Situational simulation teaching effectively improves dental students' non-operational clinical competency and objective structured clinical examination performance.

BACKGROUND: Appropriate communication with dental patients enhances treatment outcomes and patient satisfaction. Implementing simulated patient interviews courses can improve patient-centered care and reduce conflict during clerkship training. Therefore, this study explored the relationship among student participation in a situational simulation course (SSC), academic performance, clerkship performance, and objective structured clinical examination (OSCE) performance. METHODS: This study was conducted with a sample of fifth-year dental students undergoing clerkship training. After implementing a situational simulation course to investigate the relationship among participation in SSC, academic performance, clerkship performance, and OSCE performance, a path analysis model was developed and tested. RESULTS: Eighty-seven fifth-year dental students were eligible for the SSC, and most (n = 70, 80.46%) volunteered to participate. The path analysis model revealed that academic performance had a direct effect on OSCE performance (ß = 0.281, P = 0.003) and clerkship performance (ß = 0.441, P < 0.001). In addition, SSC teaching had a direct effect on OSCE performance (ß = 0.356, P < 0.001). CONCLUSIONS: SSCs can enhance dental students' non-operational clinical competency and OSCE performance effectively. Simulated patient encounters with feedback, incorporated into the dental curricula, have led to improved communication. Based on our findings, we suggest implementing SSC teaching before the OSCE to improve communication and cognitive skills.

Patient perception of service quality to preanesthetic oral examination: a cross-sectional study using the SERVQUAL model.

BACKGROUND: A phase-III interdisciplinary quality improvement program, the preanesthetic oral examination (PAOE), was implemented as a new program in an academic medical center to prevent perioperative dental injuries. This study was aimed at surveying the perceived service quality and satisfaction of patients who had undergone PAOE based on the SERVQUAL model. METHODS: This cross-sectional survey was conducted at the Kaohsiung Medical University Hospital using convenience sampling. Patients referred for PAOE (PAOE group) and those who had voluntarily availed dental services (control group) were recruited. A modified SERVQUAL questionnaire was used to assess the perceived service quality and patient satisfaction with dental services. Cronbach's alpha for SERVQUAL was 0.861. RESULTS: We enrolled 286 (68.8%) and 130 (31.2%) participants in the PAOE and control groups, respectively. The path analysis revealed that the PAOE group scored lower in dimensions of reliability (ß = -0.074, P = 0.003), responsiveness (ß = -0.148, P = 0.006), and empathy (ß = -0.140, P = 0.011). Furthermore, reliability (ß = 0.655, P < 0.001) and responsiveness (ß = 0.147, P = 0.008) showed a direct effect on patient satisfaction. Overall, participants were highly satisfied with the dental services. CONCLUSIONS: The PAOE group showed lower satisfaction and perceived quality of dental services compared to the control group. Although implementing an interdisciplinary program reduces the perceived service quality, its influence is limited. Employing an interdisciplinary teamwork is a win-win strategy encouraged to improve patient safety and reduce malpractice claims. Future suggestions should focus on establishing waiting times that are considered reasonable by patients. Patient-centered education related to the risk of perioperative dental injuries should be provided, and awareness of oral conditions for patient safety should be improved. Moreover, interprofessional education in continuous and undergraduate programs is necessary to improve professional quality.

Efficacy of Er:YAG laser for the peri-implantitis treatment and microbiological changes: a randomized controlled trial.

