Tissue-engineered Maxillofacial Skeletal Defect Reconstruction by 3D Printed Beta-tricalcium phosphate Scaffold Tethered with Growth Factors and Fibrin Glue Implanted Autologous Bone Marrow-Derived Mesenchymal Stem Cells.

The study aimed to investigate whether a 3D printed beta-tricalcium phosphate (ß-TCP) scaffold tethered with growth factors and fibrin glue implanted autologous bone marrow-derived mesenchymal stem cells would provide a 3D platform for bone regeneration resulting in new bone formation with plasticity. Twenty 3D printed ß-TCP scaffolds, ten scaffolds engrained with osteogenic mesenchymal stem cells with fibrin glue (group A), and ten scaffolds used as a control group with ß-TCP scaffold and fibrin glue inoculation only (group B) were included in the study. Cell infiltration, migration, and proliferation of human osteogenic stem cells on the scaffolds were executed under both static and dynamic culture conditions. Each scaffold was examined post culture after repeated changes in the nutrient medium at 2, 4 or 8 weeks and assessed for opacity and formation of any bone-like tissues macroscopic, radiographic, and microscopic evaluation. Significant changes in all the prerequisite parameters compiled with an evaluated difference of significance showing maxillofacial skeletal repair via tissue engineering by ß-TCP scaffold and MSCs remains will be the most promising alternative to autologous bone grafts and numerous modalities involving a variety of stem cells, growth factors from platelet-rich fibrin.

Spontaneous and Dramatic Improvements in Open Bite Deformity Secondary to Large Maxillofacial Venous Malformation With Macroglossia After Sclerotherapy and Laser Therapy.

BACKGROUND: Large maxillofacial venous malformation (VM) lesions can affect the craniofacial skeleton, causing occlusal and craniofacial deformity. Few studies have discussed the management of these skeletal disorders. It is unclear whether orthodontic treatment and orthognathic surgery are necessary after such a VM lesion has been significantly reduced. METHODS: A 13-year-old boy with a large, extensive maxillofacial VM lesion, severe facial asymmetry, macroglossia, and lower lip hypertrophy visited our department in 2010. He received more than 100 sclerotherapy treatments and 20 laser treatments in the past 8 years. RESULTS: The patient's cosmetic disfigurement greatly improved, and the VM lesion diminished by more than 80%. Changes in the bite and craniofacial skeleton progressed from "normal" to "open bite with skeletal deformity" and finally to "spontaneously close to normal". CONCLUSIONS: During the progression of VM, removal of pathogenic factors can inhibit the aggravation of open bite deformity and promote the spontaneous improvement, thereby circumventing the need for complicated osteotomy, orthodontic intervention and/or orthognathic surgery.

Aesthetic and Functional Rehabilitation of Postburn Maxillofacial Deformity.

Postburn maxillofacial deformities, although rare, are a significant cause of morbidity. Since contracture scars have a potential role in deforming the maxillofacial skeleton, the focus of treatment should be on growing patients, where scar contractures can drastically influence growth and morphology of the maxillofacial units. There are certain aspects of severe facial burns and deformities, especially of the jaws, that deserve sincere attention to overcome aesthetic and functional disabilities such as inability to masticate and incompetent lips. The purpose of this article, therefore, is to discuss these injuries, the mechanism of development of deformities of the jaws and associated structures and their management for better aesthetic, functional, and psychological health of patient. An interpretive clinical report is presented.

Use of platelet-rich plasma to facilitate wound healing.

