An Anatomic Predisposition to Mandibular Angle Fractures.

PURPOSE: To investigate a predisposition to mandibular angle fractures, a retrospective study was performed in which fractured mandibles were compared with healthy mandibles with no history of fracture. Other investigations of angle fracture risk have exclusively studied patients with existing fractures. In addition, the risk has not been comprehensively explained in conjunction with the specific features of mandibular anatomy. We sought to characterize any anatomic variations between the jaws that had fractured and those that had never fractured. MATERIALS AND METHODS: Healthy mandibles with no history of fracture were physically measured at the William M. Bass Skeletal Collection at the University of Tennessee, Knoxville and compared with fractured mandibles from computed tomography (CT) scans at the Dartmouth Hitchcock Medical Center. A total of 52 healthy mandibles and 44 CT scans were evaluated. MATLAB machine learning algorithms (MathWorks, Natick, MA) were used to compare the study populations and isolate those anatomic features that differed between healthy and fractured mandibles. RESULTS: Machine learning classifiers were able to differentiate between male and female jaws, with the condylion-gnathion distance the most distinguishing feature. The 6 most common anatomic features that differed between healthy and fractured mandibles were the 1) retromolar space, 2) perimeter of the cross-section just proximal to the second molar, 3) breadth of the ramal cross-section, 4) thickness of the oblique ridge, 5) transgonial angle, and 6) location of the ipsilateral mental foramen. The presence of third molars was also related to fracture risk, with third molars present in 72.7% of the fractured mandibles versus 26.9% of unfractured mandibles. Of the fractured mandibles with third molars present, 87.5% had the fracture running directly through the tooth or its socket. CONCLUSIONS: The results from the present study have provided evidence that anatomic differences exist between mandibles that sustain angle fractures and those that do not. Although much of the morphology was found to be interdependent, the fracture risk could be accurately predicted using 6 anatomic features. Understanding these mandibular variations and identifying patients vulnerable to mandibular fracture could provide clinicians with additional objective information. Furthermore, using the methods demonstrated in our study, future research could focus on developing an algorithm that includes these unique anatomic features in the hope of assisting surgeons in providing tailored treatment for mandibular angle fractures according to patient-specific morphology.

Identification of a calcium phosphoserine coordination network in an adhesive organo-apatitic bone cement system.

Calcium phosphate-based bone cements have been widely adopted in both orthopedic and dental applications. Phosphoserine (pSer), which has a natural role in biomineralization, has been identified to possess the functionality to react with calcium phosphate phases, such as tetracalcium phosphate (TTCP) and α-tricalcium phosphate (α-TCP), and form a uniquely adhesive cement. This study investigated the chemical composition and phase evolution of a heterogeneous calcium phosphate (56% TTCP and 15% α-TCP) and pSer cement system with respect to pH. The coordination network of calcium phosphoserine monohydrate was discovered as the predominant crystalline phase of this adhesive apatitic cement system. Furthermore, it was determined that pH has a significant effect on the reaction kinetics of the system, whereby a lower pH tends to accelerate the reaction rate and favor products with lower Ca/P ratios. These findings provide a better understanding of the reaction and products of this adhesive organo-ceramic cement, which can be compositionally tuned for broad applications in the orthopedic and dental spaces. STATEMENT OF SIGNIFICANCE: The application of self-setting calcium phosphate cements (CPCs) in hard tissue regeneration has been a topic of significant research since their introduction to the field 30 years ago. Traditional CPCs, however, are limited by their suboptimal mechanical properties due to their solely inorganic composition. Recently, it was discovered that monomeric phosphoserine (pSer) is capable of serving as a setting reagent for a subset of CPC systems, resulting in an adhesive organo-ceramic composite. Despite its adhesive functionality and biomedical potential, its reaction chemistry and product composition were not well characterized. The present study identifies a calcium phosphoserine coordination network as the primary crystalline phase of this apatitic cement system and further characterizes compositional tunability of the products with respect to pH.