Effects of Dietary Colostrum Basic Protein on Bone Growth and Calcium Absorption in Mice.

Colostrum basic protein (CBP) is a trace protein extracted from bovine colostrum. Previous studies have shown that CBP can promote bone cell differentiation and increase bone density. However, the mechanism by which CBP promotes bone activity remains unclear. This study investigated the mechanism of the effect of CBP on bone growth in mice following dietary supplementation of CBP at doses that included 0.015%, 0.15%, 1.5%, and 5%. Compared with mice fed a normal diet, feeding 5% CBP significantly enhanced bone rigidity and improved the microstructure of bone trabeculae. Five-percent CBP intake triggered significant positive regulation of calcium metabolism in the direction of bone calcium accumulation. The expression levels of paracellular calcium transport proteins CLDN2 and CLDN12 were upregulated nearly 1.5-fold by 5% CBP. We conclude that CBP promotes calcium absorption in mice by upregulating the expression of the calcium-transporting paracellular proteins CLND2 and CLND12, thereby increasing bone density and promoting bone growth. Overall, CBP contributes to bone growth by affecting calcium metabolism.

Comparison of different organic selenium supplementations on selenium status and serum biomarkers in dairy cows.

The objective of this study was to investigate the effects of two different organic selenium (Se) supplements, selenomethionine (Se-Met) and selenohomolanthionine (Se-Hlan), on the serum biochemical parameters and Se status of dairy cows. Different dietary Se supplementation treatments were set as follows: a control group (CON, adding sodium selenite at 0.3 mg Se/kg dry matter [DM]), 0.3 and 0.5 Se-Met (adding Se-Met at 0.3 and 0.5 mg Se/kg DM, respectively), as well as 0.3 and 0.5 Se-Hlan (adding Se-Hlan at 0.3 and 0.5 mg Se/kg DM, respectively). The experiment lasted 8 weeks. The serum measurements showed that both organic Se treatments resulted in higher uric acid than CON. Se-Met produced higher aspartate aminotransferase, glucose, urea, low-density lipoprotein cholesterol, and lactate dehydrogenase than Se-Hlan. Regarding the Se status, the highest milk Se values appeared in 0.5 Se-Met, with intermediate values in 0.3 Se-Met and 0.5 Se-Hlan, whereas the highest and lowest serum Se levels were presented in 0.5 Se-Met and 0.3 Se-Hlan, respectively. Our results suggest that Se-Hlan was not as efficient in boosting serum or milk Se as Se-Met and differences in serum biomarkers between Se-Met and Se-Hlan may be associated with distinct metabolic pathways for different forms of organic Se.

Nicolau Syndrome with Severe Facial Ischemic Necrosis after Endodontic Treatment: A Case Report.

Nicolau syndrome (NS) is a rare complication resulting from intramuscular injections. It is characterized by severe pain at the injection site and the development of purplish discoloration. Only a limited number of case reports have been published documenting the adverse effects associated with the injection of calcium hydroxide (CH) beyond the apex during endodontic treatment. Here, we present the case of a 16-year-old female with NS after the injection of CH during the root canal treatment. The radiography examination revealed distal occlusion of the right maxillary and facial arteries. This caused a substantial area of skin necrosis to develop on the patient's face, resulting in permanent scarring. NS is associated with the displacement of CH beyond the apex. To minimize the risk of NS, dentists should exercise caution by avoiding forced injection of CH during treatment, particularly when the root canal is actively bleeding.

Metagenomic next-generation sequencing for the diagnosis of oral and maxillofacial space infections.

Background/purpose: Metagenomic next-generation sequencing (mNGS) has been widely used for the detection of pathogens causing infectious diseases. This study aimed to evaluate the potential ability of mNGS to detect pathogens causing oral and maxillofacial space infection (OMSI) and compare the results with those of the traditional diagnostic microbial culture method. Materials and methods: We retrospectively reviewed the data of 218 patients diagnosed with OMSI who underwent microbial culture and mNGS at the Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, from July 2020 to January 2022. Results: The positivity rate of mNGS (216 cases) was significantly higher than that of microbial culture (123 cases). The most frequently detected bacteria were different between these two detection methods. Streptococcus constellatus (16.05%, 35), Streptococcus anginosus (15.69%, 34) and Klebsiella pneumoniae (6.88%, 15) were the most commonly isolated bacteria by culture. However, Peptostreptococcus stomatis (61.47%, 134), Parvimonas micra (68.35%, 149) and Streptococcus constellatus (57.34%, 125) were the most commonly detected bacteria by mNGS. mNGS also has advantages in diagnosing viral infections. The optimal numbers of diagnostic reads were 1162 and 588 for the diagnosis of Streptococcus anginosus and Streptococcus constellatus infections, respectively. Read numbers were significantly correlated with C-reactive protein (CRP), procalcitonin (PCT), and blood glucose levels and neutrophil percentage (NEUT%). Conclusion: For pathogens causing OMSI, mNGS had a higher rate of microbial pathogen detection and remarkable advantages in identifying coinfections involving viruses and fungi. The read numbers for mNGS are important for diagnostic accuracy and disease severity evaluation.

