Preparation and Characterization of Carboxymethyl Chitosan/Sodium Alginate Composite Hydrogel Scaffolds Carrying Chlorhexidine and Strontium-Doped Hydroxyapatite.

Herein, we introduce a novel composite hydrogel scaffold designed for addressing infectious jaw defects, a significant challenge in clinical settings caused by the inherent limited self-regenerative capacity of bone tissues. The scaffold was engineered from a blend of carboxymethyl chitosan (CMCS)/sodium alginate (SA) hydrogel (CSH), ß-cyclodextrin/chlorhexidine clathrate (ß-CD-CHX), and strontium-nanohydroxyapatite nanoparticles (Sr-nHA). The ß-CD-CHX and Sr-nHA components were synthesized using a saturated aqueous solution and a coprecipitation method, respectively. Subsequently, these elements were encapsulated within the CSH matrix. Comprehensive characterization of the CMCS/SA/ß-CD-CHX/Sr-nHA composite hydrogel scaffold via scanning electron microscopy, X-ray photoelectron spectroscopy, and Fourier-transform infrared spectroscopy validated the successful synthesis. The swelling and in vitro degradation behaviors proved that the composite hydrogel had good physical properties, while in vitro evaluations demonstrated favorable biocompatibility and osteoinductive properties. Additionally, antibacterial assessments revealed its effectiveness against common pathogens, Staphylococcus aureus and Escherichia coli. Overall, our results indicate that the CMCS/SA/ß-CD-CHX/Sr-nHA composite hydrogel scaffolds exhibit significant potential for effectively treating infection-prone jaw defects.

Preparation and properties of a 3D printed nHA/PLA bone tissue engineering scaffold loaded with a ß-CD-CHX combined dECM hydrogel.

Jaw defects, which can result from a multitude of causes, significantly affect the physical well-being and psychological health of patients. The repair of these infected defects presents a formidable challenge in the clinical and research fields, owing to their intricate and diverse nature. This study aims to develop a personalized bone tissue engineering scaffold that synergistically offers antibacterial and osteogenic properties for treating infected maxillary defects. This study engineered a novel temperature-sensitive, sustained-release hydrogel by amalgamating ß-cyclodextrin (ß-CD) with chlorhexidine (CHX) and a decellularized extracellular matrix (dECM). This hydrogel was further integrated with a polylactic acid (PLA)-nano hydroxyapatite (nHA) scaffold, fabricated through 3D printing, to form a multifaceted composite scaffold (nHA/PLA/dECM/ß-CD-CHX). Drug release assays revealed that this composite scaffold ensures prolonged and sustained release. Bacteriological studies confirmed that the ß-CD-CHX loaded scaffold exhibits persistent antibacterial efficacy, thus effectively inhibiting bacterial growth. Moreover, the scaffold demonstrated robust mechanical strength. Cellular assays validated its superior biocompatibility, attributed to dECM and nHA components, significantly enhancing the proliferation, adhesion, and osteogenic differentiation of osteogenic precursor cells (MC3T3-E1). Consequently, the nHA/PLA/dECM/ß-CD-CHX composite scaffold, synthesized via 3D printing technology, shows promise in inducing bone regeneration, preventing infection, and facilitating the repair of jaw defects, positioning itself as a potential breakthrough in bone tissue engineering.

Virtual surgical planning/3D printing assisted fibula osteoseptocutaneous flap combined with anterolateral thigh flaps for extensive composite oromandibular defects reconstruction: a retrospective study of case series.

