Clinical and radiographic outcomes of lateral sinus floor elevation with simultaneous hydrophilic implants placement: A retrospective study of 2-5 years.

AIMS: To investigate the clinical and radiographic outcomes of a chemically modified sandblasted large-grit acid-etched implant (hydrophilic) in lateral sinus floor elevation (LSFE), compared with a conventional one (hydrophobic). MATERIALS AND METHODS: A retrospective study design was adopted. Patients who received LSFE with simultaneous implant placement were recruited. According to different types of implant surfaces, patients were divided into two groups (the hydrophilic group and the hydrophobic group). Implant survival rate (SR), endo-sinus bone stability on the radiographs, mean probing depths, percentage of bleeding on probing, marginal bone loss, and patient satisfaction were evaluated. RESULTS: A total of 106 patients with 180 implants (hydrophilic:101, hydrophobic:79) in 119 maxillary sinuses were included. The follow-up period ranged from 2 to 5 years. Three hydrophobic implants and one hydrophilic implant in four different patients failed. The SR of the hydrophilic group was higher than that of the hydrophobic group but without a significant difference (p > .05). The change and change rate of endo-sinus bone height (ΔESBH and RΔESBH) and bone volume (ΔESBV and RΔESBV) in the hydrophilic group were less than those in the hydrophobic group, with a significant difference at 6 months after implantation. No other significant difference was found between the two groups. CONCLUSION: Within the limitations of this study, both hydrophilic and hydrophobic implants were suitable for LSFE with predictable clinical outcomes. Meanwhile, hydrophilic implants could contribute to the grafted endo-sinus bone stability during healing time.

Development and applications of peri-implantitis mouse models.

OBJECTIVE: Peri-implantitis is one of the most common complications of implants. However, its pathogenesis has not been clarified. In recent years, mouse models are gradually being used in the study of peri-implantitis. This review aims to summarize the methods used to induce peri-implantitis in mice and their current applications. METHOD: Articles of peri-implantitis mouse models were collected. We analyzed the various methods of inducing peri-implantitis and their application in different areas. RESULTS: Most researchers have induced peri-implantitis by silk ligatures. Some others have induced peri-implantitis by Pg gavage and LPS injection. Current applications of peri-implantitis mouse models are in the following areas: investigation of pathogenesis and exploration of new interventions, comparison of peri-implantitis with periodontitis, the interaction between systemic diseases and peri-implantitis, etc. CONCLUSION: Silk ligature for 2-4 weeks, Pg gavage for 6 weeks, and LPS injection for 6 weeks all successfully induced peri-implantitis in mice. Mice have the advantages of mature gene editing technology, low cost, and short time to induce peri-implantitis. It has applications in the study of pathogenesis, non-surgical treatments, and interactions with other diseases. However, compared with large animals, mice also have a number of disadvantages that limit their application.

Transverse dentoalveolar development in Chinese children and adolescents: A cross-sectional study using revised Andrews' Element III analysis.

INTRODUCTION: This study investigated the prevalence of maxillary transverse deficiency (MTD) in Chinese children and adolescents using revised Andrews' Element III analysis and studied transverse developmental characteristics of the maxillomandibular complex. METHODS: Plaster or digital casts of 794 participants aged 7-18 years were evaluated. MTD was diagnosed when the maxilla-mandible width difference, represented by the decompensated maxillary and mandibular first molars, exceeded 4 mm. RESULTS: The average prevalence of MTD among patients aged 7-18 years was 31.1%. Patients with MTD exhibited narrower maxillary and/or wider mandibular arches. Strikingly, 32.3% of participants with posterior crossbite because of local crowding or mandibular deviation were not diagnosed with MTD. Dental compensation, such as a greater buccolingual inclination of the first molars, was common in patients with MTD. Transverse growth of the maxillomandibular complex was completed by 17 years old, with the maxilla undergoing greater transverse growth than the mandible. The physiological buccolingual inclination of first molars was observed in patients without MTD. The 95% reference value of the palatal arch width was 31.9-42.3 mm. CONCLUSIONS: The prevalence of MTD is 31.1% among Chinese children and adolescents. However, it is often camouflaged by dental compensation and sagittal discrepancy. The etiology of MTD is uncoordinated width in the maxillomandibular complex, which is not solely attributed to a narrow maxilla but also to an excessively wide mandible. To enhance diagnostic accuracy, individualized measurements of the maxillomandibular complex and a revised dental decompensation formula, rather than posterior crossbite alone, are recommended for transverse diagnosis. A potential presence of MTD is indicated when the palatal arch width is <31.9 mm.

