Guided bone regeneration for peri-implant augmentation: A retrospective study comparing two surgical techniques with a mean follow-up of 26 months.

OBJECTIVES: To introduce a modified guided bone regeneration (GBR) technique using intact periosteum and deproteinized bovine bone mineral (DBBM) for peri-implant augmentation and compare the clinical outcomes with those of conventional GBR. MATERIALS AND METHODS: Patients who received peri-implant augmentation in posterior sites between 2015 and 2021 were reviewed in this study. Group A was treated with a modified GBR technique, and Group B was treated with conventional GBR. For group comparison, propensity score matching was performed with a sensitivity analysis. The implant survival rate, dimensional changes in hard tissue, marginal bone loss (MBL), and peri-implant parameters were evaluated. RESULTS: In total, 114 implants from 98 patients were included. The implant survival rates were 95.74% in Group A and 95.00% in Group B during the follow-up period. At 6 months, the median horizontal thickness was recorded at 0.87 mm (IQ1-IQ3 = 0.00-1.75 mm) in Group A, exhibiting a relatively lower value compared to the corresponding measurement of 0.98 mm (IQ1-IQ3 = 0.00-1.89 mm) in Group B (p = .937). Vertical height displayed no statistically significant intergroup difference between the two groups (p = .758). The mean follow-up period was 25.83 ± 12.93 months after loading in Group A and 27.47 ± 21.29 months in Group B (p = .761). MBL and peri-implant parameters were comparable between the two groups. CONCLUSIONS: Within the limitations of this study, the modified GBR technique using intact periosteum and DBBM grafting might be a viable alternative to correct bone defects around implants in molar and premolar sites.

A nomogram prediction of implant apical non-coverage on bone-added transcrestal sinus floor elevation: A retrospective cohort study.

OBJECTIVES: To identify the risk indicators and develop and validate a nomogram prediction model of implant apical non-coverage by comprehensively analyzing clinical and radiographic factors in bone-added transcrestal sinus floor elevation (TSFE). MATERIAL AND METHODS: A total of 260 implants in 195 patients receiving bone-added TSFE were included in the study. The population was divided into a development (180 implants) and a validation (80 implants) cohort. According to 6 months post-surgery radiographic images, implants were categorized as "apical non-coverage" or "apical covered." The association of risk factors including clinical and radiographic parameters with implant apical non-coverage was assessed using regression analyses. A nomogram prediction model was developed, and its validation and discriminatory ability were analyzed. RESULTS: The nomogram predicting bone-added TSFE's simultaneously placed implant's apex non-coverage after 6 months. This study revealed that sinus angle, endo-sinus bone gain, implant protrusion length, graft contact walls, and distal angle were predictors of implant apical non-coverage. The generated nomogram showed a strong predictive capability (area under the curve [AUC] = 0.845), confirmed by internal validation using 10-fold cross-validation (Median AUC of 0.870) and temporal validation (AUC = 0.854). The calibration curve and decision curve analysis demonstrated good performance and high net benefit of the nomogram, respectively. CONCLUSIONS: The clinical implementation of the present nomogram is suitable for predicting the apex non-coverage of implants placed simultaneously with bone-added TSFE after 6 months.

Effectiveness and complications of transcrestal sinus floor elevation using the cushioned grind-out technique: A retrospective cohort study with up to 7 years of follow-up.

AIM: To evaluate the effectiveness and complications of the cushioned grind-out technique. The primary outcome was endo-sinus bone gain (ESBG), while secondary outcomes included the Schneiderian membrane perforation rate and mid- to long-term implant survival. MATERIALS AND METHODS: In this retrospective study, we compared the cushioned grind-out technique with the classic osteotome technique, establishing statistical models to assess ESBG, membrane perforation rate and implant survival rate. RESULTS: A total of 259 patients and 340 implants were included. The mean ESBG was 5.31 mm for the cushioned grind-out group and 4.64 mm for the osteotome group. Multivariable regression analysis revealed that the cushioned grind-out technique significantly facilitated ESBG (p = .028). Nineteen preparation sites experienced membrane perforation, with rates of 5.5% and 6.4% for the cushioned grind-out and osteotome groups, respectively. However, the difference was not statistically significant (p = .920). Additionally, the cumulative survival rate of the implants for 7 years was 95.2% and 91.4%, respectively, with the surgical technique not significantly influencing the results. CONCLUSIONS: With 6 months to 7 years of post-prosthetic restoration review data, our findings show that the cushioned grind-out technique facilitates a higher ESBG, with no significant difference in membrane perforation or implant failure rate.

