Complications According to the Handling of the Pterygoid Plate During Bimaxillary Surgery.

BACKGROUND: During bimaxillary surgery, manipulation of the pterygoid plate is required to facilitate movement of the maxilla. This study examined the complications that occurred after handling the pterygoid plate during a Le Fort I osteotomy. PATIENTS AND METHODS: This study compared and analyzed complications according to the pterygoid plate handling method in 80 patients who underwent bimaxillary surgery at Pusan National University Dental Hospital from December 2015 to July 2020. The pterygoid plate was fractured or removed intentionally only if it interfered with the maxilla. Otherwise, it was not treated. The complications during surgery and the follow-up period were investigated. RESULTS: Fourteen patients experienced complications, of which excessive bleeding, hearing problems, and nonunion were encountered in 10, 2, and 2 patients, respectively. Of the 10 patients with excessive bleeding patients, the pterygoid plate was manipulated in 8 patients, which was controlled during surgery. Two patients complained of hearing loss with ear congestion immediately after surgery; both patients improved spontaneously within 1 month. Two nonunion patients underwent plate refixation at least 6 months postoperatively, and normal healing was achieved afterward. CONCLUSIONS: Fracture and removal of the pterygoid plate during orthognathic surgery did not significantly affect the occurrence of complications during and after surgery.

Management of Mandibular Subcondylar Fracture Through an Intraoral Approach Using a Trans-Buccal Trocar With Ramus Buccal Decortication.

PURPOSE: The aim of this study was to review retrospectively the functional recoveries of subcondylar fracture patients that underwent open reduction surgery using an extraoral approach or an intraoral approach using a trans-buccal trocar and involving ramus buccal decortication. MATERIALS AND METHODS: Of 47 patients with mandibular condyle fracture who visited Pusan National University Dental Hospital Department of Oral and Maxillofacial Surgery between May 2015 and November 2020, 38 patients underwent open reduction and were classified according to the surgical method used. Preauricular, submandibular, and retro-mandibular approaches were all classified as extraoral approaches condyle fractures were classified as described by Spiessl and Schroll (1972). Distances between bone fragments on panorama radiographs before and after surgery were measured. RESULTS: Thirty-eight patients were included in this study, 9 patients received subcondylar fracture surgery. Open reduction surgery using an extraoral approach had a greater mean operation time than the intraoral approach using a trocar. Of the 17 patients treated with an intraoral approach, the average distance between bone fragments right after surgery was 1.27 ± 1.41mm, which was significantly greater than that of the extraoral approach (0.72 ± 0.35 mm). CONCLUSIONS: Favorable results can be obtained by mandibular condylar fracture surgery through an intraoral approach using a trans-buccal trocar with ramus buccal decortication. This technique minimizes scarring, secures accessibility using a trocar, and sufficiently secures the field of view through buccal cortical bone reduction.

Skeletal Stability of Two-Jaw Surgery Without Bone Grafting in Patients With Cleft Lip and Palate.

PURPOSE: The purpose of this study was to evaluate the postoperative skeletal stability of orthognathic surgery performed without a bone graft in cleft lip and palate patients. PATIENTS AND METHODS: Nineteen cleft lip and palate patients that underwent orthognathic surgery from July 2008 to August 2019 at the Department of Oral and Maxillofacial Surgery of Pusan National University Dental Hospital were selected. None of these patients underwent bone grafting during orthognathic surgery. Lateral cephalograms were taken 1 month before surgery (T0), immediately after surgery (T1), and 6 months after surgery (T2). Lateral cephalograms were analyzed using the V-Ceph program. The analysis was performed using SPSS for Windows version 26.0. The analysis was conducted by repeated-measures analysis of variance. RESULTS: A total of 19 patients were included in this retrospective study (9 males/10 females of overall mean age 22 ±â€Š4.89 years). Mean maxillary depth values at the 3-time points were 85.37°â€Š±â€Š2.62° (T0), 90.13°â€Š±â€Š2.77° (T1), and 89.29°â€Š±â€Š2.91° (T2). Mean McNamara-N Perpend values were -5.52 ±â€Š3.19 mm (T0), 0.09 ±â€Š3.10 mm (T1), and -0.83 ±â€Š3.14 mm (T2). Mean sella nasion point A (SNA) values were 75.42°â€Š±â€Š2.98° (T0), 79.19°â€Š±â€Š2.94° (T1), and 78.45°â€Š±â€Š2.84° (T2). Mean relapse rates were maxillary depth 20.15%, McNamara-N Perpend 17.95%, and SNA 18.74%. Mean horizontal advancement was 5.61 ±â€Š2.32 mm based on McNamara vertical to A point, mean horizontal relapse was -0.92 ±â€Š0.56 mm, and the mean horizontal relapse rate was 17.95%. CONCLUSIONS: Favorable skeletal stability can be obtained without bone graft when the amount of maxillary advancement is less than 6 mm in cleft patients.

