• Title/Summary/Keyword: Oral and maxillofacial reconstruction

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Genetic determinants of periosteum-mediated craniofacial bone regeneration: a systematic review

  • Eyituoyo Okoturo
    • Archives of Craniofacial Surgery
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    • v.24 no.6
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    • pp.251-259
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    • 2023
  • Background: Periosteum-mediated bone regeneration (PMBR) is a recognized method for mandibular reconstruction. Despite its unpredictable nature and the limited degree to which it is understood, it does not share the concerns of developmental changes to donor and recipient tissues that other treatment options do. The definitive role of the periosteum in bone regeneration in any mammal remains largely unexplored. The purpose of this study was to identify the genetic determinants of PMBR in mammals through a systematic review. Methods: Our search methodology was designed in accordance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. We conducted a quality assessment of each publication, and evaluated the differences in gene expression between days 7 and 15. Results: A total of four studies satisfied the inclusion criteria. The subjects and tissues examined in these studies were Wistar rat calvaria in two studies, mini-pigs in one study, and calves and mice in one study. Three out of the four studies achieved the necessary quality score of ≥ 3. Gene expression analysis showed increased activity of genes responsible for angiogenesis, cytokine activities, and immune-inflammatory responses on day 7. Additionally, genes related to skeletal development and signaling pathways were upregulated on day 15. Conclusions: The results suggest that skeletal morphogenesis is regulated by genes associated with skeletal development, and the gene expression patterns of PMBR may be characterized by specific pathways.

Use of cone-beam computed tomography and three-dimensional modeling for assessment of anomalous pulp canal configuration: a case report

  • Sinanoglu, Alper;Helvacioglu-Yigit, Dilek;Mutlu, Ibrahim
    • Restorative Dentistry and Endodontics
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    • v.40 no.2
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    • pp.161-165
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    • 2015
  • Three-dimensional (3D) reconstruction of cone-beam computed tomography (CBCT) scans appears to be a valuable method for assessing pulp canal configuration. The aim of this report is to describe endodontic treatment of a mandibular second premolar with aberrant pulp canal morphology detected by CBCT and confirmed by 3D modeling. An accessory canal was suspected during endodontic treatment of the mandibular left second premolar in a 21 year old woman with a chief complaint of pulsating pain. Axial cross-sectional CBCT scans revealed that the pulp canal divided into mesiobuccal, lingual, and buccal canals in the middle third and ended as four separate foramina. 3D modeling confirmed the anomalous configuration of the fused root with a deep lingual groove. Endodontic treatment of the tooth was completed in two appointments. The root canals were obturated using lateral compaction of gutta-percha and root canal sealer. The tooth remained asymptomatic and did not develop periapical pathology until 12 months postoperatively. CBCT and 3D modeling enable preoperative evaluation of aberrant root canal systems and facilitate endodontic treatment.

Maxillary cement retained implant supported fixed prosthesis using the millingable Pd-Ag alloy generated by CAD/CAM system: clinical report after two years in service (상악 전부 무치악 환자에서 CAD/CAM 시스템으로 제작되는 Pd-Ag 합금을 이용한 고정성 임플란트 전악 수복 증례)

  • Lee, Jun-Sik;Han, Se-Jin;Choi, Yu-Sung
    • Journal of Dental Rehabilitation and Applied Science
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    • v.30 no.1
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    • pp.71-80
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    • 2014
  • Full-mouth reconstruction of a patient using dental implants is a challenge if there is vertical and horizontal bone resorption. Therefore, it is should be cautious in making the fixed prostheses that restore the function and the esthetics of the gingiva and teeth. In full mouth rehabilitation, CAD/CAM system makes it possible to fabricate restorations with high precision, regardless of span of the restoration. Recently, Palladium-silver (Pd-Ag) alloy which is highly biocompatible and millingable has been developed to compensate for the shortcomings of the titanium or zirconia. This clinical report presents the reconstruction of a maxillary arch with a cement retained implant supported fixed prosthesis using a Pd-Ag alloy generated by CAD/CAM system on eleven osseointegrated implants. The occluding surfaces were made of Pd-Ag alloy, to decrease the risk of chipping or fracture. The prostheses were esthetically pleasing, and no clinical complications have been reported after two years.

