Radiation therapy(RT)is a treatment option for head and neck cancer(HNC),but 2%of RT patients may experience damage to the jawbone,resulting in osteoradionecrosis(ORN).The ORN can manifest years after RT exposure.Chan...Radiation therapy(RT)is a treatment option for head and neck cancer(HNC),but 2%of RT patients may experience damage to the jawbone,resulting in osteoradionecrosis(ORN).The ORN can manifest years after RT exposure.Changes in the local microchemical bone quality prior to the clinical manifestation of ORN could play a key role in ORN pathogenesis.Chemical bone quality can be analyzed using Fourier transform infrared spectroscopy(FTIR),that is applied to examine the effects of cancer,chemotherapy,and RT on the quality of human man-dibular bone.Cortical mandibular bone samples were harvested from dental implant beds of 23 individuals,i.e.,patients with surgically and radiotherapeutically treated HNC(RT-HNC,n=7),surgically and radiochemotherapeutically treated HNC(CH-RT-HNC,n=3),only surgically treated HNC(SRG-HNC,n=4),and healthy controls(n=9).Infrared spectra were acquired from two representative regions of interest in cortical mandibular bone.Spectral parameters,i.e.,mineral-to-matrix ratio(MM),carbonate-to-matrix ratio(CM),carbonate-to-phosphate ratio(CP),collagen maturity(cross-linking),crystallinity,acid phosphate substitu-tion(APS),and advanced glycation end products(AGEs),were analyzed for each sample.Amide I region of the CH-RT-HNC group differed from the control group in cluster analysis(p=0.02).Apart from a minor variation trend in collagen maturity(p=0.07),there were no other signif-icant differences between the groups.Thus,the effect of radiochemotherapy on mandibular bone composition should be further investigated.In future trials,this study design is potential when the effects of the cancer burden and different HNC treatment modalities on jawbone composition are studied,in order to reveal ORN pathogenesis.展开更多
Large-size mandible graft has huge needs in clinic caused by infection,tumor,congenital deformity,bone trauma and so on.However,the reconstruction of large-size mandible defect is challenged due to its complex anatomi...Large-size mandible graft has huge needs in clinic caused by infection,tumor,congenital deformity,bone trauma and so on.However,the reconstruction of large-size mandible defect is challenged due to its complex anatomical structure and large-range bone injury.The design and fabrication of porous implants with large segments and specific shapes matching the native mandible remain a considerable challenge.Herein,the 6%Mg-doped calcium silicate(CSi-Mg6)andβ-andα-tricalcium phosphate(β-TCP,α-TCP)bioceramics were fabricated by digital light processing as the porous scaffolds of over 50%in porosity,while the titanium mesh was fabricated by selective laser melting.The mechanical tests showed that the initial flexible/compressive resistance of CSi-Mg6 scaffolds was markedly higher than that ofβ-TCP andα-TCP scaffolds.Cell experiments showed that these materials all had good biocompatibility,while CSi-Mg6 significantly promoted cell proliferation.In the rabbit critically sized mandible bone defects(∼13 mm in length)filled with porous bioceramic scaffolds,the titanium meshes and titanium nails were acted as fixation and load bearing.The results showed that the defects were kept during the observation period in the blank(control)group;in contrast,the osteogenic capability was significantly enhanced in the CSi-Mg6 andα-TCP groups in comparison with theβ-TCP group,and these two groups not only had significantly increased new bone formation but also had thicker trabecular and smaller trabecular spacing.Besides,the CSi-Mg6 andα-TCP groups showed appreciable material biodegradation in the later stage(from 8 to 12 weeks)in comparison with theβ-TCP scaffolds while the CSi-Mg6 group showed much outstanding mechanical capacity in vivo in the early stage compared to theβ-TCP andα-TCP groups.Totally,these findings suggest that the combination of customized strength-strong bioactive CSi-Mg6 scaffolds together with titanium meshes is a promising way for repairing the large-size load-bearing mandible defects.展开更多
This study was to describe the use of inverted-L osteotomy of ramus and lilac bone graft for the management of mandibular deficiency in adult patients. From 2008 to 2010, 11 patients （aged 19 to 29 years） with mandi...This study was to describe the use of inverted-L osteotomy of ramus and lilac bone graft for the management of mandibular deficiency in adult patients. From 2008 to 2010, 11 patients （aged 19 to 29 years） with mandibular deficiency underwent intraoral or extraoral inverted-L osteotomy of ramus and lilac crest bone grafting. Data were collected from the patients＇ records, photographs and radiographs. The height and width of the ramus were successfully expanded by inverted-L osteotomy and lilac crest bone grafting with minimal complications in all patients, resulting in significant improvement in occlusion and facial appearance. Our early results showed that the inverted-L osteotomy of ramus and lilac crest bone grafting is safe and effective, and should be considered as a good alternative for the patients with mandibular deficiency.展开更多