Correlation Between Sports-Related Maxillofacial Injuries and Head Injuries: A Five-Year Retrospective Study.

PURPOSE: As sports have become more diverse and demanding, the number of patients with a maxillofacial injury accompanied by a cranial injury or neurological symptoms has increased. This study examined the correlation between sports-related maxillofacial injuries and head injuries. PATIENTS AND METHODS: Among the patients who visited the emergency department of Pusan National University Dental Hospital due to a maxillofacial injury from sporting activities between 2014 and 2018, those who additionally had head injuries were retrospectively examined. Sporting activities were classified according to the American Academy of Pediatrics classification, and severity of injuries was determined using the Facial Injury Severity Scale (FISS). Patients whose medical records showed neurological symptoms and who underwent brain computed tomography for concomitant head injury were selected. The association between each of these variables, including age and gender, was statistically analyzed. RESULTS: A total of 95 patients were included in this study, most of whom were male teenagers, and cycling was the most common cause of injuries. The meanFISS score was 0.79. Brain computed tomography was conducted for 91 patients, and 28 patients reported neurological symptoms. Only 11 patients underwent advanced evaluation in the neurology or neurosurgery department. Most patients were diagnosed with contusion and concussion and were monitored without any treatment. CONCLUSIONS: Higher FISS values did not reflect the severity of maxillofacial and head injury. In this study, there were some patients with cranial fracture and cerebral hemorrhage with mild neurosurgical symptoms of facial trauma. Although the incidence of head trauma is not high, the necessity of wearing protective equipment cannot be overemphasized because severe trauma is permanent. Neurological signs and symptoms of patients with maxillofacial trauma should not be overlooked and require a thorough evaluation.

Optimal application of compressive palatal stents following mesiodens removal in pediatric patients: A Randomized Controlled Trial / Aplicación óptima de stents palatinos de compresión después de la extracción del mesiodens en pacientes pediátricos: un ensayo controlado aleatorio

Background: There is no scientific evidence supporting the choice of a palatal stent in patients who underwentremoval of an impacted supernumerary tooth. We aimed to investigate the effects of palatal stents in patients whounderwent supernumerary tooth removal through a palatal approach and to suggest the optimal stent thicknessand material.Material and Methods: We recruited 144 patients who underwent extraction of a supernumerary tooth between themaxillary anterior teeth. Subjects were assigned to a control group (CG) or one of four compressive palatal stentgroups (CPSGs) classified by the thickness and material of the thermoplastic acrylic stent used. Palatal gingivalswelling and objective indices (healing, oral hygiene, gingival, and plaque) were evaluated before surgery and onpostoperative days (PODs) 3, 7, and 14; pain/discomfort and the Child Oral Health Impact Profile (COHIP) wereassessed as subjective indices of the effects of the stent.Results: The CPSGs showed faster healing than did the CG on PODs 7 (P<0.001) and 14 (P=0.043); swelling wasmeasured by 1.64±0.88 mm and 4.52±0.39 mm, respectively. Although swelling was least in the 4-mm hard group(0.92±0.33 mm), the difference compared with that in the 2-mm hard group (1.01±0.18 mm) was not significant(P=0.077). The CPSGs showed better COHIP (P<0.001-0.036) and pain scores (P<0.001) than did the CG onPODs 1-3. Conclusions: Compressive palatal stents reduce discomfort by decreasing pain and alleviating swelling. Althougha stent is effective regardless of its thickness and material, 2-mm hard stents maximized such positive effects withminimal discomfort.(AU)

Trace Level Determination of Saccharides in Pristine Marine Aerosols by Gas Chromatography-Tandem Mass Spectrometry.