The aims of this study were to identify the microbiological changes in the periodontal pockets following an Er:YAG laser (ERL) irradiation and mechanical debridement to compare the effectiveness of ERL irradiation to mechanical debridement for peri-implantitis treatment through randomized controlled trials. Twenty-three patients with peri-implantitis lesions were treated in either a test group, ERL set at energy level of 100 mJ/pulse, frequency of 10 Hz, pulse duration was 100 µs, and irradiated by three passages, or a control group, with mechanical debridement using an ultrasonic scaler. An examiner measured the following clinical parameters at different stages (a baseline and at 3- and 6-month post-treatment): probing depth (PD), bleeding on probing (BOP), marginal bone loss (MBL), and anaerobic bacteria counts. Linear regression, with generalized estimation equations, was used to compare the clinical parameters and anaerobic bacterial counts at different stages and between groups. The anaerobic bacterial counts significantly decreased within the control group during the follow-ups. At the 6-month follow-up, both groups showed a significant reduction in PD (test group: mean difference of 0.84 mm; control group: mean difference of 0.41 mm), and the test group showed a significantly higher PD reduction on the buccal site (1.31 mm) compared to that of the control group (0.25 mm). Both ERL and mechanical debridement treatments led to significant improvements in PD. When mechanical debridement therapy was used, significant anaerobic bacterial count reductions were observed. Future treatment of peri-implantitis should involve a combination of both of these therapies.

The Effects of Photobiomodulation on Bone Defect Repairing in a Diabetic Rat Model.

The purpose of this study is to examine the prospective therapeutic effects of photobiomodulation on the healing of bone defects in diabetic mellitus (DM) using rat models to provide basic knowledge of photobiomodulation therapy (PBMT) during bone defect repair. For in vitro study, an Alizzarin red stain assay was used to evaluate the effect of PBMT on osteogenic differentiation. For in vivo study, micro-computed tomography (microCT) scan, H&E and IHC stain analysis were used to investigate the effect of PBMT on the healing of the experimental calvarial defect (3 mm in diameter) of a diabetic rat model. For in vitro study, the high glucose groups showed lower osteogenic differentiation in both irradiated and non-irradiated with PBMT when compared to the control groups. With the PBMT, all groups (control, osmotic control and high glucose) showed higher osteogenic differentiation when compared to the non-irradiated groups. For in vivo study, the hyperglycemic group showed significantly lower bone regeneration when compared to the control group. With the PBMT, the volume of bone regeneration was increasing and back to the similar level of the control group. The treatment of PBMT in 660 nm could improve the bone defect healing on a diabetic rat calvarial defect model.

Translation and validation of modified dental anxiety scale based on adult Taiwan population.

BACKGROUND: Dental anxiety is associated with negative experiences of dental treatment and dental-visiting behavior. The Modified Dental Anxiety Scale (MDAS) is widely used for assessing dental anxiety. The study aims to establish the psychometric properties of a Chinese version of the MDAS based on the Taiwan sample (i.e., T-MDAS). METHODS: The T-MDAS and dental-visiting behavior and experience were assessed for 402 adult subjects recruited from community and clinical sites. The following psychometric properties were assessed: (a) internal consistency, (b) temporal stability, (c) criterion-related validity (i.e., the association with the score of Index of Dental Anxiety and Fear, IDAF-4C), (d) discrimination validity (i.e., the difference in scores between the subjects with and without a habit of a regular dental visit, and (e) the construct validity from a confirmatory factor analysis (CFA). RESULTS: The T-MDAS showed good internal consistency (Cronbach's α = 0.88) and temporal stability (ρ = 0.69, p < 0.001). The score was significantly correlated with the score of the IDAF-4C (ρ = 0.76, p < 0.001) and differed between subjects who regularly visited a dentist or not, supporting good criterion-related validity and discrimination validity. Results from CFA supports good construct validity. Furthermore, higher dental anxiety was related to the lack of a regular dental visit, feeling pain during treatment, and feeling insufficient skills and empathy of dentists. A higher proportion of high-dental anxiety subjects in female subjects (8.5%), compared to male subjects (5.0%), was noted. CONCLUSIONS: The T-MDAS is a valid tool for assessing adult dental anxiety. The score is highly associated with dental-visiting behavior and experience of dental patients.

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.

The effect of low-level laser irradiation on hyperglycemia-induced inflammation in human gingival fibroblasts.

