Interdisciplinary treatment of a mutilated dentition with multiple missing teeth and horizontal impaction of a mandibular third molar using an orthodontic skeletal anchorage and dental implants-Case report.

OBJECTIVE: This case report presents a female adult patient who exhibits poor oral hygiene, a mutilated dentition with multiple missing teeth, and skeletal asymmetry. CLINICAL CONSIDERATIONS: Interdisciplinary treatment was necessary to maintain oral hygiene, treat caries, extract residual roots, and upright a horizontally impacted third molar using a miniplate. Additionally, orthodontic mini-implants were utilized as anchorage to improve sagittal relationship and space closing. Space management was completed with orthodontic treatment, followed by restoration of the multiple missing teeth with dental implants. CONCLUSION: Consequently, an esthetic smile and functional occlusion were achieved by interdisciplinary treatment using orthodontic skeletal anchorage devices and dental implants. CLINICAL SIGNIFICANCE: Missing mandibular first molar spaces were closed with retraction of the anterior teeth and protraction of the mandibular second molars using orthodontic mini-implants. The mandibular right third molar, which should have erupted, was protracted with the second molar, while the horizontally impacted mandibular left third molar was uprighted using a miniplate and was protracted with an orthodontic mini-implant. The missing maxillary lateral incisors were replaced with the maxillary canines, and the maxillary canines were replaced with the maxillary first premolars. The missing maxillary right second premolar and first molar and left first and second molars were successfully restored with dental implants.

Maxillary Sinus Augmentation With Calcium Phosphate Double-Coated Anorganic Bovine Bone: Comparative Multicenter Randomized Clinical Trial With Histological and Radiographic Evaluation.

PURPOSE: The purpose of this study was to evaluate the clinical, histological and radiographic outcomes of the calcium phosphate double-coated anorganic bovine bone (InduCera; Oscotec Inc., Seongnam, Gyeonggi, Republic of Korea) compared with that of anorganic bovine bone (Bio-Oss; Geistlich Biomaterials, Wolhusen, Switzerland) in maxillary sinus augmentation, prospectively. PATIENTS AND METHODS: Twenty-eight sinuses in 25 patients (3 bilateral) with vertical alveolar bone height from 2 to 5 mm were included in this study. The maxillary sinus was augmented with InduCera or Bio-Oss, followed by a healing period of 6 months. Trephine cores were obtained for histomorphometric evaluation with the implant placement. Cone-beam computed tomography (CBCT) scans were taken at 1 week and 6 months after sinus augmentation. RESULTS: The graft sites were healed without any notable complications in both groups. In histomorphometric analysis, the area of the newly formed bone was measured as 21.37 ± 8.87% for InduCera and 23.02 ± 5.88% for Bio-Oss, with no significant differences. Radiographically, no statistically significant differences were calculated between the groups in bone height at baseline, the height of bone augmentation, the final alveolar bone height (alveolar bone height + augmented height) after 6 months in panoramic radiograph. There were also no significant differences in the shrinkage rate of the grafted area volume in CBCT. CONCLUSION: Although calcium phosphate double-coated anorganic bovine bone showed no additional effect compared with anorganic bovine bone from a histological and radiographical point of view, it could be used as the bone graft material in maxillary sinus augmentation.

Effectiveness of Low-Level Laser Therapy with a 915 Nm Wavelength Diode Laser on the Healing of Intraoral Mucosal Wound: An Animal Study and a Double-Blind Randomized Clinical Trial.