Mandibular defects caused by injuries,tumors,and infections are common and can severely affect mandibular function and the patient's appearance.However,mandible reconstruction with a mandibular bionic structure re...Mandibular defects caused by injuries,tumors,and infections are common and can severely affect mandibular function and the patient's appearance.However,mandible reconstruction with a mandibular bionic structure remains challenging.Inspired by the process of intramembranous ossification in mandibular development,a hierarchical vascularized engineered bone consisting of angiogenesis and osteogenesis modules has been produced.Moreover,the hierarchical vascular network and bone structure generated by these hierarchical vascularized engineered bone modules match the particular anatomical structure of the mandible.The ultra-tough polyion complex has been used as the basic scaffold for hierarchical vascularized engineered bone for ensuring better reconstruction of mandible function.According to the results of in vivo experiments,the bone regenerated using hierarchical vascularized engineered bone is similar to the natural mandibular bone in terms of morphology and genomics.The sonic hedgehog signaling pathway is specifically activated in hierarchical vascularized engineered bone,indicating that the new bone in hierarchical vascularized engineered bone underwent a process of intramembranous ossification identical to that of mandible development.Thus,hierarchical vascularized engineered bone has a high potential for clinical application in mandibular defect reconstruction.Moreover,the concept based on developmental processes and bionic structures provides an effective strategy for tissue regeneration.展开更多
Experiments on maxillofacial bone tissue engineering showed the promising result;however, its healing mechanisms and effectiveness had not been fully understood. The aim of this study is to compare the bone healing me...Experiments on maxillofacial bone tissue engineering showed the promising result;however, its healing mechanisms and effectiveness had not been fully understood. The aim of this study is to compare the bone healing mechanism and osteogenic capacity between bovine bone mineral loaded with hAMSC and autogenous bone graft in the reconstruction of critical size mandibular bone defect. Critical size defects were made at the mandible of 45 New Zealand white rabbits reconstructed with BBM-hAMSC, BBM alone, and ABG, respectively. At the end of first, second, and twelfth weeks, five rabbits from each experimental week were sacrificed for histology and immunohistochemistry staining. Expressions of vascular endothelial growth factor (VEGF), bone mor-phogenic proteins-2 (BMP2), Runx2 and the amount of angiogenesis were analyzed in the first and second week groups, while expressions of Runx2, osteocalcin, collagen type-I fibres, trabecular area and bone incorporation were analyzed in the twelfth week groups. The result showed that expressions of VEGF, BMP2 and Runx2 as well as the amount of angiogenesis were higher in ABG compared with BBM-hAMSC group in the first and second weeks of healing. The result of twelfth week of healing showed that expressions of Runx2 and osteocalcin as well as the thickness of collagen type-I fibres were significantly higher in BBM-hAMSC compared to ABG group, while there was no statistically difference in trabecular area and bone incorporation between BBM-hAMSC and ABG group. This study concluded that early healing activities were higher in auto-genous bone graft than in BBM-hAMSC, while osteogenic activities in the late stage of healing were higher in BBM-hAMSC compared to autogenous bone graft. It was also concluded that the osteo-genic capacity of BBM-hAMSC was comparable to autogenous bone graft in the reconstruction of critical size defect in the mandible.展开更多
<b><span style="font-family:Verdana;">Objectives: </span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><spa...<b><span style="font-family:Verdana;">Objectives: </span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">T</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">he </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">objective</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is to</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> determine whether there are differences in the position of the hyoid bone at rest in natural head position in subjects with mandibular hyperdivergence</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> and </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">to evaluate whether there are differences in hyoid position and antegonial notch depth in mandibular hyperdivergent males and females. </span><b><span style="font-family:Verdana;">Methods and Materials: </span></b><span style="font-family:Verdana;">This is a retrospective cohort study involving a review of lateral cephalometric radiographs of 45 adult men and women with mandibular hyperdivergency. Hyperdivergency was determined by cephalometric ranges of: SN-GoGn as least +2 SD from normal, Y-axis, PP-GoGN, and gonial angle greater than +1SD from normal. A group of 45 normodivergent adults served as a control, with cephalometric ranges of: SN-GoGn within </span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">±</span><span><span style="font-family:Verdana;">1 SD of normal, with only one measurement of the other three between +1 and +1.5 standard deviations. A custom digital cephalometric analysis, the Hyoid Analysis, was designed, to measure the vertical and horizontal position and inclination of the hyoid and the antegonial notch depth. