Partial Component-Retained 2-Stage Reconstruction in the Treatment of Infected Hip Arthroplasty.

BACKGROUND: It is considered the gold standard treatment for infected hip arthroplasty to remove and reimplant the corresponding whole set of implant components before and after infection control, but it usually causes substantial bone loss to remove the well-fixed cup or stem, which may increase the difficulty in reconstruction. We would like to determine whether infected hip arthroplasty can be treated without removal of a well-fixed cup or stem. METHODS: Patients with infected hip arthroplasty and a radiographically well-fixed, cementless cup or stem were selected. During the first surgical stage, we retained the stem or cup if these cannot be removed using a stem or cup extractor. We performed the reimplantation surgery after control of infection. RESULTS: From January 2008 to December 2016, 26 patients underwent partial component-retained 2-stage reconstruction. All the patients were free of infection with a mean follow-up time of 43.85 months. CONCLUSION: Partial component-retained 2-stage reconstruction may be a treatment option for infected total hip arthroplasty with a well-fixed component in patients.

Alcohol consumption and risk of periodontitis: a meta-analysis.

AIM: A meta-analysis was conducted to quantitatively summarize the evidence from observational studies on alcohol consumption and risk of periodontitis. MATERIAL AND METHODS: A comprehensive literature search was performed in PubMed, Web of Science and Embase databases to identify eligible studies published in English. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated by random-effects models. Restricted cubic splines were used to assess the dose-response relationship. RESULTS: Eighteen studies were included in our meta-analysis. The pooled RR of periodontitis for the highest with the lowest alcohol consumption was 1.59 (95% CI: 1.37-1.85). Significant associations were also found in stratified analysis by gender [males: (1.25, 95% CI: 1.11-1.41), females (2.15, 95% CI: 1.36-3.41)] and study design [cohort studies: 1.28 (1.04-1.57) and cross-sectional studies: 1.66 (1.39-1.99)]. A linear dose-response relationship was found between alcohol consumption and periodontitis risk, and the risk of periodontitis increased by 0.4% [95% CI (1.002-1.007) (p = 0.002)] for each 1 g/day increment in alcohol consumption. CONCLUSION: This meta-analysis suggested that alcohol consumption was associated with an increased risk of periodontitis.

Bilaterally primary cementless total hip arthroplasty in patients with ankylosing spondylitis.

BACKGROUND: The purpose of this study was to document the clinical and radiographic results of a consecutive series of patients with ankylosing spondylitis (AS) who had undergone bilaterally primary THA using non-cemented components. METHODS: Twenty-six hips of 13 patients with bilateral ankylosis of the hip caused by AS were converted to THA from January 2000 to January 2008. The mean age of the patients was 33.7 years (range, 22-57 years). There were 11 males and 2 females. All the patients had bilateral bony ankylosis with 0° range of motion. The average Harris Hip Scores (HSS) was 22.1 (10-38). RESULTS: At a mean follow-up of 128.4 months, the mean HSS at the latest follow-up examination was 91.7 points (range, 75-98 points). All the patients reported marked relief of painful symptoms. Three (11.5%) of the 26 hips were outside the Lewinnek acetabular cup inclination safe range, and 5 (19.2%) of the 26 hips were outside the Lewinnek acetabular cup anteversion safe range. The probability of survival of the prostheses was 100% at 5 years and 92.3% at 10 years, but it dropped sharply to 73.1% at 13 years. CONCLUSION: Cementless THA is a worthwhile treatment for the osseous ankylosed hip joint caused by AS. Newfound mobility, maneuverability, and improved ability to sit comfortably were the outcomes that alleviated the patients' daunted morale. However, the technically demanding nature of the procedure should not be underestimated.

Fabrication of Bioresorbable Barrier Membranes from Gelatin/Poly(4-Hydroxybutyrate) (P4HB).

