Does Medullary Versus Cortical Invasion of the Mandible Affect Prognosis in Patients With Oral Squamous Cell Carcinoma?

PURPOSE: Whether mandibular involvement by oral squamous cell carcinoma (OSCC) could be identified as a factor for cancer staging and prognosis prediction remains a subject of debate. In addition, the influence of different types of mandibular invasion (cortical or medullary invasion) on patients' prognosis remains unclear. The aim of this systematic review was to establish whether mandibular invasion or its subset should be considered an independent prognostic factor for patients with OSCC. MATERIALS AND METHODS: The search for eligible studies was performed according to the predesigned inclusion criteria for a systematic review. Mandibular invasion and invasion depth were considered the primary and secondary predictor variables, respectively. The electronic search was performed using 12 databases. Manual searching covered 14 related journals and references of the included studies were scanned. The risk of bias assessment was evaluated by 2 reviewers using risk-of-bias assessment tools recommended by Saltaji et al (Angle Orthod 82:1115, 2012). Two reviewers extracted the data in duplicate. RevMan 5.2 was used for meta-analysis to assess the primary outcomes (disease-free survival and overall survival) and the secondary outcomes (2- and 5-year survival rate and local control). RESULTS: Eighteen studies (total, 3,756 participants) were included and used as the study sample. Among these included studies, 7 had an unclear risk of bias and the remaining showed a high risk. The results of the meta-analyses showed a significant relation between mandibular invasion and overall survival (P = .04) and, most importantly, that medullary involvement (P = .0001), but not cortical involvement (P = .66), could decrease overall survival. When focusing on disease-specific survival, mandibular medullary involvement predicted a poor disease-specific survival (P < .0001), but cortical involvement showed no effect (P = .66). CONCLUSION: This review showed that OSCC mandibular medullary invasion, and not mandibular invasion or mandibular cortical invasion, could be an independent prognostic factor for patients.

Efficacy of positive space acquiring membrane and antimicrobial membrane combined with granular bone substitute implantation in guiding oral bone regeneration.

Augmentation of the alveolar bone is important before oral implantation. For large bone defects, it becomes necessary to apply guided bone regeneration (GBR) materials, accompanied by filling defect sites with autologous or allogeneic bone, or bone substitutes such as acellular bone powder. In this study, we tested a granular bone substitute and GBR membrane combination therapy in treating MC3T3-E1 and L929 cells in vitro and rat calvarial and alveolar defects in vivo. The recovery conditions of bone defects were monitored by micro-CT, and 3D reconstruction of the CT images was applied to evaluate the bone augmentation semi-quantitatively. Test GBR materials could support the proliferation of MC3T3-E1 cells, poly (p-dioxanone-co-L-phenylalanine) (PDPA)-based membrane could induce apoptosis of L929 cells. Among GBR membranes applied groups, the regeneration condition of defected calvarial defects of PDPA based membrane applied group was the best and this may be caused by its excellent positive space acquiring effect. However, in a complex bacteriogenic environment, the oral bone regeneration-guided efficacy of the PDPA membrane decreased in the post-repair stage with the aggravation of infections. By contrast, the antimicrobial membrane combined with the PDPA membrane exhibited continually increasing GBR efficacy at the later stage of repair owing to its multifunctional properties, which are infection-inhibiting and positive space acquiring. Therefore, multifunctional GBR membranes are preferable for GBR in complex oral environments, and further research should be conducted to determine their efficacy in other models.

Comprehensive reparative effects of bacteriostatic poly(L-lactide-co-glycolide)/poly(L-lactide-co-ε-caprolactone) electrospinning membrane on alveolar bone defects in progressive periodontitis.