Genetic evidence strengthens the bidirectional connection between gut microbiota and periodontitis: insights from a two-sample Mendelian randomization study.

BACKGROUND: Recent research has established the correlation between gut microbiota and periodontitis via oral-gut axis. Intestinal dysbiosis may play a pivotal bridging role in extra-oral inflammatory comorbidities caused by periodontitis. However, it is unclear whether the link is merely correlative or orchestrated by causative mechanistic interactions. This two-sample Mendelian randomization (MR) study was performed to evaluate the potential bidirectional causal relationships between gut microbiota and periodontitis. MATERIALS AND METHODS: A two-sample MR analysis was performed using summary statistics from genome-wide association studies (GWAS) for gut microbiota (n = 18,340) and periodontitis (cases = 12,251; controls = 22,845). The inverse-variance weighted (IVW) method was used for the primary analysis, and we employed sensitivity analyses to assess the robustness of the main results. The PhenoScanner database was then searched for pleiotropy SNPs associated with potential confounders. In order to identify the possibly influential SNPs, we further conducted the leave-one-out analysis. Finally, a reverse MR analysis was performed to evaluate the possibility of links between periodontitis and genetically predicted gut microbiota alternation. RESULTS: 2,699 single nucleotide polymorphisms (SNPs) associated with 196 microbiota genera were selected as instrumental variables (IVs). IVW method suggested that order Enterobacteriales (OR: 1.35, 95% CI 1.10-1.66), family Bacteroidales S24.7group (OR: 1.22, 95% CI 1.05-1.41), genus Lachnospiraceae UCG008 (OR: 1.16, 95% CI 1.03-1.31), genus Prevotella 7 (OR: 1.11, 95% CI 1.01-1.23), and order Pasteurellales (OR: 1.12, 95% CI 1.00-1.26) may be associated with a higher risk of periodontitis, while genus Ruminiclostridium 6 may be linked to a lower risk (OR: 0.82, 95% CI 0.70-0.95). The sensitivity and heterogeneity analyses yielded no indication of horizontal pleiotropy or heterogeneity. Only the association between order Enterobacteriales and the likelihood of periodontitis remained consistent across all alternative MR approaches. In the reverse MR analysis, four microbiota genera were genetically predicted to be down-regulated in periodontitis, whereas two were predicted to be up-regulated. CONCLUSIONS: The present MR analysis demonstrated the potential bidirectional causal relationships between gut microbiota and periodontitis. Our research provided fresh insights for the prevention and management of periodontitis. Future research is required to support the finding of our current study.

A multi-center cross-sectional study of 1495 Chinese oral lichen planus patients.

OBJECTIVE: To explore the clinical epidemiological characteristics of oral lichen planus (OLP) and risk factors for erosive/ulcerative OLP. MATERIALS AND METHODS: Patients diagnosed with OLP from 11 different hospitals were included in the study. Descriptive statistical methods were used to explore the clinical epidemiological characteristics and logistic regression, sensitivity analysis, and subgroup analysis were utilized to explore the risk factors for erosive/ulcerative OLP. RESULTS: The average age of patients was 49.2 ± 13.3 years, and 61.4% of the patients were women. The ratios of patients with reticular, hyperemic/erythematous, and erosive/ulcerative lesions were 47.9%, 27.8%, and 24.2%, respectively. Analysis of risk factors for erosive/ulcerative OLP identified the following variables: age, course of disease of 12 months or more, II°-III° dental calculus, hypertension, diabetes, and heart disease, as well as regions of habitation. Subgroup analysis showed significant differences in risk factors for erosive/ulcerative OLP in patients with and without risk behaviors. CONCLUSION: The clinical epidemiological characteristics of patients with OLP in the Chinese population in this study are basically consistent with existing reports in developed countries. And we identified clinical characteristics associated with erosive/ulcerative OLP through clinical epidemiological analysis.