Maxillomandibular advancement surgery after long-term use of a mandibular advancement device in a post-adolescent patient with obstructive sleep apnea

  • Lee, Keun-Ha;Kim, Kyung-A;Kwon, Yong-Dae;Kim, Sung-Wan;Kim, Su-Jung
    • The korean journal of orthodontics
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    • v.49 no.4
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    • pp.265-276
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    • 2019
  • Patients with obstructive sleep apnea (OSA) whose phenotype belongs to a craniofacial vulnerability are referred from sleep doctors to orthodontists. In adults, for osseo-pharyngeal reconstruction (OPR) treatment, permanent maxillomandibular advancement (MMA) surgery and use of a temporary mandibular advancement device (MAD) are applied. This case report demonstrates successful treatment of OSA through application of phased MAD and MMA in a 16-year-old male with craniofacial deformity and residual growth potential. This patient showed skeletal and dentoalveolar changes after 7-year MAD use throughout post-adolescence, which affected the design and timing of subsequent MMA surgery, as well as post-surgical orthodontic strategy. This case report suggests that OPR treatment can be useful for treatment of OSA in post-adolescent patients, from an orthodontic point of view, in close collaboration with sleep doctors for interdisciplinary diagnosis and treatment.

Atrophic Alveolar Ridge Augmentation using Autogenous Block Bone Graft for Implant Placement (임플란트 식립을 위해 블록형 자가골이식을 이용한 퇴축된 치조골의 재건)

  • Chee, Young-Deok;Cho, Jin-Hyoung
    • Journal of Dental Rehabilitation and Applied Science
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    • v.22 no.2
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    • pp.161-171
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    • 2006
  • Endosseous implants have restored normal function and dental health to many patients. When implants were introduced as an effective treatment modality, their efficacy was limited by the amount of available bone. Today, various grafting procedures can surgically create bone width and volume. Implants can be placed in more ideal locations for successful prosthetic reconstruction. The use of autogenous bone grafts represents the "gold standard" for bone augmentation procedures. Either intraoral or extraoral sites may be considered for donor sites. Alveolar ridge augmentation using autogenous bone block, can be done during implant placement or staged with implant placement, after bone graft healing. In the staged technique, a better implant positioning and the use of wide diameter implants are possible. Alveolar ridge augmentation using autogenous block graft is a predictable way of treatment, for the atrophic alveolar ridge before implant placement. The cases presented in this article clinically demonstrate the efficacy of using a autogenous block graft in generating effective new bone fill for dental implant placement.

Central Giant Cell Granuloma of the Mandible: A Case Report (하악에 발생한 중심성 거대세포육아종의 치험례)

  • Chung, Jin-Wook;Oh, Deuk-Young;Seo, Je-Won;Moon, Suk-Ho;Lee, Jung-Ho;Rhie, Jong-Won;Ahn, Sang-Tae;Kim, Chang-Hyun
    • Archives of Plastic Surgery
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    • v.37 no.5
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    • pp.691-694
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    • 2010
  • Purpose: Central giant cell granuloma is a rare, benign giant cell tumor which commonly develops in areas near the teeth. It accounts for approximately less than 7% of benign tumors of the mandible. Clinically, central giant cell granuloma is classifed into aggressive and non-aggressive type, and usually requires surgical treatment. There has been no report of central giant cell granuloma in plastic surgery field of the country, and we report a case with a brief review of the diagnosis and treatment of the disease. Methods: A 23-year-old male presented with a hard, non-tender, growing mass with the size of $4.0{\times}3.0\;cm$ on mandible for several months. Computed tomography scan showed a solid mass within thinned outer cortex on mandible. The thinned outer cortex was excised with the mass and the inner cortex was partially removed burring. After the tumor removal, mandible was fixed by reconstruction plate. Results: Pathologic report showed numerous large multinucleated giant cells, diffusely distributed in a background of ovoid-to-spindle-shaped mononuclear cells. There was no evidence of recurrence after 1 year follow up. Bony defect was regenerated and we removed the reconstruction plate. Conclusion: Removal of central giant cell granuloma results in defect of outer cortex, which can be reconstructed by using reconstruction plate, autologous bone graft or bone cement. We used reconstruction plate as a conservative method to induce secondary healing of the outer cortical defect area, which resulted in normal mastication and occlusion with no recurrence.