Periodontitis is a chronic inflammatory disease that leads to the loss of alveolar bone, among several studies focusing on reconstructing periodontal bone caused by periodontitis, guided bone regeneration (GBR) is a promising approach. In this study a serial clinically applied antibiotics loaded poly(L-lactide-co-glycolide)/poly(L-lactide-co-ε-caprolactone) (PLGA/PLCA) fibrous mesh to prevent and reconstruct defective bone in periodontitis were prepared by electrospinning. Incorporation of antibiotics promoted the hydrophilicity but decreased the crystallinity of PLGA/PLCA membranes. Antibiotics could be sustained released from membranes. Metronidazole, minocycline, and doxycycline incorporated membranes could suppress Porphyromonas gingivalis (P. gingivalis) within 21 days in vitro. Metronidazole and minocycline incorporated membranes decreased 41% and 55.5% colony counts in rat gingival crevicular fluid in vivo. Minocycline-loaded membrane could support the proliferation of MC3T3-E1 cells and maintained 79% viability of human ligament fibroblasts cultured on it. And MC3T3-E1 cells could undergo osteoblastic differentiation when cultured with pure PLGA/PLCA membrane and minocycline incorporated membrane. Then in vivo repairable effects of those antibiotics loaded membranes were evaluated in alveolar bone defected P. gingivalis infected model. The application of minocycline loaded membranes, effectively prevented the bone resorption of periodontitis caused by P. gingivalis. After been treated with minocycline incorporated membrane, volume of defected bone of maintained at about 50% level of control rats. 8 weeks post-operation, newly regenerated bone was observed in the operative alveolar bone of the pure PLGA/PLCA membrane, metronidazole and minocycline incorporated PLGA/PLCA membrane treated groups. Minocycline/PLGA/PLCA electrospinning membrane is a promising GBR material that can be applied to guide regeneration of periodontitis-induced alveolar bone damage.

Positive space acquiring asymmetric membranes for guiding alveolar bone regeneration under infectious conditions.

To obtain multifunctional materials suitable for guiding alveolar bone regeneration under infectious conditions, we prepared asymmetric membranes comprising space acquiring layer that involves fibroblast inhibitor poly(p-dioxanone-co-L-phenylalanine) (PDPA), an isolating dense layer that forms barrier between two layers and an osteogenesis inducing electrospinning layer which involves hydroxyapatite or hydroxyapatite & minocycline. Then the composition, crystallization, morphology, and hydrophilicity of asymmetric membranes were analyzed. Minocycline incorporated membranes controlled the expansion of Porphyromonas gingivalis (P. gingivalis) in vitro. Hydroxyapatite-incorporated asymmetric membranes promoted the expression of osteogenesis related genes RUNX2, OPN, ALP of MC3T3-E1 cells in vitro. The mineralization of MC3T3-E1 cells cultured with hydroxyapatite-incorporated asymmetric membranes were also promoted in vitro. Asymmetric membranes especially hydroxyapatite-incorporated ones guided the regeneration of the mandibular bone defect in vivo. Bone regeneration guided under infectious conditions was evaluated in a P. gingivalis infected alveolar bone defect model. Specifically, space acquiring layer containing asymmetric membranes effectively controlled connective tissue hyperplasia at defect sites. The excellent guided bone regeneration achieved by applying a single space acquiring layer membrane further indicates the importance of acquiring space actively to induce bone regeneration. Hydroxyapatite-minocycline incorporated symmetric membranes could simultaneously suppress alveolar bone reabsorption caused by infection and guide regeneration of defects. Therefore, the hydroxyapatite-minocycline incorporated asymmetric membrane may be more suitable to be applied in guiding regeneration of bone defects under complex infectious conditions.

Recent advances in biofunctional guided bone regeneration materials for repairing defective alveolar and maxillofacial bone: A review.

The anatomy of the oral and maxillofacial sites is complex, and bone defects caused by trauma, tumors, and inflammation in these zones are extremely difficult to repair. Among the most effective and reliable methods to attain osteogenesis, the guided bone regeneration (GBR) technique is extensively applied in defective oral and maxillofacial GBR. Furthermore, endowing biofunctions is crucial for GBR materials applied in repairing defective alveolar and maxillofacial bones. In this review, recent advances in designing and fabricating GBR materials applied in oral and maxillofacial sites are classified and discussed according to their biofunctions, including maintaining space for bone growth; facilitating the adhesion, migration, and proliferation of osteoblasts; facilitating the migration and differentiation of progenitor cells; promoting vascularization; providing immunoregulation to induce osteogenesis; suppressing infection; and effectively mimicking natural tissues using graded biomimetic materials. In addition, new processing strategies (e.g., 3D printing) and new design concepts (e.g., developing bone mimetic extracellular matrix niches and preparing scaffolds to suppress connective tissue to actively acquire space for bone regeneration), are particularly worthy of further study. In the future, GBR materials with richer biological functions are expected to be developed based on an in-depth understanding of the mechanism of bone-GBR-material interactions.

