy in Koreans

Mandibular advancement with distraction osteogenesis for adult class II malocclusion patient with condylar resorption

Endoscopic-assisted open reduction and internal fixation (EAORIF) for condylar fracture

The endoscopic assisted approach for the treatment of condylar fracture is a less invasive alternative treatment modality and is considered to be able to overcome the limited access to the operation field to obtain an accurate reduction and fixation. Six patients with condylar neck and subcondylar fracture underwent the endoscopic assisted open reduction and internal fixation through the transoral approach at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. The endoscope was inserted through an intraoral incision and the reduction of fracture fragment was performed via a transbuccal approach with two transcutaneous stab incisions. Five patients showed anatomic reduction without any complications. One patient, whose fracture site was fixed with a single plate, showed displacement of fractured condylar segment during the follow up period. No patient had any facial nerve damage.

Vertical distraction osteogenesis for implant installation on the reconstructed mandible with free fibular flap

High dose rate brachytherapy in primary and recurrent tongue cancer

Clinical evaluation of alveolar distraction osteogenesis for implant installation

Midfacial measurement using occlusal maxillary CT and surgical implications of maxillary osteotomies

Implant installation using vertical distraction osteogenesis at a severely atrophied edentulous mandible

Prognostic value of proliferation factors in oral squamous cell carcinoma

Purpose: The purpose of this study is to evaluate the value of proliferation factors, Ki67 and PCNA, as prognostic markers predicting the survival and neck metastasis in patients with oral cancer. Methods: 101 patients with HNSCCs, were followed retrospectively for a median period of 60 months(from 16 to 82 months). All tumors were resected surgically and examined by conventional light microscopy, immunohistochemistry. The age, sex, tumor location, clinical stage(size), metastasis, proliferative activity index(assessed by proliferating cell nuclear antigen(PCNA) and Ki67 immunoreactivity) were considered as potential prognostic factors and were correlated with patient survival. Results: Ki67 staining results ranged from 5% to 80% of tumor cell nuclei, with a median of 25%. PCNA staining results ranged from 1% to 90% with a median of 50%. With a cut-off point of 25%, patients with lower Ki67 scores showed survival advantages over those with higher Ki67 scores (p=0.0089). With cut-off point of 50%, patients with lower PCNA scores showed survival advantages over those with higher PCNA scores (p=0.0104). Pathologically neck node positive patients(n=27) showed higher PCNA expression(p=0.02) than pathologically negative neck node patients(n=39). Conclusions: The lower expressions of Ki67 and PCNA were associated with favorable prognosis such as higher survival rate and lower neck node metastasis.

Prognostic value of proliferation factors in oral squamous cell carcinoma

Purpose: The purpose of this study is to evaluate the value of proliferation factors, Ki67 and PCNA, as prognostic markers predicting the survival and neck metastasis in patients with oral cancer. Methods: 101 patients with HNSCCs, were followed retrospectively for a median period of 60 months(from 16 to 82 months). All tumors were resected surgically and examined by conventional light microscopy, immunohistochemistry. The age, sex, tumor location, clinical stage(size), metastasis, proliferative activity index(assessed by proliferating cell nuclear antigen(PCNA) and Ki67 immunoreactivity) were considered as potential prognostic factors and were correlated with patient survival. Results: Ki67 staining results ranged from 5% to 80% of tumor cell nuclei, with a median of 25%. PCNA staining results ranged from 1% to 90% with a median of 50%. With a cut-off point of 25%, patients with lower Ki67 scores showed survival advantages over those with higher Ki67 scores (p=0.0089). With cut-off point of 50%, patients with lower PCNA scores showed survival advantages over those with higher PCNA scores (p=0.0104). Pathologically neck node positive patients(n=27) showed higher PCNA expression(p=0.02) than pathologically negative neck node patients(n=39). Conclusions: The lower expressions of Ki67 and PCNA were associated with favorable prognosis such as higher survival rate and lower neck node metastasis.