Preparation of prefabricated vascularized bone graft with neoangiogenesis by combination of autologous tissue and biodegradable materials.

Prefabricated vascularized bone grafts have previously been prepared by combining an autologous vessel bundle with auto-particulate cancellous bone and marrow (PCBM) and a biodegradable membrane. Only small quantities of low-density vascularized bone tissue have been formed using this method. The authors of the present study combined beta-tricalcium phosphate (beta-TCP), a biodegradable ceramic, with a prefabricated vascularized bone graft to augment osteogenesis. A saphenous vessel bundle from a rat was wrapped in a biodegradable membrane. Then, autologous PCBM was mixed with beta-TCP granules and packed into the rolled membrane. In the control group, beta-TCP was omitted. Bone formation was histologically assessed 6 and 9 weeks after implantation. The volume of newly formed bone tissue in the rolled membrane was greater in the presence of beta-TCP granules than in the control. Microvessels had formed throughout the new bone tissue. When a prefabricated vascularized bone graft was onlay-grafted to the femur of the same rat, the prefabricated vascularized bone graft directly fused to the cortical surface of the femur, with no intervening fibrous tissue. These findings suggest that beta-TCP in combination with PCBM enhances the volume and density of bone tissue in prefabricated vascularized bone grafts.

Calcifying odontogenic cysts: co-expression of intermediate filament proteins, and immunohistochemical distribution of keratins, involucrin, and filaggrin.

The epithelia lining the cyst of five cases of calcifying odontogenic cyst (COC) were evaluated immunohistochemically with the use of monoclonal antibodies (MoAb's) against keratin (PKK1, KL1, K4.62, K8.12) and vimentin, and polyclonal antisera agonist involucrin and filaggrin. Epithelial lining of COC was classified into 1) thin squamous-cell epithelium, 2) ameloblastoma-like, and 3) thin or 4) thick calcifying odontogenic epithelium. Foci consisting of ghost cells or calcified cells were categorized as calcifying epithelial odontogenic tumor (CEOT). Thin squamous-cell epithelium reacted with PKK1, KL1, K4.62, K8.12, and anti-vimentin MoAb's, thus demonstrating the co-expression of keratin and vimentin. Ameloblastoma-like cells showed positive staining with PKK1, KL1, and sometimes with anti-vimentin. Thick calcifying odontogenic epithelial lining showed stratification of cell layers, and the most strikingly reactive zone was the upper intermediate layer, which showed the presence of keratin, involucrin, and a small amount of filaggrin. Cells of this layer might be the most differentiated type of cells in COC. Undifferentiated odontogenic cells of COC masses were characterized by co-expression of keratin and vimentin, and by the absence of involucrin and filaggrin. All ghost cells were devoid of any immunostaining except for filaggrin, which was rarely positive, but eosinophilic or basophilic cells surrounding the ghost cells showed intense staining for all keratin proteins except vimentin.

Prognostic evaluation of ameloblastoma based on histologic and radiographic typing.

Ninety-one patients with ameloblastoma of the mandible were studied. Among the 23 patients treated with radical surgery the recurrence rate was 8.7%, whereas the rate of 45.65% in the 68 conservatively treated patients. The prognoses of the patients treated by conservative surgery were analyzed based on the histologic and radiologic criteria of each lesion. The recurrence rate was significantly higher in the follicular type (56.8%) than in the plexiform type (32.3%). Recurrence was seen more frequently in the multilocular or soap bubble type (60.7%) than in the unilocular type (35.0%). When the recurrence rate was compared between patients aged less than 20 years and patients aged greater than or equal to 20 years, younger patients had better prognoses. It was concluded that there is a prognostic value in the histologic, radiographic, and age factors.

Pilot study of the heterogeneous patterns of masticatory muscle coordination in nonpatient population.

This pilot study characterized coordination patterns of the muscles of mastication during voluntary chewing in a nonclinical population. Dental students (n = 177) who did not exhibit symptoms of temporomandibular disorder were screened by a comprehensive muscle and temporomandibular joint palpation examination. A group of 44 students was identified on the basis of the presence of four or more tender points indicated during palpation. This group was further subgrouped by the absence (group A-1) and presence (group A-2) of temporomandibular joint clicking. Five volunteers from groups A-1 and A-2 and five volunteers without any palpation tenderness and joint clicking (control group) were examined by simultaneous recordings of electromyography of bilateral masseter and posterior one third of the temporalis muscles and by mandibular kinesiography. The electromyographic coordination pattern for the control group demonstrated predominantly working masseter muscle activity. This "predominant working masseter" pattern was not observed in groups A-1 or A-2. Additional analyses of the recordings indicated that a hypoactive tendency of the working side masseter muscle particularly outlasting the tooth contact was present in group A-1, whereas significant hyperactivity of the posterior one third of the temporalis was present in group A-2. The data suggested that an asymptomatic nonpatient population may be functionally diverse.

