[Evaluation of the effect of cattle calcined bone grafting material to repair alveolar bone defect after tooth extraction].

PURPOSE: To verify the efficacy and safety of calcined cattle bone grafting material in filling alveolar bone defect after tooth extraction. METHODS: A randomized, bind, parallel, positive-control multicenter clinical trial was conducted. A total of 280 subjects were randomly assigned to either the experimental group (calcined cattle bone group) or control group (Bio-Oss group) equally. The main efficacy indicator was the imaging changes 24 weeks after material implantation. Secondary efficacy indicators were wound healing, rejection, bone metabolism, post-filling symptoms and signs of bone infection. The safety of material was assessed by the incidence of adverse events and serious adverse events. SAS 8.2 software package was used for statistical analysis. RESULTS: A total of 280 cases were included, of them 267 cases completed the study while 13 cases fell off. The effective rate of FAS(PPS) was 90.58%(97.46%) in the experimental group and 87.05% (95.04%) in the control group. The difference of effective rate between the experimental group and control group (95%CI) was 3.53% (-3.88%, 10.94%) of FAS, 2.42% (-2.38%, 7.22%) of PPS, and there was no significant difference between the two groups. The incision healing of the two groups was good, and the incidence of rejection, bone infection signs, post-filling symptoms and bone metabolic changes was very low. The incidence of adverse events was similar in the two groups, and no serious adverse events related to the study materials occurred. CONCLUSIONS: The efficacy of calcined cattle bone grafting material in filling alveolar bone defect after tooth extraction is not inferior to that of Bio-Oss, and it is safe and effective for alveolar bone defect repair.

Effect on implant drills and postoperative reactions for pre-extraction interradicular implant bed preparation during the COVID-19 pandemic and beyond.

The aim of the present study was to observe the abrasion of implant drills and postoperative reactions for the preparation of the interradicular immediate implant bed during the COVID-19 pandemic and beyond. Thirty-two implant drills were included in four groups: blank, improved surgery, traditional surgery, and control. In the improved surgery group, a dental handpiece with a surgical bur was used to decoronate the first molar and create a hole in the middle of the retained root complex, followed by the pilot drilling protocol through the hole. The remaining root complex was separated using a surgical bur and then extracted. Subsequently, the implant bed was prepared. Implant drills were used in the traditional surgery group to complete the decoronation, hole creation, and implant-drilling processes. The tooth remained intact until the implant bed was prepared. The surface roughness of the pilot drill was observed and measured. Surgery time, postoperative reactions (swelling, pain, and trismus), and fear of coronavirus disease 2019 scale (FCV-19S) were measured and recorded, respectively. Statistical analysis revealed significant difference with surface roughness among blank group (0.41 ± 0.05 µm), improved surgery group (0.37 ± 0.06 µm), traditional surgery group (0.16 ± 0.06 µm), and control group (0.26 ± 0.04 µm) (P < .001). Significant differences were revealed with surgery time between improved surgery group (5.63 ± 1.77 min) and traditional surgery group (33.63 ± 2.13 min) (P < .001). Swelling, pain, and trismus (improved group: r ≥ 0.864, P ≤ .006; traditional group: r ≥ 0.741, P ≤ .035) were positively correlated with the FCV-19S. This study proved that a new pilot drill could only be used once in traditional surgery but could be used regularly in improved surgery. Improved surgery was more effective, efficient, and economical than the traditional surgery. The higher FCV-19S, the more severe swelling, pain, and trismus.

Calcitonin gene-related peptide enhances osteogenic differentiation and recruitment of bone marrow mesenchymal stem cells in rats.

