Influence of commercial adhesive with/without silane on the bond strength of resin-based composite repaired within twenty-four hours.

BACKGROUND/PURPOSE: It is not clear whether the ground surface of resin-based composite (RBC) polymerized requires the application of an adhesive with/without a silane to improve bond strength. This study investigated the bond strength of RBC repaired within 24 h via the application of adhesive with/without a silane. MATERIALS AND METHODS: Seventy RBC blocks were prepared and assigned to either 0 or 24 h repair stage. Each stage was divided into seven groups: a control group with no surface roughening or applied adhesive, a surface-roughened group with no applied adhesive, two surface-roughened groups treated with a G-aenial Bond adhesive and a BeautiBond Multi adhesive, two surface-roughened groups treated with the previously-mentioned adhesives as well as silane coupling agents, and one group treated with a Single Bond Universal silane-containing adhesive. Microtensile bond strength (µTBS) measurements were performed after the repaired RBC blocks of each group (n = 5) had been immersed in a 37 °C water bath for 24 h. The failure mode of each sample was determined, and the data were analyzed via one-way analysis of variance and Dunnett's test (p = 0.05). RESULTS: Regardless of the repair stage, the µTBS values of the adhesive-only and silane-adhesive groups did not differ significantly from those of the control group (p > 0.05). Only the no-adhesive groups exhibited a significantly time-dependent increase in adhesive failure rate. CONCLUSION: Our results suggest that the application of adhesives either with or without silane can significantly increase the bond strength of repairs to RBCs polymerized within 24 h.

The impact of the COVID-19 epidemic on the utilization of dental services and attitudes of dental residents at the emergency department of a medical center in Taiwan.

BACKGROUND/PURPOSE: Dental visits are a high risk activity during the COVID-19 pandemic. This study investigated the utilization of emergency dental services and clinical practical attitudes of dental residents in this period. MATERIALS AND METHODS: Retrospective chart data from 13th November 2019 to 31st March 2020 in Kaohsiung Medical University Hospital, Taiwan were used. We obtained electronic medical records to review data from 515 patients who visited the emergency department with dental complaints and we contacted the 26 residents assigned to act as primary care providers to participate in this study. RESULTS: After the COVID-19 outbreak, 17% fewer patients had dental emergency utilization at a hospital emergency center relative to the previous period. A survey of residents also showed a decline in the number of patients. There were no significant differences of patients' problems and diagnoses between the two periods. After the COVID-19 outbreak, 61.5% of the residents were afraid of being infected by a patient's disease and the proportions of dentists wearing waterproof gowns, face shields, and surgical hair caps were 76.9%, 88.5%, and 76.3%, respectively. These variables increased significantly after the outbreak of COVID-19. CONCLUSION: Despite the trend of a decreased number of patients, their utilization of dental emergency services seems to be similar before and after the COVID-19 outbreak, possibly related to strict hospital infection control policies and the relatively low number of COVID-19 confirmed patients internationally at that time.

Effect of toothbrush/dentifrice abrasion on weight variation, surface roughness, surface morphology and hardness of conventional and CAD/CAM denture base materials.

We evaluated the effect of toothbrush/dentifrice brushing on the weight variation and surface properties of different denture bases. Four denture base materials (conventional heat cure, high impact, CAD/CAM, and polyamide resins) were subjected to toothbrushing abrasion (50,000 strokes). The weight value, surface roughness, and topography of each group were determined before and after toothbrushing. The hardness was measured by the Vickers hardness test. Data were analyzed using ANOVA and Bonferroni tests. After toothbrushing, the weight of the polyamide resin had significantly increased; significant weight losses were observed for conventional heat cure and high impact resins, but none for the CAD/CAM resin. The surface roughness of each group increased significantly owing to the wear caused by toothbrushing. The weight variation and surface roughness were not affected by the hardness. Our results suggested that denture base materials deteriorate after brushing with toothpaste, in which the polyamide resin exhibited lower levels of abrasion.

A Study of Low Young's Modulus Ti-15Ta-15Nb Alloy Using TEM Analysis.