The quantification and identification of saccharides in pristine marine aerosols can provide useful information for determining the contributions of anthropogenic and natural sources of the aerosol. However, individual saccharide compounds in pristine marine aerosols that exist in trace amounts are difficult to analyze due to their low concentrations. Thus, in this study, we applied gas chromatography-tandem mass spectrometry (GC-MS/MS) in multiple reaction monitoring (MRM) mode to analyze the particulate matter with an aerodynamic diameter equal or less than 2.5 µm (PM2.5) samples, and the results were compared with those of conventional GC-MS. To investigate the chemical properties of pristine marine aerosols, 12 PM2.5 samples were collected while aboard Araon, an ice-breaking research vessel (IBRV), as it sailed from Incheon, South Korea to Antarctica. The method detection limits of GC-MS/MS for 10 saccharides were 2-22-fold lower than those of GC-MS. Consequently, the advantages of GC-MS/MS include (1) more distinct peak separations, enabling the accurate identification of the target saccharides and (2) the quantification of all individual saccharide compounds with concentrations outside the quantifiable range of GC-MS. Accordingly, the time resolution for sampling saccharides in pristine marine aerosols can be improved with GC-MS/MS.

Sports-Related Oral and Maxillofacial Injuries: A 5-Year Retrospective Study, Pusan National University Dental Hospital.

PURPOSE: The incidence of sports trauma is gradually increasing, and its importance is therefore also increasing. The present study was conducted to analyze the types, proportions, and tendencies of sports trauma associated with the oral and maxillofacial regions. PATIENTS AND METHODS: Patients who visited the Emergency Department of Pusan National University Dental Hospital between 2014 and 2018 for more than 5 years were surveyed through retrospective epidemiologic investigations. Type of sports was classified according to American Academy of Pediatrics classification. For statistical analysis, age and gender distribution, cause of trauma, and annual trends data were collected. RESULTS: Of the 517 patients, most of the patients were teenagers (27.9%), followed by those younger than 10 years (23.2%) (χ2 = 22.897; P = .002), and noncontact sports, which is cycling, was the most common (43.5%) cause for trauma in both adult and children groups (χ2 = 91.824; P < .001). The most common sports associated with contact sports, limited-contact sports, and noncontact sports were football (47.7%), baseball (50.0%), and cycling (74.8%), respectively. The causes for trauma injury were as follows: contact sports, other person's body (53.4%); limited-contact sports, other objects (60.9%); and noncontact sports, slip down (77.4%) (χ2 = 298.901; P < .001). The prevalence and incidence of sports injuries increase every year, and the proportion of injured patients in May was the highest (χ2 = 52.360; P = .181). The high percentage of traumatic sports demonstrated statistically significant trends (χ2 = 43.073; P = .002). Kickboard injuries showed a rapid increase recently (P for linear trend = .045), whereas other sports showed no significant trends. CONCLUSIONS: Considering the increasing incidence of sports-related injuries, oral and maxillofacial surgeons should be more concerned with maxillofacial trauma during sports.

Recent Occurrence of PAHs and n-Alkanes in PM2.5 in Seoul, Korea and Characteristics of their Sources and Toxicity.