Cushioned grind-out technique transcrestal sinus floor elevation for simultaneous implantation in severe atrophic maxilla: A retrospective study with up to 7 years of follow-up.

OBJECTIVES: This study aimed to evaluate the effects of the cushioned grind-out technique transcrestal sinus floor elevation for simultaneous implant placement with ≤4 mm of residual bone height (RBH). MATERIALS AND METHODS: This was a retrospective propensity score matching (PSM) study. Five PSM analyses included the confounding variables of Schneiderian membrane perforation, early and late implant failure, and peri-implant apical and marginal bone resorption. After PSM, we compared the difference in five aspects between the RBH ≤ 4 and >4 mm groups. RESULTS: A total of 214 patients with 306 implants were included in this study. After PSM, the generalized linear mixed model (GLMM) indicated that RBH ≤ 4 mm had no significantly higher risk of Schneiderian membrane perforation and early and late implant failure (p = .897, p = .140, p = .991, respectively). The implant cumulative 7-year survival rate of the RBH ≤ 4 and >4 mm groups was 95.5% and 93.9%, respectively (log-rank test: p = .900). Within at least 40 cases per group after PSM, two multivariate GLMMs indicated that RBH ≤ 4 mm could not be identified as the promotive factor of bone resorption of either endo-sinus bone gain or crest bone level (RBH × time interaction p = .850, p = .698, respectively). CONCLUSIONS: Within the limitations, 3 months to 7 years of post-prosthetic restoration review data indicated an acceptable mid-term survival and success rate of applying the cushioned grind-out technique in RBH ≤ 4 mm cases.

Inhibition of Rgs10 aggravates periodontitis with collagen-induced arthritis via the nuclear factor-κB pathway.

OBJECTIVE: To explore the role of the Rgs10-associated nuclear factor (NF)-κB signalling pathway in periodontitis with rheumatoid arthritis. METHODS: Porphyromonas gingivalis and collagen were locally applied to mice to establish in vivo periodontitis and rheumatoid arthritis models, respectively. Both agents were administered together to establish the comorbid group. All models were treated with adeno-associated virus-green fluorescent protein (AAV-GFP) or adeno-associated virus small hairpin Rgs10 (AAV-sh-Rgs10). In vivo expression of Rgs10 and inflammatory cytokines was analysed, along with exploration of the NF-κB signalling pathway in lipopolysaccharide-stimulated mouse-derived RAW264.7 cells, with and without treatment of small interfering RNA (siRNA; Rgs10-Mus-MSS245072). RESULTS: In the comorbidity mouse group (mice with both periodontitis and rheumatoid arthritis), inhibition of Rgs10 exacerbated periodontitis, along with upregulation of phospho-RelA (pP65), tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) expression in the NF-κB signalling pathway. Similarly, treatment of LPS-stimulated RAW264.7 cells with siRNA resulted in the inhibition of Rgs10, along with upregulation of pP65, TNF-α and IL-6 expression in vitro. CONCLUSION: Inhibition of Rgs10 in mice with periodontitis and rheumatoid arthritis can promote the progression of periodontitis, indicating the potential therapeutic role of Rgs10 in this condition.

Effect of the implant apical exposure and coverage < or ≥ 2 mm bone graft on transcrestal sinus floor elevation: a 1- to 7-year retrospective cohort study.

