• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권2호
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• pp.87-93
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• 2010

Introduction: In our previous studies, we isolated porcine skin-derived mesenchymal stem cells (pSDMSCs) from the ears of adult miniature pigs and evaluated the pluripotency of these pSDMSCs based on expressions of transcription factors, such as Oct-4, Sox-2, and Nanog. Moreover, the characteristic of mesenchymal stem cells was revealed by the expression of various mesenchymal stem cell markers, including CD29, CD44, CD90, and vimentin. The aim of this study was to evaluate in vivo osteogenesis after maxillary sinus lift procedures with autogenous pSDMSCs and scaffold. Materials and Methods: The autogenous pSDMSCs were isolated from the 4 miniature pigs, and cultured to 3rd passage with same methods of our previous studies. After cell membranes were labeled using a PKH26, $1{\times}10^{7}$ cells/$100{\mu}L$ of autogenous pSDMSCs were grafted into the maxillary sinus with a demineralized bone matrix (DBM) and fibrin glue scaffold. In the contralateral control side, only a scaffold was grafted, without SDMSCs. After two animals each were euthanized at 2 and 4 weeks after grafting, the in vivo osteogenesis was evaluated with histolomorphometric and osteocalcin immunohistochemical studies. Results: In vivo PKH26 expression was detected in all specimens at 2 and 4 weeks after grafting. Trabecular bone formation and osteocalcin expression were more pronounced around the grafted materials in the autogenous pSDMSCs-grafted group compared to the control group. Newly generated bone was observed growing from the periphery to the center of the grafted material. Conclusion: The results of the present study suggest that autogenous skin-derived mesenchymal stem cells grafting with a DBM and fibrin glue scaffold can be a predictable method in the maxillary sinus floor elevation technique for implant surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권2호
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• pp.71-77
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• 2010

Introduction: The purpose of this study is to evaluate the effect of platelet rich plasma in bone formation and osseointegration of implant installed in the bone marrow space. Materials and Methods: Five beagle dogs were used as experimental animals. Two implants were installed on each tibia in the dogs. Implants of the control group were installed with no additional graft. Those of the experimental group 1 were installed with autogenous bone graft from the ilium autogenous bone. Platelet rich plasma (PRP) alone was used in experimental group 2 and the mixture of PRP and autogenous bone was used in experimental group 3. The animals were sacrificed at 8 weeks after implantation. The parts of tibia containing implant were harvested and radiographs were taken for radiographic examination. The specimens were prepared for histological examination and histomorphometric analysis of implant-bone contact ratios. Results: 1. All implants showed sufficient osseointegration in the cortical bone radiographically and histologically, but osseointergration in the marrow space was not satisfactory. 2. Histomorphometrically, the implant-bone contact ratios in the bone marrow was sequentially high in the experimental group 3 (autogenous bone + PRP group), group 1 (autogenous bone group), group 2 (PRP group), and control group (non-additive). 3. It was verified that there was statistical significance between two experimental groups (group 1 and 3) and the other groups (group 2 and control group). (P<0.005) 4. However, there was no statistical significance between group 3 and group 1, also group 2 and control group respectively. Conclusion: These results suggest that platelet rich plasma is effective to osseointegration in the implant installation but there is no statistical significance.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권6호
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• pp.515-519
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• 2010

Introduction: Bone defects in the jaw are frequently observed after odontogenic cyst enucleation. The success of bone healing appears to be related to the size of the bone defect, the anatomical location, the patient's age and other parameters. The use of bone grafting material is dependent on the operator's preference. No evidence-based definite treatment protocol has been established. This study evaluated the effect of a bone graft into the defect after odontogenic cyst enucleation. Materials and Methods: A total of 55 patients, who had been treated for an odontogenic cyst with cyst enucleation from 2000 to 2009 at the department of Oral and Maxillofacial Surgery, Samsung Medical Center, were included in this study. Patients who were followed-up for more than 1 year were included. Two groups were defined according to the bone graft (with or without a bone graft) after cyst enucleation. The differences in the healing periods and patterns of bone healing were compared clinically and radiologically. The postoperative 1 year radiographs were analyzed for bone healing and density. Statistical analysis was performed using a Pearson chi square test and Wilcoxon rank-sum test. Results: More infection signs were observed in the bone graft group than in the other group, but there was no statistically significant difference. Radiographically, there was also no significant difference in the size of the radiolucent lesions between the two groups. Conclusion: There was no significant difference in healing between the groups with a bone graft and without bone graft after cyst enucleation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권5호
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• pp.392-401
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• 2010

