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Manni A, Boggio A, Gastaldi G, Cozzani M. Is significant mandibular advancement possible after the peak of puberty? Dento-osseous palatal expansion and the STM4 technique (Skeletal Therapy Manni Telescopic Herbst 4 miniscrews): A case report. Int Orthod 2024; 22:100868. [PMID: 38471383 DOI: 10.1016/j.ortho.2024.100868] [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: 01/16/2024] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Treatment of skeletal class II growing patients often requires the use of functional appliances, aimed at promoting mandibular advancement. Among these, Herbst appliance is recommended for its effectiveness, efficiency, and reduced need for compliance. Despite its skeletal favourable effects, well-known dental compensations can occur, especially when the appliance is not used close to the pubertal peak: upper incisors retroclination, lower incisors proclination, upper molars distalization and lower molars mesialization could reduce the overjet needed for a proper mandibular advancement. To counteract these unfavourable effects skeletal anchorage could be crucial. AIM The aim of this case report is to describe and evaluate the effects of using a skeletally anchored Herbst appliance in an 18-year-old (CVM5) male patient with skeletal Class II malocclusion and a convex profile. TREATMENT PROTOCOL The treatment started with a tooth-bone-borne palatal expansion, then the upper arch was bonded with pre-adjusted ceramic brackets. After 2months, a Manni Telescopic Herbst (MTH) supported by 4 miniscrews (two in the maxilla and two in the mandible) was applied. To avoid anchorage loss, TADs were connected with elastic chains to the arches. Nine months later, the Herbst was removed, the lower teeth were bonded and the patient wore class 2 elastics to stabilise the occlusion. RESULTS AND CONCLUSIONS After 24months the treatment goal was achieved with a considerable improvement of the profile and a clinically significant mandibular advancement (Pogonion moved forward 7mm). A one-year follow-up lateral X-rays showed a good stability of the result.
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Affiliation(s)
- Antonio Manni
- Postgraduate Program in Orthodontics, Vita-Salute San Raffaele University, Milan, Italy; Istituto Giuseppe Cozzani, La Spezia, Italy
| | - Andrea Boggio
- Postgraduate Program in Orthodontics, Vita-Salute San Raffaele University, Milan, Italy; Istituto Giuseppe Cozzani, La Spezia, Italy.
| | - Giorgio Gastaldi
- Postgraduate Program in Orthodontics, Vita-Salute San Raffaele University, Milan, Italy
| | - Mauro Cozzani
- Postgraduate Program in Orthodontics, Vita-Salute San Raffaele University, Milan, Italy; Istituto Giuseppe Cozzani, La Spezia, Italy
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Plaza-Ruiz SP, Rojas-Plaza PA, Basto-Tacuma J, Velandia-Palacio LA, Jara-López L. Comparative evaluation of the dentoalveolar effects of three Class II correctors: A finite element analysis study. J Orthod 2024; 51:41-52. [PMID: 37646245 DOI: 10.1177/14653125231195096] [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: 09/01/2023]
Abstract
OBJECTIVE To compare the stress distribution and total strain applied to the dentition, periodontal ligament (PDL) and cortical and trabecular bones by three Class II correctors using finite element analysis. DESIGN Three-dimensional analysis of stresses and total strain of the dentition with three Class II correctors. SETTING Computational study. METHODS Three-dimensional finite element models of Class II elastics, the Forsus Fatigue Resistant Device (FRD) and the Carriere Motion Appliance (CMA) were constructed from a cone-beam computed tomography (CBTC) image of an orthodontic Class II patient. The distribution of stress (von Mises and principal stress) and the total strain (mm) in maxillo-mandibular dentition, PDL, cortical and trabecular bone were analysed. RESULTS The highest von Mises yield and the maximum principal stress in the three models were found at the teeth, followed by the cortical bone, trabecular bone and PDL. The maximum stress and total deformation were located at the upper canines and lower molars in the Class II elastics and CMA models, in the upper first molars in the Forsus FRD and CMA, and in the lower first premolars in the Forsus FRD. In addition, stress was distributed in the anterior and posterior regions of the teeth, and the total deformation was found in the distal direction in the upper arch and in the mesial direction in the lower arch. CONCLUSION The stress concentrations in the three models were located close to the active components of each appliance, producing specific patterns of stress distribution and displacement that should be taken into account when planning the type of appliance to be used for the correction of the Class II malocclusion.