The present study evaluated the effects of calcitonin gene-related peptide (CGRP) on bone marrow mesenchymal stem cells (BMMSCs) in vitro and in a rat model of mandibular distraction osteogenesis (MDO). Rat BMMSCs were isolated then treated with CGRP or CGRP antagonist (CGRP8-37). The proliferation and migration ability of BMMSCs was determined using 5-bromo-2'-deoxyuridine and Transwell assays, respectively. Osteogenic-related gene expression was analyzed with reverse transcription-quantitative polymerase chain reaction. For the in vivo analysis, thirty MDO rats were randomly assigned to control, CGRP or CGRP8-37 groups. To evaluate the mobilization of BMMSCs, nestin and stromal cell-derived factor 1 (SDF-1) were detected by immunohistochemistry and ELISA. Rats were sacrificed following 14 days and new bone formation was assessed by histological and micro-computed tomography analysis. In the in vitro results, the CGRP group demonstrated significantly higher migration and proliferation, as well as enhanced alkaline phosphatase and runt-related transcription factor 2 expression compared with the control. In the in vivo experiments, bone mineral density of the newly formed bone in the CGRP group was significantly higher than controls. The nestin and SDF-1 expression in the CGRP group was also significantly upregulated. In conclusion, the present study demonstrated that CGRP administration increased new bone formation, possibly via enhancing BMMSC migration and differentiation in MDO rats.

Distribution of Cathepsin K in Late Stage of Tooth Germ Development and Its Function in Degrading Enamel Matrix Proteins in Mouse.

Cathepsin K (CTSK) is a member of cysteine proteinase family, and is predominantly expressed in osteoclastsfor degradationof bone matrix proteins. Given the similarity in physical properties of bone and dental mineralized tissues, including enamel, dentin and cementum, CTSK is likely to take part in mineralization process during odontogenesis. On the other hand, patients with pycnodysostosis caused by mutations of the CTSK gene displayedmultipledental abnormalities, such as hypoplasia of the enamel, obliterated pulp chambers, hypercementosis and periodontal disease. Thereforeitis necessary to study the metabolic role of CTSK in tooth matrix proteins. In this study, BALB/c mice at embryonic day 18 (E18), post-natal day 1 (P1), P5, P10 and P20 were used (5 mice at each time point)for systematic analyses of CTSK expression in the late stage of tooth germ development. We found that CTSK was abundantly expressed in the ameloblasts during secretory and maturation stages (P5 and P10) by immunohistochemistry stainings.During dentinogenesis, the staining was also intense in the mineralization stage (P5 and P10),but not detectable in the early stage of dentin formation (P1) and after tooth eruption (P20).Furthermore, through zymography and digestion test in vitro, CTSK was proved to be capable of hydrolyzing Emdogain and also cleaving Amelogenininto multiple products. Our resultsshed lights on revealing new functions of CTSK and pathogenesis of pycnodysostosis in oral tissues.

The Past, Present, and Future of Dentoalveolar Surgery in China.

Dentoalveolar surgery, formerly known as dental surgery or oral surgery, is one of the basic branches of oral and maxillofacial surgery. While it has a long history; however, there are great differences in its evolution globally. This article presents a brief review on the development of dentoalveolar surgery internationally. Furthermore, a systematic review on its development in China, is detailed in 6 stages. However, while its development in China since 2005 has been most profound, improvements are still needed in treatment concepts, instruments, treatment processes, attention to high-risk populations and cooperation with other dental/medical disciplines. Future projections based on present standards of care are also presented.

Influence of the lateral pterygoid muscle on traumatic temporomandibular joint bony ankylosis.

