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Balumuka D, Daly GE, Krakauer K, Burch S, Jedrzejewski B, Johnson A, Howell LK, Wolfswinkel EM. Gingivoperiosteoplasty in Children with Cleft Lip and Palate: The Need for Alveolar Bone Grafting. Cleft Palate Craniofac J 2024:10556656241256917. [PMID: 38778553 DOI: 10.1177/10556656241256917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This study aimed to determine the efficacy of gingivoperiosteoplasty (GPP) in preventing alveolar bone grafting (ABG) among children with cleft lip and palate (CLP). DESIGN/SETTING Retrospective university hospital single center study. PATIENTS Children with CLP treated with GPP from 2000-2015 were included. Those under eight years of age, without definitive conclusions regarding need for ABG or with incomplete data were excluded. INTERVENTIONS Included patients were analyzed for demographics, cleft type, age at GPP, associated cleft surgery, use of nasoalveolar molding (NAM), indication for ABG, operating surgeon and presence of residual alveolar fistula. T-tests and Fisher's exact tests were utilized for statistical analysis. MAIN OUTCOME MEASURE The need for ABG. RESULTS Of the 1682 children identified with CLP, 64 underwent GPP and met inclusion criteria. 78% of patients with CLP who underwent GPP were recommended for ABG. Those who received GPP at a younger age (P = .004) and at the time of initial cleft lip repair (P = .022) were less likely to be recommended for ABG. Patients with complete CLP were more likely to be recommended for ABG than patients with cleft lip and alveolus only (P = .015). The operating surgeon impacted the likelihood of ABG (P = .004). Patient gender, race, ethnicity, laterality, and NAM were not significantly associated with recommendation for ABG. CONCLUSION GPP does not preclude the need for ABG. Therefore, the success of ABG after GPP and maxillary growth restriction should be analyzed further to determine if GPP is a worthwhile adjunct to ABG in cleft care.
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Affiliation(s)
- Darius Balumuka
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Gwendolyn E Daly
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Kelsi Krakauer
- Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA, USA
| | - Samantha Burch
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Breanna Jedrzejewski
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Alicia Johnson
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Lori K Howell
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Erik M Wolfswinkel
- Division of Plastic and Reconstructive Surgery, Oregon Health and Science University, Portland, OR, USA
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Ko J, Rustia S, Alkharafi L, Ganguly R, Yen SLK, Oberoi S. Comparison of Alveolar Bone Grafting Outcomes using CBCT in Individuals with UCLP Based on the Presurgical Orthodontic Treatment Methods. Cleft Palate Craniofac J 2024; 61:791-800. [PMID: 36748327 PMCID: PMC10981178 DOI: 10.1177/10556656221143945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The purpose is to evaluate outcomes of alveolar bone grafting based on the pre-grafting orthodontic preparation methods. DESIGN Retrospective analysis of individuals with unilateral cleft lip and palate. SUBJECTS AND SETTINGS 28 individuals with non-syndromic UCLP from two craniofacial centers, 14 individuals each from XXXX and XXXX. INTERVENTIONS The alignment group underwent maxillary expansion with incisors alignment while the non-alignment group underwent only maxillary expansion for presurgical orthodontic preparation. METHODS Initial and post-surgical CBCT scans were compared to observe changes in angulation of the incisor adjacent to the cleft site, alveolar bony root coverage, and bone graft outcomes. RESULTS In the alignment group, the buccolingual rotation decreased by 32.35 degrees (p = .0002), the anteroposterior inclination increased by 14.01 degrees (p = .0004), and the mesiodistal angulation decreased by 17.88 degrees (p = .0001). Alveolar bony coverage did not change after bone graft in both groups, and no difference was observed between the groups. Chelsea scale showed satisfactory bone graft outcome (category A, C) in 12 cases (85.71%) in the alignment group and 11 cases (78.51%) in the non-alignment group. The volumetric measurement showed the alignment group had better bone fill of 69.85% versus 51.45% in the non-alignment group (p = .0495). CONCLUSIONS Alveolar bony coverage on the tooth adjacent to cleft sites did not change with alveolar bone grafting surgery in either of the alignment and non-alignment group. Presurgical orthodontic alignment does not induce root exposure nor poorer bone grafting outcome.