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Affiliation(s)
| | | | - Jessica Basto-Tacuma
- Department of Orthodontics - CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
| | | | - Liliana Jara-López
- Department of Orthodontics - CICO, Institución Universitaria Colegios de Colombia UNICOC, Bogotá, Colombia
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Ashok S, Batra P, Sharma K, Raghavan S, Talwar A, Srivastava A, Duggal I. An assessment of masticatory efficiency and occlusal load distribution in adolescent patients undergoing orthodontic treatment with functional jaw orthopedics: A prospective cohort study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101570. [PMID: 37507010 DOI: 10.1016/j.jormas.2023.101570] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/22/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Functional jaw orthopaedics, produces a radical change in the occlusal scheme and the masticatory apparatus, particularly in patients with Class II malocclusion. It remains to be seen how the changes brought about by a functional appliance alter the masticatory ability of a growing child, who needs the necessary nutrition to properly grow the craniofacial region. MATERIALS AND METHODS Pretreatment and Post-treatment values of masticatory efficiency and the distribution of the occlusal load at centric occlusion were evaluated and compared for 20 patients with Class II division 1 malocclusion undergoing functional jaw orthopaedics. RESULTS Significant increase in the masticatory efficiency was seen during and after treatment (p < 0.5) There was an increase in the anterior distribution of occlusal load associated with a concomitant decrease in the posterior region at centric occlusion. CONCLUSION Improvement in the masticatory efficiency was observed after treatment of a retrognathic mandible with functional jaw orthopaedics in the adolescent participants with Class II malocclusion. This highlights the importance of treatment with functional jaw orthopaedics, which apart from providing esthetic and functional improvement also improves the ability of a growing child to extract proper nutrition from his/her diet.
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Affiliation(s)
- Shoj Ashok
- Department of Orthodontics and Dentofacial Orthopedics, Institute of Dental Studies and Technologies, India
| | - Puneet Batra
- Post Graduate Board of Studies, Department of Orthodontics and Dentofacial Orthopedics, Manav Rachna Dental College, Faridabad, India
| | | | | | - Aditya Talwar
- Department of Orthodontics and Dentofacial Orthopedics, Manav Rachna Dental College, Faridabad, Haryana, India.
| | | | - Isha Duggal
- Division of Orthodontics & Dentofacial Deformities, CDER, All India Institute of Medical Sciences, New Delhi, India
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Huang W, Dong L, Yu S, Zheng Y, Wu H, Li C, Zhang Y, Zhang Q, Yan X, Lv T, Yuan X. Stress distribution of the modified clear twin-block aligner on the temporomandibular joint, alveolar bone and teeth: A finite element analysis. Int Orthod 2023; 21:100815. [PMID: 37839391 DOI: 10.1016/j.ortho.2023.100815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE The modified clear twin-block aligner (CTBA) was developed to provide a mandibular advancement appliance for the treatment of mandibular retrognathia. The objective of this study was to analyse the stress distribution changes of CTBA with 45°, 60° and 70° bite blocks. MATERIAL AND METHODS A three-dimensional model of the craniomaxillofacial bones and teeth was generated from a spiral computed tomography (CT) scan. The models of the articular disc, capsule, periodontal ligament and CTBA were constructed mathematically. After assigning the appropriate material properties and the boundary condition using ABAQUS software, we simulated the CTBA with different bite blocks to analyse the mechanical effects. RESULTS In the temporomandibular joint (TMJ) region, the posterior aspect of the condyle and glenoid fossa experienced tensile stress that was approximately about 22 times greater at 70° than at 45°. The Von Mises stress distribution on the articular disc tended to be uniform. The strain direction of the condyle was backward. In the maxillary bone, the stress on the labial alveolar bone was about 5.83MPa at 70° and greater than that on the lingual side. The resulting displacement of the dentition revealed a tendency for the upper teeth to shift backward and the lower teeth to move forward by 0.46 to 0.49mm. The foregoing stress and displacement rose as the angle of the bite blocks increased. CONCLUSIONS CTBA with 70° bite blocks constituted an advantageous biomechanical setting for the treatment of mandibular retrognathia in teenagers and provided a superior therapeutic effect.
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Affiliation(s)
- Wenli Huang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Lirong Dong
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Shaoyang Yu
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Yao Zheng
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Haoting Wu
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Chenzhi Li
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Yingyue Zhang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Qiang Zhang
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Xiao Yan
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China
| | - Tao Lv
- Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration & Shandong Provincial Clinical Research Center for Oral Diseases, 250000 Jinan, China.
| | - Xiao Yuan
- Department of Orthodontics, The Affiliated Hospital of Qingdao University, 266003 Qingdao, China; School of Stomatology, Qingdao University, 266023 Qingdao, China.