Dental implant surgery is a procedure that replaces damaged or missing teeth with an artificial implant. During this procedure, guided bone regeneration (GBR) membranes are commonly used to inhibit the migration of epithelium and GBR at the surgical sites. Due to its biodegradability, good biocompatibility, and unique biological properties, gelatin (GT) is considered a suitable candidate for guiding periodontal tissue regeneration. However, GT-based membranes come with limitations, such as poor mechanical strength and mismatched degradation rates. To confront this challenge, a series of GT/poly(4-hydroxybutyrate) (P4HB) composite membranes are fabricated through electrospinning technology. The morphology, composition, wetting properties, mechanical properties, biocompatibility, and in vivo biodegradability of the as-prepared composite membranes are carefully characterized. The results demonstrate that all the membranes present excellent biocompatibility. Moreover, the in vivo degradation rate of the membranes can be manipulated by changing the ratio of GT and P4HB. The results indicate that the optimized GT/P4HB membranes with a high P4HB content (75%) may be suitable for periodontal tissue engineering because of their good mechanical properties and biodegradation rate compatible with tissue growth.

Poly(Lysine)-Derived Carbon Quantum Dots Conquer Enterococcus faecalis Biofilm-Induced Persistent Endodontic Infections.

Introduction: Persistent endodontic infections (PEIs) mediated by bacterial biofilm mainly cause persistent periapical inflammation, resulting in recurrent periapical abscesses and progressive bone destruction. However, conventional root canal disinfectants are highly damaging to the tooth and periodontal tissue and ineffective in treating persistent root canal infections. Antimicrobial materials that are biocompatible with apical tissues and can eliminate PEIs-associated bacteria are urgently needed. Methods: Here, ε-poly (L-lysine) derived carbon quantum dots (PL-CQDs) are fabricated using pyrolysis to remove PEIs-associated bacterial biofilms. Results: Due to their ultra-small size, high positive charge, and active reactive oxygen species (ROS) generation capacity, PL-CQDs exhibit highly effective antibacterial activity against Enterococcus faecalis (E. faecalis), which is greatly dependent on PL-CQDs concentrations. 100 µg/mL PL-CQDs could kill E. faecalis in 5 min. Importantly, PL-CQDs effectively achieved a reduction of biofilms in the isolated teeth model, disrupting the dense structure of biofilms. PL-CQDs have acceptable cytocompatibility and hemocompatibility in vitro and good biosafety in vivo. Discussion: Thus, PL-CQDs provide a new strategy for treating E. faecalis-associated PEIs.

Lidocaine-Loaded Hyaluronic Acid Adhesive Microneedle Patch for Oral Mucosal Topical Anesthesia.

The pain and fear caused by direct local injection of anesthetic or the poor experience with surface anesthetic cream increase the difficulty of clinical treatment for oral diseases. To address this problem, a hyaluronic acid microneedle patch (Li-HAMNs) that consists of fast-dissolving lidocaine hydrochloride (LDC)-loaded tips and a wet-adhesive backing layer made of polyvinyl alcohol (PVA)/carboxymethylcellulose sodium (CMC-Na) was fabricated to explore its potential use in dental topical anesthesia. Li-HAMNs could puncture the stratum corneum with an insertion depth of about 279 µm in the isolated porcine oral mucosal. The fast-dissolving tips could release LDC to improve the patients' convenience and compliance. Importantly, the backing layer, which has good adhesion ability and water-absorbing properties, could surmount the contraction and extension of oral masticatory muscles and the saliva scour. In the tail flick test, the topical anesthesia efficacy of the Li-HAMNs group was much better than clinical lidocaine cream (EMLA cream, LDC, 1.2 mg) in spite of a relatively lower LDC dose with Li-HAMNs (LDC, 0.5 mg). It is believed that the proposed adhesive microneedle patch could enhance transmucosal delivery of anesthetics and thus open a new chapter in the painless treatment of oral diseases.

Engineering Electrospun Nanofibers for the Treatment of Oral Diseases.

With the increase of consumption of high-sugar foods, beverages, tobacco, and alcohol, the incidence rate of oral diseases has been increasing year by year. Statistics showed that the prevalence of oral diseases such as dental caries, dental pulpal disease, and periodontal disease has reached as high as 97% in 2015 in China. It is thus urgent to develop functional materials or products for the treatment of oral diseases. Electrospinning has been a widely used technology that is capable of utilizing polymer solution to generate micro/nano fibers under an appropriate high voltage condition. Owing to their excellent structures and biological performances, materials prepared by electrospinning technology have been used for a wide range of oral-related applications, such as tissue restoration, controlled drug release, anti-cancer, etc. In this regard, this article reviews the application and progress of electrospun nanofibers to various oral diseases in recent years. Firstly, engineering strategies of a variety of nanofiber structures together with their resultant functions will be introduced. Then, biological functions of electrospun nanofibers as well as their applications in the treatment of oral diseases are summarized and demonstrated. Finally, the development viewpoint of functional nanofibers is prospected, which is expected to lay the foundation and propose the direction for further clinical application.