Hyperglycemia-induced inflammation can greatly increase the risk of periodontal disease in people with diabetes. Low-level laser irradiation (LLLI) has been used for wound healing and anti-inflammation in many cases, and LLLI is known to inhibit the lipopolysaccharide (LPS)-stimulated inflammatory response. However, the therapeutic effect of LLLI in diabetes patients with periodontitis remains unknown. In this study, we cultured human gingival fibroblasts (HGFs) in high-glucose medium (35 mM) to mimic a hyperglycemic environment, and then measured the anti-inflammatory effect of LLLI by assessing the expression of pro-inflammatory genes including tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, IL-6, and IL-8 by quantitative real-time polymerase chain reaction. The results demonstrated no significant inflammatory response in HGFs cultured in mannitol medium and in those treated only with LLLI. However, HGFs cultured only in high-glucose medium showed significantly higher expression of pro-inflammatory cytokine than in those treated together with LLLI. We then observed that LLLI reduced the expression of pro-inflammatory cytokines in HGFs cultured in high-glucose medium by modulating cAMP signaling. We also investigated whether antioxidant (vitamin C) treatment reduced the inflammatory effect of oxidative stress in HGFs cultured in high-glucose medium but found no additive effect upon co-treatment with LLLI, suggesting that LLLI may activate cAMP signaling, but not reactive oxygen species (ROS) signaling, to reduce the high glucose-induced inflammation. In conclusion, LLLI may have an anti-inflammatory effect on HGFs in a high glucose environment and may benefit the treatment of periodontal disease in diabetes patients.

Association study between novel CYP26 polymorphisms and the risk of betel quid-related malignant oral disorders.

BQ chewing may produce significant amounts of reactive oxygen species (ROS), resulting in oral mucosa damage, and ROS may be metabolized by CYP26 families. Because the CYP26 polymorphisms associated with malignant oral disorders are not well known, we conducted an association study on the associations between the single nucleotide polymorphisms (SNP) of CYP26 families and the risks of malignant oral disorders. BQ chewers with the CYP26A1 rs4411227 C/C+C/G genotype and C allele showed an increased risk of oral and pharyngeal cancer (adjusted odds ratio (aOR) = 2.30 and 1.93, respectively). The CYP26B1 rs3768647 G allele may be associated with oral and pharyngeal cancer (aOR = 3.12) and OPMDs (aOR = 2.23). Subjects with the rs9309462 CT genotype and C allele had an increased risk of oral and pharyngeal cancer (aOR = 9.24 and 8.86, respectively) and OPMDs (aOR = 8.17 and 7.87, respectively). The analysis of joint effects between the CYP26A1 rs4411227 and CYP26B1 rs3768647/rs9309462 polymorphisms revealed statistical significance (aOR = 29.91 and 10.03, respectively). Additionally, we observed a significant mRNA expression of CY26A1 and CYP26B1 in cancerous tissues compared with adjacent noncancerous tissues. Our findings suggest that novel CYP26 polymorphisms are associated with an increased risk of malignant oral disorders, particularly among BQ chewers.

Analysis of maximum mouth opening and its related factors in 3- to 5-year-old Taiwanese children.

Maximum mouth opening (MMO) can reflect the function of the dentofacial musculature and joint system, and routine oral examinations should include its assessment. To diagnose abnormalities using MMO measurements, it is necessary to establish the normal range of MMO; however, few studies have investigated this subject in Taiwan. Therefore, the purposes of this study were to determine the normal MMO range in 3- to 5-year-old preschool children and to investigate the factors correlated with MMO. We examined the interincisal distance, defined as the distance between the edges of the upper and lower incisors, in 518 preschool children (age range 3-5 years; 271 boys and 247 girls) with a plastic sliding caliper. The MMO on both sides of the mouth and mouth width (MW) was measured 3 times. No differences in MMO were found between the genders. The interincisal distance was 37.47 (±4.11) mm for boys and 36.93 (±3.85) mm for girls, whereas the mean MMO was 37.21 (±3.99) mm. The MMO increased with the increasing age of the children, and the mean value of MMO in children aged 3, 4, and 5 was 35.31 (±4.03), 36.61 (±3.79), and 38.31 (±3.88) mm, respectively. Furthermore, MMO was found to correlate with weight and MW. MMO increased by 0.19 mm per increased weight and 0.37 mm per increased MW. The mean value of MMO in 3- to 5-year-old preschool children was 37.21 (±3.99) mm. MMO in 3- to 5-year-old preschool children increased with age and was correlated with weight and MW.