A novel method for determining dose distribution on panoramic reconstruction computed tomography images from radiotherapy computed tomography

  • Hiroyuki Okamoto;Madoka Sakuramachi;Wakako Yatsuoka;Takao Ueno;Kouji Katsura;Naoya Murakami;Satoshi Nakamura;Kotaro Iijima;Takahito Chiba;Hiroki Nakayama;Yasunori Shuto;Yuki Takano;Yuta Kobayashi;Hironori Kishida;Yuka Urago;Masato Nishitani;Shuka Nishina;Koushin Arai;Hiroshi Igaki
    • Imaging Science in Dentistry
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    • v.54 no.2
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    • pp.129-137
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    • 2024
  • Purpose: Patients with head and neck cancer (HNC) who undergo dental procedures during radiotherapy (RT) face an increased risk of developing osteoradionecrosis (ORN). Accordingly, new tools must be developed to extract critical information regarding the dose delivered to the teeth and mandible. This article proposes a novel approach for visualizing 3-dimensional planned dose distributions on panoramic reconstruction computed tomography (pCT) images. Materials and Methods: Four patients with HNC who underwent volumetric modulated arc therapy were included. One patient experienced ORN and required the extraction of teeth after RT. In the study approach, the dental arch curve (DAC) was defined using an open-source platform. Subsequently, pCT images and dose distributions were generated based on the new coordinate system. All teeth and mandibles were delineated on both the original CT and pCT images. To evaluate the consistency of dose metrics, the Mann-Whitney U test and Student t-test were employed. Results: A total of 61 teeth and 4 mandibles were evaluated. The correlation coefficient between the 2 methods was 0.999, and no statistically significant difference was observed (P>0.05). This method facilitated a straightforward and intuitive understanding of the delivered dose. In 1 patient, ORN corresponded to the region of the root and the gum receiving a high dosage (approximately 70 Gy). Conclusion: The proposed method particularly benefits dentists involved in the management of patients with HNC. It enables the visualization of a 3-dimensional dose distribution in the teeth and mandible on pCT, enhancing the understanding of the dose delivered during RT.

THE INVESTIGATION OF MICROVASCULATURE CHANGES IN OSSEOUS REGENERATION BY GUIDED TISSUE REGENERATION PROCEDURE (골재생유도술에 의한 골재생시 미세혈관 구축 양상)

  • Choi, Du-Hee;Ryoo, Hyun-Mo;Shin, Hong-In
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.21 no.3
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    • pp.257-265
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    • 1999
  • To investigate the sequential changes in microvascular architecture and osseous regeneration during the bony healing after an application of the guided tissue regeneration method, we made artificial defects measuring $0.7cm{\times}0.3cm$ in size on femoral bones of rats measuring about 200gm and applied non-absorbable TEFE membrane at experimental sites but not at control sites. Then we observed the sequential changes and correlations between new vacuolation and bony regeneration using microvascular corrosion cast method and routine light microscopic observation at 1, 2 and 3 weeks after operation, respectively. The results showed that there were close relationships between regeneration of microvasculature and bone. In early phase, the invasion of granulation tissue at control sites delayed bony regeneration, however, in later phase, there was no remarkable differences in bony regeneration between control and experimental sites. The placement of barrier also affected in revascularization of regenerating bony defects. This is, the experimental sites showed parallel arranged nutritional vessels along long axis with well developed retiform plexus whereas the control revealed vertical invasion of microvasculature from outside of marrow space through bony defects which was also rearrange with time into parallel pattern with a vertical plexus but lesser organized than that of experimental sites. These findings suggest that the reconstruction of regenerating vasculature within the marrow cavity only may be sufficient and/or more be efficient in regeneration of bony defects.