A clinicopathologic study of ameloblastoma.

One hundred four ameloblastomas, 97 in the mandible, five in the maxilla, and two in peripheral locations, were studied. A consistent correlation between the age of the patient and the radiographic or histologic type of mandibular ameloblastoma was observed. There was a tendency for ameloblastomas of the follicular type to show a multilocular or soap bubble appearance and for those of the plexiform type to show a unilocular appearance. Recurrent ameloblastomas had a predominantly multilocular appearance. Histologically, the ameloblastomas in the maxilla were of the follicular type.

Effect of osseointegrated implants on the coordination of masticatory muscles: a pilot study.

STATEMENT OF PROBLEM: The neuromuscular network of masticatory function is, in part, coordinated with afferent information provided by the periodontal ligament (PDL). Osseointegrated implant-supported prostheses lack this PDL-derived proprioceptive feedback mechanism. PURPOSE: This pilot study was designed to address the hypothesis that implant patients acquire different patterns of functional coordination. Patients with implant-supported prostheses were characterized in regard to masticatory muscle tenderness and fatigue as well as changes in the coordinated activities of masticatory muscles during chewing and maximal occluding force. Results were compared with those of patients with natural teeth and interpreted to assess the functional outcome of implant therapy. MATERIAL AND METHODS: Fifty-seven volunteers (25 partially edentulous patients restored with implantsupported fixed prostheses; 32 control patients) were evaluated. A comprehensive set of clinical examinations was performed, including occlusal analysis and examination of masticatory muscle and TMJ. EMG recordings of 5 volunteers from each group were further evaluated. EMG activities of the masseter and anterior temporalis were recorded during habitual chewing and voluntary maximal occluding force. RESULTS: There were essentially no differences in the clinical evaluations between volunteers in the implant and control groups and no significant alterations in the masticatory muscle coordination for habitual chewing. During the maximal occluding force measurement, EMG recordings revealed a unique masticatory muscle coordination pattern in the implant group with a tendency to activate the working and nonworking side muscles simultaneously. CONCLUSION: Patients with implant-supported prostheses appeared to be well adapted to perform habitual masticatory functions. However, during a nonhabitual function such as maximal occluding force, our pilot data revealed a less coordinated masticatory muscle activity in the implant patients.

Correlation of E- and P-cadherin expression with differentiation grade and mode of invasion in gingival carcinoma.

The expression pattern of two Ca(2+)-dependent cell-cell adhesion molecules, E- and P-cadherin (CD), in 25 primary gingival squamous cell carcinomas (SCC) was examined immunohistochemically. The occurrence of reduced-type expression of both E- and P-CD increased significantly with the grade of carcinoma differentiation, culminating in a complete loss of P-CD in poorly differentiated SCC. The occurrence of reduced-type P-CD expression also increased significantly with the mode of invasion, as was the case with E-CD. Furthermore, no P-CD molecules were detected in one of the six SCC having a diffuse, cord-like invasion and in three of the six having a diffuse type of invasion. These findings suggest that the down-regulation of these cell adhesion molecules closely correlates with the differentiation grade and mode of invasion of gingival SCC.

Immunohistochemical investigation of epidermal growth factor receptor expression in ameloblastomas.

Immunohistochemical analysis was performed to determine the localization of epidermal growth factor receptor (EGFR) in ameloblastomas. Ameloblastoma samples were classified into follicular, plexiform, and basal cell types. The number of cases in each category was 17, 19 and 3, respectively. Ameloblastomas, disregarding their histological type, consist of two cell forms: peripheral columnar cells and central stellate cells. The frequency of EGFR expression was much higher in the latter than in the former (P < 0.005). On analysis with respect to histological types, the frequency of EGFR expression in columnar cells was not significantly different between the follicular and the plexiform types, but was observed more frequently in the stellate cells in the follicular than in the plexiform ameloblastomas (P < 0.05). This pattern of EGFR expression was not consistent with the PCNA staining pattern, but was similar to that of keratin expression which we have reported previously. The present study suggests that EGFR expression in ameloblastomas is closely associated with tumour differentiation, and squamous differentiation in particular.

Correlation of lining thickness and expression of alpha 2 and alpha 3 integrins within the epithelial lining of odontogenic cysts.

Using monoclonal antibodies, we performed immunohistochemical investigations of the expression of alpha 2, alpha 3 and beta 4 integrin subunits within the squamous epithelial linings of odontogenic cysts. Tissue samples consisted of both follicular cysts and odontogenic keratocysts from 15 patients. It was found that beta 4 integrin was expressed on the basement membrane regardless of the histological type of the cyst. The degree of immunostaining for alpha 2 and alpha 3 integrin expression corresponded to the thickness of the epithelial cyst wall. We found that the thickness of the epithelial lining of odontogenic cysts had a direct correlation with the expression of integrin molecules.