Introduction: Diabetes mellitus, as a major health problem for the elderly has been shown to alter the properties of the bone and impair bone healing around a titanium implant in both humans and animals. The aim of this study was to examine the effect of adipose-derived stem cells on the healing process around a titanium implant in streptozotocin-induced diabetic rats. Materials and Methods: Thirteen rats were divided into two groups: adipose-derived stem cells injected group and a control group. A titanium screw implant (diameter: 2.0 mm, length: 3.5 mm) was placed into both tibia of 13 rats: 13 right tibia as the control group and 13 left tibia as the experimental group. The rats were sacrificed at different intervals (1, 2, and 4 weeks) after implantation for histopathology observations and immunohistochemistric analysis. Results: The histopathological findings revealed earlier new formed bone in the experimental group than the control group. In particular, at 1 week after implantation, the experimental group showed more newly formed bone and collagen around the implant than the control group. In immunohistochemistric analysis, osteoprotegerin (OPG) expression in the experimental group increased early compared to that of the control group until 2 weeks after implantation. However, after 2 weeks, OPG expression in the experimental group was similar to OPG expression in the control group. The receptor activator of nuclear factor ${\kappa}B$ ligand (RANKL) expression in the experimental group increased early compared to that of the control group, and then decreased at 2 weeks. After 2 weeks, the level of RANKL expression was similar in both groups. Conclusion: These results suggest that adipose-derived stem cells in implantation can promote bone healing around titanium, particularly in diabetes mellitus induced animals.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권5호
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• pp.386-391
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• 2010

Introduction: Bone resorption is a unique function of osteoclasts. Osteoclasts are a specialized macrophage polykaryon whose differentiation is regulated principally by macrophage colony-stimulating factors, receptor activator of nuclear factor ${\kappa}B$ ligand (RANK) ligand, osteoprotegerin (OPG), and interleukins (IL). Reflecting the integrin-mediated signals, osteoclasts develop a specialized cytoskeleton that allows it to establish an isolated micro-environment between itself and the bone, wherein matrix degradation occurs by a process involving proton transport. The levels of IL-1, IL-6, OPG, and prostaglandin $E_2$ ($PGE_2$) expression were evaluated to study the correlations between dental implant teeth and the adjacent teeth. Materials and Methods: The exudate of the gingival crevice acquired from dental implants, adjacent teeth, opposite teeth and contralateral teeth of 24 patients. Results: 1. The levels of IL-1, IL-6, OPG and $PGE_2$ expression in dental implant teeth were higher than those of the contralateral teeth. 2. IL-1 revealed a higher expression level in the adjacent teeth than in dental implant teeth. 3. The dental implant teeth and adjacent teeth did not show a remarkable difference in the level of IL-1 expression. 4. All the other cytokines were strongly expressed in the dental implant compared to the adjacent teeth. Conclusion: These results suggest that there might be close correlation between dental implant teeth and adjacent teeth in terms of the expressions of cytokines that affect the development and regulation of osteoclasts.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권6호
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• pp.502-507
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• 2010

Introduction: This study examined the genetic influence of mandibular prognathism epidemiologically in Korean families. Materials and Methods: Over a 5-year period from 2005 to 2009, a questionnaire with a pedigree chart was given to 100 (male 51, female 49) probands with skeletal Class III mandibular prognathism, who had undergone orthognathic surgery in Samsung Medical Center. Results: The average age of the probands was 22.1. The average SNA, SNB and ANB angles of the probands were $81.2^{\circ}$, $84.1^{\circ}$ and $-2.9^{\circ}$, respectively. A total of 2729 (male 1,354, female 1,375) family members were examined, and the affected ratio of the families was 3.5% with no significant difference between genders. 45% of families had at least one member with a Class III malocclusion other than the proband. The affected ratio of the first-degree relatives (10.9%) was significantly higher than those of the second-degree (3.3%) and third-degree (1.9%) relatives. The affected ratio of the total relatives from the male probands (4.2%) was significantly higher than that of the female probands (2.8%). Heritability ($h^2$, Falconer' method) was estimated to be 29.8% ($0.298{\pm}0.059$) in first-degree relatives. Conclusion: These results showed the significant influence of mandibular prognathism with relatively low heritability in first-degree relatives in Korean families of probands, who had undergone orthognathic surgery to correct a skeletal Class III malocclusion.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권5호
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• pp.375-379
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• 2010