Resveratrol May Reduce the Degree of Periodontitis by Regulating ERK Pathway in Gingival-Derived MSCs.

Gingival-derived mesenchymal stem cells (GMSCs) have strong self-renewal, multilineage differentiation, and immunomodulatory properties and are expected to be applied in anti-inflammatory and tissue regeneration. However, achieving the goal of using endogenous stem cells to treat diseases and even regenerate tissues remains a challenge. Resveratrol is a natural compound with multiple biological activities that can regulate stem cell immunomodulation when acting on them. This study found that resveratrol can reduce inflammation in human gingival tissue and upregulate the stemness of GMSCs in human gingiva. In cell experiments, it was found that resveratrol can reduce the expression of TLR4, TNFα, and NFκB and activate ERK/Wnt crosstalk, thereby alleviating inflammation, promoting the proliferation and osteogenic differentiation ability of GMSCs, and enhancing their immunomodulation. These results provide a new theoretical basis for the application of resveratrol to activate endogenous stem cells in the treatment of diseases in the future.

Pseudocysts of the jaw: a retrospective study of 41 cases from a single institution.

OBJECTIVE: The purpose of this retrospective study was to investigate and compare the clinical, radiographic, pathological, pathogenesis, and therapeutic features of simple bone cysts (SBCs) and aneurysmal bone cysts (ABCs) of the jaw. METHODS: 35 patients with SBCs and 6 patients with ABCs who received treatment at the Department of Oral and Maxillofacial Surgery, Zhejiang University School of Medicine from 2017 to 2022 were followed up and reviewed retrospectively. RESULTS: The study included 41 patients, accounting for 2.14% of all jaw pathologies, with 35 patients having SBCs and 6 patients having ABCs; their average ages were 26.63 ± 13.62 years and 17.83 ± 7.88 years, respectively. The prevalence of SBC and ABC did not differ significantly by sex. The mandible was the most vulnerable area to be involved. Only 5.71% (2/35) of patients with SBCs and 16.7% (1/6) of patients with ABCs reported histories of previous trauma in the same region of the pseudocysts. A total of 42.86% (15/35) of SBC cases and 66.67% (4/6) of ABC cases had malocclusions. The radiographic features of pseudocysts varied in shape, were associated with the root, and unilocular or multilocular. All patients had curettage with or without bone graft or substitute implantation, and recurrences did not occur in 94.29% (33/35) of SBC patients and 100% (6/6) of ABC patients after a mean follow-up time of 26.23 ± 15.47 months and 21.67 ± 19.75 months, respectively. CONCLUSIONS: Pseudocysts, including SBCs and ABCs, are benign osteolytic lesions without an epithelial lining that occur occasionally in the jaw, mostly in adolescents and young adults, and their incidence did not significantly differ by sex. The most vulnerable site of involvement is the mandible, and they are generally not overtly aggressive. Trauma has a less significant role in pseudocysts, but minor trauma, such as malocclusion, has the potential to influence pseudocyst development. The clinical presentation of pseudocysts lacks specificity, and most patients are asymptomatic and found incidentally during radiographs. Dental panoramic radiographs and CBCT cannot accurately distinguish between SBC and ABC, and the final diagnosis depends on pathological diagnosis. Curettage combined with bone grafting is currently the best treatment for both, with a 5.71% (2/35) recurrence rate for SBC and no recurrence found for ABC.

Multifocal epithelial hyperplasia confined to the interdental papilla of an adult Chinese man: a rare case report and literature review.