Preparation of functional poly-(lactic acid-co-glycolic acid)-based guided bone-regeneration membrane and its application in the reconstruction of mandibular defects in rats.

OBJECTIVES: This study aimed to prepare functional composite electrospinning fibrous membranes with the functions of antifibrosis and bacteriostasis, as well as to explore its repair effect on rat jaw defect. METHODS: Poly-(lactic acid-co-glycolic acid) fibrous membrane loaded with cyclic-arginine-glycine-aspartic acid sequence, ornidazole, and nanohydroxyapatite (n-HA) was prepared by electrospinning as the functional layer (GBRL) for adhering onto defective bone. A barrier layer with the function of supporting and isolating different functional layers was prepared by tape-casting method. Poly(p-dioxanone-co-l-phenylalanine) fiber membrane with the function of inhibiting fibrosis was prepared by electrospinning technology as the antifibrosis layer (AFL). The morphology of the composite membrane was characterized by scanning electron microscopy. The effects of different functional layers on the proliferation of mouse osteoblast precursor cells (MC3T3-E1) and mouse fibroblasts (L929) were studied by cell-proliferation test (CCK-8 method). The inhibitory effect of composite membrane on the proliferation of Porphyromonas gingivalis was studied by bacteriostatic circle test. A rat mandibular-bone defect model was established to study the repair effect of composite fiber membrane on bone-defect tissue. This repair effect was compared with that of collagen oral-repair membrane commonly used in clinics. RESULTS: The GBRL layer could support the proliferation of MC3T3-E1 cells, and the AFL layer could inhibit the proliferation of L929 cells. Composite membranes loaded with ornidazole could inhibit the proliferation of Porphyromonas gingivalis. Various composite membranes can induce the reconstruction of rat jaw defects, among which the composite membranes loaded with ornidazole and n-HA had the best repair effect, which was better than that of collagen oral-repair membrane. CONCLUSIONS: The electrospun membrane loaded with ornidazole and n-HA as the composite fiber membrane of GBRL layer had excellent antibacterial and bone-tissue-regeneration activity. The effect was better than that of the commonly used collagen oral-repair membrane. Therefore, this material has great potential to induce bone regeneration for defects caused by periodontal diseases.

[Research progress on the expression and function of erythropoietin-producing hepatomocellular receptors and their receptor-interacting proteins in oral-related diseases].

Erythropoietin-producing hepatomocellular receptors and their receptor-interacting proteins (Eph/ephrin) can participate in the regulation of growth and development and promote the development of diseases through short-distance signal transduction between cells. To study the mechanism of Eph/ephrin and oral-related diseases, we provided a new theoretical basis and a strategy for the treatment of oral diseases. The Eph/ephrin pathway has been used to regulate oral diseases, especially in periodontal disease prevention, orthodontic bone reconstruction, and biological treatment of oral tumors. This paper reviews the research progress of Eph/ephrin pathway in oral-related diseases.

Preliminary evaluation of cone beam computed tomography in three-dimensional cephalometry for clinical application.

The present study was conducted to evaluate the three-dimensional (3D) cephalometry accuracy of cone-beam computed tomography (CBCT). A total of 40 newly diagnosed orthodontic patients (including 18 males and 22 females; age range, 12-18 years) were subjected to CBCT scanning and X-ray imaging in order to obtain lateral cephalograms. The 3D CBCT cephalograms were reconstructed and measured with in vivo 5.1 software, and compared with the results from the conventional 2D lateral cephalograms. Measurements in the two images were performed twice using the Steiner and Tweed standards and a single analyzer paired t-test was used to analyze the differences between the two cephalometric methods. The results indicated that the two methods showed significant differences in all 12 angle and 5 linear measurements (P<0.05). These findings indicated that CBCT is a more accurate technique compared with the conventional 2D method. In conclusion, CBCT may provide diagnostic and treatment information for maxillofacial deformities by using fast computer-aided analysis platform.