BACKGROUND: The pathogenesis of traumatic TMJ ankylosis remains unclear. This study aimed to verify the role of the lateral pterygoid muscle in the pathogenesis of traumatic temporomandibular joint (TMJ) bony ankylosis. METHODS: Eight 6-month-old male sheep were used in this study. Bilateral TMJ osteotomies were performed to induce sagittal fractures of the mandibular condyle. The lateral one-fourth segment of the disc was removed to establish a model of TMJ bony ankylosis. Subsequently, the function of the left and right lateral pterygoid muscles was blocked (experimental group) or maintained (control group), respectively. At 12 weeks postoperatively, animals were sacrificed and TMJ complex samples were evaluated by gross observation, spiral computed tomography (CT), micro-CT, and histological examinations. RESULTS: Gross observation revealed bony ankylosis in the control TMJs and fibrous adhesions in the experimental TMJs. Spiral CT and micro-CT demonstrated that, compared to the experimental group, the control group showed calcified callus formation in the joint space and roughened articular surfaces after new bone formation, which protruded into the joint space. Maximum mediolateral and anteroposterior condylar diameters were significantly larger in the control group than in the experimental group. Micro-CT also showed that the primary growth orientation of new trabeculae was consistent with the direction of lateral pterygoid traction in the control group, but not in the experimental group. Histological examination showed fibro-osseous ankylosis in the control group, but not in the experimental group. CONCLUSIONS: The lateral pterygoid simulates the effects of distraction osteogenesis, which is an important factor in the pathogenesis of TMJ bony ankylosis during the healing of sagittal condylar fractures.

Observational Study of Surgical Treatment of Sagittal Fractures of Mandibular Condyle.

OBJECTIVE: This study was conducted to investigate the complications that occur after surgical treatment of sagittal fracture of the mandibular condyle (SFMC). METHODS: A retrospective study was conducted on patients in whom SFMC was treated using surgical methods (87 patients, 105 sides) between January 1995 and December 2011 (79 sides were treated by rigid internal fixation and the remaining 26 sides were removed the condylar fragments). The longest follow-up was 17 years, and the shortest was 2 years. Follow-ups were conducted to assess mandibular activity, mouth opening, and computed tomography scans of condylar morphologic alterations. The postoperative complications were evaluated and the causes were analyzed. RESULTS: We observed 3 patients with joint ankylosis (all of them were removed the condylar fragments); 8, mouth opening less than 30 mm; 23, deviation on mouth opening at 6 months. At 4 weeks, 19 patients had facial nerve weakness, which was resolved within 6 months. The radiological investigation showed complete remodeling in 56.2% of the condyles (in the 59 sides, 57 sides were treated by rigid internal fixation and 2 sides were removed the condylar fragments); partial remodeling 27.6% condyles (in the 29 sides, 20 sides were treated by rigid internal fixation and 9 sides were removed the condylar fragments); poor remodeling, 16.2% condyles (in the 17 sides, 2 sides were treated by rigid internal fixation and 15 sides were removed the condylar fragments). CONCLUSIONS: Surgical treatment of SFMC is not perfect. There were some complications that occurred after the surgical treatment of SFMC. The findings also indicate that condylar anatomic reduction is the basis for functional recovery and, therefore, rigid fixation should be implemented. Furthermore, the removal of condylar fragments should be performed with caution, and if used, the fragments should be removed entirely.

Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children.

This study was designed to investigate the effects of occlusal splints in the treatment of sagittal fractures of the mandibular condyle in children. From January 1995 to December 2011, 37 sagittal fractures of the mandibular condyle in 30 patients aged 4-8 years old were included in this study. All the patients were treated with 1-2mm occlusal splints in the molar region. The mouths of the patients were kept slightly open by the occlusal splints for 3-6 months, and we reviewed the clinical and radiological remodelling of the affected condyles after treatment. Excellent (n=20) and good (n=10) clinical outcomes were achieved with full radiological remodelling seen in 19 and partial remodelling in 11. Treatment with occlusal splints is effective in delivering good results and function with minimal morbidity in children with sagittal fractures of the condyle, while permitting ongoing remodelling and growth in the short term.

[Comparative efficacies of non-surgical treatment for pediatric and adult sagittal fractures of mandibular condyle].

