Efficacy of tissue engineered bone grafts containing mesenchymal stromal cells for cleft alveolar osteoplasty in a rat model

The development of sufficient tissue engineered bone grafts for alveolar cleft osteoplasty could reduce the necessity of autogenous bone grafts and its donor site morbidity. The aim of the study was to evaluate tissue engineered bone grafts in an artificially created bone defect.Bone grafts were created in vitro colonizing a synthetic hydroxyapatite–tricalciumphosphate scaffold (BONITmatrix^®) with either undifferentiated mesenchymal stromal cells (group 1) or osteogenic differentiated mesenchymal stromal cells (group 2). Cells were multiplied from bone marrow of donor rats. Unmodified scaffolds (group 3) and the tissue engineered bone grafts were inserted into artificial maxillary defects of 54 Lewis rats. In 18 animals the defects remained unfilled (control). After one, three and six weeks the rats were sacrificed. The defect was evaluated radiologically and histologically with regard to the remaining defect volume and diameter. Statistical analysis followed.The bone grafts led to a specific bone formation at the defect margin. No complete reunion of any defect was observed within the healing time. After six weeks, the remaining defect volume was 6.86 ± 3.21 mm³ (control), 4.08 ± 1.36 mm³ (group 1), 5.00 ± 0.84 mm³ (group 2) 5.50 ± 1.05 mm³ (group 3). The remaining defect diameter measured 2.63 ± 0.52 mm (control), 2.39 ± 0.23 mm (group 1), 2.53 ± 0.22 mm (group 2) and 2.70 ± 0.66 mm (group 3). In all experimental groups the defect volume and diameter decreased over time, which was significant for group 1 (p = 0.014), group 2 (p = 0.025) and group 3 (p = 0.048). The defect volume and width was significantly reduced for bone grafts containing undifferentiated cells compared to control (p = 0.035) or scaffolds only (p = 0.05).ConclusionTissue engineered bone grafts induce a pronounced bone formation in artificial bone defects compared to unfilled controls or scaffolds only.     

Hyaluronic acid on collagen membranes: An experimental study in rats

ObjectiveThe aim of this study was to evaluate the effect of hyaluronic acid (HA) in the structure and degradation patterns of BioGide^® and OsseoGuard™ collagen membranes. HA mediates inflammation and acts in cell migration, adhesion, and differentiation, benefitting tissue remodeling and vascularization. These are desirable effects in guided regeneration procedures, but it is still unknown whether HA alters the barrier properties of absorbable membranes.DesignBone defects were created in the calvaria of rats, which were treated with HA gel 1% (HA group) or simply filled with blood clot (control group), and covered with BioGide^® or OsseoGuard™. The animals were euthanized after 1, 30, and 60 days, and their calvarias were processed for histological analysis.ResultsBioGide^®, in both HA and control groups, showed vascularization, intense cell colonization, bone formation, and tissue integration at 30 and 60 days. In contrast, Osseoguard™ presented minimal cellular colonization, and inflammatory reaction associated to foreign body reaction in both time points and groups. The HA group of BioGide^® showed higher cell colonization (574.9 ± 137.6) than the control group (269.1 ± 70.83) at 60 days (p < 0.05). Despite this finding, the structure and degradation pattern were similar for BioGide^® and Osseoguard™ in the HA and control groups.ConclusionThe results suggest that HA did not interfere with tissue integration and structural degradation of BioGide^® and Osseoguard™ membranes.     

Bone marrow aspirate concentrate and platelet-rich fibrin in fresh extraction sockets: A histomorphometric and immunohistochemical study in humans