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> In hyperdivergent subjects, the posterior aspect of the hyoid is located lower and more posterior, compared to the control group, while there is no difference in position of the anterior surface of the hyoid and the antegonial notch is 0.6</span></span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">mm deeper. In males, the posterior aspect of hyoid is lower by 8.5</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">mm, while the anterior surface is located 9.0</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">mm lower. In males, the hyoid is inclined more steeply than in females by 4.4 degrees and the antegonial notch is deeper than in females by 0.6</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">mm. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">There are differences in hyoid bone position and mandibular morphology in hyperdivergent subjects compared to normodivergent subjects and in males compared to females.展开更多
[Objectives] To shorten the time of removal of the bone embedded mandibular third molar,reduce the complications of tooth extraction,and explore a surgery method of resistance-free removal of the mandibular third mola...[Objectives] To shorten the time of removal of the bone embedded mandibular third molar,reduce the complications of tooth extraction,and explore a surgery method of resistance-free removal of the mandibular third molar. [Methods] A total of 50 patients with bone embedded mandibular third molar needing to be removed were selected. A 45° elevation turbine and a long tungsten steel drill were used to remove the mesial,buccal,and distal resistances. When necessary,tongue side and root resistance was removed,and the third molar was removed when there was basically no resistance around it. The removal time was recorded,followed up for 10 d,and the postoperative reaction was observed. [Results] The bone embedded mandibular third molars were removed for all patients within 15 min,and there was no serious postoperative reaction,all patients showed high satisfaction. [Conclusions]The method of resistance-free removal of the bone embedded mandibular third molar can significantly shorten the removal time,reduce the fear of patients,and ease pain of patients.展开更多
BACKGROUND Critically sized bone defects represent a significant challenge to orthopaedic surgeons worldwide.These defects generally result from severe trauma or resection of a whole large tumour.Autologous bone graft...BACKGROUND Critically sized bone defects represent a significant challenge to orthopaedic surgeons worldwide.These defects generally result from severe trauma or resection of a whole large tumour.Autologous bone grafts are the current gold standard for the reconstruction of such defects.However,due to increased patient morbidity and the need for a second operative site,other lines of treatment should be introduced.To find alternative unconventional therapies to manage such defects,bone tissue engineering using a combination of suitable bioactive factors,cells,and biocompatible scaffolds offers a promising new approach for bone regeneration.AIM To evaluate the healing capacity of platelet-rich fibrin(PRF)membranes seeded with allogeneic mesenchymal bone marrow-derived stem cells(BMSCs)on critically sized mandibular defects in a rat model.METHODS Sixty-three Sprague Dawley rats were subjected to bilateral bone defects of critical size in the mandibles created by a 5-mm diameter trephine bur.Rats were allocated to three equal groups of 21 rats each.Group I bone defects were irrigated with normal saline and designed as negative controls.Defects of group II were grafted with PRF membranes and served as positive controls,while defects of group III were grafted with PRF membranes seeded with allogeneic BMSCs.Seven rats from each group were killed at 1,2 and 4 wk.The mandibles were dissected and prepared for routine haematoxylin and eosin(HE)staining,Masson's trichrome staining and CD68 immunohistochemical staining.RESULTS Four weeks postoperatively,the percentage area of newly formed bone was significantly higher in group III(0.88±0.02)than in groups I(0.02±0.00)and II(0.60±0.02).The amount of granulation tissue formation was lower in group III(0.12±0.02)than in groups I(0.20±0.02)and II(0.40±0.02).The number of inflammatory cells was lower in group III(0.29±0.03)than in groups I(4.82±0.08)and II(3.09±0.07).CONCLUSION Bone regenerative quality of critically sized mandibular bone defects in rats was better promoted by PRF membranes seeded with BMSCs than with PRF membranes alone.展开更多
Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted sur...Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon’s hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.展开更多