BACKGROUND: Multifocal epithelial hyperplasia (MEH), or focal epithelial hypertension (FEH), or Heck's disease, is an uncommon, benign oral mucosal disease associated with human papillomavirus infection. It is mostly observed in indigenous populations of the world, and has been rarely reported in China. However, previous research suggested there might be a greater prevalence of MEH in the Chinese population. While predominantly involves the lips, buccal mucosa and tongue, MEH was occasionally reported to affect the hard palate and gingiva as well. CASE PRESENTATION: This paper reports a case of extensive MEH lesions that confined to the interdental papilla of a Chinese male without detection of HPV, and summarizes the published gingiva-involved MEH reports from 1966 until present. The lesions were excised with an Er: YAG laser after scaling and root planning, no recurrence was observed after 6-month follow-up. CONCLUSIONS: The present report illustrates the need for clinicians to be aware of rare presentations of MEH to facilitate a prompt diagnosis and proper management. More reports are encouraged to determine a correct prevalence rate of MEH in China.

Association between human herpes simplex virus and periodontitis: results from the continuous National Health and Nutrition Examination Survey 2009-2014.

BACKGROUND: Periodontitis is a common chronic oral disease which seriously affects people's quality of life. Although human herpes simplex virus (HSV) is also found in periodontal lesions, the association between HSV infection and periodontitis is unclear. METHODS: The National Health and Nutrition Examination Survey (NHANES) data for 2009-2010, 2011-2012 and 2013-2014 was combined, and the association between HSV infection and periodontitis in the general population and particular subgroups was investigated through weighted multi-logistic analyses. RESULTS: There were 4,733 participants aged 30-50 years old with clinically assessed periodontitis concurrent with HSV infection. In general analysis, after adjusted for covariates, both HSV-1 (OR = 1.09, P < 0.001) and HSV-2 (OR = 1.06, P = 0.030) infection was significantly associated with periodontitis. In subgroup analyses, compared with patients without HSV infection, patients with HSV-1( +) & HSV-2( +) and HSV-1( +) & HSV-2(-) infection showed higher risk of periodontitis in all subgroups (OR = 1.15, OR = 1.09, P < 0.001), while patients with HSV-1(-) & HSV-2( +) infection showed higher risk of and periodontitis only in the subgroup of people aged 40-50 years (OR = 1.10, P = 0.032) and the Mexican-American subgroup (OR = 1.35, P = 0.042). When only severe periodontitis is considered, HSV infection was associated with periodontitis, no matter the patient was infected with either of the virus or both. CONCLUSIONS: HSV-1 infection was significantly associated with periodontitis and severe periodontitis, while HSV-2 infection was associated with severe periodontitis, and periodontitis in 40-50-year-olds and Mexican-Americans.

Association of high-density lipoprotein cholesterol and periodontitis severity in Chinese elderly: a cross-sectional study.

OBJECTIVES: Periodontitis is a local inflammatory disease of high prevalence worldwide. Increasing evidence has shown its association with cardiovascular diseases. While high-density lipoprotein is an important protective factor in preventing cardiovascular diseases, this study aims to examine whether high-density lipoprotein cholesterol (HDL-C) level is associated with different status of periodontitis. MATERIALS AND METHODS: A total of 874 Chinese retirees (≥ 60 years of age) with different statuses of periodontitis were enrolled. Periodontal clinical data were collected to define periodontal disease severity (no, mild-moderate, severe). Peripheral blood was collected for serum lipid profile analysis. Linear and logistic regression analysis with adjustment for potential confounders (gender, age, BMI, alcohol intake, exercise frequency, smoking habits) were used to determine the association of periodontitis with HDL-C. RESULTS: After adjustments for confounders, linear regression analyses revealed a significant relationship between the decreased HDL-C and periodontitis severity (p < 0.05). Although the multivariable-adjusted ORs of decreased HDL-C were not statistically significant, logistic regression analyses showed Chinese elderly with severe periodontitis had higher odds of exhibiting clinically abnormal HDL-C levels than those without periodontitis. CONCLUSIONS: The elderly population with periodontitis showed HDL-C levels significantly lower than those without periodontitis. The severity of periodontitis was positively correlated with serum HDL-C levels. CLINICAL RELEVANCE: Periodontitis reduces HDL-C level in the elderly population, indicating that oral health should be paid attention to in the prevention and treatment of dyslipidemia.