OBJECTIVE: To compare the efficacies of non-surgical treatment for pediatric and adult sagittal fractures of mandibular condyle. METHODS: From January 1985 to December 2010, our department treated 67 cases (82 sides) sagittal fractures of mandibular condyle with occlusal splint at a height of 1-2 mm in molar region for six months or other non-surgical treatment. Their clinical and radiological remodeling of affected condyles after treatment were reviewed at six mouths, one year and each year after treatment. They were divided into 2 groups according to age. There were 28 patients (34 sides) aged over 12 years and 39 patients (48 sides) under 12 years. During a follow-up period of 2-25 years, mandibular activity, mouth opening and parallel CT scan of condylar morphological alterations were examined. RESULTS: Under 12-year-old group:good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months.Only 11 of 39 patients had deviation on mouth opening at 6 months.Radiological studies showed that 32 condyles were complete remodeling and 16 condyles were partial remodeling. Poor remodeling was not observed. Over 12-year-old group:Ankylosis occurred in 4 joints. And 15 of 28 patients had deviation on mouth opening at 6 months.Radiological studies showed the remodeling of condyles was complete (n = 6), partial (n = 16) and poor (n = 12) respectively. CONCLUSION: Mandibular functional recovery and condylar remodeling are better in children with more powerful healing and reconstructing capacities.

The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process.

The aim of this study was to examine the role of the lateral peterygoid muscle in the reconstruction of the shape of the condyle during healing of a sagittal fracture of the mandibular condyle. Twenty adult sheep were divided into 2 groups: all had a unilateral operation on the right side when the anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. Ten sheep had the lateral pterygoid muscle cut, and the other 10 sheep did not. Sheep were killed at 4 weeks (n=2 from each group), 12 weeks (n=4), and 24 weeks (n=4) postoperatively. Computed tomograms (CT) were taken before and after operations. We dissected the joints, and recorded with the naked eye the shape, degree of erosion, and amount of calcification of the temporomandibular joint (TMJ). In the group in which the lateral peterygoid muscle had not been cut the joints showed overgrowth of new bone and more advanced ankylosis. Our results show that the lateral pterygoid muscle plays an important part in reconstructing the shape of the condyle during the healing of a sagittal fracture of the mandibular condyle, and combined with the dislocated and damaged disc is an important factor in the aetiology of traumatic ankylosis of the TMJ.

[Pain and prevention in extraction of the mandibular third molar].

OBJECTIVE: To study the post-operative pain-re1ated factors in lower third molar extraction, and to find an effective prevention program. METHODS: The first phase of the study was a clinical follow-up of 450 cases of lower third molar extraction. Factors associated with post-operative pain were analyzed, and difficulty assessment protocol of the tooth extinction was build. On this hasis, a pain-prevention clinical plan was constitute, and implemented in the second phase of 450 cases (selectively systemic or local medication). Treatment effects were observed. RESULTS: There were no significant differences between the two phase groups oh the distribution of ages, sex, difficulty of tooth extraction, operation time, and other related factors, means that they were statistically comparable. Tooth extraction difficulty and operation time were most important predictive factors for post-operative pain. Local infective factors (including caries) and women's menstrual cycle also account for late stage pain. Through targeted pre-operative medication or post-operative alveolar socket treatment, pain was significantly reduced or prevented. CONCLUSION: Reasonable peri-operative drug control basing on the difficulty assessment can provide a comprehensive and individualized control of pain after tooth extraction. Also, excessive or inappropriate using of drugs is largely avoided.

A new hypothesis of mechanisms of traumatic ankylosis of temporomandibular joint.

Temporomandibular joint (TMJ) ankylosis is a disease that severely affects the human health. Although it is well known that trauma is the most common cause of TMJ ankylosis, the mechanisms by which the traumatic TMJ ankylosis develops are unclear. The existing hypothesis is not convincing in explaining the genesis of traumatic TMJ ankylosis. We make a hypothesis that the distraction osteogenesis (DO) of the lateral pterygoid muscle combining with the dislocated and damaged disc is an important factor in genesis of traumatic TMJ ankylosis. If this hypothesis is verified, it will be helpful for the prevention of traumatic TMJ ankylosis and change the principle of management of sagittal fracture of mandibular condyle (SFMC).