The microstructural characteristics and Young's modulus of the as-cast Ti-15Ta-15Nb alloy are reported in this study. On the basis of the examined XRD and TEM results, the microstructure of the current alloy is essentially a mixture (α + ß+ α' + α″ + ω + H) phase. The new H phase has not previously been identified as a known phase in the Ti-Ta-Nb alloy system. On the basis of examination of the Kikuchi maps, the new H phase belongs to a tetragonal structural class with lattice parameters of a = b = 0.328 nm and c = 0.343 nm, denoting an optimal presentation of the atomic arrangement. The relationships of orientation between these phases would be {0001}α//{110}ß//{1¯21¯0}ω//{101¯}H and (011¯0)α//(11¯2)ß//(1¯010)ω//(121)H. Moreover, the Young's modulus of the as-cast Ti-15Ta-15Nb alloy is approximately E = 80.2 ± 10.66 GPa. It is implied that the Young's modulus can be decreased by the mixing of phases, especially with the presence of the H phase.

Redox control in the pathophysiology of influenza virus infection.

Triggered in response to external and internal ligands in cells and animals, redox homeostasis is transmitted via signal molecules involved in defense redox mechanisms through networks of cell proliferation, differentiation, intracellular detoxification, bacterial infection, and immune reactions. Cellular oxidation is not necessarily harmful per se, but its effects depend on the balance between the peroxidation and antioxidation cascades, which can vary according to the stimulus and serve to maintain oxygen homeostasis. The reactive oxygen species (ROS) that are generated during influenza virus (IV) infection have critical effects on both the virus and host cells. In this review, we outline the link between viral infection and redox control using IV infection as an example. We discuss the current state of knowledge on the molecular relationship between cellular oxidation mediated by ROS accumulation and the diversity of IV infection. We also summarize the potential anti-IV agents available currently that act by targeting redox biology/pathophysiology.

Photobiomodulation therapy inhibits oral submucous fibrosis in mice.

OBJECTIVES: Oral submucous fibrosis (OSMF) is a chronic inflammatory disease and a potentially malignant oral disorder. However, the best therapeutic treatment for OSMF remains uncertain. Our previous study showed that photobiomodulation (PBM) therapy and forskolin could reduce arecoline-induced fibrosis reactions via the cAMP pathway. The present study aimed to establish an animal model of areca nut extract (ANE)-induced OSMF and to evaluate the therapeutic potential of PBM and forskolin for ANE-induced OSMF. SUBJECTS AND METHODS: The mice were divided into five groups. The buccal tissues were harvested for histomorphological analysis and immunoblotting. RESULTS: Our results showed that PBM significantly reduced the development of ANE-induced OSMF, quantified by changes in submucosal layer thickness and collagen deposition. Additionally, PBM could extensively reduce the protein expression of the fibrotic marker genes alpha-smooth muscle actin (α-SMA) and connective tissue growth factor (CTGF) in buccal submucous lesions. However, forskolin treatment significantly decreased the protein expression of fibrotic marker genes but slightly decreased the observed histomorphological changes. CONCLUSIONS: We established an ANE-induced OSMF mouse model, which also provided a model for the development of a therapeutic treatment for OSMF. The anti-fibrotic effects of PBM and forskolin may be useful for clinical interventions.

Influence of cavity depth and restoration of non-carious cervical root lesions on strain distribution from various loading sites.

BACKGROUND: We aimed to investigate the load-induced strain variation in teeth with unrestored and resin-based composite restored non-carious cervical lesions (NCCLs). METHODS: Twelve extracted premolars were provided for measuring buccal-side root NCCLs. Strain gauges were fixed at four measuring sites of each tooth, two at the buccal surface and two at the lingual surface. NCCLs were prepared with occlusal margins at the cemento-enamel junction. A static 9-kg load was applied at seven occlusal loading points: buccal cusp tip (BC), inner inclination of the BC, lingual cusp tip (LC), inner inclination of the LC, center of the mesial marginal ridge or distal marginal ridge, and center of the central groove. The strain was detected at each site in teeth with NCCL depths of 0 (control), 0.5, 1.0, and 1.5 mm. Each NCCL was restored using an adhesive composite resin, and the strains were re-measured. RESULTS: The strains at the NCCL occlusal and gingival margins decreased with increasing defect depths, and the effect was significant when the depth of the defect was 1.5 mm. Loading on the buccal and lingual cusps induced prominent strain variation. The strains at all depth distribution recovered to nearly intact conditions when the NCCLs were restored. CONCLUSIONS: NCCLs at 1.5 mm depth are detrimental, but they can be restored using resin composites. CLINICAL SIGNIFICANCE: The existence of NCCLs should not be ignored. The depth of the NCCL may affect the progression of the lesion. Resin composite restoration is an appropriate method for preventing persistent NCCL deterioration.