Platelet-rich plasma (PRP) is widely used nowadays in different fields of medicine, affecting physiological processes including tissue regeneration. The use of PRP in maxillofacial surgical interventions and its efficiency in the improvement of postoperative wound healing were analysed. Patients undergoing plastic and reconstructive surgeries in the maxillofacial region were recruited: 50 patients were enrolled into a control group (received no PPRP injection) and 50 patients were enrolled into a treatment group, where PRP was applied during the surgical procedure. Evaluation of treatment outcomes was carried out by determination of IL-1ß, TNFα, and IL-6 cytokines levels in the wound-drain fluid. The stages of wound healing were assessed by cytological analyses and ultrasound within a month period. The use of the PRP has substantially positive effects, contributing to the improvement of the healing process. In the treatment group, fibroblasts, macrophages, and collagen fibres appeared and their quantities increased earlier than when compared with control group patients. The concentration of IL-1ß and TNFα in wound fluid on day 1 and day 5 after operation was higher for the treatment group as opposed to the control group, which was linked to the influence of PRP on inflammatory and granulation phases of the healing process. An ultrasound examination showed less oedema and infiltration in the tissues around the wound of the treatment group.

[Diagnostic and therapeutic interest of studying the nose in maxillo-dento-facial orthopedics]. / Intérêt diagnostique et thérapeutique de l'étude du nez en orthopédie dento-maxillo-faciale.

INTRODUCTION: Orthodontists have long tried to predict future growth. It is one of the most difficult goals to achieve precisely despite the different methods of growth forecasting. A simple technique based on clinical and radiological analyses of the nose and premaxilla makes it possible, using no measurements, to accurately predict future maxillary growth and to deduce the therapeutic indications. A morphologic study of the nose is also an important item in the diagnosis of cranio-facial syndromes. MATERIALS AND METHODS: Combining detailed semiologic and radiologic studies of the nasal and premaxillary structures, this article proposes a method for evaluating and predicting facial growth. RESULTS: Experience based on many observations and current embryological knowledg can detect growth abnormalities of the ethmoïdo-nasal-premaxillary unit and provide valuable therapeutic information. DISCUSSION: Combining clinical and radiologic analyses of nasal and premaxillary morphology is a good method to predict growth of the upper face. It is also an important feature in the diagnosis of cranio-facial syndromes. CONCLUSION: This technique should be included in the diagnosis of maxillo-dento-facial orthopedic cases.

The role of 3D printing in treating craniomaxillofacial congenital anomalies.

Craniomaxillofacial congenital anomalies comprise approximately one third of all congenital birth defects and include deformities such as alveolar clefts, craniosynostosis, and microtia. Current surgical treatments commonly require the use of autogenous graft material which are difficult to shape, limited in supply, associated with donor site morbidity and cannot grow with a maturing skeleton. Our group has demonstrated that 3D printed bio-ceramic scaffolds can generate vascularized bone within large, critical-sized defects (defects too large to heal spontaneously) of the craniomaxillofacial skeleton. Furthermore, these scaffolds are also able to function as a delivery vehicle for a new osteogenic agent with a well-established safety profile. The same 3D printers and imaging software platforms have been leveraged by our team to create sterilizable patient-specific intraoperative models for craniofacial reconstruction. For microtia repair, the current standard of care surgical guide is a two-dimensional drawing taken from the contralateral ear. Our laboratory has used 3D printers and open source software platforms to design personalized microtia surgical models. In this review, we report on the advancements in tissue engineering principles, digital imaging software platforms and 3D printing that have culminated in the application of this technology to repair large bone defects in skeletally immature transitional models and provide in-house manufactured, sterilizable patient-specific models for craniofacial reconstruction.

Cryogel scaffolds from patient-specific 3D-printed molds for personalized tissue-engineered bone regeneration in pediatric cleft-craniofacial defects.