Correlation between periodontitis and prostate-specific antigen levels in the elderly Chinese male population.

BACKGROUND: The comparison of prostate-specific antigen (PSA) levels among older individuals with different periodontal statuses has not been fully investigated. Here we aimed to explore the correlation between the staging and grading of periodontitis and PSA levels in an elderly Chinese male population, which may lead to a biopsy recommendation and prevent prostate cancer as early as possible. METHODS: The study included 996 individuals aged ≥ 55 years who participated in routine postretirement physical examinations. Periodontal data included probing depth and gingival recession on four sites/tooth and on two diagonal quadrants (1-3 or 2-4) while excluding third molars, and clinical attachment loss was calculated. Periodontal status was classified as none, mild-moderate or severe periodontitis according to the Centers for Disease Control and Prevention and the American Academy of Periodontology case definition. Blood samples, oral health status and sociodemographic characteristics were collected by using general and oral examinations and questionnaires. Linear and logistic regressions were used to estimate the correlation between periodontitis severity and PSA levels, respectively. RESULTS: A total of 479 men had mild-moderate periodontitis and 355 had severe periodontitis; 162 men were periodontally healthy individuals. After adjusting for potential confounders, PSA levels were significantly lower in the individuals without periodontitis than in those with mild-moderate (P = 0.04) or severe (P = 0.03) periodontitis. However, PSA levels did not significantly correlate with periodontitis severity (P = 0.06). Although the ORs of elevated PSA were not significant, individuals with PSA ≥ 4.0 ng/mL were more likely to have periodontitis. CONCLUSIONS: In a sample of an elderly Chinese male population, after adjusting for possible confounders, serum PSA levels in individuals with periodontitis were significantly higher than those in individuals without periodontitis, but serum PSA did not significantly correlate with periodontitis severity.

Hyperglycemia accelerates inflammaging in the gingival epithelium through inflammasomes activation.

BACKGROUND AND OBJECTIVE: Diabetes accelerates inflammaging in various tissue with an increase in senescent cell burden and senescence-associated secretory phenotype (SASP) secretion, which is a significant cause of tissue dysfunction and contributes to the diabetic complications. Recently, inflammasomes are thought to contribute to inflammaging. Here, utilizing diabetic models in vivo and in vitro, we investigated the potential association between hyperglycemia-induced inflammaging and gingival tissue dysfunction and the mechanism underlying inflammasome-associated inflammaging. MATERIALS AND METHODS: Gingival epithelium and serum were collected from control and diabetic patients and mice. The expression of p16, p21, and inflammasomes in the gingival epithelium, SASP factors in serum, and the molecular factors associated with gingival epithelial barrier function were assessed. Human oral keratinocyte (HOK) was stimulated with normal and high glucose, and pre-treated with Z-YVAD-FMK (Caspase-1 inhibitor) prior to evaluating cellular senescence, SASP secretion, and inflammasome activation. RESULTS: In vivo, hyperglycemia significantly elevated the local burden of senescent cells in the gingival epithelium and SASP factors in the serum and simultaneously reduced the expression levels of Claudin-1, E-cadherin, and Connexin 43 in the gingival epithelium. Interestingly, the inflammasomes were activated in the gingival epithelium. In vitro, high glucose-induced the inflammaging in HOK, and blocking inflammasome activation through inhibiting Caspase-1 and glucose-induced inflammaging. CONCLUSIONS: Hyperglycemia accelerated inflammaging in the gingival epithelium through inflammasomes activation, which is potentially affiliated with a decline in the gingival epithelial barrier function in diabetes. Inflammasomes-related inflammaging may be the crucial mechanism underlying diabetic periodontitis and represents significant opportunities for advancing prevention and treatment options.

Clinical evaluation of xenogeneic collagen matrix versus free gingival grafts for keratinized mucosa augmentation around dental implants: A randomized controlled clinical trial.