Effect of Ti2Cu precipitation on antibacterial property of Ti-5Cu alloy.

To instill pure Ti with an antibacterial effect, Cu was added by metallurgical alloying to produce Ti-5 wt% Cu alloy (Ti-5Cu alloy). The precipitation of the likes of Ti2Cu in a Ti-Cu alloy is one of the factors that influences its antibacterial property. However, in the present study, Ti-5Cu alloy precipitates with different microstructures were obtained by applying heat treatment at different temperatures and for different durations. After the heat treatment, metallographic, microstructure, and element analyses were performed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM) combined with energy dispersive X-ray spectroscopy (EDS). The antibacterial property of the Ti-5Cu alloy was assessed by the plated-count method using Escherichia coli (E. coli). The microstructure analysis revealed that the solution-treated alloy had no precipitation, while the aged alloy contained precipitations of intermetallic Ti2Cu compound. The aged alloy exhibited better antibacterial performance as the duration of the aging treatment increased. The optimal heat treatment for Ti-5Cu was found to be aging at 700 °C for 4 h, at which point the nucleation formation of the Ti2Cu particles would assume an acicular morphology. These acicular precipitates exhibit a high Cu content which, in turn, influences the antibacterial performance.

Influence of the acidity of electrolyzed water on the microhardness of inner layer dentin.

BACKGROUND/PURPOSE: Electrolyzed water has been identified as an effective disinfectant that could represent as an alternative to sodium hypochlorite. Unfortunately, it remains unclear whether the texture or physical properties of dentin are affected by the application of electrolyzed water of different acidities. This study was aimed to assess the influence of electrolyzed waters with differing pHs on the demineralizing of inner dentin. MATERIALS AND METHODS: The coronal superficial dentin of 20 human molars was exposed and further bisected into two pieces perpendicular to the dentin surface. The samples were immersed in strongly acidic electrolyzed water (AW group), neutral electrolyzed water (NW group), 5% sodium hypochlorite (positive control, NL group), or deionized water (negative control, DW group). Microhardness of the inner layer dentin was measured at a depth of 25 and 50 µm beneath the superficial surface layer every 5 up to 60 min. RESULTS: At a depth of 25 µm, microhardness decreased with increasing immersion time in all but the DW group. The AW group exhibited a decreasing trend from the first 5 min that became significant after 35 min of immersion and was the most rapid decrease in the four groups. The rate of decline in the NW group was low and similar to that of the NL group. Both NW and NL groups exhibited significantly less demineralization than the AW group after 15 min of immersion. No significant microhardness change was found at a depth of 50 µm in any of the samples. CONCLUSION: AW produces a more pronounced softening of dentin than NW at a depth of 25 µm.

Intensity of singular stress fields of wedge-shaped defect in human tooth due to occlusal force before and after restoration with composite resins.

Wedge-shaped defects are frequently observed on the cervical region of the human tooth. Previously, most studies explained that improper tooth-brushing causes such defects. However, recent clinical observation suggested that the repeated stress due to occlusal force may induce the formation of these wedge-shaped defects. In this study, therefore, two-dimensional human tooth models are considered with and without a wedge-shaped defect by applying the finite element method. To evaluate large stress concentrations accurately, a method of analysis is discussed in terms of the intensity of singular stress fields appearing at the tip of the sharp wedge-shaped defect. The effects of the position and direction of occlusion on the intensity of singular stress fields are discussed before and after restoration with composite resins.

Milling properties of low temperature sintered zirconia blocks for dental use.