Polycyclic Aromatic Hydrocarbons (PAHs) and n-alkanes in particulate matter with an aerodynamic diameter of 2.5 micrometers or less (PM2.5) were quantified at Seoul, Korea in 2018. The seasonal differences in the total concentration of PAHs and n-Alkanes were clear, where winter showed a higher concentration than that of summer. Compared to the PAHs measurements in 2002 at Seoul, the sum of PAHs concentrations in 2018 were reduced from 26.6 to 5.6 ng m-3. Major sources of the observed PAHs and n-alkanes were deduced from various indicators such as diagnostic ratios for PAHs and Cmax, CPI, and WNA (%) indices for n-alkanes. It was found that in winter coal and biomass combustions, and vehicular exhaust were major sources, while, in summer vehicular exhaust was major source. In addition, in winter, major emission sources were located outside of Seoul. The health effect from the recent level of PAHs was estimated and compared to the previous studies observed in Seoul, and it was found that, recently, the toxicity of PAHs in PM2.5 was significantly decreased, except for in the winter.

Versatility of the pedicled buccal fat pad flap for the management of oroantral fistula: a retrospective study of 25 cases.

PURPOSE: Maxillary bone grafts and implantations have increased over recent years despite a lack of maxillary bone quality and quantity. The number of patients referred for oroantral fistula (OAF) due to implant or bone graft failure has increased, and in patients with an oroantral fistula, the pedicled buccal fat pad is viewed as a robust, reliable option. This study was conducted to document the usefulness of buccal fat pad grafts for oroantral fistula closure. MATERIALS AND METHODS: We retrospectively studied 25 patients with OAF treated with a buccal fat pad graft from 2015 to 2018. Sex, age, OAF location, cause, duration, presence of systemic disease, smoking, previous dental surgery, and side effects were investigated. RESULTS: A total of 25 patients were studied. Mean patient age was 54.8 years, and the male to female ratio was 19:6. Causes of oroantral fistula were cyst enucleation, tumor resection, implant removal, bone graft failure, and extraction. Excellent results were obtained in 23 (92%) of the 25 patients. In the other two patients that both smoked, a small fistula was observed during follow-up. No recurrence of oroantral fistula was observed after 2 months to 1 year of follow-up. CONCLUSIONS: The incidence of oroantral fistula is increasing due to implant and bone graft failures. Oroantral fistula closure using a pedicled buccal fat pad was found to have a high success rate.

Displacement ventilation with radiant panel for hospital wards: Measurement and prediction of the temperature and contaminant concentration profiles.

Displacement ventilation (DV) is known to provide high air quality and ventilation efficiency. With DV, a contaminant interface is formed in a room, and the air quality in the occupant zone below the contaminant interface height can be kept clean. This paper proposes a DV system to solve the serious odor problem in hospital wards. A vertical radiant panel that can be controlled individually is suggested as a complementary heating system. In order to study the influence of the panel on the displacement ventilated room, the temperature and contaminant concentration profiles were examined under different panel conditions: the distance between the panel and bed, height of the panel, surface temperature of the panel, and supply airflow rate. When the radiant panel was heated, it created a stronger plume than the human body, which produced contaminated air. When there was space between the radiant panel and bed, the contaminated air was locked up before reaching the ceiling. Personal exposure of a standing person was also investigated because the contaminated interface is generally lower than the breathing zone of a standing person with DV. The zonal model and improved zonal model were validated by a comparison of their results with the measured contaminant concentrations.

Mandibular reconstruction with a ready-made type and a custom-made type titanium mesh after mandibular resection in patients with oral cancer.