AIM: To evaluate the outcomes of an apically repositioned flap (ARF) plus xenogeneic collagen matrix (XCM) in augmenting keratinized mucosa width (KMW) around dental implants when compared with ARF plus free gingival grafts (FGG). MATERIALS AND METHODS: Twenty-six participants with at least one site with KMW ≤2 mm were randomized into FGG or XCM group. Clinical examinations were performed at baseline and at 2 and 6 months after surgery, including KMW, keratinized mucosa thickness, gingival index (GI), and probing depth (PD). Post-operative pain and patient satisfaction were also evaluated. RESULTS: At 6 months, FGG attained a greater increase of KMW and thicker mucosa than XCM (4.1 ± 1.6 mm vs. 1.8 ± 1.0 mm, p < .001; 1.7 ± 0.6 mm vs. 1.2 ± 0.3 mm, p < .01). Regarding GI, PD, post-operative pain, aesthetic outcomes, and patient satisfaction, no significant difference could be detected. Moreover, the operation time of XCM group was shorter (60 ± 9 min vs. 39 ± 8 min, p < .001). CONCLUSIONS: FGG could result in greater increase of KMW than XCM, though both could increase KMW, maintain peri-implant health, and attain comparable aesthetic outcomes. The use of XCM was associated with reduced operation time.

Retrospective study on the effectiveness of a prevention strategy in a dental hospital during the COVID-19 pandemic.

OBJECTIVES: To evaluate the effectiveness of a prevention strategy against the spread of SARS-CoV-2 infection among dental hospital staff over a 3-month period. MATERIALS AND METHODS: The effectiveness of the prevention strategy, which adopted healthcare staff protective measures, including patient triage and correct usage of personal preventive equipment, was evaluated by SARS-CoV-2 detection and serological testing. Patients who visited the Affiliated Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China, between January 31 and March 1 (lockdown period) and March 2 and April 27 (reopening period) in 2020 and in the same period in 2019 were included in the study. Patients' diagnosis, age, gender, and several undergoing aerosol-generating procedures during the study period were collected from the hospital's database. Corresponding data were compared year-on-year (2020-on-2019). A total of 757 hospital staff underwent SARS-CoV-2 detection and serological testing on April 28-29, 2020. RESULTS: During the lockdown and reopening period in 2020, the number of hospital visits was dramatically decreased to about 6% and 58%, respectively, compared with the same period in 2019. However, emergency visits were increased 16- and 6.4-fold. A total of at least 6654 patients (13.58%) underwent aerosol-generating procedures during the study period in the year 2020. All hospital staff were negative according to SARS-CoV-2 detection and serological testing (IgG, IgM) data. CONCLUSION: During the study period in 2020, the total number of hospital visits dramatically reduced but emergency visits significantly increased. The prevention strategy implemented successfully prevented SARS-CoV-2 infection spread among healthcare workers in a dental hospital. CLINICAL RELEVANCE: The prevention strategy indicated patient triage and how to adopt preventive measures for controlling SARS-CoV-2 spread among healthcare workers. These data can be used as a reference for other sectors suffering from the COVID-19 pandemic.

Oral reactive capillary hemangiomas induced by SHR-1210 in the treatment of non-small cell lung cancer: a case report and literature review.

BACKGROUND: Antibodies to PD-1 and PD-L1 have remarkably improved the overall survival of many patients with advanced solid tumors. SHR-1210 is an anti-PD-1 monoclonal antibody. Dermatologic reactive capillary hemangiomas (RCH) were the most common and unique drug-related AEs of SHR-1210, but rare on oral mucosa and gastrointestinal mucosa. Herein we report a case of RCH occurred in oral mucosa during the clinical trials of SHR-1210 in the treatment of non-small cell lung cancer. CASE PRESENTATION: A male in his 60 s with a history of non-small cell lung cancer received injection of anti-PD-1 monoclonal antibodies SHR-1210. The patient developed drug-related RCH on skin after the first injection and began to have gingival hyperplasia one year after the first injection which gradually increased in size and affect eating and speaking. Anti-PD-1 treatments were continued. After periodontal treatment, two oral lesions and one skin lesion were surgically removed. Similar histological manifestation was found in all three lesions as reactive capillary hemangiomas. All lesions had a good prognosis without recurrence on oral mucosa within one year after surgery. CONCLUSIONS: Oral reactive capillary hemangiomas could be induced by SHR-1210 in the treatment of non-small cell lung cancer. Surgical resection is an effective treatment with a good prognosis.