The aim of this study was to evaluate the level of mineralized tissue and expression of bone markers in sockets grafted with platelet-rich fibrin and bone marrow aspirate concentrate (BMAC).Patients requiring extraction of one maxillary anterior tooth were randomized into three groups. After tooth extraction, the sockets in the control group (CG) were permitted to fill with blood clot. In the platelet-rich fibrin group (PRFG), after blood processing, the sockets were grafted with PRF plug. In the bone marrow aspirate concentrate combined with platelet-rich fibrin group (BM/PG), after blood and bone marrow processing, the sockets were grafted with a mixture of PRF plug and BMAC. After 6 months, the sites were reopened and bone cores were harvested and prepared for histomorphometric and immunohistochemical evaluation. The following levels were measured: mineralized tissue, expression of RUNX-2, and osteocalcin.Fifteen patients were included in this study. The histomorphometric analysis showed a more pronounced level of mineralized tissue in PRFG and BM/PG (54.20 ± 4.31% and 64.70 ± 6.74%, respectively) when compared with CG (40.60 ± 5.98%) (p = 0.0283 and p = 0.0090, respectively). The expression of RUNX-2 was very low in BM/PG (0.80 ± 0.84%) and absent in CG and PRFG (p = 0.0528). Osteocalcin expression was higher for BM/PG (23.40 ± 1.52%) when compared with CG and PRFG (18.40 ± 2.07% and 16.20 ± 1.92%, respectively) (p = 0.0117 and p = 0.0088, respectively).This preliminary study indicates that clinical use of bone marrow aspirate concentrate, when combined with platelet-rich fibrin as a carrier, might have some potential to increase mineralization in fresh extraction sockets.     

The effect of current used bone substitution materials and platelet-rich plasma on periosteal cells by ectopic site implantation: An in-vivo pilot study

The aim of this study was to investigate de novo bone formation following ectopic site implantation of bone substitutes covered by periosteum, with and without the application of autologous platelet-rich plasma (PRP). Twenty-four weeks after subcutaneous implantation of various bone substitutes (bovine hydroxyapatite (bHAP), phycogenic hydroxyapatite (pHAP), and bioglass (BG)) in 35 mini-pigs, bone regeneration rates were compared microradiographically and histologically. Without PRP, bHAP showed a mean de novo bone formation of 32.41% ± 29.99, in contrast to the other substitute materials where no mineralization could be detected. In combination with PRP, in the bHAP (63.61% ± 12.98; p ± 0.03) and pHAP (34.37 ± 29.38; p = 0.015) group, significantly higher de novo bone formation was ascertained than without PRP. No ossification could be detected in the BG group. In conclusion, bHAP and pHAP bone substitutes in combination with PRP showed a significant positive effect on periosteal cells by de novo bone formation after ectopic, subcutaneous, low-vascular site implantation.     

The primacy of platelet-rich fibrin on bone regeneration of various grafts in rabbit's calvarial defects

AimsThis study investigated the effect of platelet-rich fibrin (PRF) on bone regeneration of various grafting materials in rabbit calvarial defects.Material and methodsTwo bicortical skull defects were prepared in 20 New Zealand white rabbits; 10 rabbits were treated with PRF and the other 10 were non-PRF. In both groups, autogenous bone was compare to empty defects in 5 rabbits and the composite of autogenous bone and deproteinized bovine bone versus deproteinized bovine bone (DBB) in the other five. The animals were sacrificed at 8 weeks. Bone formation was assessed by radiographic densitometry and histomorphometric analysis.ResultsThe mean optical density (OD) and histomorphometric analysis (HA) of the percentage of new bone showed that the PRF groups were significantly higher than the non-PRF groups in the autogenous bone graft (OD: 0.60 ± 0.19 vs 0.36 ± 0.03; HA: 38.03 ± 4.23 vs 26.21 ± 10.58) and the empty defect (OD: 0.29 ± 0.06 vs 0.11 ± 0.06; HA: 18.81 ± 9.27 vs 6.24 ± 5.01), but not in the DBB group (OD: 1.18 ± 0.17 vs 1.07 ± 0.05; HA: 13.067 ± 3.64 vs 9.63 ± 5.47) and the composite group (OD: 0.81 ± 0.15 vs 0.91 ± 0.05; HA: 22.63 ± 3.61 vs 21.29 ± 3.52).ConclusionsPRF had a positive effect on bone formation when used alone or combined with autogenous bone, but not with deproteinized bovine bone.     