Oromandibular tumors or osteoradionecrosis often lead to extensive composite defects encompassing intraoral, bone and extraoral tissues. A single flap cannot simultaneously offer sufficient bone and soft tissue. The combination of free flaps could be a prospective approach to overcome the challenge. The study aims to assess the efficacy of virtual surgical planning (VSP) and 3D printing assisted fibula osteoseptocutaneous flap (FOSCF) combined with anterolateral thigh flaps (ALT) in reconstructing extensive composite defects in the oromandibular region. A retrospective analysis was conducted on 8 patients who underwent reconstruction using FOSCFs combined with ALTs. Post-surgical excision of the lesions, we obtained mean values for the defects of intraoral soft tissue, bone, extraoral soft tissue, namely, being 42.7 cm2, 96 mm, and 68.9 cm2. The mean surgical procedures took 712.5 min. A total of 16 flaps were harvested and transplanted for the 8 patients, with all successfully surviving. Postoperatively, complications manifested as localized intraoral infections in 2 cases, intermuscular vein thrombosis in another 2 cases, and pulmonary infections in 2 patients. Two patients unfortunately experienced tumor recurrence, at 12 and 3 months post-operation respectively. For the surviving 6 patients, the average follow-up period was 12.2 months. Regarding patient satisfaction, one expressed dissatisfaction with the contour of the mandible, and two exhibited moderate trismus. Objective assessments identified 1 case of oral incontinence and 2 cases where external flap contractures were observed. All 8 patients experienced restoration of masticatory function and were able to consume a soft diet within a month post-surgery. VSP/3D printing assisted FOSCFs combined with ALTs can be performed safely to reconstruct the extensive composite tissue defects in our study, with desirable esthetic and functional results, and it is a reliable option in selecting patients with defects involving multiple tissue types. However, the benefits of this method needed more cases to validate.

Biomechanical evaluation of custom-made short implants with wing retention applied in severe atrophic maxillary posterior region restoration: A three-dimensional finite element analysis.

Severe bone atrophy in the maxillary posterior region poses a big challenge to implant restoration. Digitally designed and customized short implants with wing retention provide a safer and minimally invasive implant restoration scheme in such circumstances. Small titanium wings are integrated with the short implant supporting the prosthesis. Using digital designing and processing technology, the wings fixed by titanium screws can be flexibly designed, providing the main fixation. The design of the wings will influence the stress distribution and implant stability. This study analyzes the position, structure, and spread area of the wings fixture scientifically by means of three-dimensional finite element analysis. The design of the wings is set to linear, triangular, and planar styles. Under the simulated vertical and oblique occlusal forces, the implant displacement and stress between the implant and the bone surface are analyzed at different bone heights of 1 mm, 2 mm, and 3 mm. The finite element results show that the planar form can better disperse the stress. By adjusting the cusp slope to reduce the influence of lateral force, short implants with planar wing fixtures can be used safely even if the residual bone height is only 1 mm. The results of the study provide a scientific basis for the clinical application of this new customized implant.

Chitosan-vancomycin hydrogel incorporated bone repair scaffold based on staggered orthogonal structure: a viable dually controlled drug delivery system.

In clinical practice, challenges remain in the treatment of large infected bone defects. Bone tissue engineering scaffolds with good mechanical properties and antibiotic-controlled release are powerful strategies for infection treatment. In this study, we prepared polylactic acid (PLA)/nano-hydroxyapatite (nHA) scaffolds with vertical orthogonal and staggered orthogonal structures by applying 3D printing technology. In addition, vancomycin (Van)-based chitosan (CS) hydrogel (Gel@Van) was loaded on the scaffold (PLA/nHA/CS-Van) to form a local antibiotic release system. The microstructure of the composite scaffold had high porosity with interconnected three-dimensional networks. The mechanical properties of the PLA/nHA/CS-Van composite scaffold were enhanced by the addition of CS-Van. The results of the water contact angle analysis showed that the hydrophilicity of the drug-loaded scaffold improved. In addition, the composite scaffold could produce sustained release in vitro for more than 8 weeks without adverse effects on the proliferation and differentiation of mouse embryonic osteoblasts (MC3T3-E1), which confirmed its good biocompatibility. During the in vitro antimicrobial study, the composite scaffold effectively inhibited the growth of Staphylococcus aureus (S. aureus). Therefore, our results suggest that the PLA/nHA/CS-Van composite scaffold is a promising strategy for treating infected bone defects.

The relationship between the oblique sagittal temporomandibular joint disc position and the volume surface area of the condyle in young TMD adults.

The present study aims to compare the volume surface area of the condyle, the horizontal condylar axial angle and the disc-condyle angle between temporomandibular disorder (TMD) and asymptomatic volunteers, explore and analyze the relationship between the temporomandibular joint (TMJ) disc position in oblique sagittal plane and the volume surface area of the condyle in young adults with TMD symptoms. 84 young adult volunteers were received TMJ examination by Magnetic Resonance Imaging (MRI) and Cone Beam Computed Tomography (CBCT). TMD and asymptomatic volunteers were 42 each. MRI was used to assess the position of TMJ disc in the oblique sagittal plane with the condyle apex method. CBCT data were used for three-dimensional (3D) reconstruction of condyle and the measurements of the horizontal condylar axial angle and the volume surface area of the condyle. The condylar volume surface area of the TMD group was smaller than that of the asymptomatic group (p < 0.05), the disc condyle angle was larger than that of the asymptomatic group (p < 0.05), and no significant difference was found in the horizontal condylar axial angle (p > 0.05). In terms of correlation, the volume surface area of the condyle were negatively correlated with the position of the articular disc in TMD patients (p < 0.05). This significant negative correlation suggests that the possibility of disc displacement can be considered when poor condylar morphology is found.