A novel antitubulin agent, DPQZ, induces cell apoptosis in human oral cancer cells through Ras/Raf inhibition and MAP kinases activation.

6-(N,N-Dimethylamino)-2-(naphthalene-1-yl)-4-quinazolinone (DPQZ)-induced apoptosis was accompanied by the characteristics of DNA fragmentation and phosphatidylserine externalization in human oral cancer HSC-3 cells. The IC50 (half maximal inhibitory concentration) value of DPQZ is about 0.25 µM at 24 h. The interference in the dynamics of tubulin and cell division of DPQZ, like vinblastine (0.01 µM), has been proven in this study. Treatment of HSC-3 cells with DPQZ resulted in many of mitotic cells with multipolar spindles. Up-regulation of MAP kinases, such as ERK, JNK, and p38, mediated by DPQZ appears to be involved in DPQZ-induced apoptosis in HSC-3 cells. It is worthy of note that the expression of Ras and c-Raf that lie upstream of ERK were inhibited by DPQZ. In addition, the DPQZ-induced cell death was attenuated by JNK inhibitor SP600125 (3 or 10 µM), not by the ERK or p38 inhibitors. JNK inhibitor abolished the DPQZ-induced increase in the phosphorylation of Bcl-2 and the protein levels of proform caspase-3, caspase-8, and caspase-9, indicating that JNK is an upstream activator of Bcl-2 and caspase family members and plays a key role in DPQZ-induced HSC-3 cell apoptosis. We also attempted to develop an anticancer drug that is designed to kill rapidly dividing cancer cells while causing less damage to normal cells. The DPQZ-induced cytotoxicity against human gingival fibroblasts was less than that against HSC-3 cells. Our work provides a new strategy and mechanism for developing anticancer drug and may contribute to clinical anticancer drug discovery and application.

Transcriptome analysis revealed the role of mTOR and MAPK signaling pathways in the white strain of Hypsizygus marmoreus extracts-induced cell death of human hepatoma Hep3B cells.

The aim of this study was to investigate the anticancer mechanisms of white genius mushroom (WGM). WGM is a popular edible mushroom in Taiwan and has been demonstrated to mediate potent antiproliferation effects against human Hep3B liver cancer cells in our previous study. According to next generation sequencing technology and KEGG pathway enrichment analysis, mTOR and MAPK signaling pathways were markedly changed during treatment with WGM extracts in Hep3B cells. Therefore, this study examined the effects of WGM extracts on the expression of mTOR and MAPK signaling pathway-related proteins, such as PI3K, Akt, mTOR, Ras, Raf, MEK, ERK, p38 and JNK in Hep3B cells. According to the results of immunoblotting, we demonstrated that the protein expression of the members of PI3K/Akt/mTOR and MAPK signaling pathways were involved in WGM extracts-induced cell death. Furthermore, the inhibitors of PI3K/Akt/mTOR and MAPK signaling pathways such as rapamycin, MK2206, LY3214996 and SB202190, blocked the induction of cell death and vacuoles formation induced by WGM extracts. This study also demonstrated that WGM extracts is able to inhibit Hep3B cell migration and colony formation in a dose-dependent manner. In addition to being a very popular food, WGM should be a pharmacologically safe natural agent for cancer treatment. Therefore, WGM might be designed to develop into a dietary chemopreventive agent for the cancer treatment.