Single-nanowire-morphed mechanical slingshot for directional shooting delivery of micro-payloads.

Stretching elastomer bands to accumulate strain energy, for a sudden projectile launching, has been an old hunting skill that will continue to find new applications in miniaturized worlds. In this work, we explore the use of highly resilient and geometry-tailored ultrathin crystalline silicon nanowires (SiNWs) as elastic medium to fabricate the first, and the smallest, mechanical slingshot. These NW-morphed slingshots were first grown on a planar surface, with desired layout, and then mounted upon standing pillar frames, with a unique self-hooking structure that allows for a facile and reliable assembly, loading and shooting maneuver of microsphere payloads. Impressively, the elastic spring design can help to store 10 times more strain energy into the NW springs, compared with the straight ones under the same pulling force, which has been strong enough to overcome the sticky van der Waals (vdW) force at the touching interfaces that otherwise will hinder a reliable releasing onto soft surface with low-surface energy or adhesion force, and to achieve a directional shooting delivery of precise amount of tiny payload units onto delicate target with the least impact damage. This NW-morphing construction strategy also provides a generic protocol/platform to fast design, prototype, and deploy new nanoelectromechanical and biological applications at extremely low costs.

A Study of Two Novel Techniques for One-stage Closure of Chronic Oroantral Fistula and Sinus Floor Lift.

PURPOSE: This study aimed to compare two novel techniques for chronic oroantral fistula (OAF) closure combined with maxillary sinus floor elevation. MATERIALS AND METHODS: Ten patients who had implant installation needs but suffered from a chronic OAF were enrolled in the study from January 2016 to June 2021. The technique applied involved OAF closure and simultaneous sinus floor elevation by either a transalveolar or lateral window approach. Bone graft material evaluation results, postoperative clinical symptoms and complications were compared between the two groups. Student's t -test and χ 2 test were used to analyze the results. RESULTS: In this study, 5 patients with a chronic OAF were treated with the transalveolar approach (group I), and 5 were treated with the lateral window approach (group II). The alveolar bone height was significantly higher in group II than in group I ( P ＜0.001). The pain at 1 day ( P =0.018) and 3 days ( P =0.029) postoperatively and facial swelling at 7 days ( P =0.016) postoperatively were obviously greater in group II than in group I. There were no severe complications in either group. CONCLUSIONS: The techniques combined OAF closure with sinus lifting to reduce surgical frequency and risks. The transalveolar approach resulted in milder postoperative reactions, but the lateral approach could provide more bone volume.

The predictive value of laboratory tests in oro-maxillofacial infection of different severity.

OBJECTIVE: We aimed to investigate the value of individual laboratory tests and combinations of tests for predicting disease severity. METHODS: We retrospectively reviewed 62 patients with space infections in the oral and maxillofacial head and neck regions. Patients were divided into three groups according to severity. Laboratory tests associated with disease severity were identified. RESULTS: As the severity of infection increased, leukocytes, neutrophils, C-reactive protein (CRP), procalcitonin (PCT), soluble interleukin receptor (sILR) 2, IL6, and creatinine (CR) increased. In the ROC analysis of group 1 (moderate infection) versus group 2 (severe infection), the area under the curve (AUC) values for leukocytes (AUC = 0.724), neutrophils (AUC = 0.714), PCT (AUC = 0.762) and a combination of the 3 tests (AUC = 0.768) suggested a strong predictive value. Furthermore, in the ROC analysis of group 2 (severe infection) versus group 3 (extremely severe infection), the AUC values for CRP (AUC = 0.84), PCT (AUC = 0.799), sIL2R (AUC = 0.937), IL6 (AUC = 0.863) and a combination of the four tests (AUC = 0.943) suggested a strong predictive value. CONCLUSIONS: Leukocytes, neutrophils, and PCT were associated with multispace infection and high severity. CRP, PCT, sIL2R, and/or IL6 were associated with extremely severe infections occurring in the oral and maxillofacial head and neck regions.