The goal of this study was to assess the effect of the intermittent combination of an antiresorptive agent （calcitonin） and an anabolic agent （vitamin D3） on treating the detrimental effects of Type 1 diabetes mel...The goal of this study was to assess the effect of the intermittent combination of an antiresorptive agent （calcitonin） and an anabolic agent （vitamin D3） on treating the detrimental effects of Type 1 diabetes mellitus （DM） on mandibular bone formation and growth. Forty 3-week-old male Wistar rats were divided into four groups： the control group （normal rats）, the control C＋D group （normal rats injected with calcitonin and vitamin D3）, the diabetic C＋D group （diabetic rats injected with calcitonin and vitamin D3） and the diabetic group （uncontrolled diabetic rats）. An experimental DM condition was induced in the male Wistar rats in the diabetic and diabetic C＋ D groups using a single dose of 60 mg.kg-1 body weight of streptozotocin. Calcitonin and vitamin D3 were simultaneously injected in the rats of the control C＋D and diabetic C＋D groups. All rats were killed after 4 weeks, and the right mandibles were evaluated by micro-computed tomography and histomorphometric analysis. Diabetic rats showed a significant deterioration in bone quality and bone formation （diabetic group）. By contrast, with the injection of calcitonin and vitamin D3, both bone parameters and bone formation significantly improved （diabetic C＋ D group） （P 〈 0.05）. These findings suggest that these two hormones might potentially improve various bone properties.展开更多
Planar bone Scintigraphy has been frequently used to assess the active or inactive nature of mandibular hypercondylia. We report here the case of a patient whose diagnosis of active mandibular hypercondylia was retain...Planar bone Scintigraphy has been frequently used to assess the active or inactive nature of mandibular hypercondylia. We report here the case of a patient whose diagnosis of active mandibular hypercondylia was retained after a complement with SPECT/CT imaging, the planar bone scan being negative. This case confirms the use of SPECT/ CT as the examination of choice for full assessment of mandibular hypercondylia in adults. Using bone Scintigraphy SPECT/CT improves both sensitivity and specificity of diagnosing this condition.展开更多
Objectives: To 1) explore the planar scintigraphic findings in asymmetry patients caused by unilateral condylar hyperplasia (UCH) or asymmetric mandibular hyperplasia (AMH);2) develop a local agecondylar activity refe...Objectives: To 1) explore the planar scintigraphic findings in asymmetry patients caused by unilateral condylar hyperplasia (UCH) or asymmetric mandibular hyperplasia (AMH);2) develop a local agecondylar activity reference norm;and 3) check the accuracy of the new norm and compare with other analytical methods. Material and Method: Chinese patients with mandibular asymmetry and scintigraphic findings available were recruited. Clinical, radiographic records and scintigraphic condylar activity ratio (CAR) were studied. Regression analysis was performed to quantify the relationship between age and CAR to develop a new norm. The sensitivity of condylar activity assessment using a) traditional norm;b) new norm;and c) percentile difference was compared. In patients with serial data available, longitudinal analysis of the scintigraphic changes were checked. Result: 109 patients were eligible for the study. Significant difference in CAR was noted between UCH and AMH patients. Linear relationship was observed between age and CAR. A new norm of the age-CAR was established, which showed improved sensitivity in condylar activity prediction in UCH and AMH when compared with traditional norm. Relative to percentile difference, the sensitivity of new norm was lower in AMH but not in UCH patients. Serial analysis revealed gradual decline in CAR with minimal change in percentile difference. Conclusion and Clinical Relevance: There is difference in scintigraphic condylar activity between UCH and AMH patients. A norm of age-CAR relationship was established, which showed improved sensitivity in condylar activity prediction in UCH patients. Further study is required to confirm the role of scintigraphy in AMH.展开更多
The effects of childhood masticatory function loss and soft foods on the mandibular condyle have been the subject of much research. However, the corresponding bone turnover is not fully understood. The purpose of the ...The effects of childhood masticatory function loss and soft foods on the mandibular condyle have been the subject of much research. However, the corresponding bone turnover is not fully understood. The purpose of the present study was to clarify the effects of a lack of teeth and a soft food diet during the growth period on bone turnover in the mandibular condyle. We divided 3-week-old Wistar rats into the following three groups: 1) Extraction group: The maxillary molars were extracted at the age of 4 weeks, and animals were fed powdered standard feed. 2) Powder group: Animals were fed powdered standard feed without tooth extraction. 3) Control group: Animals were fed solid standard feed without tooth extraction. Non-decalcified thin-slice specimens of sagittal sections of the mandibular condyle were obtained at the age of 20 weeks for histological analysis. We used micro-CT analysis and bone histomorphometry to measure bone volume (BV), bone mineral content (BMC), bone mineral density (BMD), bone microstructure, bone resorption, and osteogenesis in the mandibular condyle, and we compared the results among groups. In the extraction and the powder groups, we found deformation and disruption of the arrangement of chondrocytes, coagulation of chondrocytes, and duplication of the tidemark in the cartilage. We also found an increase in multinuclear osteoclasts in the cancellous bone. We found a reduction in BV, BMC, and BMD in the extraction and powder groups compared to the control group, as well as a reduction of bone volume, a lowering of osteogenesis parameters, and an increase in bone resorption parameters in the secondary cancellous bone. These results suggest that a lack of teeth and a soft food diet during the growth period cause a decline in bone microstructure, a decrease in osteogenesis, and an increase in bone resorption.展开更多