Background and objectives: Diode laser has been the most popular low-level laser therapy (LLLT) technique in dentistry due to its good tissue penetration, lower financial costs, small size for portable application, and convenience to use. A series of recent studies with 940 nm or 980 nm lasers demonstrated that LLLT showed positive effects after third molar extraction or periodontal flap surgery. However, the effects of LLLT on intraoral mucosal wound healing after surgical incision have not yet been determined in human clinical study. Materials and Methods: The present study was performed to determine the efficacy and safety of 915 nm wavelength low-level laser therapy (LLLT) in mucosal wound healing. A total of 108 Sprague-Dawley rats were used. They were divided into three groups: Abrasive wound group, immediate LLLT once group, and daily LLLT group. As a clinical study, a total of 16 patients with split-mouth design subjected to bilateral mandibular third molar extraction were allocated into the LLLT group and placebo group. The process of LLLT was performed on postoperative days 0, 1, and 7, and parameters related to wound healing were analyzed on days 1, 7, and 14. Results: Repeated laser irradiation promoted mucosal wound healing of the rats. In the clinical study, although there were no significant statistical differences between the LLLT and placebo groups in all inflammatory parameters, the early stage mucosal healing tendency of wound dehiscence was higher in the LLLT group than in the placebo group clinically on postoperative day 1. Conclusions: The present results showed that 915 nm LLLT could be applied safely as an auxiliary therapy for mucosal wound healing.

Autogenous demineralized dentin matrix from extracted tooth for the augmentation of alveolar bone defect: a prospective randomized clinical trial in comparison with anorganic bovine bone.

OBJECTIVES: The aim of this study was to prospectively evaluate the clinical efficacy and histological outcome of the autogenous tooth graft material (AutoBT) compared to that of anorganic bovine bone (Bio-Oss® , Geistlich, Switzerland) in post-extraction alveolar bone augmentation. PATIENTS AND METHODS: A total of 33 graft sites in 24 patients were included in this study. AutoBT was used in 21 sites of 15 patients and Bio-Oss® was used in 12 sites of 9 patients for alveolar bone augmentation 2-4 weeks after dental extraction. Vertical dimension of grafted bone was measured both at the time of graft placement and at implant fixture placement after 6 months. Trephine cores were harvested for the histomorphometric evaluations during implant placement when feasible. The primary stability of implant fixture was also measured. RESULTS: Infection of graft material or graft bed was not observed and graft sites healed without any notable complications in both groups. The vertical dimensions of alveolar bone increased by 5.38 ± 2.65 mm in AutoBT group and 6.56 ± 3.54 mm in Bio-Oss® group at 6 months post-extraction. Histomorphometrically, new bone formation of AutoBT-grafted site was 31.24 ± 13.87% while that of Bio-Oss® was 35.00 ± 19.33%. The implant stability quotient (ISQ) of implants placed in AutoBT-grafted sites measured 72.80 ± 10.81 while those placed in Bio-Oss® -grafted sites measured 70.0 ± 12.86. There were no statistically significant differences between measurements of the two groups. CONCLUSION: Autogenous demineralized dentin matrix from extracted tooth grafted to extraction sockets for the augmentation of vertical dimension was as effective as augmentation using anorganic bovine bone. Both groups showed favorable wound healing, similar amount of implant stability, and histologically confirmed new bone formation. Thus, the results of this study suggest that autogenous tooth graft material is a viable option for alveolar bone augmentation following dental extraction.

Clinical outcomes of magnesium-incorporated oxidised implants: a randomised double-blind clinical trial.

OBJECTIVES: This study evaluated implant stability and clinical outcomes obtained with magnesium-incorporated oxidised implants (Mg titanate) and compared them to those blasted magnesium-incorporated oxidised implants (blasted Mg titanate). PATIENTS AND METHODS: Mg titanate was manufactured using the microarc oxidation (MAO) process. To obtain blasted Mg titanate, the MAO process was performed after blasting with TiO2 particles. The 15-month, randomised, double -blind clinical trial was conducted on 54 implants in 40 patients (Mg titanate, 27 implants in 18 subjects; blasted Mg titanate, 27 implants in 22 subjects), in whom 4.0 mm × 10 mm implants were placed to restore the unilateral loss of one or two molars in the mandible. The final prosthesis was attached 3 months postoperatively. Implant stability was measured by the implant stability quotient (ISQ) and periotest value (PTV) at the time of implant insertion, and 2, 3, and 15 months postoperatively. Marginal bone loss was evaluated at 2, 6, and 15 months postoperatively. Soft tissue analysis was performed at 15 months postoperatively. RESULTS: Both implant systems showed high stability at all time points (>71). Mean marginal bone loss was 0.71 ± 0.65 mm and 0.75 ± 0.73 after 15 months in Mg titanate and blasted Mg titanate, respectively. There were no significant differences between the two implant surfaces with respect to ISQ(P = 0.988), PTV(P = 0.935), and marginal bone loss(P = 0.807) after 15 months. CONCLUSION: The success rate after 1 year of follow-up was 100% for both magnesium-incorporated oxidised implants. There were no significant differences in the clinical outcomes between the two surfaces at 15 months follow-up.