Genistein mitigates senescence of bone marrow mesenchymal stem cells via ERRα-mediated mitochondrial biogenesis and mitophagy in ovariectomized rats.

Senescence of bone marrow mesenchymal stem cells (BMMSCs) induced by chronic oxidative stress is an important factor contributes to the postmenopausal osteoporosis (PMOP). Mitochondrial quality control takes a pivotal role in regulating oxidative stress and cell senescence. Genistein is a major isoflavone in soy products, which is best known for its ability to inhibit bone loss in both postmenopausal women and ovariectomized (OVX) rodents. Here we show that OVX-BMMSCs displayed premature senescence, elevated reactive oxygen species (ROS) level and mitochondria dysfunction, while genistein rescued these phenotypes. Using network pharmacology and molecular docking, we identified estrogen-related receptor α (ERRα) as the potential target of genistein. Knockdown of ERRα greatly abolished the anti-senescence effect of genistein on OVX-BMMSCs. Further, the mitochondrial biogenesis and mitophagy induced by genistein were inhibited by ERRα knockdown in OVX-BMMSCs. In vivo, genistein inhibited trabecular bone loss and p16INK4a expression, upregulated sirtuin 3 (SIRT3) and peroxisome proliferator-activated receptor gamma coactivator one alpha (PGC1α) expression in the trabecular bone area of proximal tibia in OVX rats. Together, this study revealed that genistein ameliorates senescence of OVX-BMMSCs through ERRα-mediated mitochondrial biogenesis and mitophagy, which provided a molecular basis for advancement and development of therapeutic strategies against PMOP.

Ultra-Confined Catalytic Growth Integration of Sub-10 nm 3D Stacked Silicon Nanowires Via a Self-Delimited Droplet Formation Strategy.

Fabricating ultrathin silicon (Si) channels down to critical dimension (CD) <10 nm, a key capability to implementing cutting-edge microelectronics and quantum charge-qubits, has never been accomplished via an extremely low-cost catalytic growth. In this work, 3D stacked ultrathin Si nanowires (SiNWs) are demonstrated, with width and height of Wnw  = 9.9 ± 1.2 nm (down to 8 nm) and Hnw  = 18.8 ± 1.8 nm, that can be reliably grown into the ultrafine sidewall grooves, approaching to the CD of 10 nm technology node, thanks to a new self-delimited droplet control strategy. Interestingly, the cross-sections of the as-grown SiNW channels can also be easily tailored from fin-like to sheet-like geometries by tuning the groove profile, while a sharply folding guided growth indicates a unique capability to produce closely-packed multiple rows of stacked SiNWs, out of a single run growth, with the minimal use of catalyst metal. Prototype field effect transistors are also successfully fabricated, achieving Ion/off ratio and sub-threshold swing of >106 and 125 mV dec-1 , respectively. These results highlight the unexplored potential of versatile catalytic growth to compete with, or complement, the advanced top-down etching technology in the exploitation of monolithic 3D integration of logic-in-memory, neuromorphic and charge-qubit applications.

Highly Stretchable High-Performance Silicon Nanowire Field Effect Transistors Integrated on Elastomer Substrates.

Quasi-1D silicon nanowires (SiNWs) field effect transistors (FETs) integrated upon large-area elastomers are advantageous candidates for developing various high-performance stretchable electronics and displays. In this work, it is demonstrated that an orderly array of slim SiNW channels, with a diameter of <80 nm, can be precisely grown into desired locations via an in-plane solid-liquid-solid (IPSLS) mechanism, and reliably batch-transferred onto large area polydimethylsiloxane (PDMS) elastomers. Within an optimized discrete FETs-on-islands architecture, the SiNW-FETs can sustain large stretching strains up to 50% and repetitive testing for more than 1000 cycles (under 20% strain), while achieving a high hole carrier mobility, Ion /Ioff current ratio and subthreshold swing (SS) of ≈70 cm2 V-1 s-1 , >105  and 134 - 277 mV decade-1 , respectively, working stably in an ambient environment over 270 days without any passivation protection. These results indicate a promising new routine to batch-manufacture and integrate high-performance, scalable and stretchable SiNW-FET electronics that can work stably in harsh and large-strain environments, which is a key capability for future practical flexible display and wearable electronic applications.