Different imaging techniques for the detection of pelvic lymph nodes metastasis from gynecological malignancies: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to evaluate the diagnostic performance of different imaging techniques and the corresponding diagnostic criteria for preoperative detection of pelvic lymph node metastasis from gynecological carcinomas. METHODS: Six databases were systematically searched for retrieving eligible studies. Study inclusion, data extraction and risk of bias assessment were performed by 2 reviewers independently. STATA 14.0 was used to perform the meta-analysis. RESULTS: Eighty eligible studies were collected. The pooled sensitivity, specificity, and area under curve (AUC) of CT, MRI and DWI were 47%, 93%, 0.7424; 50%, 95%, 0.8039 and 84%, 95%, 0.9523 respectively. As regards PET, PET-CT and US, the pooled sensitivity, specificity and AUC were 56%, 97%, 0.9592; 68%, 97%, 0.9363 and 71%, 99%, 0.9008 respectively. The summary receiver operating characteristic (SROC) curve indicated that the systematic diagnostic performances of PET, PET-CT, DWI were superior to other imaging modalities. CONCLUSIONS: The present work demonstrated that DWI, PET, PET-CT were the top-priority consideration of imaging modalities for detecting metastatic pelvic lymph node in gynecological carcinoma. DWI was recommended as the first choice for metastasis exclusion and all the other imaging techniques including CT and MRI were suitable for metastasis conformation. However, for the early stage lymph node malignancy, PET or PET-CT could represent a better choice. More studies exploring the diagnostic efficacy of detailed criteria are required in the future.

Genetic polymorphisms of non-coding RNAs associated with increased head and neck cancer susceptibility: a systematic review and meta-analysis.

Genetic polymorphisms, including single nucleotide polymorphisms (SNP) and nucleotide repeat expansions, can occur in regions that transcribe non-coding RNAs (ncRNA), such as, but not limited to, micro RNA and long non-coding RNA. An association between genetic polymorphisms of ncRNA and increasing head and neck cancer (HNC) risk has been identified by several studies. Therefore, the aim of this systematic review is to consolidate existing findings to clarify this association. Four electronic databases, such as MEDLINE, EMBASE, Chinese BioMedical Literature Database, and China National Knowledge Infrastructure, were utilised. Inclusion of studies and data extraction were accomplished in duplicate. A total of 42 eligible studies were included, involving 28,527 cases and 37,151 controls. Meta-analysis, sensitivity analysis and publication bias detection were performed. Among the eligible studies, 102 SNPs were investigated, and 21 of them were considered eligible for meta-analysis. Our analysis revealed that HOTAIR rs920778, uc003opf.1 rs11752942, and miR-196a2 rs11614913 were related to HNC susceptibility, while let-7 rs10877887, miR-124-1rs531564, and miR-608 rs4919510 were considered as protective factors. In conclusion, our results showed the extreme importance of an up-to-date comprehensive meta-analysis encompassing the most recent findings to obtain a relevant and reliable framework to understand the relationship between ncRNA SNPs and HNC susceptibility.

Oral health status in Sichuan Province: findings from the oral health survey of Sichuan, 2015-2016.

To investigate oral health status in the residents of Sichuan Province, southwest China, a cross-sectional study was performed using the latest Oral Health Survey Basic Methods recommended by the World Health Organization. A multistage stratified random cluster-sampling method was used to enroll participants from the following three groups: children aged 3-5 years, adolescents aged 12 years, and people aged 65-74 years. In these three groups, the mean numbers of teeth that were affected by caries were 3.28, 0.86 and 5.13, respectively, resulting in a prevalence of 63.47%, 37.20% and 83.20%, respectively. Relative to the high rate of decayed teeth, the prevalence of fillings was very low in all age groups (0.97%, 7.24% and 5.43%, respectively). In the 12-year-old adolescent group, only 3.61% had good pit and fissure sealing. In addition, the rate of dental fluorosis was 24.80%, and the Community Fluorosis Index value was 0.39. In the elder group, the community periodontal index was 2.92. The prevalence in the elderly of having lost at least one tooth was 75.54%. Additionally, 4.44% of these participants were edentulous. The incidence of dental prosthesis was 51.75%, the proportion with a removable partial denture, a fixed denture, full dentures, dental implants and an informal fixed bridge was 21.59%, 11.45%, 4.64%, 0 and 16.67%, respectively. In this study, 8.2% of the elderly participants were affected by different types of oral mucosal lesions. Among such lesions, recurrent aphthous ulcers were most prevalent (2.69%) and oral lichen planuses were second (1.6%). The conclusion presented in this survey is that oral diseases, especially dental caries and periodontal disease, are frequent and common in Sichuan province, China. Moreover, the treatment rate is very low, and primary prevention and treatment options are therefore urgently needed in this population.