Biomechanical evaluation of magnesium-based resorbable metallic screw system in a bilateral sagittal split ramus osteotomy model using three-dimensional finite element analysis.

PURPOSE: The aim of this study was to evaluate the stress distribution of a magnesium (Mg)-based resorbable screw system in a bilateral sagittal split ramus osteotomy (BSSO) and to compare its biomechanical stability with those of titanium (Ti)-based and polymer (IN)-based systems. MATERIALS AND METHODS: A 3-dimensional BSSO model (10-mm advancement and setback) was constructed with Mimics. Bicortical screw fixation using Ti, IN, and Mg screws was performed with 4 different geometries of fixation. With an occlusal load of 132 N on the lower first molar, the von Mises stress (VMS) distribution was calculated using ANSYS. RESULTS: The VMS distribution of Mg was more similar to that of Ti than to that of IN. In all cases, the highest VMS was concentrated on the screw at the most posterior and superior area. Stress was distributed mainly around the screw holes (cancellous bone) and the retromolar area (cortical bone). In the advancement surgery, fixation with 5 Mg screws (5A-Mg, 99.810 MPa at cortical bone) showed biomechanical stability, whereas fixation with the same number of IN screws did not (5A-IN, 109.021 MPa at cortical bone). In the setback surgery, although the maximum VMSs at cortical bone for Mg, IN, and Ti were lower than 108 MPa (yield strength of cortical bone), Mg screws showed more favorable results than IN screws because the maximum VMSs of Mg at cancellous bone were lower than those of IN. CONCLUSION: The Mg-based resorbable screw system is a promising alternative to the IN-based system.

Long-Term Outcomes of Implants Placed in Autogenous Onlay Bone Grafts Harvested from Mandibular Ramus and Risk Analysis.

PURPOSE: This study evaluated the long-term survival and success rates of dental implants placed with autogenous onlay block bone grafts harvested from the mandibular ramus. MATERIALS AND METHODS: Patients treated with onlay bone graft from the mandibular ramus due to a severe vertical alveolar defect from 2001 to 2017 were included in this study. The marginal bone loss, success, and survival time of the implants were recorded and analyzed with clinical factors, such as time from bone graft to implant placement, type of implant prosthesis connection, history of periodontitis, and insertion depth. RESULTS: Seventy-five implants in 40 onlay bone-grafted areas of 38 patients were included, with a mean follow-up period of 102 months (range: 14 to 192 months). Two grafts were removed before implant placement. Of the 75 implants, 11 implants were lost. History of periodontitis and marginal bone loss at 6 months after implant placement were significantly associated with implant success. The receiver operating characteristic curve showed that a marginal bone loss of 0.75 mm after 6 months of implant placement was related to implant success, with a sensitivity of 72.2% and specificity of 89.6%. CONCLUSION: Implants placed with onlay bone graft from ramal bone had more frequent biologic complications, and failures may be predicted by measuring the amount of implant bone loss after 6 months of placement.

Enhanced osteogenic differentiation of human mesenchymal stem cells on Ti surfaces with electrochemical nanopattern formation.

Titanium (Ti) and its alloys are mainly used for dental and orthopedic applications due to their excellent biocompatibility and mechanical properties. However, their intrinsic bioinertness often quotes as a common complaint for biomedical applications. Herein, we produced nanopattern Ti surfaces with 10 nm nanopores in 120 nm dimples by electrochemical nanopattern formation (ENF), and evaluated the osteogenic differentiation of human mesenchymal stem cells (hMSCs) on the nanopattern Ti surfaces. The ENF surfaces were obtained by removing the TiO2 nanotube (NT) layers prepared by an anodization process. To determine the in vitro effects of the ENF surface, cell proliferation assay, alkaline phosphatase activity assay, alizarin red staining, western blotting, and immunocytochemistry were performed. Atomic force microscopy and scanning electron microscopy analysis show that the ENF surface has an ultrafine surface roughness with highly aligned nanoporous morphology. hMSCs on ENF surfaces exhibit increased proliferation and enhanced osteogenic differentiation as compared to the ordered TiO2 nanotubular and compact TiO2 surfaces. Surface modification with the ENF process is a promising technique for fabricating osteointegrative implant materials with a highly bioactive, rigid and purified nano surfaces.

