Effect of 3D-printed polycaprolactone/osteolectin scaffolds on the odontogenic differentiation of human dental pulp cells.

Cell-based tissue engineering often requires the use of scaffolds to provide a 3-dimensional (3D) framework for cell proliferation and tissue formation. Polycaprolactone (PCL), a type of polymer, has good printability, favorable surface modifiability, adaptability, and biodegradability. However, its large-scale applicability is hindered by its hydrophobic nature, which affects biological properties. Composite materials can be created by adding bioactive materials to the polymer to improve the properties of PCL scaffolds (PSs). Osteolectin is an odontogenic factor that promotes the maintenance of the adult skeleton by promoting the differentiation of LepR+ cells into osteoblasts. Therefore, the aim of this study was to evaluate whether 3D-printed PCL/osteolectin scaffolds supply a suitable microenvironment for the odontogenic differentiation of human dental pulp cells (hDPCs). The hDPCs were cultured on 3D-printed PSs with or without pores. Cell attachment and cell proliferation were evaluated using EZ-Cytox. The odontogenic differentiation of hDPCs was evaluated by alizarin red S staining and alkaline phosphatase assays. Western blotting was used to evaluate the expression of the proteins DSPP and DMP-Results: The attachment of hDPCs to PSs with pores was significantly higher than to PSs without pores. The odontogenic differentiation of hDPCs was induced more in PCL/osteolectin scaffolds than in PSs, but there was no statistically significant difference. 3D-printed PSs with pores are suitable for the growth of hDPCs, and the PCL/osteolectin scaffolds can provide a more favorable microenvironment for the odontogenic differentiation of hDPCs. .

Transoral Endoscopy-Assisted Tongue-Lip Adhesion With Modified Tongue Base Suspension in a Pierre-Robin Sequence: A Safe and Effective Technique.

Life-threatening airway obstruction is a major concern in patients with Pierre-Robin sequence. Tongue-lip adhesion (TLA) has been used to manage airway obstruction. The authors present the case of a female neonate with Pierre-Robin sequence who presented with airway obstruction and a cleft palate. She underwent a TLA procedure with modified tongue base suspension (TBS). Endoscopy was used to check and control the traction of the tongue base to enable unobstructed self-ventilation. Positive outcomes including improved O2 saturation and weight gain were noted. The effectiveness of TLA was enhanced by using TBS with real-time endoscopy to evaluate the oropharyngeal airway space required to alleviate airway obstruction. The use of endoscopy enabled us to check and determine how much the tongue base should be tracted by manipulating the tongue anteriorly and posteriorly. The authors report transoral endoscopy-assisted TLA and modified TBS.

Whole Exome Sequencing of a Patient with a Milder Phenotype of Xeroderma Pigmentosum Group C.

A 17-year-old female Korean patient (XP115KO) was previously diagnosed with Xeroderma pigmentosum group C (XPC) by Direct Sanger sequencing, which revealed a homozygous nonsense mutation in the XPC gene (rs121965088: c.1735C > T, p.Arg579Ter). While rs121965088 is associated with a poor prognosis, our patient presented with a milder phenotype. Hence, we conducted whole-exome sequencing in the patient and her family members to detect coexisting mutations that may have resulted in a milder phenotype of rs121965088 through genetic interaction. Materials and Methods: the whole-exome sequencing analysis of samples obtained from the patient and her family members (father, mother, and brother) was performed. To identify the underlying genetic cause of XPC, the extracted DNA was analyzed using Agilent's SureSelect XT Human All Exon v5. The functional effects of the resultant variants were predicted using the SNPinfo web server, and structural changes in the XPC protein using the 3D protein modeling program SWISS-MODEL. Results: Eight biallelic variants, homozygous in the patient and heterozygous in her parents, were detected. Four were found in the XPC gene: one nonsense variant (rs121965088: c.1735C > T, p.Arg579Ter) and three silent variants (rs2227998: c.2061G > A, p. Arg687Arg; rs2279017: c.2251-6A > C, intron; rs2607775: c.-27G > C, 5'UTR). The remaining four variants were found in non-XP genes, including one frameshift variant [rs72452004 of olfactory receptor family 2 subfamily T member 35 (OR2T35)], three missense variants [rs202089462 of ALF transcription elongation factor 3 (AFF3), rs138027161 of TCR gamma alternate reading frame protein (TARP), and rs3750575 of annexin A7 (ANXA7)]. Conclusions: potential candidates for genetic interactions with rs121965088 were found. The rs2279017 and rs2607775 of XPC involved mutations in the intron region, which affected RNA splicing and protein translation. The genetic variants of AFF3, TARP, and ANXA7 are all frameshift or missense mutations, inevitably disturbing the translation and function of the resultant proteins. Further research on their functions in DNA repair pathways may reveal undiscovered cellular relationships within xeroderma pigmentosum.