OBJECTIVES: This study aimed to analyze the effect of the apex coverage by the bone graft, including exposure and coverage less than or greater than 2 mm on implant survival rate and peri-implant bone and soft tissue remodeling. MATERIALS AND METHODS: A total of 264 implants in 180 patients who had undergone transcrestal sinus floor elevation (TSFE) with simultaneous implant placement were included in this retrospective cohort study. Radiographic assessment was used to categorize the implants into three groups based on apical implant bone height (ABH): ≤ 0 mm, < 2 mm, or ≥ 2 mm. The implant survival rate, peri-implant marginal bone loss (MBL) during short-term (1-3 years) and mid- to long-term (4-7 years) follow-up, and clinical parameters were used to evaluate the effect of implant apex coverage after TSFE. RESULTS: Group 1 had 56 implants (ABH ≤ 0 mm), group 2 had 123 implants (ABH > 0 mm, but < 2 mm), and group 3 had 85 implants (ABH ≥ 2 mm). There was no significant difference in the implant survival rate between groups 2 and 3 compared to group 1 (p = 0.646, p = 0.824, respectively). The MBL during short-term and mid- to long-term follow-up indicated that apex coverage could not be considered a risk factor. Furthermore, apex coverage did not have a significant effect on other clinical parameters. CONCLUSIONS: Despite limitations, our study found that implant apex coverage by the bone graft, including exposure and coverage levels less than or greater than 2 mm, did not significantly affect implant survival, short-term or mid- to long-term MBL, or peri-implant soft tissue outcomes. CLINICAL RELEVANCE: Based on 1- to 7-year data, the study suggests that implant apical exposure and coverage levels of less than or greater than 2 mm bone graft are both valid options for TSFE cases.

Horizontal ridge augmentation in the anterior maxilla with in situ onlay bone grafting: a retrospective cohort study.

OBJECTIVES: This study aimed to introduce a digitally guided in situ autogenous onlay grafting technique and compare its effectiveness with the conventional (ex situ) onlay technique in augmenting horizontal bone defects of the anterior maxilla. MATERIALS AND METHODS: This retrospective cohort study included 24 patients who had received autogenous onlay bone grafts combined with guided bone regeneration (GBR) in the anterior maxilla. Fourteen patients were recruited into the in situ onlay grafting group (EG), and 10 were recruited into the ex situ onlay group (CG), defined by the donor sites. The clinical parameters, radiographic changes, micro-CT, and histological processes were evaluated after a mean follow-up period of 1.7 years. RESULTS: The horizontal bone width reflected significant bone modeling over time (p < 0.001) in the first 6 months. Multivariable analysis showed that the treatment modality (grouping) was a critical factor positively associated with vertical bone height alteration. However, neither the alteration rate of horizontal bone width nor the bone volume was associated with the treatment modality. The number of periosteal screws per graft positively affected horizontal contour maintenance (p < 0.05). No significant differences were observed between the groups in the clinical parameters (complications, success rate, and peri-implant parameters). The micro-CT and histological outcomes were similar between the groups. CONCLUSION: Despite the limitations of this study, in situ onlay grafting combined with GBR was an effective and reliable approach for horizontal bone augmentation in the anterior maxilla and appeared to demonstrate better stability in vertical bone remodeling. CLINICAL RELEVANCE: This study introduces a modified and minimally invasive technique of onlay grafting for horizontal bone augmentation. This in situ onlay grafting demonstrates superior stability in vertical bone remodeling. The trial registration number is ChiCTR2100054683.

Influence of implant location on titanium-zirconium alloy narrow-diameter implants: A 1-year prospective study in smoking and nonsmoking populations.