Long-term follow-up of autogenous tooth bone graft blocks with dental implants.

Demineralized dentin matrix block (ABTB: Autogenous Tooth Bone Graft Block) is 3-D scaffold with same components and geometry with alveolar bone. ABTB is well incorporated and remodelled into cortico-cancellous bone with dental implant. The shape and volume were maintained with little marginal bone loss after average 44 months of follow-up.

Recombinant human fibroblast growth factor-2 promotes nerve regeneration and functional recovery after mental nerve crush injury.

Several studies have shown that fibroblast growth factor-2 (FGF2) can directly affect axon regeneration after peripheral nerve damage. In this study, we performed sensory tests and histological analyses to study the effect of recombinant human FGF-2 (rhFGF2) treatment on damaged mental nerves. The mental nerves of 6-week-old male Sprague-Dawley rats were crush-injured for 1 minute and then treated with 10 or 50 µg/mL rhFGF2 or PBS in crush injury area with a mini Osmotic pump. Sensory test using von Frey filaments at 1 week revealed the presence of sensory degeneration based on decreased gap score and increased difference score. However, at 2 weeks, the gap score and difference score were significantly rebounded in the mental nerve crush group treated with 10 µg/mL rhFGF2. Interestingly, treatment with 10 µg/mL rhFGF had a more obviously positive effect on the gap score than treatment with 50 µg/mL rhFGF2. In addition, retrograde neuronal tracing with Dil revealed a significant increase in nerve regeneration in the trigeminal ganglion at 2 and 4 weeks in the rhFGF2 groups (10 µg/mL and 50 µg/mL) than in the PBS group. The 10 µg/mL rhFGF2 group also showed an obviously robust regeneration in axon density in the mental nerve at 4 weeks. Our results demonstrate that 10 µg/mL rhFGF induces mental nerve regeneration and sensory recovery after mental nerve crush injury.

Maximal strength and endurance scores of the tongue, lip, and cheek in healthy, normal Koreans.

OBJECTIVES: The purpose of this study was to establish normative data for healthy Korean adults by measuring the maximal strength and endurance scores of the tongue, lip, and cheek, and to examine correlations between these measurements. MATERIALS AND METHODS: This study included 120 subjects that were divided into three groups according to age: young (20-39 years), middle-aged (40-59 years), and older (over 60 years); and by gender. Measurements were taken using the Iowa Oral Performance Instrument (IOPI). RESULTS: The mean maximal tongue strengths were as follows: young men (46.7±10.2 kPa) and women (32.1±7.9 kPa), middle-aged men (40.9±9.3 kPa) and women (36.9±8.6 kPa), and older men (35.2±9.0 kPa) and women (34.5±6.9 kPa). The mean tongue endurance scores were: young men (28.8±12.6 seconds) and women (20.8±13.5 seconds), middle-aged men (17.0±8.5 seconds) and women (15.3±5.2 seconds), and older men (15.8±6.7 seconds) and women (17.9±8.1 seconds). The mean maximal lip strengths were: young men (11.6±3.0 kPa) and women (11.4±3.8 kPa), middle-aged men (11.4±4.2 kPa) and women (11.1±5.1 kPa), and older men (14.5±3.9 kPa) and women (11.7±2.6 kPa). The mean lip endurance scores were: young men (41.1±23.9 seconds) and women (22.4±21.7 seconds), middle-aged men (24.3±10.3 seconds) and women (30.5±13.4 seconds), and older men (24.9±11.0 seconds) and women (12.8±7.6 seconds). The mean maximal cheek strengths were: young men (24.5±4.6 kPa) and women (20.5±4.3 kPa), middle-aged men (25.2±6.4 kPa) and women (21.2±5.5 kPa), and older men (22.4±5.3 kPa) and women (18.0±4.8 kPa). The mean cheek endurance scores were: young men (47.8±24.4 seconds) and women (43.9±25.0 seconds), middle-aged men (27.3±11.3 seconds) and women (20.0±14.6 seconds), and older men (21.7±14.5 seconds) and women (17.2±11.4 seconds). CONCLUSION: The data collected in this study will provide an important database of standardized measurements for maximal strength and endurance scores of the tongue, lip and cheek in healthy, normal Koreans.