Designable Integration of Silicide Nanowire Springs as Ultra-Compact and Stretchable Electronic Interconnections.

Stretchable electronics are finding widespread applications in bio-sensing, skin-mimetic electronics, and flexible displays, where high-density integration of elastic and durable interconnections is a key capability. Instead of forming a randomly crossed nanowire (NW) network, here, a large-scale and precise integration of highly conductive nickel silicide nanospring (SiNix -NS) arrays are demonstrated, which are fabricated out of an in-plane solid-liquid-solid guided growth of planar Si nanowires (SiNWs), and subsequent alloy-forming process that boosts the channel conductivity over 4 orders of magnitude (to 2 × 104 S cm-1 ). Thanks to the narrow diameter of the serpentine SiNix -NS channels, the elastic geometry engineering can be accomplished within a very short interconnection distance (down to ≈3 µm), which is crucial for integrating high-density displays or logic units in a rigid-island and elastic-interconnection configuration. Deployed over soft polydimethylsiloxane thin film substrate, the SiNix -NS array demonstrates an excellent stretchability that can sustain up to 50% stretching and for 10 000 cycles (at 15%). This approach paves the way to integrate high-density inorganic electronics and interconnections for high-performance health monitoring, displays, and on-skin electronic applications, based on the mature and rather reliable Si thin film technology.

Unexpected phosphorus doping routine of planar silicon nanowires for integrating CMOS logics.

Complementary doping control in silicon nanowire (SiNW) channels is crucial for the construction of high-performance CMOS logics. Though planar in-plane solid-liquid-solid (IPSLS) growth, with an amorphous Si (a-Si) thin film as a precursor, has demonstrated a precise and scalable integration of orderly SiNWs, a complementary and tunable n-type doping has not been accomplished. This has been hindered by the fact that the phosphorus (P) gas dopants will react with the indium (In) catalyst droplet to form insoluble InP precipitates. Nevertheless, we herein report on an unexpected discovery that the P dopants first incorporated into the a-Si matrix can easily diffuse over the In catalyst droplets, without forming an InP compound, and thus reverse continuously the initial p-type SiNWs into an n-type channel. Uniform and efficient doping effects have been confirmed by both atomic probe tomography mapping and the transfer properties of SiNW FETs, which demonstrate a steep subthreshold swing of 105 mV dec-1, an on/off ratio of >107 and an electron mobility of 142 cm2 V-1 s-1. Finally, true CMOS inverters are successfully demonstrated based on the closely-packed SiNW channels of distinct doping polarities, indicating a new convenient and highly efficient doping routine to construct more advanced SiNW logics and sensors.

A new classification of descending necrotizing mediastinitis and surgical strategies.

BACKGROUND: Descending necrotizing mediastinitis (DNM) is an inflammation occurring in the oropharynx and descending to the deep cervical space and mediastinum, which is a serious infectious disease. The investigation of a new classification system and treatment methods for DNM is still necessary. METHODS: A total of 139 patients with DNM caused by odontogenic or pharyngeal infection were retrospectively analyzed in last 20 years in the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were divided into the traditional treatment Group T (Group T: 43 patients) and the new classification Group N (Group N: 96 patients). A new DNM classification was developed based on the progression of mediastinal infection as follows: type Ia: infection in the anterosuperior mediastinum; type I: infection in the anterior mediastinum; type II: infection in the posterior mediastinum; and type III: infection of the whole mediastinum. RESULTS: There were 49, 8, 10, and 29 patients classified as type Ia, I, II, and III, respectively in the Group N. The type Ia DNM patients were managed with transcervical mediastinal drainage, and the patients with types I and II DNM underwent open (thoracoscopic) surgery, 1 patient within types I died. The 29 patients with type III were managed with unilateral or bilateral open (thoracoscopic) surgery, among them, 8 patients died. The mortality rate for patients with type III DNM was 27.6%. The overall mortality rate in Group N was 9.4%. The mortality rate for patients in the Group T was 25.6%. The mortality rate of Group N was significantly lower than that of Group T (P<0.05). CONCLUSIONS: We have carried out a new clinical classification of DNM, and selected the appropriate treatment method according to the classification, and achieved a better effect than the traditional treatment method.