BACKGROUND: After the resection at the mandibular site involving oral cancer, free vascularized fibular graft, a type of vascularized autograft, is often used for the mandibular reconstruction. Titanium mesh (T-mesh) and particulate cancellous bone and marrow (PCBM), however, a type of non-vascularized autograft, can also be used for the reconstruction. With the T-mesh applied even in the chin and angle areas, an aesthetic contour with adequate strength and stable fixation can be achieved, and the pores of the mesh will allow the rapid revascularization of the bone graft site. Especially, this technique does not require microvascular training; as such, the surgery time can be shortened. This advantage allows older patients to undergo the reconstructive surgery. CASE PRESENTATION: Reported in this article are two cases of mandibular reconstruction using the ready-made type and custom-made type T-mesh, respectively, after mandibular resection. We had operated double blind peer-review process. A 79-year-old female patient visited the authors' clinic with gingival swelling and pain on the left mandibular region. After wide excision and segmental mandibulectomy, a pectoralis major myocutaneous flap was used to cover the intraoral defect. Fourteen months postoperatively, reconstruction using a ready-made type T-mesh (Striker-Leibinger, Freibrug, Germany) and iliac PCBM was done to repair the mandible left body defect.Another 62-year-old female patient visited the authors' clinic with pain on the right mandibular region. After wide excision and segmental mandibulectomy on the mandibular squamous cell carcinoma (SCC), reconstruction was done with a reconstruction plate and a right fibula free flap. Sixteen months postoperatively, reconstruction using a custom-made type T-mesh and iliac PCBM was done to repair the mandibular defect after the failure of the fibula free flap. The CAD-CAM T-mesh was made prior to the operation. CONCLUSIONS: In both cases, sufficient new-bone formation was observed in terms of volume and strength. In the CAD-CAM custom-made type T-mesh case, especially, it was much easier to fix screws onto the adjacent mandible, and after the removal of the mesh, the appearance of both patients improved, and the neo-mandibular body showed adequate bony volume for implant or prosthetic restoration.

Healing pattern of intentional pterygoid plate fracture after posterior movement of maxilla through Le Fort I osteotomy.

BACKGROUND: To evaluate maxillary stability following Le Fort I osteotomy using postero-superior movement after pterygoid plate fracture. Additionally the authors sought to analyze the postoperative changes at the intentional pterygoid plate fracture site. MATERIALS AND METHODS: Thirty-six patients with class III deformities treated with total maxillary setback at the Lefort I level were enrolled in a retrospective cohort study. Relative changes in measurement points were identified on cone-beam computed tomographic scans (CBCT) as well as lateral cephalograms. The outcome variables were determined as changes at measurement points obtained preoperatively, immediately postoperatively, and 6 months after surgery. RESULTS: The average posterior repositioning of ANS in the 36 patients was 1.78 mm and the mean superior repositioning at PNS was 2.78 mm. The maximal recurrence rate was less than 10% at the 6 months postoperative time point. The intentional fracture site of the pterygoid plates healed with a linear pattern. There were no major complications such as airway edema, hemorrhage and nerve damage reported over the 6-month follow-up period. CONCLUSIONS: Intentional fracture of the pterygoid plates has a role in the retropositioning of the maxilla with good healing at the fracture site, little relapse and satisfactory postoperative stability.

Corrigendum: Relationship between disease stage and renal function in bisphosphonate-related osteonecrosis of the jaw.

[This corrects the article on p. 16 in vol. 43, PMID: 28280705.].

Magnetic resonance electrical properties tomography for small anomalies using boundary conditions: A simulation study.

PURPOSE: Magnetic resonance electrical property tomography (MREPT) is an emerging imaging modality using measured B1 maps from magnetic resonance imaging (MRI) to measure a distribution of electric conductivity and permittivity of the subject at the Larmor frequency. Conventional MREPT approaches at single transmit channel system using the Helmholtz equation rely on an assumption that conductivity and permittivity of the subject are locally homogeneous. For small tissue structures and tissue boundaries, in which the assumption of locally homogeneous conductivity and permittivity does not hold, the reconstructed conductivity values deviated from the actual values, so called "Boundary Artifacts." The aim of this study is to propose new reconstruction processes based on time-harmonic Maxwell's equations to reconstruct conductivity for small tissue structures and tissue boundaries. METHODS: Instead of removing the electric fields from the equations as done in the Helmholtz equation, three key identities of circularly polarized and longitudinal components of electric fields, circularly polarized component of magnetic fields, and electric properties from time-harmonic Maxwell's equations are derived. Based on the three key identities, the proposed reconstruction methods determine conductivity, permittivity, and circularly polarized component and longitudinal component of electric fields using the measured H1+ . In each iterative step, estimated conductivity, permittivity, electric fields, and artifact-free mask region, Ω, where the contribution of the boundary artifacts is small, were updated. Using the estimated values in the artifact-free mask region as boundary conditions, the estimates beyond the mask region were updated. EM simulations were performed on three types of numerical phantoms with very small regions of homogeneous conductivity and permittivity. The performance of the proposed methods was evaluated using the simulated electric and magnetic fields. RESULTS: For the numerical simulation model, the proposed methods significantly reduced the boundary artifacts compared to conventional methods using Helmholtz equations. In addition, previous methods using the Helmholtz equation could measure conductivity of only large anomalies, but the proposed method can measure the conductivity of the small compartments whose size is 2-3 voxels. The proposed approaches are compatible with spatial filtering which can be used to reduce noise. If a good image segmentation is available as a prior information, better initial boundary conditions can be estimated, and thus the proposed approach can be more accurate for small tissue structures. CONCLUSIONS: The proposed reconstruction method not only determines electrical properties, but also circularly polarized component and longitudinal component of electric fields using an iterative process. The proposed method can quantitatively detect the conductivity of the small anomalies better than conventional methods.