Masticatory muscle pain and progressive mouth opening limitation caused by amyotrophic lateral sclerosis: a case report.

This article reports a case of masticatory muscle pain and progressive limited mouth opening secondary to amyotrophic lateral sclerosis (ALS), popularly known as Lou Gehrig's disease. The symptoms were first mistaken as those of temporomandibular disorders, before fatty degeneration of all masticatory muscles were discovered on magnetic resonance imaging (MRI). ALS should be considered in the differential diagnosis process when the patient presents with longstanding progressive mouth opening limitation associated with pain. MRI could facilitate the diagnostic process.

Mandibular condylar-ramal reconstruction using vascularised costochondral graft based on the serratus anterior composite flap.

BACKGROUND: Nonvascularised autogenous costochondral rib grafts are the gold standard for replacement of the mandibular ramus and condyle. However, condylar defects present a difficult condition to treat when soft tissue defects are involved. Thus, we used vascularised costochondral grafts (VCGs) with a cartilaginous cap based on the serratus anterior muscle flap to reconstruct these composite defects. The purpose of this study was to evaluate the advantages and effectiveness of VCGs based on long-term observation. METHODS: We evaluated 15 patients who underwent mandibular condyle and ramus reconstruction using VCG after a mean follow-up of 75.9 months (range 46-156 months). Our 15 case of mandibular reconstruction with a serratus anterior/rib composite free flap due to congenital or acquired defects involved a total of 18 condyles (bilateral reconstruction in 3 cases and unilateral reconstruction in 12 cases). RESULTS: Our success rate with the use of the serratus anterior/rib composite free flap was 100%, and there were no cases of resorption or malunion of the graft. The mean maximum mouth opening (MMO) at the last follow-up was 31.29 ± 7.56 mm (range 15-45 mm). Although two patients exhibited excessive growth of the graft, deficient growth of the graft was also found in our paediatric patients. Four patients who developed ankylosed TMJ during the follow-up period received additional gap arthroplasty. CONCLUSION: VCG based on a serratus anterior flap was an excellent treatment modality for patients with uni-or bilateral composite defects of the ramus and condyle, in which soft tissue and hard tissue, including both bone and cartilage, were necessary.

Biologic properties of nano-hydroxyapatite: An in vivo study of calvarial defects, ectopic bone formation and bone implantation.

This study investigated the biologic properties of nano-hydroxyapatite (nHAp) using the rat calvarial defect, ectopic bone formation, and rabbit tibia implant installation models. Animals were divided into two groups: those implanted with nHAp, and negative controls (Collagen). Eight weeks after creating an 8 mm calvarial defect, bone regeneration was evaluated radiographically and histologically. To investigate ectopic bone formation, materials were injected into the right thigh muscle and were evaluated after 8 weeks. nHAp coated implant and conventional titanium implant were placed bilaterally in rabbit tibias. After 4 weeks, bone-implant contact (BIC), new bone area inside the thread, and removal torque were measured. In the calvarial defect model, radiographic and histologic analysis showed more bone formation in the nHAp Group; particularly, histologically assessed bone area (p=0.034) and microcomputed tomography assessed bone mineral density (p=0.034). In the ectopic bone formation model, calcification and expression of osteogenic biomarkers were seen in the nHAp-injected samples but in none of the controls. nHAp coated implant resulted in increased BIC, new bone area, and increased removal torque, with statistical significance for BIC (p=0.034). This study suggests that nHAp has potential as a coating material for dental implant surfaces and as a bone graft material.

Influencing factor on the prognosis of arthrocentesis.