Improvement of mechanical and antibacterial properties of porous nHA scaffolds by fluorinated graphene oxide.

Nano-hydroxyapatite (nHA) is widely used as a bio-scaffold material due to its good bioactivity and biocompatibility. In this study, fluorinated graphene oxide (FG) was added to nHA to improve its poor formability, weak mechanical properties, undesirable antimicrobial activity and other disadvantages that affect its clinical application. FG was synthesized by a simple hydrothermal method. Novel porous composite scaffolds were prepared by adding different weight ratios (0.1 wt%, 0.5 wt% and 1 wt%) of FG to nHA using the 3D printing technique. The morphology, phase composition and mechanical properties of the composite scaffolds were characterized. In addition, the degradation performance of the composite scaffolds, antibacterial activity against Staphylococcus aureus and Escherichia coli, and cytocompatibility were also investigated. The results showed that the nHA/FG composite scaffold was successfully prepared with a uniform distribution of FG on the scaffold. The mechanical properties showed that the compression strength of the nHA/FG composite scaffold was significantly higher than that of the nHA scaffold (7.22 ± 1.43 MPa). The porosity of all composite scaffolds was above 70%. The addition of FG significantly improved the mechanical properties of the nHA scaffold without affecting the porosity of the scaffold. In addition, the 0.5 wt% nHA/FG scaffold exhibited satisfactory cytocompatibility and antibacterial properties. Therefore, the constructed nHA/FG composite scaffold can be considered as a novel antimicrobial bone substitute material with good application prospects.

Digital Workflow for the Design, Manufacture, and Application of Custom-Made Short Implants With Wing Retention Device.

The severe deficiency of vertical bone height in the posterior maxillary region poses a challenge to implant restoration. In response to this issue, this article introduces a custom-made short implant with a wing retention structure and describes a precise and minimally invasive dental implant restoration scheme with digital technology.

Improvement of the mechanical properties and osteogenic activity of 3D-printed polylactic acid porous scaffolds by nano-hydroxyapatite and nano-magnesium oxide.

Porous bone scaffolds based on high-precision 3D printing technology gave recently been developed for use in bone defect repair. However, conventional scaffold materials have poor mechanical properties and low osteogenic activity, limiting their clinical use. In this study, a porous composite tissue-engineered bone scaffold was prepared using polylactic acid, nano-hydroxyapatite, and nano-magnesium oxide as raw materials for high-precision 3D printing. The composite scaffold takes full advantage of the personalized manufacturing features of 3D printers and can be used to repair complex bone defects in clinical settings. The composite scaffold combines the advantages of nano-hydroxyapatite, which improves the formability of scaffold printing, and of nano-magnesium oxide, which regulates pH during degradation and provide a good environment for cell growth. Additionally, nano-magnesium oxide and nano-hydroxyapatite have a bidirectional effect on promoting the compressive strength and osteogenic activity of the scaffolds. The prepared composite porous scaffolds based on 3D printing technology show promise for bone defect repair.

Preparation and Characterization of Vancomycin Hydrochloride-Loaded Mesoporous Silica Composite Hydrogels.

This study aims to explore the feasibility of the novel temperature-sensitive hydrogel-based dual sustained-release system (Van/SBA-15/CS-GP-SA) in the repair and treatment of infectious jaw defects. Van/SBA-15 was prepared using the mesoporous silica (SBA-15) as a carrier for vancomycin hydrochloride (Van), and Van/SBA-15 was characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy dispersive spectrometry (EDS), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared (FTIR), Brunauer-Emmett-Teller (BET), and Barrett-Joyner-Halenda (BJH). The characterization results confirm that Van is loaded in SBA-15 successfully. Van/SBA-15/CS-GP-SA is constructed by encapsulating Van/SBA-15 in chitosan-sodium glycerophosphate-sodium alginate hydrogel (CS-GP-SA). The microstructures, sustained-release ability, biocompatibility, and antibacterial properties of Van/SBA-15/CS-GP-SA were systematically studied. Van/SBA-15/CS-GP-SA is found to have promising sustained-release ability, outstanding biocompatibility, and excellent antibacterial properties. This study provides new ideas for the management of infectious jaw defects.