The Antimicrobial Peptide LL-37 Promotes Migration and Odonto/Osteogenic Differentiation of Stem Cells from the Apical Papilla through the Akt/Wnt/ß-catenin Signaling Pathway.

INTRODUCTION: The antimicrobial peptide LL-37, in addition to its broad spectrum of antibacterial function, can promote odontogenesis and osteogenesis. Stem cells from the apical papilla (SCAPs) are essential for the formation of dentin/bonelike tissues. However, little information on these cells is available in regenerative endodontics. This study aimed to evaluate the effects of LL-37 on the proliferation, migration, and differentiation of SCAPs. METHODS: SCAPs were isolated, cultured, and characterized. Cell viability was analyzed by Cell Counting Kit-8 assays (Dojindo, Kumamoto, Japan). Cell migration was investigated by transwell assays. Dentin sialophosphoprotein, dentin matrix protein 1, runt-related transcription factor 2, and osterix were assessed by quantitative polymerase chain reaction and Western blots. Alkaline phosphatase (ALP) activity and ALP staining were assessed to determine the in vitro potential for osteogenic differentiation. The involvement of the Akt/Wnt/ß-catenin signaling pathway was also studied. RESULTS: In the 2.5-µg/mL LL-37 -treated group, cell proliferation and migration were up-regulated. Quantitative polymerase chain reaction and Western blot assays both revealed that LL-37 at 2.5 µg/mL up-regulated odonto/osteogenic markers (dentin sialophosphoprotein, dentin matrix protein 1, runt-related transcription factor 2, and osterix). LL-37 at 2.5 µg/mL significantly promoted ALP activity and increased the staining in SCAPs. In addition, the p-Akt and p-glycogen synthase kinase-3ß levels were increased in LL-37-treated SCAPs. The migratory and odonto/osteogenic differentiation capacities of SCAPs were inhibited after treatment with inhibitors LY294002 and XAV-939. CONCLUSIONS: Our study showed that LL-37 at 2.5 µg/mL promoted the migration and odonto/osteogenic differentiation of SCAPs by activating the Akt/Wnt/ß-catenin signaling pathway.

A Retrospective Cohort Study of Risk Factors for Descending Necrotizing Mediastinitis Caused by Multispace Infection in the Maxillofacial Region.

PURPOSE: Descending necrotizing mediastinitis (DNM) has been the most common life-threatening complication of multispace infection (MSI) in the maxillofacial region owing to the lack of a timely diagnosis and treatment. We assessed the clinical characteristics and diagnosis of odontogenic MSI and evaluated the risk factors for DNM caused by MSI. PATIENTS AND METHODS: We performed a retrospective cohort study of inpatients with MSI in the maxillofacial region from January 2012 to October 2016. The patients were classified into a non-DNM group and a secondary DNM group. The information collected included gender, age, systemic comorbidities, source of maxillofacial infection, computed tomography imaging data, and laboratory test results. Univariate analysis (t test and χ2 test, or the Fisher exact test) and logistic regression analysis were applied. RESULTS: A total of 296 patients were included. The mortality was 6.3%. On univariate analysis, the following factors were statistically significant: gender (P = .001); age (P = .003); source of infection (P = .004); number of affected spaces (P < .001); involvement of the parotid space (P < .001), submandibular space (P < .001), subgingival space (P < .001), pterygomandibular space (P < .001), parapharyngeal space (P < .001), and retropharyngeal space (P < .001); and percentage of neutrophils (P < .001). On multivariate analysis, the parapharyngeal space (P = .008), source of infection (P = .037), and number of affected spaces (P < .001) were statistically significant. CONCLUSIONS: Glandular infection, parapharyngeal space involvement, and the presence of multiple affected spaces were risk factors for DNM. Clinicians should vigilantly watch for these factors during clinical treatment and effective measures taken to prevent the occurrence of DNM as soon as possible.

Internal Jugular Vein Thrombosis With Serious Cervical Necrotizing Fasciitis.

Internal jugular vein thrombosis (IJVT) is a rare complication of cervical necrotizing fasciitis (CNF) which may lead to life threat. This article reports a patient with severe CNF complicated with IJVT, and combined with the literature to analyze the diagnosis and treatment of CNF and IJVT.

Performance of mature compost to control gaseous emissions in kitchen waste composting.