Introduction: In the management of dentofacial deformities, variable movement of the maxilla can be made possible by a Le Fort I osteotomy. Posterior impaction of the maxilla necessary for rotation of the maxillomandibular complex enhances the functions and esthetic results. In cases of posterior impaction of the maxilla, an increase in the figure of the occlusal plane angle and incisor inclination can occur. This study reports the relationship between the amount of posterior impaction and the change in the occlusal plane angle and incisor inclination in a Le Fort I osteotomy by preoperative and postoperative lateral cephalograms. Materials and Methods: Twenty patients who had undergone orthognathic surgery in Dong-A University Medical Center participated in this study. Lateral cephalometrics, within 3 weeks prior to surgery and 3 days after surgery, were used for analysis. Pre and postoperative measurements of the occlusal plane angle and incisal inclination based on the Frankfort horizontal (FH) plane were performed. X and Y were defined as the amount of vertical change in the upper incisor tip and the amount of vertical change in the upper first molar mesial cup tip through the operation. The amount of final posterior maxillary impaction was determined by subtracting Y from X, which is the difference in vertical height. According to the amount of posterior maxillary impaction, the change in the occlusal plane angle and incisal inclination was measured. Results: The average posterior maxillary impaction was 2.91 mm and the average change in the occlusal plane angle and incisal inclination was $6.54^{\circ}$after surgery. As a result, each mm of posterior maxillary impaction changed the occlusal plane angle and incisal inclination by $2.25^{\circ}$. Statistically, there was high significance. Two cases were observed: one with the same amount of posterior maxillary impaction performed on both the right and left showing $2.20^{\circ}$, and the other with a different amount of posterior maxillary impaction performed showing $2.35^{\circ}$. In this case, there was no significance difference between the two cases. Conclusion: Each mm of posterior maxillary impaction changes the occlusal plane angle and incisal inclination by an average of $2.25^{\circ}$. In posterior maxillary impaction, there was no significant difference in the amount of change in the occlusal plane angle and incisal inclination regardless of whether there was an equal amount of posterior maxillary impaction on both sides. This study is expected to help in the presurgical orthodontic preparation and presurgical treatment planning.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권6호
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• pp.481-489
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• 2010

Introduction: TLR-5, a member of the toll-like receptor (TLR) family, is a element of the type I transmembrane receptors, which are characterized by an intracellular signaling domain homolog to the interleukin-1 receptor. These receptors recognize microbial components, particularly bacterial flagellin. All-trans retinoic acid (atRA, tretinoin), a natural metabolite of vitamin A, acts as a growth and differentiation factor in many tissues, and is also needed for immune functions. In this study, THP-1 human macrophage-monocytes were used to examine the mechanisms by which atRA regulated the expression of TLR-5. Because the molecular mechanism underlying this regulation at the transcriptional level is also unclear, this study examined which putative transcription factors are responsible for TLR-5 expression by atRA in immune cells. Materials and Methods: This study examined whether atRA induces the expression of TLR-5 in THP-1 cells using reverse transcription-polymerase chain reaction (RT-PCR), and which transcription factors are involved in regulating the TLR-5 promoter in RAW264.7 cells using a reporter assay system. Western blot analysis was used to determine which signal pathway is involved in the expression of TLR-5 in atRA-treated THP-1 cells. Results: atRA at a concentration of 10 nM greatly induced the expression of TLR-5 in THP-1 cells. Human TLR-5 promoter contains three Sp-1/GC binding sites around -50 bp and two NF-kB binding sites at -380 bp and -160 bp from the transcriptional start site of the TLR-5 gene. Sp-1/GC is primarily responsible for the constitutive TLR-5 expression, and may also contribute to NF-kB at -160 bp to induce TLR-5 after atRA stimulation in THP-1 cells. The role of NF-kB in TLR-5 expression was further confirmed by inhibitor pyrrolidine dithiocarbamate (PDTC) experiments, which greatly reduced the TLR-5 transcription by 70-80%. Conclusion: atRA induces the expression of the human TLR-5 gene and NF-kB is a critical transcription factor for the atRA-induced expression of TLR-5. Accordingly, it is conceivable that retinoids are required for adequate innate and adaptive immune responses to agents of infectious diseases. atRA and various synthetic retinoids have been used therapeutically in human diseases, such as leukemia and other cancers due to the antiproliferative and apoptosis inducing effects of retinoids. Therefore, understanding the molecular regulatory mechanism of TLR-5 may assist in the design of alternative strategies for the treatment of infectious diseases, leukemia and cancers.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권6호
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• pp.466-472
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• 2010