Testosterone Regulates NUCB2 mRNA Expression in Male Mouse Hypothalamus and Pituitary Gland.

Nesfatin-1/NUCB2 is known to take part in the control of the appetite and energy metabolism. Recently, many reports have shown nesfatin-1/NUCB2 expression and function in various organs. We previously demonstrated that nesfatin-1/NUCB2 expression level is higher in the pituitary gland compared to other organs and its expression is regulated by 17ß-estradiol and progesterone secreted from the ovary. However, currently no data exist on the expression of nesfatin-1/NUCB2 and its regulation mechanism in the pituitary of male mouse. Therefore, we examined whether nesfatin-1/NUCB2 is expressed in the male mouse pituitary and if its expression is regulated by testosterone. As a result of PCR and western blotting, we found that a large amount of nesfatin-1/NUCB2 was expressed in the pituitary and hypothalamus. The NUCB2 mRNA expression level in the pituitary was decreased after castration, but not in the hypothalamus. In addition, its mRNA expression level in the pituitary was increased after testosterone treatment in the castrated mice, whereas, the expression level in the hypothalamus was significantly decreased after the treatment with testosterone. The in vitro experiment to elucidate the direct effect of testosterone on NUCB2 mRNA expression showed that NUCB2 mRNA expression was significantly decreased with testosterone in cultured hypothalamus tissue, but increased with testosterone in cultured pituitary gland. The present study demonstrated that nesfatin-1/NUCB2 was highly expressed in the male mouse pituitary and was regulated by testosterone. This data suggests that reproductive-endocrine regulation through hypothalamus-pituitary-testis axis may contribute to NUCB2 mRNA expression in the mouse hypothalamus and pituitary gland.

Relationship between disease stage and renal function in bisphosphonate-related osteonecrosis of the jaw.

OBJECTIVES: Bisphosphonate is the primary cause of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Bisphosphonates are eliminated from the human body by the kidneys. It is anticipated that bisphosphonate levels in the body will increase if the kidney is in a weak state or if there is systemic disease that affects kidney function. The aim of this study was to analyze the relevance of renal function in the severity of BRONJ. MATERIALS AND METHODS: Ninety-three patients diagnosed with BRONJ in Pusan National University Dental Hospital from January 2012 to December 2014 were included in this study. All patients underwent a clinical exam, radiographs, and serologic lab test, including urine analysis. The patient's medical history was also taken, including the type of bisphosphonate drug, the duration of administration and drug holiday, route of administration, and other systemic diseases. In accordance with the guidelines of the 2009 position paper of American Association of Oral and Maxillofacial Surgeons, the BRONJ stage was divided into 4 groups, from stage 0 to 3, according to the severity of disease. IBM SPSS Statistics version 21.0 (IBM Co., USA) was used to perform regression analysis with a 0.05% significance level. RESULTS: BRONJ stage and renal factor (estimated glomerular filtration rate) showed a moderate statistically significant correlation. In the group with higher BRONJ stage, the creatinine level was higher, but the increase was not statistically significant. Other factors showed no significant correlation with BRONJ stage. There was a high statistically significant correlation between BRONJ stage and 'responder group' and 'non-responder group,' but there was no significant difference with the 'worsened group.' In addition, the age of the patients was a relative factor with BRONJ stage. CONCLUSION: With older age and lower renal function, BRONJ is more severe, and there may be a decrease in patient response to treatment.