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Affiliation(s)
- Jaemin Ko
- Craniofacial and Special Care Orthodontics, Division of Dentistry, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Samantha Rustia
- School of Dentistry, University of California, San Francisco, CA, USA
| | - Lateefa Alkharafi
- Program in Craniofacial Biology and Division of Craniofacial Anomalies, Department of Orofacial Sciences, University of California, San Francisco, CA, USA
| | - Rumpa Ganguly
- Oral and Maxillofacial Radiology, Department of Orofacial Sciences, University of California, San Francisco, CA, USA
| | - Stephen L-K Yen
- Craniofacial and Special Care Orthodontics, Division of Dentistry, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Snehlata Oberoi
- Program in Craniofacial Biology and Division of Craniofacial Anomalies, Department of Orofacial Sciences, University of California, San Francisco, CA, USA
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Ren J, Li Z, Liu W, Fan Y, Qi L, Li S, Kong C, Zou H, Liu Z. Demineralized bone matrix for repair and regeneration of maxillofacial defects: A narrative review. J Dent 2024; 143:104899. [PMID: 38428719 DOI: 10.1016/j.jdent.2024.104899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES Demineralized bone matrix (DBM) is a well-established bone graft material widely accepted by dentists and the public for its favorable osteoconductivity and osteoinductive potential. This article aimed to provide a narrative review of the current therapeutic applications and limitations of DBM in maxillofacial bone defects. STUDY SELECTION, DATA, AND SOURCES Randomized controlled trials, prospective or retrospective clinical studies, case series and reports, and systematic reviews. MEDLINE, PubMed, and Google Scholar were searched using keywords. CONCLUSIONS Some evidence supported the therapeutic application of DBM in periodontal intrabony defects, maxillary sinus lifts, ridge preservation, ridge augmentation, alveolar cleft repair, orthognathic surgery, and other regional maxillofacial bone defects. However, the limitations of DBM should be considered when using it, including potential low immunogenicity, instability of osteoinductive potential, handling of the graft material, and patient acceptance. CLINICAL SIGNIFICANCE With the increasing demand for the treatment of maxillofacial bone defects, DBM is likely to play a greater role as a promising bone graft material. Safe and effective combination treatment strategies and how to maintain a stable osteoinductive potential will be the future challenges of DBM research.
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Affiliation(s)
- Jiwei Ren
- Hospital of Stomatology, Jilin University, China
| | - Zhiwei Li
- Hospital of Stomatology, Jilin University, China
| | - Wantong Liu
- Hospital of Stomatology, Jilin University, China
| | - Yixin Fan
- Hospital of Stomatology, Jilin University, China
| | - Le Qi
- Hospital of Stomatology, Jilin University, China
| | - Sining Li
- Hospital of Stomatology, Jilin University, China
| | - Chen Kong
- Hospital of Stomatology, Jilin University, China
| | - He Zou
- Hospital of Stomatology, Jilin University, China
| | - Zhihui Liu
- Hospital of Stomatology, Jilin University, China.
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Guo W, Lu B, Liu F, Jin D, Wu S, Zhou S, Li Z, Lv Y, Zhao Z, Zhang J, Li Y. Comprehensive repair of the alveolar cleft using cortical and cancellous bone layers: A retrospective study. J Craniomaxillofac Surg 2024; 52:310-315. [PMID: 38212164 DOI: 10.1016/j.jcms.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 10/11/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
To retrospectively review the clinical effect of comprehensive treatment of alveolar cleft (CTAC) using the mandible as the bone source. Patients with alveolar clefts who met the inclusion criteria were subjected to a CTAC protocol that included the following: (1) preoperative orthodontic treatment for creating good soft-tissue conditions; (2) 'area-like grafting' with subperiosteal osteogenic chin bone instead of cartilaginous osteogenic iliac bone; (3) simulation of normal bone anatomy via a sandwich-like bone graft consisting of 'cortical bone + cancellous bone + cortical bone'; and (4) strong internal fixation to ensure initial bone block stability. At 6 months postoperatively, the titanium plate was removed and cone-beam computed tomography was performed to evaluate the surgical results. A total of 54 patients underwent treatment with the CTAC protocol. The average age at the initial operation was 10.3 ± 2.1 years, and the average hospital stay was 2.8 ± 0.6 days. At 6 months postoperatively, 49 patients (90.7%) showed good clinical results. The transplanted bone block formed a 'cortical bone + cancellous bone + cortical bone' structure similar to that of the normal jawbone. A mature bone bridge formed, and the impacted permanent teeth continued to erupt and enter the bone graft area. CTAC is a comprehensive restorative solution for alveolar cleft repair that integrates multiple concepts, including orthodontics, embryology, anatomy, and improvements to surgical methods. The method is easy to perform, causes little surgical trauma, and shows a stable success rate, and is thus worth promoting.