Morphological evaluation of temporomandibular joint after open and closed treatment of type B diacapsular condylar fractures in sheep.

The incidence of diacapsular fracture of the mandibular condyle (DFMC) has increased in recent years. However, the specific modality of treatment which would provide maximum benefit and good results for adult patients of DFMC has been controversial. To evaluate and compare morphological changes of temporomandibular joint (TMJ) after open and closed treatments for DFMC, a sheep model of a type B DFMC was created by osteotomy. Eight sheep models of type B DFMC were randomly divided into 2 groups to receive closed treatment (Group 1) and open reduction and internal fixation (ORIF, Group 2), respectively, and morphological changes of TMJ were scored according to the radiological and anatomical criteria of scoring and compared between the 2 groups. Compared with Group 1 animals treated by the closed method, Group 2 animals treated with ORIF received significantly lower scores for morphological changes 12 weeks after treatment. We conclude that ORIF is more efficient than the closed functional treatment in restoring morphology of TMJ to treat type B DFMC.

Matrix metalloproteinase and its inhibitor in temporomandibular joint osteoarthrosis after indirect trauma in young goats.

Our aim was to examine the change in expression of matrix metalloproteinases (MMP-13), matrix metalloproteinases-3 (MMP-3), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in the articular cartilage of goats with experimentally-induced osteoarthrosis of the temporomandibular joint (TMJ) at various times. Osteoarthrosis was induced in 20 goats in the bilateral TMJ and 5 goats acted as controls. There were 5 goats in each group, and a group was killed at 7 days, and 1, 3, and 6 months postoperatively. The samples were collected, and the joints evaluated histologically. Immunofluorescence was used to detect the presence of MMPs and TIMP-1 in the articular disc and condylar cartilage. The ultrastructure of the articular disc and condylar surface at 1 month was examined with scanning electron microscopy (SEM). Osteoarthrosis of the TMJ progressed gradually over time. MMP-13, MMP-3, and TIMP-1 were expressed strongly in the TMJ soon after injury; MMP-13 became gradually weakened, and MMP-3 strengthened later. None of these were expressed in the normal condyle. After a month the surface of the arthrotic condyle was uneven, and the underlying collagen fibrils were exposed in irregular fissures on the surface. The secretion of TIMP-1 was related closely to the changes of MMPs during osteoarthrosis of the TMJ. The unbalanced ratio between them caused degradation of the matrix of the cartilage and might be the cause of osteoarthrosis of the TMJ.

[Diameter and length double objectives robust analysis of cylinder dental implant].

OBJECTIVE: To determine the jaw bone stress variation affected by cylinder implant diameter and length simultaneously in Ansys DesignXplorer module. METHODS: Finite element model of segment mandible with a cylinder implant was created. The range of the implant diameter (D) and length (L) were set from 2.5 mm to 5.0 mm and from 6.0 mm to 16.0 mm respectively. The maximum Von Mises stresses in jaw bone and sensitivity to D and L were evaluated. RESULTS: Under axial (buccolingual) load, when one variable equaled to median, the amplification of maximum Von Mises stresses in cortical bone and cancellous bone were 44.66% (71.32%) and 51.45% (58.50%) respectively with the D increasing. The amplification of maximum Von Mises stresses in cortical bone and cancellous bone were 45.97% (21.66%) and 52.15% (37.75%) respectively with the L increasing. When D exceeded 3.7 mm and L exceeded 10.0 mm, the response curve curvatures of maximum Von Mises stresses to L and D in jaw bone ranged from -1 to 0. And the variation of the maximum Von Mises stresses in jaw bone was more sensitive to D than to L. CONCLUSION: Stresses in jaw bone under buccolingual and axial load are apt to be affected by implant diameter and length respectively. And to a cylinder implant, the diameter exceeds 3.7 mm and length exceeds 10.0 mm are optimal selections. Diameter should pay more attention to than to length for cylinder implant. Expanding the width of the jaw bone is more important than expanding the height of the jaw bone in clinical experience.