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Accuracy of three-dimensional periodontal ligament models generated using cone-beam computed tomography at different resolutions for the assessment of periodontal bone loss

  • Hangmiao Lyu;Li Xu;Huimin Ma;Jianxia Hou;Xiaoxia Wang;Yong Wang;Yijiao Zhao;Weiran Li;Xiaotong Li
    • The korean journal of orthodontics
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    • v.53 no.2
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    • pp.77-88
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    • 2023
  • Objective: To develop a method for generating three-dimensional (3D) digital models of the periodontal ligament (PDL) using 3D cone-beam computed tomography (CBCT) reconstruction and to evaluate the accuracy and agreement of the 3D PDL models in the measurement of periodontal bone loss. Methods: CBCT data collected from four patients with skeletal Class III malocclusion prior to periodontal surgery were reconstructed at three voxel sizes (0.2 mm, 0.25 mm, and 0.3 mm), and 3D tooth and alveolar bone models were generated to obtain digital PDL models for the maxillary and mandibular anterior teeth. Linear measurements of the alveolar bone crest obtained during periodontal surgery were compared with the digital measurements for assessment of the accuracy of the digital models. The agreement and reliability of the digital PDL models were analyzed using intra- and interexaminer correlation coefficients and Bland-Altman plots. Results: Digital models of the maxillary and mandibular anterior teeth, PDL, and alveolar bone of the four patients were successfully established. Relative to the intraoperative measurements, linear measurements obtained from the 3D digital models were accurate, and there were no significant differences among different voxel sizes at different sites. High diagnostic coincidence rates were found for the maxillary anterior teeth. The digital models showed high intra- and interexaminer agreement. Conclusions: Digital PDL models generated by 3D CBCT reconstruction can provide accurate and useful information regarding the alveolar crest morphology and facilitate reproducible measurements. This could assist clinicians in the evaluation of periodontal prognosis and establishment of an appropriate orthodontic treatment plan.

Comparison of personal computer with CT workstation in the evaluation of 3-dimensional CT image of the skull (전산화단층촬영 단말장치와 개인용 컴퓨터에서 재구성한 두부 3차원 전산화단층영상의 비교)

  • Kang Bok-Hee;Kim Kee-Deog;Park Chang-Seo
    • Imaging Science in Dentistry
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    • v.31 no.1
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    • pp.1-7
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    • 2001
  • Purpose : To evaluate the usefulness of the reconstructed 3-dimensional image on the personal computer in comparison with that of the CT workstation by quantitative comparison and analysis. Materials and Methods : The spiral CT data obtained from 27 persons were transferred from the CT workstation to a personal computer, and they were reconstructed as 3-dimensional image on the personal computer using V-works 2.0/sup TM/. One observer obtained the 14 measurements on the reconstructed 3-dimensional image on both the CT workstation and the personal computer. Paired Nest was used to evaluate the intraobserver difference and the mean value of the each measurement on the CT workstation and the personal computer. Pearson correlation analysis and % incongruence were also performed. Results: I-Gn, N-Gn, N-A, N-Ns, B-A, and G-Op did not show any statistically significant difference (p>0.05), B-O, B-N, Eu-Eu, Zy-Zy, Biw, D-D, Orbrd R, and L had statistically significant difference (p<0.05), but the mean values of the differences of all measurements were below 2 mm, except for D-D. The value of correlation coefficient y was greater than 0.95 at I-Gn, N-Gn, N-A, N-Ns, B-A, B-N, G-Op, Eu-Eu, Zy-Zy, and Biw, and it was 0.75 at B-O, 0.78 at D-D, and 0.82 at both Orbrd Rand L. The % incongruence was below 4% at I-Gn, N-Gn, N-A, N-Ns, B-A, B-N, G-Op, Eu-Eu, Zy-Zy, and Biw, and 7.18%, 10.78%, 4.97%, 5.89% at B-O, D-D, Orbrd Rand L respectively. Conclusion : It can be considered that the utilization of the personal computer has great usefulness in reconstruction of the 3-dimensional image when it comes to the economics, accessibility and convenience, except for thin bones and the landmarks which are difficult to be located.

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