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Affiliation(s)
- Weiwei Guo
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Bin Lu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Fuwei Liu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Dan Jin
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Simo Wu
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Shanluo Zhou
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Zhiye Li
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Yaoguang Lv
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Zhihe Zhao
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Junrui Zhang
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China.
| | - Yunpeng Li
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China.
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Saskianti T, Wardhani KK, Fadhila N, Wahluyo S, Dewi AM, Nugraha AP, Ernawati DS, Kanawa M. Polymethylmethacrylate-hydroxyapatite antibacterial and antifungal activity against oral bacteria: An in vitro study. J Taibah Univ Med Sci 2024; 19:190-197. [PMID: 38229827 PMCID: PMC10790095 DOI: 10.1016/j.jtumed.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 01/18/2024] Open
Abstract
Objective Reconstruction of alveolar bone defects resulting from aging, trauma, ablative surgery or pathology, remains a significant clinical challenge. The objective of this study was to investigate the antibacterial and antifungal activities of mixed polymethylmethacrylate-hydroxyapatite (PMMA-HA) against oral microorganisms. Our findings could provide valuable insights into the prospective application of PMMA-HA as a synthetic bone graft material to manage alveolar bone defects via tissue engineering. Methods HA powder was obtained from the Center for Ceramics in Indonesia and PMMA granules were obtained from HiMedia Laboratories; these were prepared in 20:80, 30:70, and 40:60 ratios. The antibacterial diffusion method was then performed against Staphylococcusaureus, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Fusobacterium nucleatum, while the antifungal diffusion method was used to test against Candida albicans. Standardized protocols were used for microbial culturing and inhibition zones were measured with digital calipers. Statistical analyses included one-way ANOVA and Kruskal-Wallis tests, supplemented by post-hoc Tukey HSD tests. Results A PMMA-HA scaffold with a 20:80 ratio demonstrated the highest antibacterial activity against S. aureus, A. actinomycetemcomitans, P. gingivalis, and F. nucleatum. This was followed by the 30:70 and 40:60 ratios in terms of antibacterial activity. Statistical significance was achieved with p < 0.05 in comparison to controls. However, none of the PMMA-HA ratios showed antifungal activity against C. albicans. Conclusion PMMA-HA scaffolds have significant activity against bacteria, but not against fungi.
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Affiliation(s)
- Tania Saskianti
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Karina K. Wardhani
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Naura Fadhila
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Soegeng Wahluyo
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Ardianti M. Dewi
- Department of Pediatric Dentistry, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Alexander P. Nugraha
- Department of Orthodontics, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Diah S. Ernawati
- Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Indonesia
| | - Masami Kanawa
- Department of Natural Science Center for Basic Research and Development, Hiroshima University, Higashi-Hiroshima, Japan
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Brudnicki A, Petrova T, Dubovska I, Kuijpers-Jagtman AM, Ren Y, Fudalej PS. Alveolar Bone Grafting in Unilateral Cleft Lip and Palate: Impact of Timing on Palatal Shape. J Clin Med 2023; 12:7519. [PMID: 38137587 PMCID: PMC10743654 DOI: 10.3390/jcm12247519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Alveolar bone grafting (ABG) is a critical surgical intervention in patients with a cleft of the alveolus, aimed at reconstructing the alveolar ridge to facilitate proper eruption, periodontal support, and alignment of adjacent permanent teeth. The optimal timing for ABG remains debated, with late secondary ABG between the ages of 9 and 11 being widely adopted. This study compared the palatal shapes of 28 children at a mean age of 9.5 years (SD = 0.7) who underwent early secondary ABG at a mean age of 2.1 years (SD = 0.6) or 33 children at a mean age of 10.8 years (SD = 1.5) who underwent late secondary ABG at a mean age of 8.6 years (SD = 1.3) to 60 non-cleft controls at a mean age of 8.6 years (SD = 1.2). The palatal shapes were captured with 239 landmarks digitized on the palate on a digital model. Utilizing geometric morphometric methods, i.e., generalized Procrustes superimpositions, principal component analysis, and permutation tests, we assessed the impact of ABG timing on palatal morphology. The first five principal components (PCs) explained 64.1% of the total shape variability: PC1 = 26.1%; PC2 = 12%; PC3 = 11.9%; PC4 = 7.8%; and PC5 = 6.4%. The Procrustes distance between both cleft groups and the control group was more than twice as large as the Procrustes distance between the early ABG and late ABG groups. Nonetheless, all intergroup differences were statistically significant. Our findings suggest that early ABG has a limited negative effect on palatal shape, providing comparable outcomes to late ABG. The study highlights the potential suitability of early ABG, challenging conventional practices and encouraging further exploration into its long-term effects on maxillary growth.