This study investigated the performance of mature compost to mitigate gaseous emissions during kitchen waste composting. Cornstalk was mixed with kitchen waste at a ratio of 3:17 (wet weight) as the bulking agent. Mature compost (10% of raw composting materials on the wet weight basis) was mixed into or covered on the composting pile. A control treatment without any addition of mature compost was conducted for comparison. Results show that mature compost did not significantly affect the composting process. Nevertheless, gaseous emissions during kitchen waste composting were considerably reduced with the addition of mature compost. In particular, mixing mature compost with raw composting materials reduced ammonia, methane, and nitrous oxide emissions by 58.0%, 44.8%, and 73.6%, respectively. As a result, nitrogen could be conserved to increase nutrient contents and germination index of the compost product. Furthermore, the total greenhouse gas emissions during kitchen waste composting were reduced by 69.2% with the mixture of mature composting. By contrast, a lower reduction in gaseous emissions was observed when the same amount of mature compost was covered on the composting pile.

Risk Factors Affecting the Prognosis of Descending Necrotizing Mediastinitis From Odontogenic Infection.

PURPOSE: Descending necrotizing mediastinitis (DNM) is a serious complication of head and neck infections and has an excessively high mortality rate owing to the lack of understanding of DNM. We assessed the clinical characteristics, diagnosis, treatment, and outcomes of odontogenic DNM and evaluated the risk factors affecting the prognosis of DNM to provide an up-to-date overview for clinical practice. MATERIALS AND METHODS: We performed a retrospective cohort study, enrolling a sample of patients with DNM due to odontogenic infection who had been referred from January 2013 to December 2016. The patients were classified into surviving and deceased groups. The primary predictors in the present study were the presence of multiple comorbidities, complications, demographic data (age, gender), laboratory tests (white blood cell count, percentage of neutrophils), and time (duration before diagnosis, length of hospital stay). The primary outcome variable was the patient outcome (dead or alive). The continuous variables were evaluated using Student's t test or the t test, and the categorical and binary variables were compared using the χ2 test or Fisher exact test. RESULTS: A total of 81 patients (68 men, 13 women; median age of 57.2 ± 12.2 years) were included. The mortality was 4.9%. The most frequent cause of DNM was periapical periodontitis (66.7%). The lower posterior molars were involved in 39.5% of the cases. Treatment consisted of antibiotic therapy, aggressive transcervical mediastinal drainage (n = 74), and thoracotomy (n = 7). The associated risk factors for mortality were complications (P < .005) and severe sepsis or septic shock (P < .001) on bivariate analysis. CONCLUSIONS: Septic shock and complications were the risk factors that correlated with a poor prognosis. A timely diagnosis and use of aggressive mediastinal drainage are fundamental to reducing the incidence of complications and the development of septic shock in odontogenic DNM patients.

Piezosurgery for the Lingual Split Technique in Lingual Positioned Impacted Mandibular Third Molar Removal: A Retrospective Study.

The aim of this study was to evaluate the effect and safety of lingual split technique using piezosurgery for the extraction of lingual positioned impacted mandibular 3rd molars with the goal of proposing a more minimally invasive choice for this common surgery.Eighty-nine consecutive patients with 110 lingual positioned impacted mandibular 3rd molars requiring extraction were performed the lingual split technique using piezosurgery. One sagittal osteotomy line and 2 transverse osteotomy line were designed for lingual and occlusal bone removal. The success rate, operative time, postoperative outcome, and major complications (including nerve injury, mandible fracture, severe hematoma or edema, and severe pyogenic infection) were documented and analyzed.All impacted mandibular 3rd molars were successfully removed (110/110). The average time of operation was 14.6 minutes (ranged from 7 to 28 minutes). One hundred and seven extraction sites (97.3%) were primary healing. Pain, mouth opening, swelling, and PoSSe scores on postoperative 7-day were 0.34 ±â€Š0.63, 3.88 ±â€Š0.66(cm), 2.4 ±â€Š0.2(cm), and 23.7 ±â€Š5.9, respectively. There were 6 cases (5.5%) had lingual nerve disturbance and 3 cases (2.7%) developed inferior alveolar nerve impairment, and achieved full recovery within 2 months by neurotrophic drug treatment.Our study suggested piezosurgery for lingual split technique provided an effective way for the extraction of lingual positioned and deeply impacted mandibular 3rd molar.