OCCS Classification and Treatment Algorithm for Comminuted Mandibular Fractures Based on 109 Patients and 11 Years Experiences: A Retrospective Study.

Comminuted mandibular fractures (CMFs) pose significant challenges to surgeons for their serious complications and poor outcomes. We aimed at proposing a classification with treatment algorithm of each category for CMFs. Patients with CMFs were retrospectively reviewed and classified into five categories: Type I: relatively good occlusion, no or slightly displaced fragments, no continuity destruction or bone defect; Type II: relatively good occlusion, damaged morphology, low comminution degree but intact continuity without bone defect; Type III: damaged morphology and higher comminution degree with intact continuity and relatively good occlusion; Type IV: high comminution, impaired continuity and poor occlusion without segmental bone defect; Type V: segmental bone defect. Conservative treatment, open reduction and internal fixation or microvascular osteocutaneous free flap transplantation was performed, accordingly. Demographics, perioperative data, complications and reasons for reoperations were recorded. The chi-square test was used for statistical analysis. In total, 109 patients were included in the study. After surgery, in the following group, 5 manifested infections, 1 manifested bone non-union, and 2 experienced reoperations, while in the unfollowing group, 10 manifested infections, 5 manifested bone non-union and 8 experienced reoperations. The OCCS classification and algorithm for CMFs achieve better outcomes and with lower complication rate.

Impact of human adipose tissue-derived stem cells on dermatofibrosarcoma protuberans cells in an indirect co-culture: an in vitro study.

BACKGROUND: Autologous adipose tissue transfer may be performed for aesthetic needs following the resection of dermatofibrosarcoma protuberans (DFSP), the most common cutaneous soft tissue sarcoma, excluding Kaposi sarcoma. The regenerative effectiveness of cell-assisted lipotransfer is dependent on the presence of adipose tissue-derived stem cells (ADSCs). This is the first study to evaluate the potential oncological risks as ADSCs could unintentionally be sited within the proximity of the tumor microenvironment of DFSP cells. METHODS: Primary DFSP cells were indirectly co-cultured with ADSCs in a conditioned medium or in a Transwell system. The impact was analyzed by assessing proliferation, migration, invasion, angiogenesis, and tumor-associated genes and proteins. Results of these assays were compared between co-culture and mono-culture conditions. RESULTS: Our experimental results showed that ADSCs were able to promote proliferation, migration, invasion, and angiogenesis of DFSP cells; this was accompanied by a significant increase in the expression levels of beta-type platelet-derived growth factor receptor, collagen type I alpha 1 chain, vascular endothelial growth factor, hepatocyte growth factor, and basic fibroblast growth factor. CONCLUSIONS: The current report clearly demonstrates that ADSCs can enhance different malignant properties of DFSP cells in vitro, which should not be neglected when considering the clinical use of human ADSCs and its related derivatives in skin regenerative therapies.

Interpositional arthroplasty of post-traumatic temporomandibular joint ankylosis: A modified method.

The purpose of this study was to evaluate a modified method of interpositional arthroplasty for post-traumatic temporomandibular joint ankylosis. All patients were treated with a modified interpositional arthroplasty that included: navigation-assisted accurate bone dissection with minimal removal of only 5 mm of the ankylosed bony mass, novel application of bone wax and porcine acellular dermal matrix to prevent re-ankylosis, and a unique 3D-printed splint for occlusal stabilization and gap maintaining. The pre- and post-operative physical and radiological examinations of patients were recorded during routine follow-up visits. Postoperative follow-up visits lasted at least 12 months. Twelve patients, seven males and five females, ranging from 21 years to 59 years, were enrolled in this retrospective case series. All of the twelve patients with eighteen bony ankylosed temporomandibular joints were treated by our new method. The post-operative follow-up periods ranged from 1 year to 4 years. During the follow-up visits within at least 1 year, no one manifested re-ankylosis. The mean maximum incisor opening changed from 7.4 ± 5.3 mm (p < 0.001, before surgery) to 37.6 ± 3.9 mm (p < 0.001, last follow-up visit). No sign of post-operative infection or foreign body rejection was observed during the follow-up visits. The post-operative occlusal relationship was sound and stable. It is suggested that the modified method of interpositional arthroplasty provides favorable clinical and radiographic outcomes after a short-term follow up.