OBJECTIVES: The purpose of this article is to evaluate factors influencing prognosis of arthrocentesis in patients with temporomandibular joint (TMJ) disorder. MATERIALS AND METHODS: The subjects included 145 patients treated with arthrocentesis at the Dental Center of Ajou University Hospital from 2011 to 2013 for the purpose of recovering mouth opening limitation (MOL) and pain relief. Prognosis of arthrocentesis was evaluated 1 month after the operation. Improvement on MOL was defined as an increase from below 30 mm (MOL ≤30 mm) to above 40 mm (MOL ≥40 mm), and pain relief was defined as when a group with TMJ pain with a visual analog scale (VAS) score of 4 or more (VAS ≥4) decreased to a score of 3 or more. The success of arthrocentesis was determined when either mouth opening improved or pain relief was fulfilled. To determine the factors influencing the success of arthrocentesis, the patients were classified by age, gender, diagnosis group (the anterior disc displacement without reduction group, the anterior disc displacement with reduction group, or other TMJ disorders group), time of onset and oral habits (clenching, bruxism) to investigate the correlations between these factors and prognosis. RESULTS: One hundred twenty out of 145 patients who underwent arthrocentesis (83.4%) were found to be successful. Among the influencing factors mentioned above, age, diagnosis and time of onset had no statistically significant correlation with the success of arthrocentesis. However, a group of patients in their fifties showed a lower success rate (ANOVA P=0.053) and the success rate of the group with oral habits was 71% (Pearson's chi-square test P=0.035). CONCLUSION: From this study, we find that factors influencing the success of arthrocentesis include age and oral habits. We also conclude that arthrocentesis is effective in treating mouth opening symptoms and for pain relief.

Clinical outcome of conservative treatment of injured inferior alveolar nerve during dental implant placement.

OBJECTIVES: Infererior alveolar nerve (IAN) damage may be one of the distressing complications occurring during implant placement. Because of nature of closed injury, a large proportion is approached non-invasively. The purpose of this study was to analyze the outcomes of conservative management of the injured nerve during dental implant procedure. MATERIALS AND METHODS: Sixty-four patients of implant related IAN injury, who were managed by medication or observation from January 1997 to March 2007 at the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, were retrospectively investigated. The objective tests and subjective evaluations were performed to evaluate the degree of damage and duration of sensory disturbance recovery. Tests were performed on the day of the first visit and every two months afterward. Patient's initial symptoms, proximity of the implant to the IAN, time interval between implant surgery and the first visit to our clinic, and treatment after implant surgery were analyzed to determine whether these factors affected the final outcomes. RESULTS: Among the 64 patients, 23 had a chief complaint of sensory disturbance and others with dysesthesia. The mean time until first visit to our hospital after the injury was 10.9 months.One year after nerve injury, the sensation was improved in 9 patients, whereas not improved in 38 patients, even 4 patients experienced deterioration. Better prognosis was observed in the group of patients with early visits and with implants placed or managed not too close to the IAN. CONCLUSION: Nearly 70% of patients with IAN injury during implant placement showed no improvement in sensation or dysesthesia with the conservative management. Earlier decision for active treatment needs to be considered because of possibility of deterioration of symptoms and unsatisfactory recovery.

Human umbilical cord blood-derived mesenchymal stem cells promote regeneration of crush-injured rat sciatic nerves.

Several studies have demonstrated that human umbilical cord blood-derived mesenchymal stem cells can promote neural regeneration following brain injury. However, the therapeutic effects of human umbilical cord blood-derived mesenchymal stem cells in guiding peripheral nerve regeneration remain poorly understood. This study was designed to investigate the effects of human umbilical cord blood-derived mesenchymal stem cells on neural regeneration using a rat sciatic nerve crush injury model. Human umbilical cord blood-derived mesenchymal stem cells (1 × 10(6)) or a PBS control were injected into the crush-injured segment of the sciatic nerve. Four weeks after cell injection, brain-derived neurotrophic factor and tyrosine kinase receptor B mRNA expression at the lesion site was increased in comparison to control. Furthermore, sciatic function index, Fluoro Gold-labeled neuron counts and axon density were also significantly increased when compared with control. Our results indicate that human umbilical cord blood-derived mesenchymal stem cells promote the functional recovery of crush-injured sciatic nerves.