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Affiliation(s)
- Andrzej Brudnicki
- Department of Pediatric Surgery, Institute of Mother and Child, 01-211 Warsaw, Poland;
| | - Tereza Petrova
- Department of Orthodontics and Cleft Anomalies, 3rd Medical Faculty, Faculty Hospital Royal Vineard, Dental Clinic, Charles University, 11636 Prague, Czech Republic;
| | - Ivana Dubovska
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, 77900 Olomouc, Czech Republic (P.S.F.)
| | - Anne Marie Kuijpers-Jagtman
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, 3010 Bern, Switzerland
- Faculty of Dentistry, Universitas Indonesia, Campus Salemba, Jakarta 10430, Indonesia
| | - Yijin Ren
- Department of Orthodontics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Piotr S. Fudalej
- Institute of Dentistry and Oral Sciences, Faculty of Medicine and Dentistry, Palacký University Olomouc, 77900 Olomouc, Czech Republic (P.S.F.)
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, Medical Faculty, University of Bern, 3010 Bern, Switzerland
- Department of Orthodontics, Jagiellonian University in Cracow, 31-007 Krakow, Poland
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Strujak G, Marlière DAA, de Lima Medeiros Y, Carlini JL, de Lima AAS. Radiographic Assessment of Different Autogenous Bone Grafts in the Alveolar Cleft: A Retrospective Longitudinal Study. J Maxillofac Oral Surg 2023; 22:938-945. [PMID: 38105821 PMCID: PMC10719184 DOI: 10.1007/s12663-023-01981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/19/2023] [Indexed: 12/19/2023] Open
Abstract
Objectives To assess feasibility and maintenance of bone after alveolar cleft reconstructions using graft from iliac crest and mandibular symphysis. Methods 51 alveolar clefts grafted with iliac crest and 51 ones grafted with mandibular symphysis bones were selected from patients aged between 7 and 12 years. At three (T1) and 12 months (T2) after surgeries, periapical radiographs were performed to measure the height of the grafted bone based on the modified Bergland scale. Chi-square and Mann-Whitney-Wilcoxon tests compared differences between T1 and T2 according to each bone graft. Results From the clefts grafted with mandibular symphysis bone, 47 were classified as type I (92.5%) and 04 as type II (7.84%) at T1. At T2, 36 were classified as type II (25.49%) and 02 as type III (3.92%). In the analysis of the clefts grafted with iliac crest at T1, 48 were classified as type I (94.11%) and three as type II (5.88%). At T2, 37 classifieds as type I (72.54%), 12 as type II (23.52%) and two as type III (3.92%). There was no statistically significant difference between treatments. Conclusions It was concluded that iliac crest and mandibular symphysis are adequate areas from which bone grafts can be obtained for reconstruction of alveolar cleft.