The factors that influence postoperative stability of the dental implants in posterior edentulous maxilla.

BACKGROUND: All clinicians are aware of the difficulty of installing a dental implant in posterior maxilla because of proximate position of maxillary sinus, insufficient bone width, and lower bone density. This study is to examine which factors will make the implantation in the posterior maxilla more difficult, and which factors will affect the postoperative implant stability in this region. METHODS: Five hundred seventy-three fixtures on the maxilla posterior were included for this study from all the patients who underwent an installation of the dental implant fixture from January 2010 to December 2014 at the Department of Oral and Maxillofacial Surgery in Pusan National University Dental Hospital (Yangsan, Korea). The postoperative implant stability quotient (ISQ) value, fixture diameter and length, presence of either bone graft or sinus lift, and graft material were included in the reviewed factors. The width and height of the bone bed was assessed via preoperative cone beam CT image analysis. The postoperative ISQ value was taken just before loading by using the OsstellTM mentor® (Integration Diagnostics AB, Gothenburg, Sweden). The t test and ANOVA methods were used in the statistical analysis of the data. RESULTS: Mean ISQ of all the included data was 79.22. Higher initial bone height, larger fixture diameter, and longer fixture length were factors that influence the implant stability on the posterior edentulous maxilla. On the other hand, the initial bone width, bone graft and sinus elevation procedure, graft material, and approach method for sinus elevation showed no significant impact associated with the implant stability on the posterior edentulous maxilla. CONCLUSIONS: It is recommended to install the fixtures accurately in a larger diameter and longer length by performing bone graft and sinus elevation.

Recombinant human bone morphogenic protein-2 Induces the Differentiation and Mineralization of Osteoblastic Cells Under Hypoxic Conditions via Activation of Protein Kinase D and p38 Mitogen-Activated Protein Kinase Signaling Pathways.

Hypoxia suppresses osteoblastic differentiation and the bone-forming capacity. As the leading osteoinductive growth factor used clinically in bone-related regenerative medicine, recombinant human bone morphogenic protein-2 (rhBMP-2) has yielded promising results in unfavorable hypoxic clinical situations. Although many studies have examined the effects of rhBMP-2 on osteoblastic differentiation, mineralization and the related signaling pathways, those of rhBMP-2 on osteoblastic cells remain unknown, particularly under hypoxic conditions. Therefore, this study was conducted under a 1% oxygen tension to examine the differentiating effects of rhBMP-2 on osteoblastic cells under hypoxia. rhBMP-2 could also induce the differentiation and mineralization of Osteoblastic (MC3T3-E1) cells under 1% hypoxic conditions. rhBMP-2 could also induce the differentiation and mineralization of MC3T3-E1 cells under 1% hypoxic conditions. rhBMP-2 increased the alkaline phosphatase {ALP} activity in a time dependent manner, and expression of ALP, collagen type-1 (Col-1) and osteocalcin (OC) mRNA were up-regulated significantly in a time- and concentration-dependent manner. In addition, the area of the mineralized nodules increased gradually in a concentration-dependent manner. Western blot analysis, which was performed to identify the signaling pathways underlying rhBMP-2-induced osteoblastic differentiation under hypoxic conditions, showed that rhBMP-2 significantly promoted the phosphorylation of the p38 mitogen-activated protein kinase (MAPK) in a time-dependent manner. A pretreatment with SB203580, a p38 MAPK inhibitor, inhibited the rhBMP-2-mediated differentiation and mineralization. Moreover, the phosphorylation of p38 induced by rhBMP-2 was inhibited in response to a pretreatment of the cells with Go6976, a protein kinase D {PKD) inhibitor. These findings suggest that rhBMP-2 induces the differentiation and mineralization of MC3T3-E1 cells under hypoxic conditions via activation of the PKD and p38 MAPK signaling pathways.

Effect of low-level laser therapy on bisphosphonate-treated osteoblasts.