Experimental and clinical evaluation of BMP2-CPC graft versus deproteinized bovine bone graft for guided bone regeneration: A pilot study.

In this study, we proposed BMP2-incorporated calcium phosphate cement (BMP2-CPC), for application in guided bone regeneration (GBR) and compared the experimental bone restoration performance and clinical alveolar bone reconstruction outcome of BMP2-CPC with those of deproteinized bovine bone (DBB). The animal study indicated that, compared to DBB, which induced the slow ingrowth of new bone, BMP2-CPC induced numerous small growth centers for bone regeneration and facilitated a significant amount of bone regeneration in rabbit calvarial bone defects. Fewer residual graft particles remained in the BMP2-CPC-treated defects than in the DBB-treated defects. The clinical study indicated that BMP2-CPC was similar to DBB in remedying alveolar bone insufficiency and maintaining implant stability. In conclusion, the results of this present study indicate that compared to DBB, BMP2-CPC can significantly enhance in vivo bone regeneration and remodeling in rabbit calvarial bone defects and shows preliminary support on its clinical application in GBR surgeries.

Concentrated growth factor promotes gingival regeneration through the AKT/Wnt/ß-catenin and YAP signaling pathways.

Although concentrated growth factor (CGF) is known to promote gingival regeneration and improve the outcomes of clinical treatment, the mechanisms underlying its effects remain unknown. Therefore, this study aimed to elucidate the effects of CGF on gingival thickening. To this end, gingival mesenchymal stem cells (GMSCs) were treated with different concentrations of CGF, and the effects of CGF on cell proliferation and migration; collagen-1 (Col-1), fibronectin (FN), vascular endothelial growth factor (VEGF), and angiopoietin-1 (Ang-1) expression; and the AKT, Wnt/ß-catenin, and Yes-associated protein (YAP) signalling pathways were investigated. The effects of CGF in vivo were also investigated in a rat buccal gingival injection model. GMSCs cultured with CGF showed improved cell proliferation and migration. Moreover, CGF treatment improved the levels of FN, Col-1, VEGF, and ANG-1. These effects of CGF were mediated by the AKT/Wnt and YAP pathways, with the AKT pathway possibly functioning upstream of the Wnt/ß-catenin and YAP pathways. YAP was also shown to be overexpressed in the in vivo model. Thus, CGF can promote gingival regeneration, and YAP transport into the nucleus may be a key factor underlying this activity, which provides a novel perspective for gingival regeneration and further promotion of the clinical application of CGF.

Association between periodontal disease and tooth loss and mortality in an elderly Chinese population.

BACKGROUND: Poor oral health is a risk indicator of poor quality of life and mortality. However, whether these associations remain potent in elderly subjects after adequately considering the confounding factors is not yet clearly elucidated. The present study aimed to investigate the associations between periodontal disease and tooth loss and total mortality and cardiovascular disease (CVD) outcomes in the elderly > 75 years old. METHODS: A total of 1385 individuals, receiving periodontal treatment in Shanghai, participated in this retrospective study. Data on oral status were obtained from radiographs to calculate the proportion of residual bone. The information about mortality was collected from the Shanghai Municipal Center for Disease Control and Prevention (SCDC). Univariate Cox proportional hazards model, multivariable-adjusted model, and competing risk hazard model were used to analyze the association between periodontal disease or tooth loss and mortality. RESULTS: Those with severe periodontitis were associated with higher risk of total mortality than healthy individuals [hazard ratio (HR) = 1.48, 95% confidence interval (95% CI) 1.11-1.98]. Further, missing teeth increased the risk of total mortality (HR = 1.02, 95% CI 1.01-1.03). However, no significant difference was detected in the association between periodontitis or tooth loss and CVD mortality. In competing risk hazard model, an increased risk was observed for other-cause mortality, not CVD mortality, in those with severe periodontitis and missing teeth. CONCLUSION: Periodontal diseases and tooth loss were the potential predictors of total mortality even after adjustment for confounding factors. However, these were not independent indicators for CVD mortality.