To investigate the milling properties of different yttria-tetragonal zirconia polycrystalline (Y-TZP) block materials by applying a dental computer numerical control (CNC) milling center. Low temperature sintering zirconia block denoted by KMUZ (experimental) with two commercial zirconia blocks for T block made in Taiwan and a G block made in Germany were compared for the milling properties. Seventy-two specimens were milled using the same CNC milling center, and properties were evaluated by measuring the weight loss (g), milling time (s), margin integrity (%) and broken diameter (µm). The crystalline phases contents were identified by X-ray diffraction and the microstructures of the sintering specimens were observed by scanning electron microscopy and transmission electron microscopy. The mean milling time of G and KMUZ were significantly shorter than T (P<0.05). The KMUZ samples exhibited the least weight loss among the three kinds of blocks (P<0.05). The percentages of marginal integrity after milling were high in G and KMUZ but low in T (P<0.05). The mean broken diameters were from 90µm to 120µm. The phase transformation of t-ZrO2 (KMUZ: 7.4%, G: 5.9%, T: 3.2%) to m-ZrO2 when facing the milling pressure in ZrO2 blocks was observed by XRD. The result of TEM microstructure of KMUZ revealed that Y and Si were soluble in grain boundaries. The results show that the milling properties of KMUZ were better than one commercial T and near the G. The hindered grain growth, as a result of the Y3+ content in the grain boundaries, also plays a role in promoting the abnormal grain growth of 3Y-TZP.

Low-power laser irradiation inhibits arecoline-induced fibrosis: an in vitro study.

Oral submucous fibrosis (OSF) is a potentially malignant disorder that is characterized by a progressive fibrosis in the oral submucosa. Arecoline, an alkaloid compound of the areca nut, is reported to be a major aetiological factor in the development of OSF. Low-power laser irradiation (LPLI) has been reported to be beneficial in fibrosis prevention in different damaged organs. The aim of this study was to investigate the potential therapeutic effects of LPLI on arecoline-induced fibrosis. Arecoline-stimulated human gingival fibroblasts (HGFs) were treated with or without LPLI. The expression levels of the fibrotic marker genes alpha-smooth muscle actin (α-SMA) and connective tissue growth factor (CTGF/CCN2) were analysed by quantitative real-time reverse transcription polymerase chain reaction (RT-PCR) and western blots. In addition, the transcriptional activity of CCN2 was further determined by a reporter assay. The results indicated that arecoline increased the messenger RNA and protein expression of CCN2 and α-SMA in HGF. Interestingly, both LPLI and forskolin, an adenylyl cyclase activator, reduced the expression of arecoline-mediated fibrotic marker genes and inhibited the transcriptional activity of CCN2. Moreover, pretreatment with SQ22536, an adenylyl cyclase inhibitor, blocked LPLI's inhibition of the expression of arecoline-mediated fibrotic marker genes. Our data suggest that LPLI may inhibit the expression of arecoline-mediated fibrotic marker genes via the cAMP signalling pathway.

Effect of different acidities of electrolyzed water on dentin surface roughness, decalcification and microhardness -a preliminary study.

This study investigated the exposed coronal superficial dentin of 28 human molars were immersed in strongly acidic electrolyzed water (AW group), neutral electrolyzed water (NW group), 5% sodium hypochlorite (negative control, NL group), or deionized water (positive control, DW group). Microhardness was determined at 5-min intervals for 60 min. Surface roughness, energy dispersive X-ray spectroscopy and scanning electron microscopy analyses were performed after 5 and 60 min. Reductions in microhardness were observed in the AW, NW and NL groups, with further decreases as immersion time increased. Surface roughness was also markedly greater, and the Ca/P ratio markedly decreased, in the AW group. Prolonged immersion of dentin in strongly acidic electrolyzed water markedly decreased the microhardness and Ca/P ratio and markedly increased surface roughness. Prolonged immersion can lead to greater softening effect in dentin depending on the acidity of the electrolyzed water used.

Relationship between Frontal Gap and Postoperative Stability in the Treatment of Mandibular Prognathism.

Objectives. To investigate the correlation between frontal gaps and skeletal stability after intraoral vertical ramus osteotomy (IVRO) for correction of mandibular prognathism. Materials and Methods. Thirty-three patients with frontal gaps after IVRO-based mandibular prognathism correction were included. Three lateral and frontal cephalometric radiographs were obtained: preoperatively (T1), immediately postoperatively (T2), and 2 years postoperatively (T3). Two linear measurements (menton [Me] and frontal gap) were compared from T1 to T3 (T21: immediate surgical changes; T32: postoperative stability; T31: 2-year surgical change). Data were analyzed using Pearson's correlation coefficient and multiple linear regression. Results. The T21 mean surgical horizontal change in the Me position was 12.4 ± 4.23 mm. Vertically, the mean downward Me movement was 0.6 ± 1.73 mm. The mean frontal gaps were 4.7 ± 2.68 mm and 4 ± 2.48 mm in the right and left gonial regions, respectively. Postoperative stability (T32) significantly correlated with the amount of setback. Frontal gaps did not have a significant effect on postoperative stability. However, multiple regression model (R2 = 0.341, P = 0.017) showed value predictability, especially in the amount of setback. Conclusion. Frontal gaps occur after IVRO but have no significant effect on long-term postoperative skeletal stability. The primary risk factor for postoperative relapse remains the amount of mandibular setback.