STATEMENT OF PROBLEM: Titanium-zirconium (Ti-Zr) alloy (Roxolid) narrow-diameter implants (NDIs) have been widely used for implant-supported prostheses in anterior and posterior regions in the jaws. However, the relationship between implant location and clinical outcome remains unclear. PURPOSE: The purpose of this clinical study was to evaluate and compare the clinical and radiographic outcomes of NDIs placed in different regions of the jaws in both smokers and nonsmokers. MATERIAL AND METHODS: Eighty-four participants scheduled to receive NDIs for tooth rehabilitation were included, and the inserted NDIs were divided into 3 groups depending on their locations: implants used to restore anterior teeth, implants used to restore premolars, and implants used to restore molars. Crestal bone loss (CBL), implant survival and success rates, bleeding on probing (BOP), and pocket probing depth (PPD) were evaluated 6 and 12 months after implant loading (α=.017 for implant survival and success rates after Bonferroni correction, α=.05 for other parameters). RESULTS: Statistical analysis of 6- and 12-month CBL of all participants presented no statistically significant difference among the 3 groups. For smokers, the molar group presented significantly more CBL than the premolar group (0.90 ±0.94 versus 0.16 ±0.27 mm, P=.027) at the 6-month examination. The implant survival rates were 95.65%, 100%, and 100% for anterior, premolar, and molar regions, respectively (P=.283). No statistically significant difference was observed regarding periodontal parameters (P>.05). CONCLUSIONS: Implant location has no influence on the clinical and radiographic parameters of Ti-Zr NDIs placed in a nonsmoking population. However, the combination of posterior location and smoking may induce higher risk of crestal bone loss. Caution should be taken when restoring molars for smokers with NDIs.

Radiographic evaluation of a cross-shaped incision technique for thick-gingiva and thin-gingiva patients treated with implant-supported fixed prosthesis.

BACKGROUND: To evaluate a cross-shaped incision technique for thick-gingiva and thin-gingiva patients treated with implant-supported fixed prosthesis. METHODS: Total 55 patients receiving cross-shaped incision were assigned into thick-gingiva group (29 cases) and thin-gingiva group (26 cases). Follow-up was performed at 3 and 12-month after final restoration. RESULTS: Mesial and distal papilla height was significantly greater in thick-gingiva group than thin-gingiva group at 3 and 12 months, while periodontal depth and crestal marginal bone level around implant had no significant difference between the two groups during follow-up. No case of recession of buccal marginal gingiva was observed in thick-gingiva group. However, the recession of marginal gingiva of buccal aspect of the crown was found in 5 patients (19.2%) with thin-gingiva. CONCLUSIONS: The cross-shaped incision may be applied to reconstruct gingival papillae and avoid the gingival recession in patients with thick-gingiva phenotype. Trial registration This study was registered at ClinicalTrials.gov (registration number NCT04706078, date 12 January 2021, Retrospectively registered).

Fish Collagen and Hydroxyapatite Reinforced Poly(lactide- co-glycolide) Fibrous Membrane for Guided Bone Regeneration.

The purpose of this study was to fabricate a low-immunogenicity fish collagen (FC) and bioactive nanohydroxyapatite (n-HA) enhanced poly(lactide- co-glycolide) (PLGA) nanofibrous membrane for guided bone regeneration (GBR) via electrospinning. The physicochemical properties and morphology study revealed that FC and n-HA particles were homogeneously dispersed in the PLGA fibrous matrix. Notably, the formation of enhanced polymeric chain network due to the interaction between FC and PLGA significantly improved the tensile strength of the PLGA membrane. The incorporation of FC altered the degradation behavior of fibers and accelerated the degradation rate of the PLGA-based membranes. Moreover, the membranes exhibited favorable cytocompatibility with bone mesenchymal stem cells (BMSCs) and human gingiva fibroblasts (HGF) cells. More importantly, the optimized membrane satisfied the requirements of the 'Biological evaluation of medical devices' during the incipient biosafety evaluation. All the results indicate that this composite fibrous membrane exhibits significant potential for guided bone or tissue regeneration.

Early Healing of Immediate Implants Connected With Two Types of Healing Abutments: A Prospective Cohort Study.

PURPOSE: To compare hard- and soft-tissue changes around immediate implants connected with 2 types of healing abutments during the early phases of healing. MATERIALS AND METHODS: Twenty-eight immediate implants were placed into molar/premolar sockets through a modified osteotomy method. The gaps around implants were grafted with deproteinized bovine bone mineral. According to the size of the alveoli, the implants were connected with titanium healing abutments (traditional group) or customized healing abutments (CA group). Radiographic and intraoral examinations were performed before surgery, postoperatively, and at the 6-month recall. RESULTS: Buccal (P = 0.717) and lingual (P = 0.087) vertical bone loss was comparable between groups. More significant incomplete defect fill was found at the distal aspect of the CA group (P = 0.000). The buccal bone thickness alterations were similar between the 2 groups (P = 0.902 at the implant platform). The mid-facial soft-tissue level was well maintained in both groups. CONCLUSIONS: Within the limitations of this study, for immediate implants placed into posterior sockets, customized healing abutments can facilitate closure of large sockets. Despite more pronounced incomplete defect fill, healing abutments consisting of polyether ether ketone and resin did not render an increased risk for periimplant bone loss or soft-tissue recession during the early healing period.