BACKGROUND: This study investigates the effect of alendronate-treated osteoblasts, as well as the effect of low-level laser therapy (LLLT) on the alendronate-treated osteoblasts. Bisphosphonate decreases the osteoblastic activity. Various treatment modalities are used to enhance the bisphosphonate-treated osteoblasts; however, there were no cell culture studies conducted using a low-level laser. METHODS: Human fetal osteoblastic (hFOB 1.19) cells were treated with 50 µM alendronate. Then, they were irradiated with a 1.2 J/cm2 low-level Ga-Al-As laser (λ = 808 ± 3 nm, 80 mW, and 80 mA; spot size, 1 cm2; NDLux, Seoul, Korea). The cell survivability was measured with the MTT assay. The three cytokines of osteoblasts, receptor activator of nuclear factor κB ligand (RANKL), osteoprotegerin (OPG), and macrophage colony-stimulating factor (M-CSF) were analyzed. RESULTS: In the cells treated with alendronate at concentrations of 50 µM and higher, cell survivability significantly decreased after 48 h (p < 0.05). After the applications of low-level laser on alendronate-treated cells, cell survivability significantly increased at 72 h (p < 0.05). The expressions of OPG, RANKL, and M-CSF have decreased via the alendronate. The RANKL and M-CSF expressions have increased, but the OPG was not significantly affected by the LLLT. CONCLUSIONS: The LLLT does not affect the OPG expression in the hFOB cell line, but it may increase the RANKL and M-CSF expressions, thereby resulting in positive effects on osteoclastogenesis and bone remodeling.

Three-dimensional morphometric analysis of mandibule in coronal plane after bimaxillary rotational surgery.

BACKGROUND: The aim of this report is to present a new reference for aesthetic mandible surgery using three-dimensional cone-beam computed tomography-based treatment planning for orthognathic surgery which can be implemented in surgical planning and perioperative procedure. METHODS: To make an objective standard for evaluating aesthetic mandibular outline, we make an aesthetic scoring criteria with consideration of asymmetry, broad mandibular border line, and prominent mandibular angle. Two maxillofacial surgeons and two orthodontists rated their aesthetical evaluation from 1 to 5. Experimental group consisting of 47 female and 38 male patients who had rotational orthognathic two-jaw surgery from 2010 to 2011 were chosen according to aesthetic scoring done by two maxillofacial surgeons and two orthodontists. A high aesthetic score (≥16) means the facial contour is symmetric, with no broad and narrow aesthetic mandible frontal profiles. Control A group consisted of ten female and ten male patients who had no orthognathic surgery experience and low aesthetic score (≤10). Control B group consisted of ten female and ten male patients who had no orthognathic surgery experience and had anaesthetic mandibular frontal profile and a high aesthetic score (≥16). The three-dimensional image of the patient was taken from dental cone-beam CT (DCT) scanning (experimental group and control A group: 6 months DCT after surgery, control B group: 1st visit DCT). Each DCT was reformatted to reorient the 3D image using 3D analyzing program (OnDemand3D, cybermed Inc, CA, USA). After selection of 12 landmarks and the construction of reoriented horizontal, vertical, and coronal reference lines, 15 measurements were taken in 3D analysis of frontal mandibular morphology. Afterwards, horizontal and vertical linear measurements and angular measurements, linear ratio were obtained. RESULTS: Mean Go'Rt-Me'-Go'Lt angular measurement was 100.74 ± 2.14 in female patients and 105.37 ± 3.62 in male patients. These showed significant difference with control A group in both genders. Ratio of Go'Rt,Go'Lt-Me' length to some linear measurements (ratio of Me'-Cd'RtCd'Lt to Me'-Go'RtGo'Lt, ratio of Me'-Go' to Me'-Go'RtGo'Lt, ratio of Go'Rt-Go'Lt to Me'-Go'RtGo'Lt) showed significant difference with control A group in both genders. CONCLUSION: This study was intended to find some standard measurement of mandible frontal view in 3D analysis of aesthetic patient. So, these potential measurement value may be helpful for orthognathic treatment planning to have more aesthetic and perspective outcomes.