Positive Feedback Loop of OCT4 and c-JUN Expedites Cancer Stemness in Liver Cancer.

The network of stemness genes and oncogenes in human patient-specific reprogrammed cancer stem cells (CSCs) remains elusive, especially in liver cancer. HepG2-derived induced pluripotent stem cell-like cells (HepG2-iPS-like cells) were generated by introducing Yamanaka factors and the knockdown vector shTP53. They exhibited features of stemness and a higher tumorigenesis after xenograft transplantation compared with HepG2 cells. The cancerous mass of severe combined immunodeficiency (SCID) mice derived from one colony was dissected and cultured to establish reprogrammed HepG2-derived CSC-like cells (designated rG2-DC-1C). A single colony exhibited 42% occurrence of tumors with higher proliferation capacities. rG2-DC-1C showed continuous expression of the OCT4 stemness gene and of representative tumor markers, potentiated chemoresistance characteristics, and invasion activities. The sphere-colony formation ability and the invasion activity of rG2-DC-1C were also higher than those of HepG2 cells. Moreover, the expression of the OCT4 gene and the c-JUN oncogene, but not of c-MYC, was significantly elevated in rG2-DC-1C, whereas no c-JUN expression was observed in HepG2 cells. The positive-feedback regulation via OCT4-mediated transactivation of the c-JUN promoter and the c-JUN-mediated transactivation of the OCT4 promoter were crucial for promoting cancer development and maintaining cancer stemness in rG2-DC-1C. Increased expression of OCT4 and c-JUN was detected in the early stage of human liver cancer. Therefore, the positive feedback regulation of OCT4 and c-JUN, resulting in the continuous expression of oncogenes such as c-JUN, seems to play a critical role in the determination of the cell fate decision from iPS cells to CSCs in liver cancer. Stem Cells 2016;34:2613-2624.

Oncogenic function of the homeobox A13-long noncoding RNA HOTTIP-insulin growth factor-binding protein 3 axis in human gastric cancer.

To study the mechanisms of gastric tumorigenesis, we have established CSN cell line from human normal gastric mucosa, and CS12, a tumorigenic and invasive gastric cancer cell line from CSN passages. Many stem cell markers were expressed in both CSN and CS12 cells, but LGR5 and NANOG were expressed only in CS12 cells. Increased expression of homeobox A13 (HoxA13) and its downstream cascades was significant for the tumorigenic activity of CS12 cells, and was associated with recruitment of E2F-1 to HoxA13 promoter accompanied with increased trimethylation of histone H3 lysine 4 (H3K4me3) at the hypomethylated E2F motifs. Knockdown of HoxA13 caused the downregulation of long non-coding RNA HOTTIP and insulin growth factor-binding protein 3 (IGFBP-3) genes, indicating that both were targets of HoxA13. Concurrent regulation of HoxA13-HOTTIP was mediated by the mixed lineage leukemia-WD repeat domain 5 complex, which caused the trimethylation of H3K4 and then stimulated cell proliferation. HoxA13 transactivated the IGFBP-3 promoter through the HOX-binding site. Activation of IGFBP-3 stimulated the oncogenic potential and invasion activity. Increased expression of HoxA13 (63.2%) and IGFBP-3 (28.6%) was detected in human gastric cancer tissues and was found in the gastric cancer data of The Cancer Genome Atlas. Taken together, the HoxA13-HOTTIP-IGFBP-3 cascade is critical for the carcinogenic characteristics of CS12 cells.

Application of neutral electrolyzed water to disinfection of alginate impression.

Neutral electrolyzed water was developed with new concepts of long-term good durability and minimum corrosiveness to metal in addition to its excellent bactericidal activities similar to acid type of electrolyzed waters. The present study examined the bactericidal effects of the neutral electrolyzed water on disinfection of the alginate impression of a dental arch model contaminated by bacteria. Only 1-min immersion in neutral electrolyzed water could sufficiently disinfect the alginate impression including the metallic tray under ultrasonic with no significant differences from acid electrolyzed waters. No bactericidal effects were found in any electrolyzed water when used as mixing water. Considering the advantages and disadvantages of each electrolyzed water in a comprehensive way, it was suggested that neutral electrolyzed water may be the most appropriate for the disinfection of alginate impression.