Identification of Key Pathways Involved in White Strain of Hypsizygus marmoreus Extracts-Induced Cell Death of Human Hepatoma Hep3B Cells by Next Generation Sequencing.

White strain of Hypsizygus marmoreus is named as white genius mushroom (WGM) and is a popular food in Taiwan. We have confirmed the cytotoxicity of WGM extracts on human Hep3B liver cancer cells. A total of 8711 significantly differential genes were identified through large-scale transcriptome sequencing. According to the KEGG pathway enrichment analysis, autophagy, mitophagy and apoptosis pathways were identified as significant in WGM extracts-treated cells. WGM extracts induced a dose-dependent generation of reactive oxygen species (ROS) and membrane-enclosed vacuoles in Hep3B cells. The inhibition of ROS by the ROS scavengers blocked the induction of cell death and vacuoles formation. We suggested that the cell death and membrane-enclosed vacuoles induced by WGM extracts are dependent on ROS production in Hep3B cells. (2E,6E)-3,7,11,15,19,23,27,31,35-Nonamethylhexatriaconta-2,6,34-triene-1,11,15,19,23,27,31-heptol and (18:2) lysophosphatidylcholine were identified in WGM extracts. In addition to being a very popular edible mushrooms, WGM may be developed into a dietary supplement or dietary chemopreventive agent for the cancer treatment.

Correlation between the change of gonial region and skeletal relapse after intraoral vertical ramus osteotomy for correction of mandibular prognathism.

BACKGROUND: The gonial region is coincided with harmonious face and masticatory function. The aims of the present study were to assess changes in the gonial region in patients who had mandibular setback surgery by intraoral vertical ramus osteotomy (IVRO) and to investigate the contributing factors in relation to skeletal relapse. METHODS: Twenty-one patients with mandibular prognathism were corrected by IVRO. Three cephalometric radiographs were collected from preoperative orthodontic treatment (T1), immediately after surgery (T2), and at 2-year postoperative follow-up (T3). Relapse was defined as forward movement of menton (Me) after the 2-year follow-up. Three angular (SN-Go angle, mandibular plane angle, and gonial angle) and 2 linear (horizontal-Me and vertical-Me) measurements were compared after immediate operation and at the 2-year follow-up. Spearman rank correlation and Student t tests were used for statistical analysis. RESULTS: The mean setback of the Me was 12.7 mm, and the mean relapse was 1.5 mm. The magnitude of setback was not significant for relapse. There were weak correlations between relapse and factors concerned with the gonial region (SN-Go angle, mandibular plane angle, and gonial angle). CONCLUSIONS: Surgical correction of mandibular prognathism using IVRO can lead to an increase in the angle changes of gonial region but not correlate to skeletal relapse in long-term follow-up.

Changes in the transverse dimensions by vertical ramus osteotomy after mandibular prognathism correction.

OBJECTIVE: A harmonious face displays not only a good lateral profile but also a pleasant frontal appearance. The purpose of the current study was to evaluate the changes in the transverse dimensions by vertical ramus osteotomy (VRO) in the treatment of mandibular prognathism correction. METHODS: Twenty patients who underwent mandibular prognathism correction by VRO were included. Lateral and frontal cephalometric radiographs were obtained at the following stages: preoperative (T1), immediately after the surgery (T2), and completion of orthodontic treatment (T3). Three linear measurements (menton, intercondylion, and intergonial distances) and the ramus angle were compared from T1 to T3. RESULTS: A final mean menton setback of 12.2 mm and upward movement of 0.3 mm were noted. The intercondylion and intergonial distances significantly increased by 5.1 and 7.1 mm, respectively. Without significant difference, ramus angles decreased 1.7 degrees in the right side and 0.1 degrees in the left side. CONCLUSION: The surgical correction of mandibular prognathism using VRO led to an increase in the transverse dimensions.