文摘Radiation therapy(RT)is a treatment option for head and neck cancer(HNC),but 2%of RT patients may experience damage to the jawbone,resulting in osteoradionecrosis(ORN).The ORN can manifest years after RT exposure.Changes in the local microchemical bone quality prior to the clinical manifestation of ORN could play a key role in ORN pathogenesis.Chemical bone quality can be analyzed using Fourier transform infrared spectroscopy(FTIR),that is applied to examine the effects of cancer,chemotherapy,and RT on the quality of human man-dibular bone.Cortical mandibular bone samples were harvested from dental implant beds of 23 individuals,i.e.,patients with surgically and radiotherapeutically treated HNC(RT-HNC,n=7),surgically and radiochemotherapeutically treated HNC(CH-RT-HNC,n=3),only surgically treated HNC(SRG-HNC,n=4),and healthy controls(n=9).Infrared spectra were acquired from two representative regions of interest in cortical mandibular bone.Spectral parameters,i.e.,mineral-to-matrix ratio(MM),carbonate-to-matrix ratio(CM),carbonate-to-phosphate ratio(CP),collagen maturity(cross-linking),crystallinity,acid phosphate substitu-tion(APS),and advanced glycation end products(AGEs),were analyzed for each sample.Amide I region of the CH-RT-HNC group differed from the control group in cluster analysis(p=0.02).Apart from a minor variation trend in collagen maturity(p=0.07),there were no other signif-icant differences between the groups.Thus,the effect of radiochemotherapy on mandibular bone composition should be further investigated.In future trials,this study design is potential when the effects of the cancer burden and different HNC treatment modalities on jawbone composition are studied,in order to reveal ORN pathogenesis.
基金supported by the National Key Research and Development Program of China(2017YFE0117700 and 2018YFA0703000)the Science and Technology Department of Zhejiang Province Foundation(LGF20H140008 and GF22E038891)National Natural Science Foundation of China(81871775 and 81902225).
文摘Large-size mandible graft has huge needs in clinic caused by infection,tumor,congenital deformity,bone trauma and so on.However,the reconstruction of large-size mandible defect is challenged due to its complex anatomical structure and large-range bone injury.The design and fabrication of porous implants with large segments and specific shapes matching the native mandible remain a considerable challenge.Herein,the 6%Mg-doped calcium silicate(CSi-Mg6)andβ-andα-tricalcium phosphate(β-TCP,α-TCP)bioceramics were fabricated by digital light processing as the porous scaffolds of over 50%in porosity,while the titanium mesh was fabricated by selective laser melting.The mechanical tests showed that the initial flexible/compressive resistance of CSi-Mg6 scaffolds was markedly higher than that ofβ-TCP andα-TCP scaffolds.Cell experiments showed that these materials all had good biocompatibility,while CSi-Mg6 significantly promoted cell proliferation.In the rabbit critically sized mandible bone defects(∼13 mm in length)filled with porous bioceramic scaffolds,the titanium meshes and titanium nails were acted as fixation and load bearing.The results showed that the defects were kept during the observation period in the blank(control)group;in contrast,the osteogenic capability was significantly enhanced in the CSi-Mg6 andα-TCP groups in comparison with theβ-TCP group,and these two groups not only had significantly increased new bone formation but also had thicker trabecular and smaller trabecular spacing.Besides,the CSi-Mg6 andα-TCP groups showed appreciable material biodegradation in the later stage(from 8 to 12 weeks)in comparison with theβ-TCP scaffolds while the CSi-Mg6 group showed much outstanding mechanical capacity in vivo in the early stage compared to theβ-TCP andα-TCP groups.Totally,these findings suggest that the combination of customized strength-strong bioactive CSi-Mg6 scaffolds together with titanium meshes is a promising way for repairing the large-size load-bearing mandible defects.
文摘This study was to describe the use of inverted-L osteotomy of ramus and lilac bone graft for the management of mandibular deficiency in adult patients. From 2008 to 2010, 11 patients （aged 19 to 29 years） with mandibular deficiency underwent intraoral or extraoral inverted-L osteotomy of ramus and lilac crest bone grafting. Data were collected from the patients＇ records, photographs and radiographs. The height and width of the ramus were successfully expanded by inverted-L osteotomy and lilac crest bone grafting with minimal complications in all patients, resulting in significant improvement in occlusion and facial appearance. Our early results showed that the inverted-L osteotomy of ramus and lilac crest bone grafting is safe and effective, and should be considered as a good alternative for the patients with mandibular deficiency.