Preoperative and postoperative assessment of temporal and masseter muscle size with magnetic resonance imaging in patients undergoing unilateral temporomandibular joint surgery

The aim of this study was to assess any change between the preoperative and postoperative sizes of temporal and masseter muscles with magnetic resonance imaging (MRI) in patients undergoing unilateral temporomandibular joint surgery.This study was designed and implemented retrospectively. For clinical evaluation, a visual analog scale (VAS) and maximum mouth opening (MMO) were used. In order to make a preoperative diagnosis and perform a 6-month control, muscle size was measured in millimeters (mm) on T1 axial sections in MRI. Statistical analyses were performed using the SPSS 23.0 software package. Numeric variables were compared between two dependent groups using the Wilcoxon signed rank test. Statistical significance was set at p < 0.05.Twelve patients who underwent unilateral discectomy plus dermis-fat grafting, with classical preauricular inverse L incision, were included in the study, and data for eleven female patients were evaluated. The difference in size between the operated and non-operated sides was found to be statistically insignificant at the preoperative stage for both masseter muscle (operated side m^M: 13.264 ± 1.822 mm; non-operated side m^M: 13.264 ± 2.315 mm; p^M = 0.929) and temporal muscle (operated side m^T: 20.345 ± 2.609 mm; non-operated side m^T: 20.582 ± 2.366 mm; p^T = 0.594). There was a significant size reduction in the masseter muscle on the operated side in the postoperative period (preop m^M: 13.264 ± 1.822 mm; postop m^M: 12.036 ± 1.728 mm; p^M = 0.018). Although there was also a size reduction in the operated side of the temporal muscle in the postoperative period, that difference did not reach statistical significance (preop m^T: 20.345 ± 2.609 mm; postop m^T: 19.445 ± 1.603 mm; p^T = 0.182). On the non-operated side, there were no significant postoperative changes in the sizes of either the masseter muscle (preop m^M: 13.264 ± 2.315 mm; postop m^M: 12.682 ± 2.059 mm; p^M = 0.248) or the temporal muscle (preop m^T: 20.582 ± 2.366; postop m^T: 19.891 ± 3.487 mm; p^T = 0.625).Considering the study findings as a whole, a size reduction was observed in the operated side of the masseter muscle after TMJ surgery. The etiology of this change may be surgical trauma to the temporal and masseter muscles, skeletal alteration resulting from condylar change secondary to discectomy, and patients restraining themselves from application of maximum bite force as a result of a self-protection mechanism due to postoperative pain.     

Influence of tumour necrosis factor alpha on epithelial–mesenchymal transition of oral cancer cells in co-culture with mesenchymal stromal cells

Tumour progression in head and neck squamous cell carcinoma (HNSCC) is influenced by the surrounding stroma and inflammatory cytokines such as tumour necrosis factor alpha (TNF-α). The aim of this study was to test the hypothesis that TNF-α modulates the interactions of HNSCC cell line PCI-13 and bone marrow mesenchymal stromal cells (BMSCs) and influences markers of epithelial–mesenchymal transition (EMT). Following induction with TNF-α, mono- and co-cultures of BMSCs and the established HNSCC cell line PCI-13 were analyzed; protein expression of E-cadherin and vimentin and qRT-PCR expression of Snail, Twist, MMP14, vimentin, E-cadherin, and β-catenin were examined, and changes in cellular AKT signalling were analyzed. TNF-α induced a significant decrease in E-cadherin (64.5 ± 6.0%, P = 0.002) and vimentin (10.4 ± 3.5%, P = 0.04) protein expression in co-cultured PCI-13, while qRT-PCR showed a significant increase in β-catenin (BMSCs P < 0.0001; PCI-13 P = 0.0005) and Snail (BMSCs P = 0.009; PCI-13 P = 0.01). TNF-α also resulted in a down-regulation of AKT downstream targets S6 (38.7 ± 20.9%, P = 0.01), p70S6 (16.7 ± 12%, P = 0.05), RSK1 (23.6 ± 28.8%, P = 0.02), and mTOR (27.4 ± 17.5%, P = 0.004) in BMSC co-cultures. In summary, while reducing the expression of vimentin and AKT-signalling in PCI-13 and BMSC, respectively, TNF-α introduced an inflammatory-driven tumour–stroma transition, marked by an increased expression of markers of EMT.     