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Affiliation(s)
| | - Daniel Amaral Alves Marlière
- Division of Oral and Maxillofacial Surgery, Piracicaba Dental School, State University of Campinas, Limeira Avenue, 901, Areião, Piracicaba, São Paulo, 13414-903 Brazil
| | | | - João Luiz Carlini
- Department of Stomatology, School of Dentistry, Federal University of Paraná, Curitiba, Paraná Brazil
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Yang R, Chen J, Wang D, Xu Y, Ou G. Self-Assembling Peptide RADA16 Nanofiber Scaffold Hydrogel-Wrapped Concentrated Growth Factors in Osteogenesis of MC3T3. J Funct Biomater 2023; 14:jfb14050260. [PMID: 37233370 DOI: 10.3390/jfb14050260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/27/2023] Open
Abstract
Concentrated growth factors (CGFs) are widely used in surgery with bone grafting, but the release of growth factors from CGFs is rapid. RADA16, a self-assembling peptide, can form a scaffold that is similar to the extracellular matrix. Based on the properties of RADA16 and CGF, we hypothesized that the RADA16 nanofiber scaffold hydrogel could enhance the function of CGFs and that the RADA16 nanofiber scaffold hydrogel-wrapped CGFs (RADA16-CGFs) would perform a good osteoinductive function. This study aimed to investigate the osteoinductive function of RADA16-CGFs. Scanning electron microscopy, rheometry, and ELISA were performed, and MC3T3-E1 cells were used to test cell adhesion, cytotoxicity, and mineralization after administration with RADA16-CGFs. We found that RADA16 endowed with the sustained release of growth factors from CGFs, which can help maximize the function of CGFs in osteoinduction. The application of the atoxic RADA16 nanofiber scaffold hydrogel with CGFs can be a new therapeutic strategy for the treatment of alveolar bone loss and other problems that require bone regeneration.
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Affiliation(s)
- Renjie Yang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Eastern Clinic, West China Hospital of Stomatology, Sichuan University, Chengdu 610051, China
| | - Jiali Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Dingjie Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yichen Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Guomin Ou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Sanchla AD, Shrivastav S, Bhola ND, Kamble R. Interdisciplinary Treatment of a Case With Unilateral Cleft Lip and Palate in the Mixed Dentition. Cureus 2023; 15:e37148. [PMID: 37168178 PMCID: PMC10166415 DOI: 10.7759/cureus.37148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
A 10-year-old girl had reported to Sharad Pawar Dental College. Her parents had chief complaints of lip and palate deformity. On examination, it was found that the patient had unilateral cleft lip and palate on the right side. The aim was to expand the maxilla with alveolar bone grafting in the cleft region to facilitate the eruption of permanent canine and further reduce the deformity to prepare the patient for face mask therapy, reduce morbidity in the permanent dentition, and avoid Le Fort one surgery in the future. She had been previously operated on for cleft lip repair and palatal fistula closure eight years back. The present condition in the mixed dentition needed arch expansion, bone in the cleft region for the eruption of permanent canine, and further arch alignment for facemask therapy. This would reduce the severity of skeletal deformity and later on avoid the surgical advancement of the maxilla.
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Recent Clinical Treatment and Basic Research on the Alveolar Bone. Biomedicines 2023; 11:biomedicines11030843. [PMID: 36979821 PMCID: PMC10044990 DOI: 10.3390/biomedicines11030843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
The periodontal ligament is located between the bone (alveolar bone) and the cementum of the tooth, and it is connected by tough fibers called Sharpey’s fibers. To maintain healthy teeth, the foundation supporting the teeth must be healthy. Periodontal diseases, also known as tooth loss, cause the alveolar bone to dissolve. The alveolar bone, similar to the bones in other body parts, is repeatedly resorbed by osteoclasts and renewed by osteogenic cells. This means that an old bone is constantly being resorbed and replaced by a new bone. In periodontal diseases, the alveolar bone around the teeth is absorbed, and as the disease progresses, the alveolar bone shrinks gradually. In most cases, the resorbed alveolar bone does not return to its original form even after periodontal disease is cured. Gum covers the tooth surface so that it matches the shape of the resorbed alveolar bone, exposing more of the tooth surface than before, making the teeth look longer, leaving gaps between the teeth, and in some cases causing teeth to sting. Previously, the only treatment for periodontal diseases was to stop the disease from progressing further before the teeth fell out, and restoration to the original condition was almost impossible. However, a treatment method that can help in the regeneration of the supporting tissues of the teeth destroyed by periodontal diseases and the restoration of the teeth to their original healthy state as much as possible is introduced. Recently, with improvements in implant material properties, implant therapy has become an indispensable treatment method in dentistry and an important prosthetic option. Treatment methods and techniques, which are mainly based on experience, have gradually accumulated scientific evidence, and the number of indications for treatment has increased. The development of bone augmentation methods has contributed remarkably to the expansion of indications, and this has been made possible by various advances in materials science. The induced pluripotent stem cell (iPS) cell technology for regenerating periodontal tissues, including alveolar bone, is expected to be applied in the treatment of diseases, such as tooth loss and periodontitis. This review focuses on the alveolar bone and describes clinical practice, techniques, and the latest basic research.