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Graillon N, Foletti JM, Godio-Raboutet Y, Guyot L, Varazzani A, Thollon L. Mandibular Titanium Miniplates Change the Biomechanical Behaviour of the Mandible in the Case of Facial Trauma: A Three-Dimensional Finite Element Analysis. Bioengineering (Basel) 2023; 10:994. [PMID: 37760096 PMCID: PMC10525150 DOI: 10.3390/bioengineering10090994] [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: 06/06/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023] Open
Abstract
Our study aimed to compare the biomechanical behaviour of mandibles with or without titanium miniplates when subjected to an impact after bone healing using a finite element model (FEM) of the human mandible. We simulated mandibular trauma on an FEM of a human mandible carrying or not two parasymphyseal miniplates and applying a concentrated force of 2000 N to four different areas, including the insertion area, the area straddling the edge of the miniplates and the adjacent bone, at a distance from the miniplates on the symphysis, and on the basilar border of the mandible below the miniplates. Then, we compared the Von Mises stress distributions between the two models. In the case of an impact on the miniplates, the maximum Von Mises stress occurred in two specific areas, on the cortical bone at the posterior border of the two miniplates at a distance from the impact, while in the model without miniplates, the Von Mises stresses were homogenously distributed in the impact area. The presence of titanium miniplates in the case of trauma affects the biomechanical behaviour of the mandible and could cause more complex fractures. We recommend informing patients of this potential risk.
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Affiliation(s)
- Nicolas Graillon
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Jean-Marc Foletti
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Yves Godio-Raboutet
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
| | - Laurent Guyot
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
- Department of Oral and Maxillofacial Surgery/Assistance Publique-Hopitaux de Marseille (APHM), Conception University Hospital, 13005 Marseille, France
| | - Andrea Varazzani
- Maxillo-Facial Surgery, Facial Plastic Surgery, Stomatology and Oral Surgery, Hospices Civils de Lyon, Lyon-Sud Hospital—Claude-Bernard Lyon 1 University, 69310 Pierre-Benite, France;
| | - Lionel Thollon
- Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, 13015 Marseille, France; (J.-M.F.); (Y.G.-R.); (L.G.); (L.T.)
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Ritchie C, McGregor S, Bearn DR. Temporary anchorage devices and the forces and effects on the dentition and surrounding structures during orthodontic treatment: a scoping review. Eur J Orthod 2023; 45:324-337. [PMID: 36763546 DOI: 10.1093/ejo/cjac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND Temporary anchorage devices (TADs) offer the clinician an immediate temporary source of skeletal anchorage for a range of orthodontic interventions. It is important to understand forces involved in using TADs and the effects on the dentition and surrounding structures, to improve clinical outcomes. OBJECTIVE To examine and qualitatively synthesize literature on the forces involved with the use of TADs and the effects on the dentition and surrounding structures in orthodontic tooth movement, to provide better understanding of the complex interactions and the clinical implications. SEARCH METHODS Electronic databases searched included: Cochrane Library [including Central Register of Controlled Trials (CENTRAL)], Embase via OVID, Pubmed, and Scopus. Study screening and selection were conducted in duplicate. SELECTION CRITERIA Studies selected were clinical studies, simulation studies (computer or laboratory-based), or animal studies with no restriction over gender, age, study type (excluding case reports), or setting. Studies focusing on the forces involved with the use of TADs in orthodontic treatment and their effects on the dentition and surrounding structures were included. DATA COLLECTION AND ANALYSIS A data charting form was piloted and refined. Data charting was performed independently and in duplicate. This consisted of key fields with predetermined options and free text. The extracted data were collated, and a narrative synthesis conducted. RESULTS The results from 203 included studies were grouped into seven TAD based interventions combining the clinical, simulation, and animal studies. They were: En masse retraction of anterior teeth, intrusion, movement of a single tooth, orthopaedic interventions, distalisation, maxillary expansion and other types. The forces involved with the use of TADs, and their effects on the dentition and surrounding structures, were presented in descriptive and tabular formats. LIMITATIONS This review restricted study language to English. Formal appraisal of the quality of evidence is not a required feature of scoping reviews, as per the PRISMA-ScR guidelines, however it was evident that a proportion of clinical studies were of high risk of bias and low quality and therefore any proposed changes the reader may consider to their clinical practice should be contextualized in light of this. CONCLUSIONS Across the seven types of TAD based interventions the effects on the dentition and surrounding structures are described providing a better understanding of the complex interactions. A guide to the level and direction of forces in each type of intervention is provided to aid clinicians in achieving high quality outcomes. IMPLICATIONS There is a need to validate future FEA simulation studies by comparing to clinical data. It is also recommended that future scoping reviews incorporate a formal critical appraisal of studies to facilitate the translation of the results into clinical practice. Development of a standard set of terms for TADs is recommended to facilitate future research. REGISTRATION Registration of a scoping review is not possible with PROSPERO. FUNDING None to declare.