Does glucosamine,chondroitin sulfate,and methylsulfonylmethane supplementation improve the outcome of temporomandibular joint osteoarthritis management with arthrocentesis plus intraarticular hyaluronic acid injection. A randomized clinical trial

The purpose of this study was to compare clinical outcomes obtained with the use of glucosamine, chondroitin sulfate, and methylsulfonylmethane (GCM) supplementation after arthrocentesis plus intraarticular hyaluronic acid (HA) injection.A randomized clinical trial was implemented with adult participants with TMJ-OA who were referred to the author’s clinic between February 2014 and May 2015. The sample was entirely composed of patients with TMJ-OA who were treated randomly with a one-session arthrocentesis plus intraarticular HA injection only (control group), or an initial one-session arthrocentesis plus intraarticular HA injection followed by 3 months of GCM supplementation (study group). The predictor variable was management (treatment) technique. The outcome variables were visual analog scale evaluations (masticatory efficiency, pain complaint, joint sound) and mandibular mobility (maximal interincisal opening [MIO], and lateral and protrusive motions of the mandible). The outcome variables were recorded preoperatively and 12 months postoperatively.Thirty-one participants were enrolled in the study. Five were lost during follow-up. The final study sample consisted of 26 participants (age 28.35 ± 10.85 y): 14 in the control group (age 28.71 ± 10.94 y); and 12 in the study group (age 27.92 ± 11.20 y). Pain complaints (p < 0.001) and joint sounds (p = 0.030 for the control group; p = 0.023 for the study group) showed statistically significant decreases. Masticatory efficiency (p < 0.001 for the control group; p = 0.040 for the study group) and lateral mandibular motion (p = 0.040 for the control group; p = 0.004 for study group) showed statistically significant increases in both groups, whereas MIO and protrusive mandibular motion showed no significant changes in either group (p > 0.05). After estimating the differences between the follow-up and baseline outcomes, the mean changes in the primary outcome variables (VAS scores, MIO, and mandibular motion) showed no statistically significant differences between the two groups (p > 0.05).Progressions (reparative remodeling) of hard-tissue TMJ structures were observed on CBCT scans of some participants in both groups.These findings suggested that the use of GCM supplementation after arthrocentesis plus intraarticular HA injection produced no additional clinical benefits or improvements for patients with TMJ-OA compared with arthrocentesis plus intraarticular HA injection alone.     

The effect of nicotine on osteoinduction by recombinant human bone morphogenetic protein 2

Nicotine, one of the constituents of tobacco, is known to have an adverse effect on human health. We sought to clarify the interaction between nicotine and recombinant human bone morphogenetic protein 2 (rhBMP-2) in terms of osteogenesis in vitro and osteoinduction in vivo. Nicotine did not inhibit or stimulate alkaline phosphatase (ALP) activity or the amount of osteocalcin in C2C12 cells in the presence of rhBMP-2 in vitro. Ectopic bone formation using a collagen sponge containing rhBMP-2 was evaluated with and without nicotine after 21 days using radiographic, histological, biochemical, and immunohistochemical analyses. ALP activity in the medium-dose group (2.2 ± 0.9 IU/mg protein; P = 0.047) and the high-dose group (2.0 ± 0.1 IU/mg protein; P = 0.03) was significantly lower than in the control group. The calcium content in the medium-dose group (35.4 ± 12.9 μg/mg tissue; P = 0.0099) and high-dose group (34.8 ± 10.5 μg/mg tissue; P = 0.006) was significantly lower than in the control group. The number of vascular endothelial growth factor-positive cells in the high-dose group (671.9 ± 57.3 cells/mm²; P = 0.03) was significantly lower than in the control group. Results showed that nicotine did not inhibit the stimulatory effect of rhBMP-2 in vitro, but a high dose of nicotine inhibited bone formation in vivo by adversely affecting vascularization.     