The effect of an interfragmentary gap on the clinical outcome after mandibular angle fracture surgery.

BACKGROUND/AIM: The mandibular angle fracture occasionally widens at the lower border after surgery using a single miniplate. However, the effects of an interfragmentary gap have not been fully investigated. The aim of this study was to determine the effects of gaps caused by mandibular angle fracture surgery using a single superior border miniplate technique. MATERIAL AND METHODS: In this prospective study, the interfragmentary gap was measured by panoramic radiography and cone-beam computed tomography (CBCT) postoperatively. The width of the gap measured by panoramic radiography and CBCT scans was compared. The patients were divided into two groups based on the gap width (more or less than 1.5 mm). In CBCT scans, bucco-lingual displacement of the proximal segment was evaluated. Clinical results and complication rates were investigated according to the gap and displacement. The findings were statistically analyzed. RESULTS: Thirty-two patients were included in the study. The mean interfragmentary gap widths were 1.56 ± 0.83 mm by panoramic radiography and 2.12 ± 0.87 mm by CBCT scans. CBCT measured a gap width of approximately 0.5 mm wider than panoramic radiography (P = 0.001). Twenty-two patients (68.8%) had an interfragmentary gap width of >1.5 mm, and ten patients (31.2%) had a gap width of <1.5 mm. All patients had favorable occlusion at the last clinical examination. There were no statistically significant differences in intermaxillary fixation periods and complication rates (P > 0.05). One patient in the wider gap group experienced pain in the temporomandibular joint when opening the mouth. Six patients (18.8%) had lingual displacement of the proximal fragment. Displacement did not significantly influence the complication rate (P > 0.05). CONCLUSION: The presence of an interfragmentary gap after mandibular angle fracture surgery did not affect the clinical outcome.

Simultaneous surgery for subcondylar fracture and prominent angle of the mandible.

We experienced a patient of subcondylar fracture who had a squared contour of the lower face with prominent angle of the mandible and masseter hypertrophy. Our patient was increasingly seeking esthetic improvement of the lower third of the face. But she did not want multi-stage operations. Thus, we decided and performed a one-stage mandibular angle ostectomy with fracture management. We have a stable and esthetic result simultaneously despite fractures of the fixation plates during follow-up period, so report a case.

Cavernous sinus thrombosis progression from trismus.

In the Department of Oral and Maxillofacial Surgery, patients with trismus can be easily identified. If the cause of trismus is infection of the masticatory space near the pterygoid plexus, the possibility of cavernous sinus thrombosis should be considered. We report the case of a patient who presented with limited mouth opening and progressed to cavernous sinus thrombosis, along with a review of the relevant literature.

A simple method of intraoperative intubation tube change.

Nasotracheal intubation should be performed in patients with jaw fractures because maxillomandibular fixation is required. However, when there are concomitant fractures of the nose and facial bones, an intubation tube positioned at the nose makes it difficult to perform an intricate surgery. In order to overcome these problems, a variety of ways to change the position of the tube have been introduced. We describe a simple technique of switching the tube from a nasal to oral position, which was easily executed in a patient with concomitant nasal and mandibular fractures, accompanied by a literature review.

Closed suction drainage for deep neck infections.