基金National Key Research and Development Program of China(2018YFA0703000)National Natural Science Foundation of China(8212200044,52075482,82071085,81873720)+2 种基金Zhejiang Provincial Natural Science Foundation of China(LR21H140001)Key Research and Development Program of Zhejiang,China(2017C01054,2018C03062)Scientific Research Fund of Zhejiang Provincial Education Department(Y202045564)。
文摘Mandibular defects caused by injuries,tumors,and infections are common and can severely affect mandibular function and the patient's appearance.However,mandible reconstruction with a mandibular bionic structure remains challenging.Inspired by the process of intramembranous ossification in mandibular development,a hierarchical vascularized engineered bone consisting of angiogenesis and osteogenesis modules has been produced.Moreover,the hierarchical vascular network and bone structure generated by these hierarchical vascularized engineered bone modules match the particular anatomical structure of the mandible.The ultra-tough polyion complex has been used as the basic scaffold for hierarchical vascularized engineered bone for ensuring better reconstruction of mandible function.According to the results of in vivo experiments,the bone regenerated using hierarchical vascularized engineered bone is similar to the natural mandibular bone in terms of morphology and genomics.The sonic hedgehog signaling pathway is specifically activated in hierarchical vascularized engineered bone,indicating that the new bone in hierarchical vascularized engineered bone underwent a process of intramembranous ossification identical to that of mandible development.Thus,hierarchical vascularized engineered bone has a high potential for clinical application in mandibular defect reconstruction.Moreover,the concept based on developmental processes and bionic structures provides an effective strategy for tissue regeneration.
文摘Experiments on maxillofacial bone tissue engineering showed the promising result;however, its healing mechanisms and effectiveness had not been fully understood. The aim of this study is to compare the bone healing mechanism and osteogenic capacity between bovine bone mineral loaded with hAMSC and autogenous bone graft in the reconstruction of critical size mandibular bone defect. Critical size defects were made at the mandible of 45 New Zealand white rabbits reconstructed with BBM-hAMSC, BBM alone, and ABG, respectively. At the end of first, second, and twelfth weeks, five rabbits from each experimental week were sacrificed for histology and immunohistochemistry staining. Expressions of vascular endothelial growth factor (VEGF), bone mor-phogenic proteins-2 (BMP2), Runx2 and the amount of angiogenesis were analyzed in the first and second week groups, while expressions of Runx2, osteocalcin, collagen type-I fibres, trabecular area and bone incorporation were analyzed in the twelfth week groups. The result showed that expressions of VEGF, BMP2 and Runx2 as well as the amount of angiogenesis were higher in ABG compared with BBM-hAMSC group in the first and second weeks of healing. The result of twelfth week of healing showed that expressions of Runx2 and osteocalcin as well as the thickness of collagen type-I fibres were significantly higher in BBM-hAMSC compared to ABG group, while there was no statistically difference in trabecular area and bone incorporation between BBM-hAMSC and ABG group. This study concluded that early healing activities were higher in auto-genous bone graft than in BBM-hAMSC, while osteogenic activities in the late stage of healing were higher in BBM-hAMSC compared to autogenous bone graft. It was also concluded that the osteo-genic capacity of BBM-hAMSC was comparable to autogenous bone graft in the reconstruction of critical size defect in the mandible.
文摘<b><span style="font-family:Verdana;">Objectives: </span></b></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">T</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">he </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">objective</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> is to</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> determine whether there are differences in the position of the hyoid bone at rest in natural head position in subjects with mandibular hyperdivergence</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> and </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">to evaluate whether there are differences in hyoid position and antegonial notch depth in mandibular hyperdivergent males and females. </span><b><span style="font-family:Verdana;">Methods and Materials: </span></b><span style="font-family:Verdana;">This is a retrospective cohort study involving a review of lateral cephalometric radiographs of 45 adult men and women with mandibular hyperdivergency. Hyperdivergency was determined by cephalometric ranges of: SN-GoGn as least +2 SD from normal, Y-axis, PP-GoGN, and gonial angle greater than +1SD from normal. A group of 45 normodivergent adults served as a control, with cephalometric ranges of: SN-GoGn within </span></span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">±</span><span><span style="font-family:Verdana;">1 SD of normal, with only one measurement of the other three between +1 and +1.5 standard deviations. A custom digital cephalometric analysis, the Hyoid Analysis, was designed, to measure the vertical and horizontal position and inclination of the hyoid and the antegonial notch depth. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> In hyperdivergent subjects, the posterior aspect of the hyoid is located lower and more posterior, compared to the control group, while there is no difference in position of the anterior surface of the hyoid and the antegonial notch is 0.6</span></span></span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">mm deeper. In males, the posterior aspect of hyoid is lower by 8.5</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">mm, while the anterior surface is located 9.0</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">mm lower. In males, the hyoid is inclined more steeply than in females by 4.4 degrees and the antegonial notch is deeper than in females by 0.6</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">mm. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">There are differences in hyoid bone position and mandibular morphology in hyperdivergent subjects compared to normodivergent subjects and in males compared to females.