Reconstruction of Mandibular Segmental Detects Using Transport Disk Distraction Osteogenesis.

BACKGROUND: Distraction osteogenesis (DO) has become an important alternative for bone defect reconstruction. The study aims to investigate the clinical feasibility and efficiency of transport disc DO (TDDO) for reconstruction of segmental defect of mandible and further dental implant treatment. METHODS: A serial of 6 patients diagnosed with ameloblastoma or keratocystic odontogenic tumor were included in this study. Computed tomography (CT) scanning and panoramic radiograph were performed for preoperative evaluation and surgery planning. Transport disc DO was applied simultaneously with tumor resection for reconstruction of mandibular defects. The postoperative panoramic radiographs and CT scans were taken for evaluation of the ossification level. Then a second surgery was performed for removal of the distraction apparatus. Bone graft and rigid internal fixation were also used to fill the gap between the transport disc and the stump of the residual ramus. Further dental implant treatment was also finished or in progress. RESULTS: All patients finished the whole treatment period, and no distraction device failure or tumor recurrence occurred. The distraction length ranged from 35 to 48 mm and the whole treatment period of TDDO ranged from 21 to 33 weeks. High degree of ossification was confirmed at the end of treatment by postoperative radiographs and intraoperative observation. Infection occurred in 1 of the 6 patients, and the symptom was controlled by surgical dressing change and flushing. Results of final facial profile in all patients were good. Three patients finished dental implant treatment with good occlusion. CONCLUSION: Results in this study suggest the clinical feasibility and efficiency of TDDO for reconstruction of segmental defect of mandible and further dental implant treatment.

[Effects of Gelatin on Performance of α-tricalcium Phosphate Bone Cement].

OBJECTIVE: To determine the effects of gelatin on the performance of calcium phosphate cement (CPC). METHODS: α-tricalcium phosphate (α-TCP) bone cement was mixed with different concentrations of gelatin solutions. The CPC samples were soaked into simulated body fluid for one day before their compressive and bending strengths were measured. We also compared their waterproof performance, solidification time and surface topography. RESULTS: Gelatin solutions changed the performance of CPC. Optimal performance of CPC was achieved when the volume ratio of gelatin solution to CPC (Vgelatin solution:V(CPC liquid)) was set at 25:100, which increased compressive strength from (7.874 54 ± 0.660 97) MPa to (9.936 52 ± 0.433 17) MPa and bending strength from (5.157 06 ± 0.298 30) MPa to (7.959 71 ± 0.281 63) MPa. Gelatin solution also prolonged setting time of CPC, improved its waterproof performance, and promoted formulation of more dense and uniform hydroxyapatite crystals. CONCLUSION: Gelatin can improve the compressive and bending strengths of CPC, and make CPC more suitable for clinic use through improvements in setting time and waterproof performance.

Evaluation of the efficacy of keratinized mucosa augmentation techniques around dental implants: a systematic review.