PURPOSE: There have been various incision and drainage methods for deep neck infection (DNI). Closed-suction drainage (CSD) has been used to decrease hematoma or to drain pus in other forms of medical surgery. The purpose of this investigation was to evaluate the usefulness of CSD for DNI. PATIENTS AND METHODS: This study consisted of 30 patients who underwent CSD after incision and drainage for DNI between January 2006 and December 2011. The patients' demographics, systemic diseases, methods of airway control, involved spaces, incision, CSD results, duration of hospitalization, and complications were investigated. RESULTS: CSD was used to treat 30 DNI patients. Eleven patients (37%) had underlying systemic diseases like diabetes mellitus, hypertension, hepatitis, asthma, etc. Twenty four patients (80%) had odontogenic infections in the mandibular molar region. Tracheostomy was performed in 5 patients (17%). The involved spaces were various from parapharyngeal space to mediastinum (mean: 4.8 spaces), and CSD was applied with drainage lines (mean: 3; 2-7 drains) over the course of 4-37 days (mean 14.6 days). The total amount of drained pus was 8-1344 cc (mean: 406 cc) and the daily amount was 1-61 cc (mean: 28 cc) from each patient. The mean length of hospital stay was 26 days, with a range of 9-83 days. Wound rupture happened in 7% of 56 total incision sites and spontaneous removal of the drain tube occurred in 3% of 91 total tubes. Four patients died because of cardiac arrest, pulmonary edema, and hypoxia. A statistical significance was accepted about total and daily amount of drainage at Pearson's correlation test (p < 0.001). CONCLUSION: Accurate diagnosis, safe airway management, and early surgical drainage were important in DNI treatment. Compared to other drainage systems, CSD is clinically useful for treating DNI due to minimal incision, convenience of post-operative management, and less postoperative complications.

Comparison of resorbable plates and titanium plates for fixation stability of combined mandibular symphysis and angle fractures.

OBJECTIVES: We compared resorbable plates with titanium plates for treatment of combined mandibular angle and symphyseal fractures. MATERIALS AND METHODS: Patients with mandibular angle and symphysis fractures were divided into two groups. The control (T) group received titanium plates while the experimental (R) group received resorbable plates. All procedures were carried out under general anesthesia using standard surgical techniques. We compared the frequency of wound dehiscence, development of infection, malocclusion, malunion, screw breakage, and any other technical difficulties between the two groups. RESULTS: Thirteen patients were included in the R group, where 39 resorbable plates were applied. The T group consisted of 16 patients who received 48 titanium plates. The mean age in the R and T groups was 28.29 and 24.23 years, respectively. Primary healing of the fractured mandible was obtained in all patients in both groups. Postoperative complications were minor and transient. Moreover, there were no significant differences in the rates of various complications between the two groups. Breakage of 3 screws during the perioperative period was seen in the R group, while no screws or plates were broken in the T group. CONCLUSION: Resorbable plates can be used to stabilize combined mandibular angle and symphysis fractures.

Outcomes of open versus closed treatment in the management of mandibular subcondylar fractures.

OBJECTIVES: To compare the clinical and radiological outcomes after closed reduction (CR) and open reduction and internal fixation (ORIF) in the management of subcondylar fractures. MATERIALS AND METHODS: Forty-eight patients presenting with subcondylar fracture between January 2010 and March 2013 were evaluated retrospectively. Fifteen patients were treated with CR and 33 patients with ORIF. The clinical and radiologic parameters were evaluated during follow-up (mean, 7.06 months; range, 3 to 36 months). RESULTS: In the CR group, no patients had any problems with regard to the clinical parameters. The average period of maxillomandibular fixation (MMF) was 5.47 days. The preoperative average tangential angulation of the fractured fragment was 3.67°, and loss of ramus height was 2.44 mm. In the ORIF group, no clinical problems were observed, and the average period of MMF was 6.33 days. The preoperative average tangential angulation of the subcondylar fragment was 8.66°, and loss of ramus height was 3.61 mm. CONCLUSION: CR provided satisfactory clinical results, though ORIF provided more accurate reduction of the fractured fragment. So there is no distinct displacement of fractured fragment, CR should be selected than ORIF because of no need for surgery.

Displacement of dental implants into the focal osteoporotic bone marrow defect: a report of three cases.

Focal osteoporotic bone marrow defect (FOBMD) is a radiolucent area corresponding to the presence of hematopoietic tissue rarely found in the jaws. FOBMD is most commonly located in the mandibular edentulous posterior area of a middle-aged female. From November 2011 to November 2012, we experienced three cases involving removal of implants that had accidentally fallen into the FOBMD area. All patients happened to be female, with a mean age of 54 years (range: 51-60 years). One case involved hypoesthesia of the lower lip and chin, while two cases healed without any complication. Displacement of an implant into the FOBMD area is an unusual event, which occurs rarely during placement of a dental fixture. The purpose of this study was to report on three cases of FOBMD and to provide a review of related literature.