Introduction: This study examined the effect of recombinant human bone morphogenetic protein (rhBMP)-2 and $\beta$-tricalcium phosphate ($\beta$-TCP) on new bone formation in a rabbit calvarium using a rapid prototype titanium cap (RP Ti cap). Materials and Methods: Eight New Zealand white rabbits were used in this study. Hemispherical RP Ti caps (10 mm in diameter) were implanted subperiosteally on the rabbit calvaria. $\beta$-TCP was filled in the RP Ti cap in the control group, and rhBMP-2 soaked $\beta$-TCP was used in experimental group. The rabbits were sacrificed 2 and 4 weeks after the operation. The volume and pattern of newly formed bone was analyzed by micro computed tomography (CT). Results: Macroscopically, there were no abnormal findings in any of the animals. The micro CT images revealed new bone from the calvaria that expanded gradually toward the top of the titanium cap, particularly along the inner surface of the titanium cap in the experimental group at 4 weeks after grafting. There was no significant difference in new bone volume ratio between the control and experimental groups at 2 weeks after grafting. There was a statistically significant difference in the new bone volume ratio between the experimental ($14.1{\pm}1.8\;%$) and control ($7.2{\pm}1.5\;%$) groups at 4 weeks after grafting (P<0.01). Conclusion: The RP Ti cap can effectively guide new bone formation and rhBMP-2 can induce the new bone formation.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제36권5호
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• pp.353-359
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• 2010

Introduction: This study examined the effect of cyclosporine A (CsA) on the allogenic cranial bone graft in the mice. Materials and Methods: Twenty eight 12-week-old male ICR mice weighing 40 g were used. The experimental group was injected subcutaneously with CsA (10 mg/kg/day) diluted in Caster oil for 7 days prior to the graft until sacrifice. The control group was injected with the same solution without CsA. Two full-thickness bone defects with a diameter of 3 mm were made with a trephine bur in the parietal bone lateral to the sagittal suture. A calvarial defect of a mouse was grafted with allogenic calvarial bone disc from another mouse. The experimental and control groups were injected with CsA and the solution without CsA in the same manner before surgery, respectively. The mice were sacrificed at 1 week, 2 weeks and 4 weeks after the bone graft, respectively. Results: In the experimental group, fibrous connective tissues and small amounts of inflammatory cells were observed. At 2 weeks after the allograft in the experimental group, new bone formation in fibrous collagenous tissue and around the allogenic bone was noted. At 4 weeks after the allograft, new bone formation was active along and at the periphery of the mature allogenic bone. The proliferation of blood vessels increased in bone marrow. In the control group, fibrous tissues and inflammatory cells were observed around the allogenic bone and existing bone at 1 week. At 2 weeks after the allograft, the proliferation of blood vessels accompanied by inflammatory cells were scattered in the fibrous connective tissues. New bone formation around the allogenic and existing bone could be observed. At 4 weeks after the allograft, inflammatory cells were severely infiltrated around the allogenic bone. Osteoclasts were scattered along the allogenic bone and induced bone resorption. Conclusion: These results suggest that the daily administration of CsA (10 mg/kg/day) induces efficient immunosuppression without serious complications, and this protocol might be useful for the experimental model of allogenic bone grafts.