Bone defects are extremely common in children with cleft-craniofacial conditions, especially those with alveolar cleft defects and cranial defects. This study used patient-specific 3D-printed molds derived from computed tomography and cryogel scaffold fabrication as a proof of concept for the creation of site-specific implants for bone reconstruction. Cryogel scaffolds are unique tissue-engineered constructs formed at sub-zero temperatures. When thawed, the resulting structure is macroporous, sponge-like, and mechanically durable. Due to these unique properties, cryogels have excellent potential for the treatment of patient-specific bone defects; however, there is little literature on their use in cleft-craniofacial defects. While 3D-printing technology currently lacks the spatial resolution to print the microstructure necessary for bone regeneration, it can be used to create site-specific molds. Thus, it is ideal to integrate these techniques for the fabrication of scaffolds with patient-specific geometry. Overall, all cryogels possessed appropriate geometry to allow for cell infiltration after 28 days. Additionally, suitable mechanical durability was demonstrated where, despite mold geometry, all cryogels could be compressed without exhibiting crack propagation. Such a patient-specific scaffold would be ideal in pediatric cleft-craniofacial defects, as these are complex 3D defects and children have less donor bone availability.

Influence of low-level laser therapy on the healing of human bone maxillofacial defects: A systematic review.

PURPOSE: This systematic review evaluates the effectiveness of low-level laser therapy (LLLT) to enhance maxillofacial area bone repair. METHODS: A comprehensive search of studies published up to February 2017 and listed in PubMed/MEDLINE, Scopus, and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS: The 15 selected studies evaluated a total of 374 patients (mean age, 28.5years) who were treated with LLLT. Gallium-arsenide (GaAs) and gallium aluminium arsenide (GaAlAs) were the most commonly used devices, and LLLT parameters varied greatly. Wavelengths varied from 500 to 1000nm. Tooth extraction, distraction osteogenesis, maxillary expansion, periodontal defects, orthodontic movement and maxillary cystic defects were evaluated. From the 15 selected studies, six evaluated bone repair (primary outcomes). Of these, four studies showed improvement in bone formation after using LLLT, two demonstrated improved results for only one follow up period, and one showed no additional benefits. The other 9 studies evaluated secondary parameters related to healing (secondary outcomes) in the maxillofacial area after applying LLLT, including anti-inflammatory, analgesic, and healing accelerator effects, and quality of life related to oral health. There were no adverse or negative effects of LLLT reported. CONCLUSION: Within the limitation of this review, a possible improvement in bone density can be found when LLLT is applied postoperatively in maxillofacial bony defects. LLLT also seems to promote anti-inflammatory and analgesic effects and accelerate healing, as well as enhance quality of life related to oral health. However, LLLT use protocols need to be standardized before more specific conclusions can be drawn about this subject.

Management of a large diffuse maxillofacial arteriovenous malformation previously treated with ligation of ipsilateral arterial supply.

A 32 year-old male presented with a pulsatile facial mass with palpable thrill and audible bruit. Imaging revealed a very large diffuse left-sided facial arteriovenous malformation with extensive bilateral supply, as well as a previously ligated left external carotid artery. Endovascular treatment was required to control associated hemorrhagic events as well as for palliation and was delivered via the contralateral and ipsilateral collateral supply because of ligation of the direct route to the nidus. In addition, the patient received intravenous bevacizumab and intraarterial bleomycin therapy. Under such circumstances, endovascular embolization remains often the only option when emergent therapy for massive haemorrhage is required. Collaboration and treatment planning with head and neck surgery is imperative and should be performed from the onset, avoiding disastrous ligation of arterial feeders.

Linear Epidermal Nevus: A Case Report With Oral and Facial Manifestations.

A 20-year-old man presented to the oral and maxillofacial surgery department for evaluation and treatment of a dentofacial deformity. On examination, it was noted that he had marked hemifacial hyperpigmented papillomatous lesions covering the upper and middle thirds of the right side of his face extending to the right upper lid. Of note, he also had extensive intraoral involvement. These features were highly suggestive of linear epidermal nevus, a congenital hamartomatous lesion of the ectoderm. Linear epidermal nevus with oral manifestations is extremely rare with very few cases reported in the medical literature.

[Orthodontic treatment need in school-age children in the Leningrad region].