Hollow mesoporous organosilica nanotheranostics incorporating formimidoyltransferase cyclodeaminase (FTCD) plasmids for magnetic resonance imaging and tetrahydrofolate metabolism fission on hepatocellular carcinoma.

The formimidoyltransferase cyclodeaminase (FTCD) gene encodes an enzyme required for the catabolism of histidine and tetrahydrofolate (THF). Previous studies showed that FTCD plays a role as a tumour suppressor gene in hepatocellular carcinoma (HCC). It is unknown whether the restoration of functional FTCD may exhibit an anti-tumour effect on HCC. This study constructed a delivery system based on hollow mesoporous organosilica nanotheranostics (HMON) capable of efficiently loading Mn ions and FTCD plasmids. This study showed that the Mn-doped and FTCD-loaded nanoparticles (HMON@Mn-PEI@FTCD) could efficiently induce the expression of FTCD and achieve enhanced magnetic resonance imaging. In vitro results demonstrated that the upregulation of FTCD induced by HMON@Mn-PEI@FTCD nanoparticles dramatically reduced intracellular THF levels, inhibited of NADPH/NADP+ and GSH/GSSG ratios, and induced reactive oxygen species generation and mitochondrial oxidative stress. As a result, cytochrome c release increased with the opening of the mitochondrial permeability transition pore, which finally activated the caspase-dependent cell apoptosis pathway. Therefore, our designed HMON@Mn-PEI@FTCD could induce apoptosis by activating the mitochondria-mediated apoptosis signalling pathway, and finally significantly suppressed the proliferation of HCC both in vitro and in vivo, which provides an effective strategy for the treatment of HCC.

[The effect of orthognathic surgery on speech function in patients with skeletal Class â ¢ malocclusion].

PURPOSE: To investigate the influence of the position of the upper and lower jaws on the anatomical structure of pharynx before and after orthognathic surgery in patients with skeletal Class Ⅲ malocclusion. METHODS: Craniofacial CT scan and speech data were collected from 31 patients with skeletal Class Ⅲ malocclusion before and 3 months after surgery. The collected CT data was imported into Dolphin imaging 11.95 software to establish a digital original model, and the anatomical structure of the pharynx was measured and analyzed. Speech data were analyzed objectively and subjectively by Computerized Speech Lab 4500b and professional speech specialists. Statistical analysis was performed using SPSS 24.0 software package. RESULTS: The distance from the lower edge of the soft palate to the posterior pharyngeal wall, the shortest distance from the posterior margin of the tongue to the posterior pharyngeal wall and its corresponding cross-sectional area were significantly different from those before surgery (P<0.05). The changes of SNA, SNB, ANB, OJ, and OBJ before and after surgery were significant in this series. Importantly, the speech intelligibility of orthognathic patients before and after surgery changed significantly subjectively (P<0.05). Objectively, the postoperative vowels /a/B2, B3, B4, /i/B1,B2, /u/B1,B2 and B4 of the patients were significantly different from those before surgery. There was no significant difference in the lower limit frequency of the consonants /x/, /zh/, /s/, the energy value of /zh/ and the grammatical form of /z/ before and after surgery. The maxillary advancement distance was highly correlated or significantly correlated with △S1, △VOP, and voice changes. CONCLUSIONS: Orthognathic surgery moves the upper and lower jaws to cause changes in the anatomy of the pharyngeal cavity, leading to changes of postoperative speech.

Novel core-shell CHX/ACP nanoparticles effectively improve the mechanical, antibacterial and remineralized properties of the dental resin composite.