The perception of pain following interdental microimplant treatment for skeletal anchorage: a retrospective study.

During orthodontic therapy, patients frequently complain about pain and discomfort, especially during insertion of fixed appliances. Skeletal anchorage using an interdental microimplant is a new concept in orthodontic treatment. The purpose of this study was to investigate differences and changes in the level of pain among patients in relation to orthodontic microimplant treatments. Forty microimplants were applied to the maxilla as skeletal anchors in the orthodontic treatment. The visual analog scale (VAS) was used to evaluate the patients' perception of pain during this new modality treatment. The premolar extraction VAS core was used as a baseline for the complete orthodontic procedure. The mean VAS score was 35.8 mm at 24 h after premolar extraction. The mean VAS score for insertion and removal of the microimplant 24 h after the operation was 12.3 and 7.8 mm, respectively. Three months after removal of the skeletal anchors, the VAS score had decreased to 3.2 mm and was the same as with the traditional orthodontic treatment. By using the repeated-measure general linear model (GLM), we found that the score 1 day after microimplant placement was significantly less than that 1 day after first premolar extraction or that 1 day after fixed appliance insertion. This result indicates that interdental microimplant did not generate any greater pain than other orthodontic procedures. Therefore, patients were willing to adopt the new orthodontic treatment.

Mechanical strength of orthodontic infrazygomatic mini-implants.

Orthodontic anchorages have recently been reinforced by newly developed mini-implants. The aim of the present study was to investigate the mechanical strengths of infrazygomatic mini-implants. We measured the insertion torque and pull-out strength of three brands of infrazygomatic mini-implants (AbsoAnchors, Bioray, and Lomas). All three mini-implants were 2 mm in diameter, and five of each brand were manually driven 6 mm into artificial bone. Significant differences among the brands were investigated with Kruskal-Wallis tests. We found no significant relationship between insertion torque and pull-out strength in any individual brand. Among the three brands of infrazygomatic mini-implants, we found no significant difference in mechanical strength. The design of an infrazygomatic mini-implant may be the most important factor determining its mechanical strength.

The stability of intraoral vertical ramus osteotomy and factors related to skeletal relapse.

BACKGROUND: Intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO) have been advocated as two major procedures for the correction of mandibular prognathism. However, only a few reports with at least a 2-year follow-up period describe the long-term stability especially of the IVRO method. This study aimed to identify factors contributing to skeletal relapse after a 2-year postoperative follow-up period. METHODS: A set of three standardized lateral cephalograms were obtained from each subject, taken preoperatively (T1), immediately postoperatively (T2), and 2 years postoperatively (T3). Relapse was defined as forward movement of the menton (Me) after a 2-year follow-up period. Two angular measurements (SNB and SN-occlusal plane angle) and five linear measurements (horizontal Me, vertical Me, overbite, anterior facial height, and mandibular length) were compared immediately after the operation and at the 2-year follow-up visit. RESULTS: The mean setback of the menton was 12.8 mm, and the mean relapse was 1.3 mm (10.2% = 1.3/12.8). The magnitude of the setback was not significantly accounted for in the relapse. There were weak correlations between the relapse and the concerned factors, namely, overbite, anterior facial height, mandibular length SNB, and SN-occlusal plane angle). CONCLUSION: The current study confirmed the stability of IVRO in the treatment of mandibular prognathism.

Analysis of Facial Skeletal Morphology: Nasal Bone, Maxilla, and Mandible.