Epidemiology of dentoalveolar anomalies is undoubtedly important, but in terms of the organization of orthodontic care, greater interest are data on the needs in this type of treatment. In a situation of limited manpower and resources for the provision of orthodontic care information about needs in orthodontic treatment allows you to define a group of patients with the primary need for orthodontic treatment, and to identify priorities to optimize the organization of orthodontic care in the region. Such data can be obtained by using the Dental Aesthetics Index (DAI) and Index of Orthodontic Treatment Need (IOTN). The aim of the study was to analyze the epidemiology of various forms of dentoalveolar anomalies school-age children of Kirishi district of Leningrad region, as well as their needs in orthodontic treatment in accordance with objective evaluation indices. The study involved 734 pupils of Kirishi lyceum №1 of Leningrad region. Analysis of the prevalence of dentoalveolar anomalies, as well as needs in the orthodontic treatment was conducted in three age groups: I mixed dentition period (6-9 years), II mixed dentition period (10-13 years), and permanent dentition (14-17). To determine the needs in the orthodontic treatment were used two most common international index (DAI and IOTN). In Kirishi district of Leningrad region dentoalveolar anomalies were found in 88.8% of children of school age, which is in accordance with the indices and IOTN DAI needs in orthodontic treatment is 38.8% and 54.5%, respectively. In order to reduce unnecessarily high load volume medical institutions orthodontic profile, optimize utilization of financial resources, as well as reducing social tension it is recommended to introduce the practice of doctors-orthodontists methodology for determining the needs in orthodontic treatment by objective indices.

[How I explore a dento-maxillofacial dysmorphosis]. / Comment j'explore une dysmorphose dento-maxillo-faciale.

Dento-maxillofacial dysmorphoses represent a considerable area of maxillofacial surgery. Their incidence has constantly been on the rise since the beginning of the century. This can be explained by variations in the food and society habits.We will first discuss the various causes (congenital and environnemental) and the pathophysiology of these disorders. Then, we will separate them according to the skeletal and Angle's classifications. We will examine the predictive criteria of these dysmorphoses from the youngest age and consider their clinical and cephalometrical diagnosis. We will envisage their functional and aesthetic consequences and expose the preventive options. Finally, we will describe the orthodontic and surgical treatment available today and conclude that surgery remains the gold standard by restoring the conventional axis.

Les dysmorphoses dento-maxillo-faciales (DDM) occupent un volet important de la chirurgie maxillo-faciale. Elles constituent un problème en constante progression depuis le début du siècle, s'expliquant notamment par des modifications des habitudes alimentaires et sociétales (1). Nous discuterons les diverses causes, congénitales et environnementales, ainsi que les aspects physiopathologiques de ces affections et ferons le point sur leur classification grâce à la classe squelettique et la classe dentaire d'Angle. Nous discuterons des critères prédictifs de ces dysmorphoses dès le plus jeune âge ainsi que de leur diagnostic clinique et céphalométrique. Nous détaillerons leurs conséquences esthétiques et fonctionnelles et exposerons les mesures préventives visant à éviter leur développement. Enfin, nous évoquerons la thérapeutique à la fois orthodontique et chirurgicale que nous pouvons actuellement proposer pour restaurer les fonctions masticatoires, phonétiques et respiratoires tout en harmonisant le tiers inférieur de la face.

Efeitos da expansão rápida de maxila na audição: revisão sistemática da literatura / Effects of rapid maxillary expansion on hearing: a systematic review

RESUMO Objetivo Verificar os efeitos provocados pela expansão rápida de maxila na audição. Estratégia de pesquisa Conduziu-se uma busca no mês de janeiro de 2016, usando as palavras-chave "hearing loss", "hearing", "rapid maxillary expansion" e "palatal expansion technique" nas bases de dados MEDLINE, SciELO e Bibliografia Brasileira de Odontologia (BBO). Critérios de seleção Foram selecionados artigos em inglês, português e espanhol, publicados até janeiro de 2016, sem limitação de data inicial, cuja abordagem metodológica referisse os efeitos da expansão rápida de maxila na audição. Resultados A estratégia de busca resultou na seleção de oito artigos, classificados como ensaios clínicos. Os estudos constataram que a expansão rápida de maxila realizada em crianças e/ou adolescentes melhora os limiares de audibilidade e as medidas de imitância acústica. Conclusão A expansão rápida da maxila provocou melhora na audição, apesar da diversidade e das limitações metodológicas dos estudos analisados.