OBJECTIVE: The core-shell chlorhexidine/amorphous calcium phosphate (CHX/ACP) nanoparticles were synthesized and used to modify the dental resin composite, aiming to improve its remineralized and antibacterial properties. METHODS: The core-shell CHX/ACP nanoparticles were synthesized by vesicle-templating technology and characterized, and their sustained release and antibacterial properties were also evaluated. Subsequently, the synthesized nanoparticles were incorporated into the dental resin composite at 1 wt.%, 5 wt.% or 10 wt.% to obtain different experimental groups. The physical properties, including curing depth, double bond conversion rate, water absorption and solubility, the sustained-release effects, and mechanical properties of the modified resin composite were evaluated. The remineralization ability was also measured by SEM. The antibacterial experiment of the modified resin composite with fresh preparation or aging in water for 28 days was carried out by a plate count method. RESULTS: The physical and chemical characterizations showed that the synthesized nanoparticles presented a core-shell structure, and their diameter was about 98.5 nm. The shell was composed of ACP with the core full of CHX. These nanoparticles had a release effect on calcium, phosphate ions, and CHX. The nanoparticles could effectively inhibit the growth of S. mutan at a lower concentration (≥50 µg/mL). The curing depth, the double bond conversion, the water absorption, the solubility, the flexural strength, the flexural modulus, and the compressive strength of the modified resin composite were 3.86-4.88 mm, 62.32-73.61%, 1.47-2.84%, 0.21-0.48%, 45.83-109.46 MPa, 2.57-4.91 GPa, and 66.43-160.38 MPa, respectively. The modified resin composite containing 5 wt.% and above CHX/ACP nanoparticles could effectively inhibit the growth of S. mutans regardless of aging in water, with immediate and aging antibacterial rate of more than 92%. In addition, the modified resin composite had a certain remineralization property in the SBF solution verified by SEM. SIGNIFICANCE: The core-shell CHX/ACP nanoparticles were successfully prepared and used to modify the resin composite. The modified dental resin composite with 5 wt.% CHX/ACP nanoparticles had excellent mechanical, antibacterial, and remineralization properties. It is expected to be an ideal restorative filling material for clinical application.

[Fabrication of hydrophilic medical catheter with hydrogel grafting and the in vivo evaluation of its histo-compatibility].

The biocompatible hydrogel was fabricated under suitable conditions with natural dextran and polyethylene glycol (PEG) as the reaction materials. The oligomer (Dex-AI) was firstly synthesized with dextran and allylisocyanate (AI). This Dex-AI was then reacted with poly (ethyleneglycoldiacrylate) (PEGDA) under the mass ratio of 4∶6 to get hydrogel (DP) with the maximum water absorption of 810%. This hydrogel was grafted onto the surface of medical catheter via diphenyl ketone treatment under ultraviolet (UV) initiator. The surface contact angle became lower from (97 ± 6.1)° to (25 ± 4.2)° after the catheter surface was grafted with hydrogel DP, which suggests that the catheter possesses super hydrophilicity with hydrogel grafting. The in vivo evaluation after they were implanted into ICR rats subcutaneously verified that this catheter had less serious inflammation and possessed better histocompatibility comparing with the untreated medical catheter. Therefore, it could be concluded that hydrogel grafting is a good technology for patients to reduce inflammation due to catheter implantation, esp. for the case of retention in body for a relative long time.

Improvements on biological and antimicrobial properties of titanium modified by AgNPs-loaded chitosan-heparin polyelectrolyte multilayers.

Microbial infection around dental implants is a major cause for the loss of devices, including soft tissue infection in early period, post-operation peri-implantitis, and osseointegration failure. Silver nanoparticles (AgNPs) with wide antimicrobial spectrum, strong antimicrobial effect and hypotoxicity, as well as low incidence of antibiotic resistance, are widely involved in biomedical applications. Herein, firmly anchoring AgNPs onto the surface of implants through physical-chemical reaction is likely to relieve the above issues. In this study, AgNPs were biosynthesized by a simple and "green" method with chitosan (CS) as stabilizing and reducing agents. Then, AgNPs-loaded CS-heparin polyelectrolyte multilayers (PEMs) were constructed on alkali-heat treated titanium (Ti) substrates via layer-by-layer (LbL) self-assembly technique. The successful surface modification could be confirmed by scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS), and the constructed system could provide the continuous release of Ag+ over 28 days till mucosa healing. In short, this work revealed that the construction of multilayer coatings containing AgNPs on Ti substrates promoted adhesion and proliferation of human gingival fibroblasts (HGFs) and also enhanced the antimicrobial properties. This manifests the LbL technique is a viable and promising method for forming continuous antimicrobial coatings, to reduce microbial infection and improve the quality of peri-implant soft tissue seal. The preparation process of AgNPs-loaded CS-heparin PEMs on Ti substrate.