基金Supported by the People's Livelihood Science and Technology Program of Qingdao City(15-9-2-73-nsh)
文摘[Objectives] To shorten the time of removal of the bone embedded mandibular third molar,reduce the complications of tooth extraction,and explore a surgery method of resistance-free removal of the mandibular third molar. [Methods] A total of 50 patients with bone embedded mandibular third molar needing to be removed were selected. A 45° elevation turbine and a long tungsten steel drill were used to remove the mesial,buccal,and distal resistances. When necessary,tongue side and root resistance was removed,and the third molar was removed when there was basically no resistance around it. The removal time was recorded,followed up for 10 d,and the postoperative reaction was observed. [Results] The bone embedded mandibular third molars were removed for all patients within 15 min,and there was no serious postoperative reaction,all patients showed high satisfaction. [Conclusions]The method of resistance-free removal of the bone embedded mandibular third molar can significantly shorten the removal time,reduce the fear of patients,and ease pain of patients.
文摘BACKGROUND Critically sized bone defects represent a significant challenge to orthopaedic surgeons worldwide.These defects generally result from severe trauma or resection of a whole large tumour.Autologous bone grafts are the current gold standard for the reconstruction of such defects.However,due to increased patient morbidity and the need for a second operative site,other lines of treatment should be introduced.To find alternative unconventional therapies to manage such defects,bone tissue engineering using a combination of suitable bioactive factors,cells,and biocompatible scaffolds offers a promising new approach for bone regeneration.AIM To evaluate the healing capacity of platelet-rich fibrin(PRF)membranes seeded with allogeneic mesenchymal bone marrow-derived stem cells(BMSCs)on critically sized mandibular defects in a rat model.METHODS Sixty-three Sprague Dawley rats were subjected to bilateral bone defects of critical size in the mandibles created by a 5-mm diameter trephine bur.Rats were allocated to three equal groups of 21 rats each.Group I bone defects were irrigated with normal saline and designed as negative controls.Defects of group II were grafted with PRF membranes and served as positive controls,while defects of group III were grafted with PRF membranes seeded with allogeneic BMSCs.Seven rats from each group were killed at 1,2 and 4 wk.The mandibles were dissected and prepared for routine haematoxylin and eosin(HE)staining,Masson's trichrome staining and CD68 immunohistochemical staining.RESULTS Four weeks postoperatively,the percentage area of newly formed bone was significantly higher in group III(0.88±0.02)than in groups I(0.02±0.00)and II(0.60±0.02).The amount of granulation tissue formation was lower in group III(0.12±0.02)than in groups I(0.20±0.02)and II(0.40±0.02).The number of inflammatory cells was lower in group III(0.29±0.03)than in groups I(4.82±0.08)and II(3.09±0.07).CONCLUSION Bone regenerative quality of critically sized mandibular bone defects in rats was better promoted by PRF membranes seeded with BMSCs than with PRF membranes alone.
文摘Craniomaxillofacial surgery is difficult due to the complexity of the regional anatomy. Computer-assisted surgery is a promising tool aiming to improve the safety and precision of such surgery. A computer-assisted surgical navigation approach for reconstruction of mandibular defects using a patient-specific titanium mesh tray and particulate cancellous bone and marrow (PCBM) harvested from bilateral anterior ilia is proposed. This case report involves a large multicystic ameloblastoma affecting the right mandible of a 31-year-old male patient. Following detailed clinical examination, radiological interpretation, and histopathological diagnosis, computer-assisted surgical simulation with a virtual 3-dimensional (3-D) model was designed using surgical planning software based on the pre-operative computed tomography data. Long-span segmental resection of the mandible was planned, and the defect was analyzed for reconstruction using a patient-specific reconstruction titanium mesh tray mediated with computer-aided design and manufacturing (CAD/CAM) techniques. During the actual surgery, the ultrasonic bone cutting instrument in the surgeon’s hand was connected to the navigation system to touch an anatomical position on the patient. Therefore, osteotomies were performed finely and smoothly according to the navigation images of the cutting bone line by sequentially moving the instrument. Finally, a CAD/CAM-mediated titanium mesh tray condensed by PCBM was adapted to the remaining mandibular fragments. Six months postoperatively, the patient had a good mandibular configuration and facial contour. Integration of different technologies, such as software planning and 3-D surgical simulation, combined with intraoperative navigation and CAD/CAM techniques, provides safe and precise mandibular reconstruction surgery.