High molecular weight hyaluronic acid reduces the growth and biofilm formation of the oral pathogen Porphyromonas gingivalis

BackgroundPorphyromonas gingivalis (P. gingivalis) is viewed as a keystone microorganism in the pathogenesis of periodontal and peri-implant diseases. Hyaluronic acid (HA) is believed to exert antimicrobial activity. The aim of this study is to assess the in-vitro growth and biofilm formation of P. gingivalis under HA and compare the effect of HA to that of azithromycin (AZM) and chlorhexidine (CHX).Materials and methodsIn each material, the minimum inhibitory concentration (MIC), 50% MIC, 25% MIC, and 12.5% MIC were tested. The growth of P. gingivalis was evaluated by absorbance spectrophotometry after 48 h. A biofilm inhibition assay was performed on a 72-hour culture by washing planktonic bacterial cells, fixing and staining adherent cells, and measuring the variation in stain concentrations relative to the untreated control using absorbance spectrophotometry.ResultsThe results show that the overall growth of P. gingivalis after 48 h was 0.048 ± 0.030, 0.008 ± 0.013, and 0.073 ± 0.071 under HA, AZM, and CHX, respectively, while the untreated control reached 0.236 ± 0.039. HA was also able to significantly reduce the biofilm formation of P. gingivalis by 64.30 % ± 22.39, while AZM and CHX reduced biofilm formation by 91.16 %±12.58 and 88.35 %±17.11, respectively.ConclusionsHigh molecular-weight HA significantly inhibited the growth of P. gingivalis. The overall effect of HA on the growth of P. gingivalis was similar to that of CHX but less than that of AZM. HA was also able to significantly reduce the biofilm formation of P. gingivalis. However, the ability of HA to prevent the biofilm formation of P. gingivalis was generally less than that of both AZM and CHX.     

Maxillary sinus floor augmentation and dental implant placement using dentin matrix protein-1 gene-modified bone marrow stromal cells mixed with deproteinized boving bone: A comparative study in beagles

ObjectiveThe aim of the study was to evaluate the effects of the combined use of dentin matrix protein-1 (DMP1) gene-modified bone marrow stromal cells (BMSCs) and Bio-Oss^® for maxillary sinus floor augmentation (MSFA) implant placement in dogs.Materials and methodsBMSCs were derived from bone marrow of six beagles and cultured. The cells were transduced with a lentiviral vector overexpressing the DMP1 gene and enhanced green fluorescent protein (EGFP) gene (Lenti-DMP1/EGFP) in test group, and with a lentiviral vector encoding EGFP gene (Lenti-EGFP) in control group. Six dogs received sinus augmentations using the bilateral approach with a simultaneous implant placement at each site respectively. At the same concentration, 2 × 10⁷ cells/ml, one sinus was grafted using a mixture of autologous DMP1/EGFP gene-modified BMSCs and Bio-Oss^® (DMP1 group), and the contralateral sinus was grafted with autologous EGFP gene-modified bMSCs and Bio-Oss^® (EGFP group). After a 3 month healing period, bone regeneration and osseointegration were evaluated using histologic and histomorphometric methods.ResultsThe bone-implant contact (BIC) and the bone area fraction in the DMP1 group (BIC: 34.67% ± 8.23%, bone area fraction: 35.16% ± 3.32%) were significantly greater compared with the EGFP group (BIC: 26.06% ± 5.16%, bone area fraction: 20.74% ± 1.63%) (P < 0.05). No significant difference between the residual bone substitute material volume (BSMV) in the DMP1 group (35.86 ± 7.35) and the EGFP group (32.16 ± 9.16) was found in our study (P > 0.05).ConclusionBMSCs modified with the DMP1 gene can be used as an adjunct to Bio-Oss^® to enhance new bone formation and the osseointegration of dental implants in MSFA of dogs.     

Potentiometric investigation of oxide solubilities in molten KCl–NaCl eutectic.: The effect of surface area of solid particles on the solubilities