The prevalence of fimA genotypes of Porphyromonas gingivalis in patients with chronic periodontitis: A meta-analysis.

FimA is an important virulence factor of Porphyromonas gingivalis (P. gingivalis). According to its DNA sequence, the fimA genotype of P. gingivalis can be divided into six categories (I, Ib, Ⅱ, III, IV, V). The fimA gene may be a key factor in the diversity of virulence found in P. gingivalis. Moreover, the role fimA plays in the pathogenesis of P. gingivalis is closely associated with periodontitis, making it an important factor of study for disease prevention and treatment. In this study, the prevalence of fimA genotypes of P. gingivalis in patients with periodontal diseases was evaluated by meta-analysis. The Embase and PubMed databases were searched for articles from 1999 to 2019 using the following search terms: Porphyromonas gingivalis or P. gingivalis; periodontitis or chronic periodontal disease; fimA or fimA genotype. The reference lists of relevant published articles were searched manually. A total of 17 studies were included in this report. A statistical software package (Stata, version 11.0/mp, StataCorp) was utilized to calculate and analyze the P. gingivalis fimA genotypes for each combined incidence estimate. The pooled rates of fimA Ⅰ, fimA Ib, fimA Ⅱ, fimA Ⅲ, fimA Ⅳ and fimA Ⅴ genotypes of P. gingivalis were 8.4% (95% CI: 5.7-11.1), 11.7% (95% CI: 7.4-16), 42.9% (95% CI: 34.2-51.7), 6.5% (95% CI: 5.1-7.9), 17.8% (95% CI: 9.0-26.5), and 3.2% (95% CI: 1.6-4.9), respectively. This study showed that the fimA Ⅱ and fimA Ⅳ genotypes of P. gingivalis are highly present in patients with periodontal disease. Therefore, these two genotypes may be related to the pathogenesis and progress of periodontal disease, one of the main risk factors of periodontitis.

Study on the Role of Salivary Flora and NF-κB Inflammatory Signal Pathway in Oral Lichen Planus.

Oral lichen planus (OLP) is an inflammatory disease. It is believed that infection and immune dysfunction play a key role in its pathogenesis, but the specific mechanism of action remains unclear. The 16s rRNA high-throughput sequencing technique was used to analyze the microbial flora structure in the saliva of OLP patients and healthy controls. The relative abundance of Derxia, Haemophilus, and Pseudomonas in the saliva of the OLP group was lower than that of the healthy control group, but there was no significant difference in the overall structure of the microbial population. In addition, we measured the protein expression levels of toll-like receptor 4 (TLR4) and nuclear factor-kappab p65 (NF-κB p65) in the tissues of OLP patients, and found that there was a significant increase and positive correlation between them (r = 0.907, P = 0.034). The expression levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in the OLP group were consistent with those of NF-κB p65. Therefore, we believe that changes in the composition ratio of microbialflora break the original balance state of flora, promote the occurrence of immune inflammatory reaction, and then lead to the generation or aggravation of OLP disease. This discovery provides new ideas for further research on OLP initiation and immune regulation mechanism.

[Reconstruction of femoral defects with particulate bone grafting in revision total hip arthroplasty].

OBJECTIVE: To explore the clinical effect of particulate bone grafting on reconstruction of femoral defects in revision total hip arthroplasty. METHODS: Fifteen patients (20 hips) with femoral defects were treated by revision total hips arthroplasty with particulate bone grafting. After the operations, 14 patients (19 hips) were evaluated by X-rays and the Harris score. RESULTS: During a follow-up of 43.6 months (11 approximately 65 months), 17 hips (89.5%) were cured, without obvious bone absorption or prosthesis sinking. Harris scores improved from 34.18 pre-operation to 86.6 post-operation. CONCLUSION: Reconstruction of femoral defects with particulate bone grafting is an effective method for bone defects in revision total hip arthroplasty.