ABSTRACT Purpose Verifying the effects of rapid maxillary expansion on hearing. Research strategy The search was conducted in the bibliographic collection of the electronic databases MEDLINE, SciELO and Bibliografia Brasileira de Odontologia (BBO) in January 2016. The keywords used for the research were: "hearing loss", "hearing", "rapid maxillary expansion" and "palatal expansion technique". Selection criteria Articles in Portuguese, English and Spanish were selected, published up to January 2016, without initial date limitation. Studies related to the rapid maxillary expansion on hearing topic were included in this systematic review. Results The research strategy resulted in the selection of eight articles, which were classified as clinical trials. The studies explains that the rapid maxillary expansion performed on children and/or teenagers improves hearing thresholds and acoustic impedance measurements. Conclusion The rapid maxillary expansion caused hearing improvement, despite the methodological limitations and diversity of the analyzed studies.

Ellis-Van Creveld syndrome: dental management considerations and description of a new oral finding.

Ellis-Van Creveld is a rare syndrome with characteristic dental and orofacial findings. Dental management of patients with Ellis-Van Creveld syndrome can be complicated by the associated skeletal and cardiac abnormalities. Here, we present the dental and orofacial findings in a patient with Ellis-Van Creveld syndrome, describe a new oral finding, and discuss the dental management considerations.

Orthodontic Treatment of Binder Syndrome: A Case Report With 5 Years of Follow-up.

We report here the case of orthodontic nonsurgical treatment in a patient with Binder syndrome. This rare syndrome (<1/10,000) is a deforming alteration of the middle third of the face, also known as maxillonasal dysplasia/dysostosis. The therapeutic approach often undertaken is an orthodontic-surgical protocol, which includes several invasive interventions such as LeFort I or II. In this patient and early diagnosis made it possible to intervene on an orthodontic level only, thus avoiding highly invasive surgical procedures (as of a 5-year follow-up).

Avaliação estética e condutas terapêuticas relacionadas aos principais perfis faciais / Aesthetic evaluation and therapeutic procedures related to main facial profiles

Introdução: A cirurgia ortognática para correções de deformidades dentofaciais proporciona uma face mais harmoniosa, funcional e estética. O objetivo desse estudo foi avaliar a percepção dos cirurgiões bucomaxilofaciais quanto à estética dos perfis faciais padrões I, II e III, relacionada ao sexo, etnia e às principais condutas terapêuticas. Métodos: Foram entrevistados 18 cirurgiões especialistas ou em formação em Cirurgia e Traumatologia Bucomaxilofacial, utilizando uma ficha clínica padronizada para avaliação estética e condutas terapêuticas de 12 imagens manipuladas simulando os perfis faciais, sexo e raças. Resultados: Quanto à estética, destacaram-se os perfis faciais tipo I, que apresentaram as melhores médias, enquanto os perfis faciais tipo III as menores; entretanto, não houve diferenças significativas entre as médias obtidas nos diferentes perfis faciais em relação ao sexo e à raça. As condutas terapêuticas foram homogêneas nos perfis II e III, com maiores percentuais para condutas clássicas no tratamento ortocirúrgico destas deformidades dentofaciais. Conclusão: O perfil facial I foi o considerado mais estético; então, houve influência do sexo e do tipo racial na estética para a amostra estudada. Os perfis faciais I foram os mais difíceis de avaliar quanto às condutas terapêuticas, o que resultou em grande variedade de opções em relação aos perfis II e III.