STATEMENT OF PROBLEM: The absence of periimplant keratinized mucosa is considered risky in patients with a predisposition to periodontitis or recession. Although various soft tissue augmentation techniques exist, dentists are seeking for more efficient approaches to augment periimplant keratinized mucosa. PURPOSE: The purpose of this systematic review was to evaluate the efficacy of the various techniques and biomaterials adopted in periimplant keratinized mucosa augmentation and whether one technique or biomaterial is superior. MATERIAL AND METHODS: A search in Medline-PubMed and the Cochrane Central Register of controlled trials was conducted. Randomized clinical trials, prospective cohort studies, clinical control studies, and case series from January 1, 1980, to December 31, 2013, with a follow-up of at least 6 months reporting changes on keratinized mucosa width were included. Several journals were hand-searched for related articles. The bibliographies of all publications selected for inclusion were also scanned. RESULTS: The screening of titles and abstracts resulted in 60 relevant publications. Six of them were finally included. Free gingival graft, connective tissue graft, acellular dermal matrix, and collagen matrix were used for keratinized mucosa augmentation. Because of heterogeneity of the studies, only descriptive analysis was performed. Improvements in keratinized mucosa width were reported in all studies. CONCLUSIONS: A definitive conclusion could not be achieved owing to the lack of well-designed studies and appropriate methods of studying soft tissue. The establishment of universal surgical guidelines and measurement systems is imperative in the future.

Implant over implant: an alternative method for solving malpositioned osseointegrated implants at the sinus floor.

An implant was malpositioned and osseointegrated at the maxillary sinus floor with no complications. However, unexpected bone formation over the implant made the implant nonfunctional. Because the patient rejected the removal of the implant, it was left in place while another short implant was placed into the newly formed bone in approximately the same position as the old implant to restore the posterior maxillary tooth. Within 6 months, the new implant over the old asymptomatic implant was functional. Radiographs revealed osseointegration and stable periimplant marginal bone level with no signs of infection or inflammation.

The three-dimensional stability and accuracy of 3D printing surgical templates: An In Vitro study.

OBJECTIVE: To evaluate the three-dimensional (3D) stability and accuracy of additively manufactured surgical templates fabricated using two different 3D printers and materials. MATERIALS AND METHODS: Forty surgical templates were designed and printed using two different 3D printers: the resin group (n = 20) used a digital light processing (DLP) 3D printer with photopolymer resin, and the metal group (n = 20) employed a selective laser melting (SLM) 3D printer with titanium alloy. All surgical templates were scanned immediately after production and re-digitalized after one month of storage. Similarly, the implant simulations were performed twice. Three-dimensional congruency between the original design and the manufactured surgical templates was quantified using the root mean square (RMS), and the definitive and planned implant positions were determined and compared. RESULTS: At the postproduction stage, the metal templates exhibited higher accuracy than the resin templates (p < 0.001), and these differences persisted after one month of storage (p < 0.001). The resin templates demonstrated a significant decrease in three-dimensional stability after one month of storage (p < 0.001), whereas the metal templates were not affected (p > 0.05). No significant differences in implant accuracy were found between the two groups. However, the resin templates showed a significant increase in apical and angular deviations after one month of storage (p < 0.001), whereas the metal templates were not affected (p > 0.05). CONCLUSION: Printed metal templates showed higher fabrication accuracy than printed resin templates. The three-dimensional stability and implant accuracy of printed metal templates remained unaffected by one month of storage. CLINICAL SIGNIFICANCE: With superior three-dimensional stability and acceptable implant accuracy, printed metal templates can be considered a viable alternative technique for guided surgery.

Investigating the effects of buccal bone fenestration on maxillary anterior implants: A 1- to 6-year retrospective study.

PURPOSE: To examine the effects of buccal bone fenestration on maxillary anterior implants. MATERIALS AND METHODS: Patients who underwent implant placement in the maxillary anterior region between January 2017 and December 2021 and had received final restorations 1 to 6 years prior were screened for inclusion in the present study. Propensity score matching was used to match the two-group sample size and reduce the influence of potential confounding factors. Generalised linear mixed models were employed to evaluate the correlation between buccal bone fenestration and peri-implant marginal bone loss. RESULTS: A total of 42 patients with 50 implants were included in the study, 16 of whom had buccal bone fenestration (group 1) and 26 of whom did not (group 2). No implant failures occurred, resulting in a cumulative implant survival rate of 100.0%. There was no statistically significant difference between the pink aesthetic scores for the two groups. The mean marginal bone loss was 0.44 ± 0.46 mm for group 1 and 0.33 ± 0.32 mm for group 2 (P > 0.05). Buccal bone fenestration was not the influencing factor of marginal bone loss (P > 0.05). Marginal bone loss was greater around implants used to replace canines than those inserted to replace central incisors (P < 0.05). Far less marginal bone loss occurred around immediately loaded implants than delayed implants with cover screws (P < 0.05). When there is sufficient keratinised mucosa around the implant, marginal bone loss will decrease significantly (P < 0.05). CONCLUSIONS: Within the limitations of this study, buccal bone fenestration defects around dental implants cannot influence peri-implant bone loss. CONFLICT-OF-INTEREST STATEMENT: The authors report no conflicts of interest relating to this study.