The sequential additions method (SAM) was used to determine solubility and disassociation characteristics of metal oxides MeO (CaO, PbO, ZnO, CdO) and carbonates (CaCO₃, SrCO₃, BaCO₃) in molten KCl–NaCl eutectic at 700 °C. A membrane oxide-reversible electrode Pt(O₂)/YSZ) was used to detect oxide ion concentrations. The oxides (MeO) were found to be weak bases in unsaturated solutions, their dissociation constants (pK) were found to be 3.27±0.2 (CaO), 3.50±0.1 (PbO), 6.1±0.2 (ZnO) 5.3±0.2 (CdO). All the emf?(?log m_MeO) plots in the vicinity of the saturation point include bends to the concentration axis. These were explained by the partial dissolution of MeO powders resulting in a decrease of their particle sizes and a corresponding rise of the molar surface areas (MSA). Calculations performed give surface energies of MeO_solid/KCl–NaCl systems of the order of 30–50 J m^?2. This allowed us to estimate MSAs of the MeO particles formed in MeO solubility determinations in molten KCl–NaCl by isothermal saturation and potentiometric titration methods. The solubilities of the alkaline earth carbonates were determined in a CO₂ atmosphere. Under these conditions solubility products of the carbonates were achieved before oxide precipitation. The alkaline earth carbonates were found to be appreciably soluble in the KCl–NaCl eutectic at 700 °C. Their solubility products determined by SAM were equal to pP_BrCO3=0.36±0.3, pP_SrCO3=2.04±0.2, pP_CaCO3=2.04±0.2 (in a CO₂ atmosphere). Under these conditions the particle size effect was imperceptible.     

A retrospective analysis of the complication rate after SARPE in 111 cases,and its relationship to patient age at surgery

PurposeSurgically assisted rapid palatal expansion (SARPE) is a well-known surgical intervention for treating maxillary transverse deficiencies (MTDs). This investigation aimed to evaluate the complication rate after SARPE, and its relationship to patient age.Materials and methodsBased on multivariate analyses, the complication rate after SARPE and its association with increasing age in 111 patients with MTD was evaluated. In every case the following variables were evaluated: age, gender, concomitant surgery, expander appliance, perioperative and dental complications, pain score, neurosensory disturbances (NSDs), postoperative excessive haemorrhage, length of hospital stay, infection, oronasal communication, palatal ulceration, asymmetrical maxillary expansion, mal- or non-union of the bone, lacrimation, and mechanical failure.ResultsOverall, 58 (52.25%) patients had minor-to-severe complications. The most common complications were NSDs (27.03%) and postoperative pain (13.51%). Multivariate analysis showed that the frequency of dental complications (mean age 35.9; SD = 10.5140; p = 0.00211), NSDs in general (mean age 30; SD = 9.9827; p = 0.01571), NSDs lasting more than 4 weeks (mean age 30,9583; SD = 10.6260; p = 0.01051), and NSDs lasting more than 1 year (mean age 36.2; SD = 8.7579; p = 0.02011) increased significantly with patient age.ConclusionDetailed data analysis revealed a limited number of severe, long-term complications after SARPE. However, careful patient selection is recommended in elderly cases.     

Comparison of temporomandibular joint function and morphology after surgical and non-surgical treatment in adult condylar head fractures

PurposeThe aim of this study was to evaluate whether surgical treatment can distinctly improve temporomandibular joint (TMJ) function and morphology in adult patients with condylar head fractures (CHFs) when compared with conservative treatment.Patients and methodsA retrospective study was performed to evaluate surgical and conservative outcomes in all patients who had suffered CHFs. In this study, all patients were divided into a surgical group and a conservative group. In the surgical group patients were treated by open reduction and internal fixation (ORIF) combined disc anchorage, while in the conservative group patients were treated by a removable splint combined with intermaxillary elastics. Clinical and radiological outcomes were evaluated and functional outcomes were assessed using the Helkimo index score. Paired t-tests, Wilcoxon signed rank tests, independent t-tests and χ² tests were used to assess inter-group differences.Results75 TMJs in 56 patients were included in this study and were divided into a surgical group (56 TMJs in 40 patients) and a conservative group (19 TMJs in 16 patients). The results showed that the Helkimo index score for TMJ in the surgical group was better than in the conservative group (p_Ai = 0.032, p_Di = 0.001, respectively). Ramus height in the surgical group (61.08 ± 4.04 mm) recovered more than in the conservative group (54.82 ± 3.06 mm) (p = 0.012). Discs became shorter, moved further forward, and became severely distorted in the conservative group (disc length = 7.32 ± 1.35 mm). In contrast, discs became longer, retained a normal disc–condyle relationship, and formed a normal shape in the surgical group (disc length = 11.05 ± 2.07 mm) (p = 0.003). According to the MRI images, joint effusion, retrodiscal tear, and lateral capsular tear were better cured in the surgical group (p = 0.001, p < 0.001, p = 0.012, respectively).ConclusionBased on these results, it seems that surgical treatment of condylar head fractures should be the preferred approach if there are no contraindications for general anesthesia.     