基金the National Plan for Science,Technology and Innovation(MAARIFAH)-King Abdulaziz City for Science Technology-the Kingdom of Saudi Arabia award number(12-MED2735-03)Science and Technology Unit,King Abdulaziz University for technical support
文摘The goal of this study was to assess the effect of the intermittent combination of an antiresorptive agent （calcitonin） and an anabolic agent （vitamin D3） on treating the detrimental effects of Type 1 diabetes mellitus （DM） on mandibular bone formation and growth. Forty 3-week-old male Wistar rats were divided into four groups： the control group （normal rats）, the control C＋D group （normal rats injected with calcitonin and vitamin D3）, the diabetic C＋D group （diabetic rats injected with calcitonin and vitamin D3） and the diabetic group （uncontrolled diabetic rats）. An experimental DM condition was induced in the male Wistar rats in the diabetic and diabetic C＋ D groups using a single dose of 60 mg.kg-1 body weight of streptozotocin. Calcitonin and vitamin D3 were simultaneously injected in the rats of the control C＋D and diabetic C＋D groups. All rats were killed after 4 weeks, and the right mandibles were evaluated by micro-computed tomography and histomorphometric analysis. Diabetic rats showed a significant deterioration in bone quality and bone formation （diabetic group）. By contrast, with the injection of calcitonin and vitamin D3, both bone parameters and bone formation significantly improved （diabetic C＋ D group） （P 〈 0.05）. These findings suggest that these two hormones might potentially improve various bone properties.
文摘Planar bone Scintigraphy has been frequently used to assess the active or inactive nature of mandibular hypercondylia. We report here the case of a patient whose diagnosis of active mandibular hypercondylia was retained after a complement with SPECT/CT imaging, the planar bone scan being negative. This case confirms the use of SPECT/ CT as the examination of choice for full assessment of mandibular hypercondylia in adults. Using bone Scintigraphy SPECT/CT improves both sensitivity and specificity of diagnosing this condition.
文摘Objectives: To 1) explore the planar scintigraphic findings in asymmetry patients caused by unilateral condylar hyperplasia (UCH) or asymmetric mandibular hyperplasia (AMH);2) develop a local agecondylar activity reference norm;and 3) check the accuracy of the new norm and compare with other analytical methods. Material and Method: Chinese patients with mandibular asymmetry and scintigraphic findings available were recruited. Clinical, radiographic records and scintigraphic condylar activity ratio (CAR) were studied. Regression analysis was performed to quantify the relationship between age and CAR to develop a new norm. The sensitivity of condylar activity assessment using a) traditional norm;b) new norm;and c) percentile difference was compared. In patients with serial data available, longitudinal analysis of the scintigraphic changes were checked. Result: 109 patients were eligible for the study. Significant difference in CAR was noted between UCH and AMH patients. Linear relationship was observed between age and CAR. A new norm of the age-CAR was established, which showed improved sensitivity in condylar activity prediction in UCH and AMH when compared with traditional norm. Relative to percentile difference, the sensitivity of new norm was lower in AMH but not in UCH patients. Serial analysis revealed gradual decline in CAR with minimal change in percentile difference. Conclusion and Clinical Relevance: There is difference in scintigraphic condylar activity between UCH and AMH patients. A norm of age-CAR relationship was established, which showed improved sensitivity in condylar activity prediction in UCH patients. Further study is required to confirm the role of scintigraphy in AMH.
文摘The effects of childhood masticatory function loss and soft foods on the mandibular condyle have been the subject of much research. However, the corresponding bone turnover is not fully understood. The purpose of the present study was to clarify the effects of a lack of teeth and a soft food diet during the growth period on bone turnover in the mandibular condyle. We divided 3-week-old Wistar rats into the following three groups: 1) Extraction group: The maxillary molars were extracted at the age of 4 weeks, and animals were fed powdered standard feed. 2) Powder group: Animals were fed powdered standard feed without tooth extraction. 3) Control group: Animals were fed solid standard feed without tooth extraction. Non-decalcified thin-slice specimens of sagittal sections of the mandibular condyle were obtained at the age of 20 weeks for histological analysis. We used micro-CT analysis and bone histomorphometry to measure bone volume (BV), bone mineral content (BMC), bone mineral density (BMD), bone microstructure, bone resorption, and osteogenesis in the mandibular condyle, and we compared the results among groups. In the extraction and the powder groups, we found deformation and disruption of the arrangement of chondrocytes, coagulation of chondrocytes, and duplication of the tidemark in the cartilage. We also found an increase in multinuclear osteoclasts in the cancellous bone. We found a reduction in BV, BMC, and BMD in the extraction and powder groups compared to the control group, as well as a reduction of bone volume, a lowering of osteogenesis parameters, and an increase in bone resorption parameters in the secondary cancellous bone. These results suggest that a lack of teeth and a soft food diet during the growth period cause a decline in bone microstructure, a decrease in osteogenesis, and an increase in bone resorption.