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Zhang X, Qin N, Zhou Z, Chen S. Machine learning in 3D auto-filling alveolar cleft of CT images to assess the influence of alveolar bone grafting on the development of maxilla. BMC Oral Health 2023; 23:16. [PMID: 36631872 PMCID: PMC9835292 DOI: 10.1186/s12903-023-02706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/02/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Machine learning based auto-segmentation of 3D images has been developed rapidly in recent years. However, the application of this new method in the research of patients with unilateral cleft lip and palate (UCLP) is very limited. In this study, a machine learning algorithm utilizing 3D U-net was used to automatically segment the maxilla, fill the cleft and evaluate the alveolar bone graft in UCLP patients. Cleft related factors and the surgery impact on the development of maxilla were analyzed. METHODS Preoperative and postoperative computed tomography images of 32 patients (64 images) were obtained. The deep-learning-based protocol was used to segment the maxilla and defect, followed by manual refinement. Paired t-tests and Mann-Whitney tests were performed to reveal the changes of the maxilla after surgery. Two-factor, two-level analysis for repeated measurement was used to examine the different trends of growth on the cleft and non-cleft sides of the maxilla. Pearson and Spearman correlations were used to explore the relationship between the defect and the changes of the maxillary cleft side. RESULTS One-year after the alveolar bone grafting surgery, different growth amount was found on the cleft and non-cleft sides of maxilla. The maxillary length (from 34.64 ± 2.48 to 35.67 ± 2.45 mm) and the alveolar length (from 36.58 ± 3.21 to 37.63 ± 2.94 mm) increased significantly only on the cleft side while the maxillary anterior width (from 11.61 ± 1.61 to 12.01 ± 1.41 mm) and posterior width (from 29.63 ± 2.25 to 30.74 ± 2.63 mm) increased significantly only on the non-cleft side after surgery. Morphology of the cleft was found to be related to the pre-surgical maxillary dimension on the cleft side, while its correlation with the change of the maxilla after surgery was low or not statistically significant. CONCLUSION The auto-segmentation of the maxilla and the cleft could be performed very efficiently and accurately with the machine learning method. Asymmetric growth was found on the cleft and non-cleft sides of the maxilla after alveolar bone graft in UCLP patients. The morphology of the cleft mainly contributed to the pre-operation variance of the maxilla but had little impact on the maxilla growth after surgery.
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Affiliation(s)
- Xin Zhang
- grid.11135.370000 0001 2256 9319Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People’s Republic of China
| | - Niu Qin
- grid.11135.370000 0001 2256 9319Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People’s Republic of China
| | - Zhibo Zhou
- grid.11135.370000 0001 2256 9319Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People’s Republic of China
| | - Si Chen
- grid.11135.370000 0001 2256 9319Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, People’s Republic of China
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Shen H, Li L, Zhang C, Chen Y, Yu H, Si J, Shen G. The strategy of composite grafting with BMP2-Loaded calcium phosphate cements and autogenous bone for alveolar cleft reconstruction. Front Physiol 2022; 13:1023772. [PMID: 36246107 PMCID: PMC9564702 DOI: 10.3389/fphys.2022.1023772] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: To remedy the drawbacks of traditional autogenous bone harvesting in alveolar bone grafting (ABG), a novel strategy of composite grafting with BMP2-loaded calcium phosphate cements (BMP2-CPC) and autogenous bone harvested by minimally invasive technique was developed and evaluated for its bone-repairing efficacy.Materials and methods: A chart review was conducted for 19 patients with unilateral alveolar clefts who underwent secondary ABG from 2017 to 2020. Of the enrolled patients, 9 patients underwent grafting with autogenous bone harvested by traditional trap door technique (group I), and 10 patients underwent grafting with the composite graft comprising BMP2-CPC and autogenous bone harvested by minimally invasive technique at a ratio of 1:1 by volume (group II). The clinical performance of the composite graft was comprehensively evaluated in terms of clinical, radiographic and histological perspectives.Results: The present results demonstrated that the composite graft exhibited satisfactory bone-repairing efficacy comparable to that of the autogenous bone graft on the premise of lower amount of harvested bone. The post-surgical resorption of bone volume and vertical height of grafted area was significantly slower in group II. The favourable resorption performance of BMP2-CPC contributed to preserving the post-surgical bony contour reconstructed with the composite graft.Conclusion: The composite graft comprising BMP2-CPC and autogenous bone harvested by minimally invasive technique was demonstrated to be an eligible alternative for application in ABG, especially for its improved resorption performance in preserving post-surgical bony contour.