Accelerated cranial distraction protocol for one-piece fronto-orbital distraction osteogenesis without bandeau in patients with craniosynostosis

This study aimed to compare the bony relapse ratios of standard and accelerated distraction protocols (ADP) in one-piece fronto-orbital distraction osteogenesis (DO).Patients with unilateral or bilateral coronal synostoses who underwent one-piece fronto-orbital DO were included. The accelerated cranial distraction protocol included a 3-day latency period and a distraction rate of 1–2 mm/day, followed by a 4-week consolidation period. Intracranial volume was measured using computed tomography (CT) before the surgery, at the end of the consolidation period, and 1 year after the removal of distractors. The intracranial volume changes and relapse ratios were calculated.This study included 32 patients; of these, 16 were included in each of the ADP and standard protocol (SP) groups. The mean ages were 1.4 years and 1.6 years in the ADP and SP groups, respectively (p = 0.895). In the ADP and SP groups, the expanded volumes were 270.9 ± 90.3 cm³ and 284.6 ± 149.7 cm³ (p = 0.91) and the growth-corrected expanded volumes were 162.1 ± 67.5 cm³ and 177.1 ± 105.2 cm³, respectively (p = 0.867). The relapse and growth-corrected relapse ratios showed no significant differences between the two groups, suggesting similar stability between the two protocols. The relapse ratios were 7.1 ± 4.8% and 7.3 ± 5.0% (p = 0.91) and the growth-corrected relapse ratios were ?3.0 ± 3.3% and ?2.4 ± 2.7%, respectively (p = 0.498).Within the limitations of the study, it seems that the ADP can shorten the distraction period without compromising stability. This may contribute to resolving the disadvantages and highlighting the advantages of DO.     

Effect of bone marrow mesenchymal stem cells on perforator skin flap survival area in rats

Trans-territory perforator flaps are commonly used to reconstruct large defects of the soft tissues. The distal portion of the flap often becomes necrotic, however, as a result of the jeopardised vasculature of choke zone II. The trophic and vascular regenerative properties of bone marrow mesenchymal stem cells (BMSC) seemed to be a promising approach to prevent flaps becoming ischaemic. The purpose of our study is to evaluate the effects of BMSC on the survival of the three-territory perforator flap. The flap model was created based on the deep circumflex iliac vessel in rats. Eighteen rats were distributed, at random, into three groups. Immediately after the flaps were placed, groups were respectively given a single panniculus carnosus injection at choke zone II of either 1 × 10⁵ (BMSCs^low), 1 × 10⁶ (BMSCs^hig) BMSC, or phosphate-buffered saline (PBS). On postoperative day seven, we assessed the gross view of the flap and survival. We also evaluated microvessels by histological examination and angiogenesis-related gene expression by quantitative real-time polymerase chain reaction. After high dosage of BMSC, the flap survival rate, diameter and density of microvessels, vascular endothelial growth factor (VEGF) and platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31) levels were significantly higher in the BMSC treatment group than the control group. We therefore confirmed the positive effects of BMSC on the survival of multi-territory perforator flaps.     

MR imaging as a precise technique to evaluate skull-base tumor volume: Comparison of CT,MR imaging and FDG PET from murine and clinical data