[Long-term effect of intruded upper molars and dental implant restoration in 24 patients].

PURPOSE: To evaluate the long-term effectiveness of intruded upper molar with orthodontic mini-screw and the long-term stability of the lower molar restored with dental implant. METHODS: Twenty-four patients with excessive growing upper molar were chosen. The upper molars were intruded by orthodontic mini-screw to increase the bite distance, and then restored with dental implant. The height of molar and the height of bone around the implant were measured on the lateral cephalometric films and panoramic films to analyze the long-term effect of molar intrusion and implantation. The data were analyzed with SPSS18.0 software package. RESULTS: There was significant difference between the length of upper molar before and after intrusion, the upper molars were intruded (2.7±0.3)mm 3.5 months after orthodontic mini-screw; there was no significant difference after 1 year with retainer and implant restoration. The height of bone around the implant decreased 1.2 mm but without significant difference. CONCLUSIONS: With the upper molar intruded by orthodontic mini-screw , more bite space can be obtained to restore lower molar with dental implant, and the long-term effect of upper molar intrusion and lower molar implant are stable.

Orofacial granulomatosis: A case report of three cases may be caused by apical periodontitis.

RATIONALE: Orofacial granulomatosis (OFG) is a rare disease characterized by noncaseating granulomatous inflammation. The most common clinical presentation is persistent swelling of the soft tissues in the oral and maxillofacial regions. The precise cause of OFG is unknown. Corticosteroids are the first-line and best treatment, but there is lack of uniform treatment prescription and standard. It is important to identify the pathogen in order to improve treatment specificity. PATIENT CONCERNS: Three patients presented with recurring lip swelling and cobblestone formation on buccal mucosa, complained of toothache or dental caries for many years. They had very similar and characteristic clinical signs, especially the corresponding location with infected teeth, which suffered from apical periodontitis. DIAGNOSES: The three patients were all diagnosed with typical clinical signs and non-caseating epithelioid cell granulomas histologically. INTERVENTIONS: The teeth with apical periodontitis were extracted or treated and corticosteroids were prescribed locally or/and systematically. OUTCOMES: A complete resolution of lip swelling and cobblestone formation were shown after treatment. LESSONS: This is the first report to highlight that apical periodontitis may intrigue the pathogenesis of OFG, which suggested that dental infection may be the direct and initial etiology of OFG. Removal of infected teeth should be performed as soon as possible in order to reduce the dosage of corticosteroids and occcurence rate of OFG.

Hydroxyapatite/tricalcium phosphate matrix scaffold as cell carriers in vitro.

OBJECTIVE: To explore the possibility of hydroxyapatite/tricalcium phosphate (HA/TCP) matrix scaffold as cell carriers in tissue engineering, and to provide a direct evidence for the resurfacing of matrix scaffold. METHODS: Human bone marrow stromal cells (hBMSCs) and umbilical vein endothelial cells (UVECs) were co-cultured on the surface of matrix scaffold. The morphologic characters during culture on HA/TCP matrix scaffold's surfaces were checked by light microscope, fluorescence microscope, and scanning electronic microscope. RESULTS: Both human bone marrow stromal cells and human umbilical vein endothelial cells showed good biocompatibility with HA/TCP matrix scaffold. The cell growth into the micropore of HA/TCP matrix scaffold could be seen under both fluorescence microscopy and scaning electron microscopy. CONCLUSION: HA/TCP matrix scaffold can be used as a vehicle for the cell transplantation.

Distribution of amelotin in mouse tooth development.

Amelotin is expressed and secreted by ameloblasts in tooth development, but amelotin distribution during enamel development is not clear. In this report, we first investigated amelotin expression in developing teeth by immunohistochemistry. Amelotin was detected in the enamel matrix at the secretion and maturation stages of enamel development. Amelotin was also observed at Tomes' processes on the apical ends of secretory ameloblasts. We then compared amelotin gene expression with those of amelogenin, enamelin, and ameloblastin in the mandibles of postnatal mice by RT-PCR. The expression of amelotin was detected as early as in postnatal day 0 mandibles and amelotin was coexpressed with amelogenin, ameloblastin, and enamelin during tooth development. These data strongly suggest that amelotin is an enamel matrix protein expressed at the secretion and maturation stages of enamel development.