Management of burning mouth Syndrome: A position paper of the Chinese Society of Oral Medicine.

BACKGROUND: Burning mouth syndrome is a syndrome with tongue as the main affected site and burning pain as the main complaint. Although a variety of therapies have been reported to treat BMS, there is a lack of widely recognized therapies and it is still a dilemma for clinicians to treat BMS. OBJECTIVE: To develop the position paper and provide the references for clinical practice of BMS in China. METHODS: Under the guidance of WHO (World Health Organization) Handbook for Guideline Development, we used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach as a tool to develop this position paper in the following steps: setting up the groups, formulating the clinical questions and choosing the outcomes, retrieving and synthesizing of evidence, assessing the evidence, investigating the patients' values and preferences, developing the recommendations, reviewing the recommendations, and writing the position paper. RESULTS: The 27 recommendations were formed from the following 7 aspects: pre-treatment examination, removal of stimuli, medication, physical therapy, psychological therapy, and antipsychotics. There are 3 strong recommendations and 12 weak recommendations in pre-treatment examination and removal of stimuli, as well as 12 weak recommendations in therapies. CONCLUSION: The Chinese position paper for management of BMS has been developed, which could provide the references for clinical practice of BMS in China. Twenty-seven recommendations were formed based on consensus of experts on the balance of benefits vs side effects, evidence, cost, and patients' values and preferences, although the quality of evidence is relatively low.

Traumatic occlusion aggravates bone loss during periodontitis and activates Hippo-YAP pathway.

AIM: This study aimed at exploring changes in YAP expression and their effect on periodontitis (PD) combined with traumatic occlusion (TO). MATERIALS AND METHODS: BALB/cJ mice were used to establish a PD model by local administration of Porphyromonas gingivalis (P.g, ATCC 33277) and a TO model by occlusal elevation (OE) using composite resin bonding on the bilateral maxillary molar. The mouse fibroblast cell line (L929) and pre-osteoblast cell line (MC3T3-E1) were subjected to cyclic tensile/compressive stress and inflammatory stimuli (lipopolysaccharide from Escherichia coli) to verify in vivo results. RESULTS: Severe bone resorption was observed by microCT scanning in OE with P.g group, when compared to OE only and P.g only groups. Mechanical stress caused by OE activated the Hippo-YAP pathway in periodontal tissues and upregulated the expression of JNK/AP-1. OE with P.g further promoted the expression of YAP and JNK/AP1, leading to the upregulation of the JNK/AP-1 related inflammatory cytokines TNF-α and IL6. Similar results were obtained when osteoblasts were subjected to mechanical stress in vitro. CONCLUSIONS: Our study demonstrated that periodontitis with TO caused severe inflammation-induced bone resorption. Activation of YAP and upregulation of JNK/AP-1 induced by TO potentially aggravated the symptoms of PD.

Genetic Etiology in Nonsyndromic Mandibular Prognathism.

Mandibular prognathism (MP) is considered to be a cranial-facial disorder resulting from the interaction between genes and environment. Recent studies have demonstrated that susceptible chromosomal regions and candidate genes may be responsible for MP. In this study, the authors present current views on the effect of genetic components in nonsystematic mandibular prognathism, in order to clarify the genetic etiology of MP. Data source were Electronic databases, manual searching, and reference lists checking, up to April 2016. Study selection, level of evidence assessment, and data extraction were done by 2 individuals in duplicate. Ninety-one studies were retrieved in initial electronic and manual search, and based on the established inclusion and exclusion criteria, 15 were selected for the review. In result, loci 1p36, 1q32.2, 1p22.3, 4p16.1, 6q25, 19p13, 14q24.3, 14q31.1, and 14q31.2 were thought to harbor genes that confer susceptibility to MP. Genes Matrilin-1, ADAMTS1, COL2A1, and EPB41 seemed to be strongly associated with MP while gene of growth hormone receptor was in dispute. Genetic components appeared to be associated with MP. However, in view of the variety of populations and results in related publications, further studies are necessary to clarify the genetic etiology of MP.