Introduction: Orthognathic surgery for correction of dentofacial deformities provides a more-symmetrical face, and functional and aesthetic benefits. The aim of this study was to evaluate the perception of buccomaxillofacial surgeons regarding the aesthetics of facial profiles patterns I, II, and III in related to sex, ethnicity, and the main therapeutic procedures. Methods: We interviewed 18 specialist surgeons or surgeons in training in buccomaxillofacial surgery by using a standardized clinical report form for aesthetic evaluation and therapeutic procedures of 12 manipulated images simulating facial profiles, sex, and race. Results: As for aesthetics, the highlights were that facial profile type I had the highest mean values, whereas facial profile type III had the lowest mean values. However, no significant differences were found between the mean values obtained in different facial profiles in relation to sex and race. The therapeutic procedures were homogeneous in profiles II and III, with higher percentages for classical procedures in the orthosurgical treatment of these dentofacial deformities. Conclusion: Facial profile I was considered more aesthetic. Furthermore, sex and racial type effects on aesthetics for the studied sample. Facial profiles I were the most difficult to assess as to therapeutic procedures, which resulted in a wide range of options in relation to profiles II and III.

[Naso-ethmoido-maxillary protrusion (NEMP): a specific dysmorphosis]. / La pro-naso-ethmoïdo-maxillie (PNEM) : une dysmorphose spécifique.

Naso-ethmoido-maxillary protrusion (NEMP) is a rare dental and facial dysmorphosis, with excessive growth of basicranium, ethmoid, maxillary, and nasal bones. The clinical presentation includes nasal and upper lip protrusion, telecanthus, a class 2 malocclusion with maxillary protrusion and exoclusion. The craniofacial field is increased in Delaire's analysis. Contrary to isolated maxillary protrusion secondary to membranous ossification dysfunction, NEMP is a constitutional anomaly resulting from an excessive primary growth of the chondrocranium. The therapeutic management of NEMP should take into account these specificities.

Human stem cells for craniomaxillofacial reconstruction.

Human stem cell research represents an exceptional opportunity for regenerative medicine and the surgical reconstruction of the craniomaxillofacial complex. The correct architecture and function of the vastly diverse tissues of this important anatomical region are critical for life supportive processes, the delivery of senses, social interaction, and aesthetics. Craniomaxillofacial tissue loss is commonly associated with inflammatory responses of the surrounding tissue, significant scarring, disfigurement, and psychological sequelae as an inevitable consequence. The in vitro production of fully functional cells for skin, muscle, cartilage, bone, and neurovascular tissue formation from human stem cells, may one day provide novel materials for the reconstructive surgeon operating on patients with both hard and soft tissue deficit due to cancer, congenital disease, or trauma. However, the clinical translation of human stem cell technology, including the application of human pluripotent stem cells (hPSCs) in novel regenerative therapies, faces several hurdles that must be solved to permit safe and effective use in patients. The basic biology of hPSCs remains to be fully elucidated and concerns of tumorigenicity need to be addressed, prior to the development of cell transplantation treatments. Furthermore, functional comparison of in vitro generated tissue to their in vivo counterparts will be necessary for confirmation of maturity and suitability for application in reconstructive surgery. Here, we provide an overview of human stem cells in disease modeling, drug screening, and therapeutics, while also discussing the application of regenerative medicine for craniomaxillofacial tissue deficit and surgical reconstruction.

Binder's syndrome.

Binder syndrome or maxillonasal dysplasia is an uncommon developmental anomaly affecting primarily the anterior part of the maxilla and nasal complex. The characteristic findings are a failure of development in the premaxillary area with associated deformities of the nasal skeleton and the overlying soft tissues. Affected individuals typically have an unusually flat, underdeveloped midface (midfacial hypoplasia), with an abnormally short nose and flat nasal bridge, underdeveloped upper jaw, relatively protruding lower jaw and/or a 'reverse overbite' (or class III malocclusion). A 16-year-old female reported to clinic with chief complaint of facial deformity, on examination patient had classical feature of maxillonasal dysplasia. A brief review of the condition and the proposed multi-disciplinary treatment plan is discussed.