In spite of the many imaging modalities used in clinics, the one that best reflects the true delineation of skull-base (infratemporal fossa, ITF) malignancies is still unknown. In order to compare the tumor recognition capabilities of different imaging modalities, established murine models and patients with skull-base tumors were evaluated by computer tomography (CT), magnetic resonance (MR) imaging, and fluorine-18 fluorodeoxyglucose (¹⁸FDG) positron emission tomography (PET) for delineation of gross tumor volume (GTV).PET, MR imaging, and CT enhanced by iodine staining were all sensitive to, and able to recognize, the skull-base tumor in the murine model. No significant difference (p > 0.9999) was observed between average GTV according to MR imaging (176.67 ± 19.6 mm³) and the histological measurement result (170.23 ± 22.24 mm³) for the murine model. In contrast, the GTVs according to CT (88.77 ± 13.03 mm³, p < 0.0001) and ¹⁸FDG PET (35.67 ± 6.56 mm³, p < 0.0001) were much smaller.In nine patients for whom the three modalities were available, tumor volume comparisons tended to be consistent with the murine model data. According to both the established murine model and clinical patient data, MR imaging possessed the optimal ability to recognize tumor contours.     

Stability of lingual plate osteotomy in orthognathic surgery for patients with severe facial asymmetry: A retrospective analysis with 1-year follow-up

This study aimed to evaluate the stability of lingual plate osteotomy after sagittal split ramus osteotomy (SSRO) in patients with severe facial asymmetry. It included 20 patients undergoing lingual plate osteotomy between January 2011 and January 2017. Cephalometric X-ray imaging and three-dimensional computed tomography (3DCT) were performed before the operation and then 1 day and 1 year after the operation. The relapse rate and postoperative complications were assessed. The operation time was compared between lingual plate osteotomy and transoral angle osteotomy.Specific values measured on cephalometric X-ray and 3DCT images showed significant changes 1 day after the operation, with 47.9% correction occurring in the occlusal plane angle (mean ± SD = 1.74 ± 0.84°, p < 0.05). However, no significant differences were found between measurements taken 1 day and 1 year after the operation, with a 5% change seen in the occlusal plane angle (mean ± SD = 0.1 ± 0.24°, p = 0.61), suggesting that the surgical outcomes can be well maintained for at least 1 year after surgery.Three patients experienced numbness postoperatively but recovered within 1 year. The operation time for lingual plate osteotomy was shorter than that for transoral angle osteotomy. Our findings indicate that lingual plate osteotomy after SSRO is stable, effective, and safe in patients with severe facial asymmetry.     

Comparative histological evaluation of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome of apicomarginal defects: A randomized clinical trial

The objective of this randomized clinical trial was to investigate the effects of two PRF formulations (PRF High and PRF Medium) on quality of life and healing outcome (2D and 3D) of apicomarginal defects.Patients presenting with endodontic lesions and concomitant periodontal communication were randomly allocated to PRF High and PRF Medium groups. The treatment protocol in each group included a periapical surgical procedure with placement of PRF clot and membrane in the bony defect and on the denuded root surface, respectively. Quality of life was assessed for 1 week after surgery following a modified version of the patient's perception questionnaire. Postoperative pain was assessed using a visual analog scale. Clinical and radiographic evaluations were performed using Rud and Molven 2D criteria and Modified PENN 3D criteria. Buccal bone formation was assessed using sagittal and corresponding axial sections in CBCT. Histological analysis was performed using hematoxylin and eosin (H and E) staining and attaching primary antibodies to tissue sections.In total, 40 patients were enrolled in the trial (N = 20 per group). PRF Medium group patients reported significantly less swelling on the 1st (p = 0.036), 2nd (p = 0.034), and 3rd (p = 0.023) days, and average pain on the 2nd (p = 0.031), 3rd (p = 0.03), and 4th (p = 0.04) days postoperatively. The difference in success rate for periapical healing was non-significant between the PRF Medium group (89.5%) and PRF High group (90%), in both 2D and 3D imaging (p = 0.957). The formation of buccal bone was observed in five cases (26.3%) and four cases (20%) in the PRF Medium and PRF High groups, respectively, with a non-significant difference (p = 0.575). PRF Medium clots had a loose fibrin structure with a significantly higher number of neutrophils (473.79 ± 82.89 per mm²) than PRF High clots, which had a dense structure and fewer neutrophils (253.15 ± 63.86 per mm²) (p = 0.001). Autologous platelet concentrates (APCs) promoted satisfactory periapical healing, with no significant difference between the groups.Within the limitations of the study, it seems that PRF Medium should be preferred over PRF High when the patients’ quality of life is the priority.