Are Hyoid Bone and Tongue the Risk Factors Contributing to Postoperative Relapse for Mandibular Prognathism?

OBJECTIVE: The purpose of this study was to investigate postoperative stability and the correlation between hyoid, tongue, and mandible position following surgery for mandibular prognathism. MATERIALS AND METHODS: Thirty-seven patients, treated for mandibular prognathism using intraoral vertical ramus osteotomy (IVRO), were evaluated cephalometrically. A set of four standardized lateral cephalograms were obtained from each subject preoperatively (T1), immediately postoperatively (T2), six weeks to three months postoperatively (T3), and more than one year postoperatively (T4). The Student t-tests, the Pearson correlation coefficient, and the multiple linear regression were used for statistical analysis. RESULTS: Immediately after surgery, menton (Me) setback was 12.8 mm, hyoid (H) setback was 4.9 mm, and vallecula epiglottica (V) setback was 5.8 mm. The postoperative stability significantly correlated (r = -0.512, p < 0.01) with the amount of setback. The hyoid bone and tongue did not have significant effects on postoperative stability. Multiple linear regression model (R(2) = 0.2658, p < 0.05) showed predictability: Horizontal Relapse Me (T4-T2) = -6.406 - 0.488Me (T2-T1) + 0.069H (T2-T1) - 0.0619V (T2-T1). CONCLUSION: Mandibular setback surgery may push the hyoid and tongue significantly backward, but this did not correlate with mandibular relapse. Postoperative stability significantly correlated with the amount of mandibular setback.

Intraoperative Hemorrhage and Postoperative Sequelae after Intraoral Vertical Ramus Osteotomy to Treat Mandibular Prognathism.

Objective. To investigate the factors affecting intraoperative hemorrhage and postoperative sequelae after orthognathic surgery. Materials and Methods. Eighty patients with mandibular prognathism underwent surgical mandibular setback with intraoral vertical ramus osteotomy (IVRO). The correlation between the blood loss volume and postoperative VAS with the gender, age, and operating time was assessed using the t-test and Spearman rank correlation coefficient. The correlation between the magnitude of mandibular setback with the presence of TMJ clicking symptoms and lip sensation was also assessed. Results. The mean operating time and blood loss volume for men and women were 249.52 min and 229.39 min, and 104.03 mL and 86.12 mL, respectively. The mean VAS in men and women was 3.21 and 2.93, and 1.79 and 1.32 on the first and second postoperative days. There is no gender difference in the operating time, blood loss, VAS, TMJ symptoms, and lip numbness. The magnitude of mandibular setback was not correlated with immediate and long-term postoperative lip numbness. Conclusion. There are no gender differences in the intraoperative hemorrhage and postoperative sequelae (pain, lip numbness, and TMJ symptoms). In addition, neither symptom was significantly correlated with the amount of mandibular setback.

Correlation Between Blood Loss and Patient-Related Factors in the Bilateral Parasymphyseal Osteotomy.

The aim of this study was to determine the correlation between pre- and postsurgical loss of blood and blood components among patients undergoing treatment of facial deformities by bilateral parasymphyseal osteotomy (BPsO).The pre- and postoperative values of blood components were determined in 30 facial deformity patients who underwent orthognathic surgery by hypotensive anesthesia. Correlations among the blood loss, sex, age, operation time, and reduced values of blood components were assessed by a correlation matrix. The mean blood loss and operation time were 437.5 (± 52.5) mL and 355.8 (± 209.42) minutes, respectively. Two patients included in this study had required blood transfusion. The mean reduced red blood cell (× 10/µL), hemoglobin (g/dL), and hematocrit (%) were -1.02, -2.98, and -9.18, respectively. There was no significant correlation between blood loss and other related factors (eg, age, operation time, and reduced blood components). All patients, however, showed significantly lower values of blood components after surgery. In conclusion, no significant factor was associated with blood loss and reduced blood components among patients undergoing BPsO. Furthermore, hypotensive anesthesia is a well-accepted method to reduce blood loss during orthognathic surgery.