Innovative principle of implant-oriented fibula placement in mandibular reconstruction using double-barrel fibula and simultaneous implants: A technical note.

Simultaneous or secondary inserted implants with double-barrel fibula to reconstruct the mandible have become a common method. However, difficulties in later restoration caused by placement errors of fibula or incipiently placed implants have also been reported in some studies. This note describes a novel technique of implant-oriented guide plates helpful for mandible ablation, fibula segmentation and positioning, and implant placement. We design a series of guide plates especially an implant-fibula placing guide plate, and record and fix the relative spatial positions of the remaining teeth, the simultaneous implants and upper fibula. During surgery, the placement of upper fibula is oriented towards appropriate placement of implants. Therefore, the position of upper fibula can meet the requirements of simultaneous implant as much as possible. Within the limits of present observation, we believe that this technique may increase the manipuility while reducing the errors and the risk of complications.

Integrated-omics profiling unveils the disparities of host defense to ECM scaffolds during wound healing in aged individuals.

Extracellular matrix (ECM) scaffold membranes have exhibited promising potential to better the outcomes of wound healing by creating a regenerative microenvironment around. However, when compared to the application in younger individuals, the performance of the same scaffold membrane in promoting re-epithelialization and collagen deposition was observed dissatisfying in aged mice. To comprehensively explore the mechanisms underlying this age-related disparity, we conducted the integrated analysis, combing single-cell RNA sequencing (scRNA-Seq) with spatial transcriptomics, and elucidated six functionally and spatially distinctive macrophage groups and lymphocytes surrounding the ECM scaffolds. Through intergroup comparative analysis and cell-cell communication, we characterized the dysfunction of Spp1+ macrophages in aged mice impeded the activation of the type Ⅱ immune response, thus inhibiting the repair ability of epidermal cells and fibroblasts around the ECM scaffolds. These findings contribute to a deeper understanding of biomaterial applications in varied physiological contexts, thereby paving the way for the development of precision-based biomaterials tailored specifically for aged individuals in future therapeutic strategies.

Vascularized fascial flap for reconstruction of combined oral mucosa-mandibular defects: The multi-modal biological assessment.

OBJECTIVE: The reconstruction of composite defects in the oral and maxillofacial region using vascularized fascial flaps, such as the fibular, iliac, and temporal fascial flaps, has gained increasing attention among surgeons. However, there remains uncertainty regarding the suitability of fascial flaps as transplants, as well as their healing processes and outcomes, due to their non-mucosal nature. This study aims to comprehensively assess the biological aspects of vascularized fascial flaps at clinical, histological, and genetic levels, with the goal of providing essential biological references for their clinical application. STUDY DESIGN: This study enrolled three patients who underwent reconstruction of combined oral mucosa-mandibular defects using fibular vascularized fascial flaps between 2020 and 2023. Data regarding changes in the appearance of the fascial flaps, bulk-RNA sequencing, and histological slices of initial fascia, initial gingiva, and transformed fascia were collected and analyzed. RESULTS: Within three months, the fascial flaps exhibited rapid epithelial coverage and displayed distinct characteristics resembling mucosa. High-throughput RNA sequencing analyses and histological slices revealed that the transformed fascia exhibited tissue structures similar to mucosa and demonstrated unique advantages in promoting blood vessel formation and reducing scarring through the high-level expression of relevant genes. CONCLUSION: These findings emphasize the potential and feasibility of utilizing vascularized fascial flaps for oral mucosa reconstruction, establishing their unique advantage as transplant materials, and providing significant biological information and references for their selection and clinical application.