The growth and development of facial bones are closely related to each other. The present study investigated the differences in the nasomaxillary and mandibular morphology among different skeletal patterns. Cephalograms of 240 participants were divided into 3 groups based on the skeletal pattern (Class I, Class II, and Class III). The dimensions of nasomaxilla (nasal bone length, nasal ridge length, nasal depth, palatal length, and maxillary height) and mandible (condylar length, ramus length, body length, symphysis length, and entire mandibular length) were measured. One-way analysis of variance and Pearson's correlation test were used for statistical analysis. No significant differences were observed among the skeletal patterns in terms of nasal bone length, palatal length, maxillary height, or condylar length. Class II had a significantly shorter ramus, mandibular body, and entire mandibular length compared with those of Class I and Class III. Nasal ridge length exhibited a significant moderate correlated with nasal bone length (correlation coefficient: 0.433) and maxillary height (correlation coefficient: 0.535). The entire mandibular length exhibited a significant moderate correlated with ramus length (correlation coefficient: 0.485) and body length (correlation coefficient: 0.536). In conclusion, nasal and maxillary dimensions exhibited no significant difference among the 3 skeletal patterns. Mandibular body and entire mandibular lengths were significantly positively correlations with Class III skeletal patterns.

Intraoperative Blood Loss and Postoperative Pain in the Sagittal Split Ramus Osteotomy and Intraoral Vertical Ramus Osteotomy: A Literature Review.

PURPOSE: The purpose of the present study was to review the literature regarding the blood loss and postoperative pain in the isolated sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO). MATERIALS AND METHODS: Investigating the intraoperative blood loss and postoperative pain, articles were selected from 1970 to 2021 in the English published databases (PubMed, Web of Science, and Cochrane Library). Article retrieval and selection were performed by two authors, and they independently evaluated them based on the eligibility criteria. The articles meeting the search criteria had especially at least 30 patients. RESULTS: In the review of intraoperative blood loss, a total of 139 articles were retrieved and restricted to 6 articles (SSRO: 4; IVRO: 2). In the review of postoperative pain, a total of 174 articles were retrieved and restricted to 4 articles (SSRO: 3; IVRO: 1). The mean blood loss of SSRO and IVRO was ranged from 55 to 167 mL and 82 to 104 mL, respectively. The mean visual analog scale (VAS) scores of the first postoperative day were 2 to 5.3 in SSRO and 2.93 to 3.13 in IVRO. The mean VAS scores of the second postoperative day were 1 to 3 in SSRO and 1.1 to 1.8 in IVRO. CONCLUSION: Compared to traditional SSRO, IVRO had a significantly lower amount of blood loss. However, the blood transfusion is not necessary in a single-jaw operation (SSRO or IVRO). Postoperative pain was similar between SSRO and IVRO.

Salivary Pro-Inflammatory Markers and Smoking Status Influences the Treatment Effectiveness of Periodontal Disease Patients with Hypertension.

BACKGROUND: Hypertension and periodontal diseases share several risk factors. Inflammation biomarkers in saliva are related to hypertension and periodontal disease. The aim of this study was to explore the role of the salivary inflammatory biomarkers in the treatment effectiveness of patients with hypertension and periodontal disease. METHODS: This observational study enrolled 160 subjects diagnosed with periodontitis, 40 of which had a history of hypertension. All subjects had completed scaling and root planning therapeutic procedures within four weeks. The clinical periodontal parameters (i.e., bleeding on probing, plaque control record (PCR), and probing depth (PD)) were evaluated before and after the treatment. Pro-inflammatory markers were determined using a commercial kit. RESULTS: The recovery rate (PD 4-9 mm) in non-hypertensive subjects was significantly higher than in hypertensive subjects (60.47% vs. 52.60%, respectively; p = 0.04). All clinical parameters, excluding PCR, positively correlated with salivary IL-1ß at baseline and after completing treatment. Our results showed that increased salivary IL-1ß levels were positively associated with decreased PCR (ß = -27.65 and p = 0.05) and PD recovery rate (ß = -17.05 and p = 0.02) in hypertensive subjects. CONCLUSIONS: The present study sheds important light on the clinical use of salivary pro-inflammatory cytokines as valuable biomarkers for predicting the treatment effectiveness of patients suffering from hypertension and periodontitis.