Transport distraction osteogenesis using nitinol spring: an exploration in canine mandible.

Some experiments in rabbits have presented the potential feasibility of using shape memory alloy spring for continuous distraction osteogenesis. To confirm the effectiveness of such method, we established canine models for the exploratory experiments of transport distraction osteogenesis using nitinol springs. Simple devices, including an internal 60-mm long sinusoid-shaped nitinol springs were used in the study. All dogs needed only one operation. In the operation, osteotomy was performed to create a 40-mm unilateral segmental mandibular body defect and a tooth-bearing transport bone disc. After reconstructive fixation of the remnant mandible, the spring was constricted and anchored across the distraction gap to activate transport distraction immediately. At the second experimental stage, an ePTFE sheet was further fixed to protect the defect and distraction gap before closing the incision. Control dogs underwent the same operation except for anchoring of the spring to examine the spontaneous bone regeneration. Automatic bone transportation, as a gradual slowdown process, was observed under the effect of the spring. The transport disc could get to the opposite side of the defect, or stopped halfway when ePTFE sheet intervened. Mandibular reconstruction was achieved in all these dogs and better in dogs with sheet protection. No integrated bone mass was found in the defect of control dogs. The study further proves that continuous distraction osteogenesis using nitinol springs is a practical technique, although the devices need more improvement for better control of the process of distraction and the quality of regenerated bone.

[Optimized thread pitch design and stress analysis of the cylinder screwed dental implant].

OBJECTIVE: To determine the optimal thread pitch for an experimental cylinder implant in Ansys Work-bench Design Xplorer environment. METHODS: Finite element models of segment jaw bone with a V-shaped thread implant were created. The thread pitch (P) was set from 0.5 mm to 1.6 mm. The maximum Equivalent stresses (EQV stresses) in jaw bone and in implant were evaluated. RESULTS: Under axial load, the amplification of maximum EQV stresses in cortical bone, cancellous bone and implant were 7.1%, 123.4% and 28.7% respectively. Under bucco-lingual load, the amplification of maximum EQV stresses in cortical bone, cancellous bone and implant were 2.8%, 28.8% and 14.9% respectively. When P exceeded 0.8 mm, the response curve curvature of maximum EQV stresses in jaw bone and in implant to P was ranged from -1 to 1. CONCLUSION: Stresses in cancellous bone are more sensitive to thread pitch than in cortical bone. Stresses in jaw bone under axial load are easier affected by thread pitch than under bucco-lingual load. Thread pitch plays a greater role in protecting dental implant under axial load than under bucco-lingual load. Thread pitch exceed 0.8 mm should be the optimal design in a cylinder implant, but oversized pitch should be avoided too.

[Design and application of internal devices for automatic elasticity distraction osteogenesis].

OBJECTIVE: To improve the design of the devices used for autoatic elasticity distraction osteogenesis, and to preliminarily testify their feasibility for clinical application. METHODS: The internal automatic distraction devices were constructed by three parts, including sinusoid shape memory alloy distractor, reconstructive plate and mini-plate. The animal model of trifocal bone transport reconstruction of canine mandibular mentis was duplicated, in which a 6 cm mandibular mentis segment was removed and the transport disc was created by osteotomy in both ends of the mandibular defect. The plates were used for internal fixation and shape reconstruction of the mandible. They also served as transport distraction guidance for the elasticity distractor. RESULTS: The new devices could complete bone transport as expected. Regenerated bone segments were formed in two months and both sides of the mandibular body were lengthened. Because of the narrow angle and obstruction from the thick soft tissues in the mentis area, the ultimate symphysis mentalis was not reconstructed. CONCLUSION: The design of the internal elasticity distraction devices showed potential feasibility for clinical practice. But further studies are still needed for better control of the strength and balance of distraction forces.