Combined Bimaxillary Distraction Osteogenesis Associated with Orthognathic Surgery for Hemifacial Microsomia in Adults.

BACKGROUND: Hemifacial microsomia (HFM) is one of the most common congenital craniofacial asymmetries. Distraction osteogenesis (DO) is always recommended as an effective option for the treatment of HFM, but some studies showed that the asymmetry remained after DO. In comparison with DO, stable clinical outcomes could be achieved by orthognathic surgery approach as well. However, soft tissue expansion cannot be performed. In this study, we aim to assess the radiographic and clinical results of bimaxillary DO associated with staged orthognathic surgery in the treatment of craniofacial asymmetry for adult HFM patients. METHODS: Twelve HFM patients who had been treated with bimaxillary DO and secondary orthognathic surgery between 2006 and 2013 were included in this study. Bimaxillary DO and staged orthognathic surgery were performed according to the particular condition. Clinical and cephalometric photographs were carried out pre- and postoperatively to evaluate the outcomes. RESULTS: No significant complications occurred postoperatively. Excellent cosmetic outcomes such as notable improvement in facial pattern and occlusion were achieved. Cephalometrically, the height ratios of the affected/unaffected ramus were improved by 23.81% on average, and the photographic analysis demonstrated a rotation of the chin point toward the mid-line. Moreover, the occlusal cant was corrected from the slant to level by 8.95° on average. CONCLUSION: The application of bimaxillary DO associated with staged orthognathic surgery in correcting the asymmetry of adult patients with HFM could have satisfactory aesthetic results, and it should be considered an alternative option for these patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Treatment of Dentofacial Deformities Secondary to Osteochondroma of the Mandibular Condyle Using Virtual Surgical Planning and 3-Dimensional Printed Surgical Templates.

PURPOSE: One-stage treatment for condylar osteochondroma and secondary facial deformities by resection and reconstruction of the mandibular condyle, orthognathic surgery, and mandibular contouring has been reported recently. This study investigated the clinical feasibility of treating osteochondroma of the mandibular condyle and secondary dento-maxillofacial deformities by virtual surgical planning and 3-dimensional (3D) printed surgical templates. MATERIALS AND METHODS: A composite skull model with accurate dentition was obtained with data from spiral computed tomography (CT) and surface scanning of the dental arch. Virtual surgical simulation was performed using Dolphin Imaging 11.7 Premium and Mimics software after a comprehensive 3D diagnosis and surgery planning. Surgical templates were fabricated by 3D printing using data from virtual surgical simulation for guidance of excision of the mandibular condyle with osteochondroma, reconstruction of the mandibular condyle, mandibular contouring, and reconstruction of a normal occlusion. Le Fort I osteotomy of the upper jaw and genioplasty were performed when indicated. The linear difference between virtually simulated and postoperative skull models was evaluated. RESULTS: All surgeries were successfully simulated using virtual surgical planning, and the guiding templates were successfully applied for all patients. Successful reconstruction of condylar function, normal occlusion, and symmetry of the facial profile was achieved. Postoperative CT scans and quantitative analysis showed that virtual surgical plans provided acceptable accuracy in the operating room. The linear difference of the incisors and first molars was no more than 1.4 mm, and the greatest difference was found for the menton landmark, which was up to 2.4 mm. CONCLUSIONS: Results from this study suggested that virtual surgical planning and guiding templates facilitated accurate diagnosis, treatment planning, accurate osteotomy, repositioning of bony segments, and contouring of the mandibular border in the treatment of condylar osteochondroma and secondary facial asymmetry.