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Affiliation(s)
- Colin Ritchie
- Orthodontic Department, Dundee Dental Hospital and Research School, University of Dundee, Scotland
| | - Scott McGregor
- Library & Learning Centre, University of Dundee, Scotland
| | - David R Bearn
- Orthodontic Department, University of Dundee, Scotland
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Roberts WE, Chang CH, Chen J, Brezniak N, Yadav S. Integrating skeletal anchorage into fixed and aligner biomechanics. J World Fed Orthod 2022; 11:95-106. [DOI: 10.1016/j.ejwf.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
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Zhu C, Li R, Yuan L, Zheng Y, Jin Y, Li H, Liu C, Xia L, Fang B. Effects of the advanced mandibular spring on mandibular retrognathia treatment: a three-dimensional finite element study. BMC Oral Health 2022; 22:271. [PMID: 35790937 PMCID: PMC9254520 DOI: 10.1186/s12903-022-02308-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background The Advanced Mandibular Spring (AMS) was newly developed as a dentofacial orthopedic appliance in conjunctive use of clear aligners to treat Class II malocclusion with mandibular retrognathia in adolescents. This study aimed to launch a biomechanical assessment and evaluate whether the stress patterns generated by AMS promote mandibular growth. Methods A three-dimensional finite element model was constructed using images of CBCT and spiral CT. The model consisted of craniomaxillofacial bones, articular discs, retrodiscal elastic stratum, masticatory muscle, teeth, periodontal ligament, aligner and AMS. Mechanical effects were analyzed in three types of models: mandibular postural position, mandibular advancement with AMS, and mandibular advancement with only muscular force. Results The stress generated by AMS was distributed to all teeth and periodontal ligament, pushing mandibular teeth forward and maxillary teeth backward. In the temporomandibular joint area, the pressure in the superior and posterior aspects of the condyle was reduced, which conformed to the stress pattern promoting condylar and mandibular growth. Stress distribution became even in the anterior aspect of the condyle and the articular disc. Significant tensile stress was generated in the posterior aspect of the glenoid fossa, which conformed to the stress pattern stimulating the remodeling of the fossa. Conclusions AMS created a favorable biomechanical environment for treating mandibular retrognathia in adolescents. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02308-w.
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Cui H, Gao L, Han J, Liu J. Biomechanical analysis of mandibular defect reconstruction based on a new base-fixation system. Comput Methods Biomech Biomed Engin 2022; 25:1618-1628. [PMID: 35060776 DOI: 10.1080/10255842.2022.2029426] [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: 11/03/2022]
Abstract
Buccal titanium plate fixation is a common method for repairing mandibular defects. However, the method presents certain problems: the requirement of a large volume of titanium plate, a large number of fixation screws, a lengthy duration of the surgical operation, and exposure of the fixation plate which easily causes wound infection. In this study, a new base-fixation system was designed. Mandibular reconstruction was performed using the three-dimensional reconstruction package Mimics. In order to compare the newly designed base-fixation system and the common buccal-fixation system, the stress distributions and the displacement distributions of the whole model under two loading conditions were studied, based on the finite element analysis package ANSYS. The safety of the base-fixation titanium plate was evaluated. The results showed that although the maximum stress of the base-fixation titanium plate was higher than that of the buccal-fixation titanium plate, it was still less than the yield strength of titanium. Therefore, under the condition of applying 300 N of vertical occlusal loading, the base-fixation titanium plate displayed superior fixation ability without permanent deformation (and concomitant fixation failure). The results of the fatigue simulation analysis showed that the safety factor of the base-fixation titanium plate in the working state was 3.8 (>1.0), indicating that its fatigue performance met the application requirements. Compared with traditional buccal fixation, the novel base-fixation system has obvious advantages, suggesting its suitability as a new treatment method for clinical mandibular defect reconstruction.
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Affiliation(s)
- Haipo Cui
- Shanghai Institute for Minimally Invasive Therapy, University of Shanghai for Science and Technology, Shanghai, China
| | - Liping Gao
- Shanghai Institute for Minimally Invasive Therapy, University of Shanghai for Science and Technology, Shanghai, China
| | - Jing Han
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, Shanghai, PR China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
| | - Jiannan Liu
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.,College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, Shanghai, PR China.,National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, PR China
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