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Affiliation(s)
- Hongzhou Shen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lvyuan Li
- Department of Orthodontics, Shanghai Ninth People’s Hospital, Collage of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenglong Zhang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Chen
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jiawen Si, ; Yang Chen, ; Hongbo Yu,
| | - Hongbo Yu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jiawen Si, ; Yang Chen, ; Hongbo Yu,
| | - Jiawen Si
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jiawen Si, ; Yang Chen, ; Hongbo Yu,
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Möhlhenrich SC, Kniha K, Magnuska Z, Chhatwani S, Hermanns-Sachweh B, Gremse F, Hölzle F, Danesh G, Modabber A. Development of root resorption during orthodontic tooth movement after cleft repair using different grafting materials in rats. Clin Oral Investig 2022; 26:5809-5821. [PMID: 35567639 PMCID: PMC9474460 DOI: 10.1007/s00784-022-04537-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate the influence of three grafting materials for cleft repair on orthodontic tooth movement in rats. MATERIALS AND METHODS Artificial alveolar clefts were created in 21 Wistar rats and were repaired 4 weeks later using autografts, human xenografts and synthetic bone substitute (beta-tricalcium phosphate/hydroxyapatite [β-TCP/HA]). A further 4 weeks later, the first molar was moved into the reconstructed maxilla. Microfocus computed tomography (μCT) was performed six times (T0-T5) to assess the tooth movement and root resorption. After 8 weeks, the affected reconstructed jaw was resected for histopathological investigation. RESULTS Total distances reached ranged from 0.82 ± 0.72 mm (β-TCP/HA) to 0.67 ± 0.27 mm (autograft). The resorption was particularly determined at the mesiobuccal root. Descriptive tooth movement slowed and root resorption increased slightly. However, neither the radiological changes during tooth movement (µCT T1 vs. µCT T5: autograft 1.85 ± 0.39 mm3 vs. 2.38 ± 0.35 mm3, p = 0.30; human xenograft 1.75 ± 0.45 mm3 vs. 2.17 ± 0.26 mm3, p = 0.54; β-TCP/HA: 1.52 ± 0.42 mm3 vs. 1.88 ± 0.41 mm3, p = 0.60) nor the histological differences after tooth movement (human xenograft: 0.078 ± 0.05 mm2; β-TCP/HA: 0.067 ± 0.049 mm2; autograft: 0.048 ± 0.015 mm2) were statistically significant. CONCLUSION The autografts, human xenografts or synthetic bone substitute used for cleft repair seem to have a similar effect on the subsequent orthodontic tooth movement and the associated root resorptions. CLINICAL RELEVANCE Development of root resorptions seems to have a secondary role in choosing a suitable grafting material for cleft repair.
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Affiliation(s)
| | - Kristian Kniha
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Zuzanna Magnuska
- Institute for Experimental Molecular Imaging, Department of Nanomedicine and Theragnostic, RWTH Aachen University, Forckenbeckstraße 55, 52074, Aachen, Germany
| | - Sachin Chhatwani
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
| | | | - Felix Gremse
- Institute for Experimental Molecular Imaging, Department of Nanomedicine and Theragnostic, RWTH Aachen University, Forckenbeckstraße 55, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Gholamreza Danesh
- Department of Orthodontics, University of Witten/Herdecke, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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Barillas AP, Michelogiannakis D, Rossouw PE, Javed F. Maxillary expansion in grafted alveolar arches in patients with cleft lip and palate: A literature review. SURGERY IN PRACTICE AND SCIENCE 2021. [DOI: 10.1016/j.sipas.2021.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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