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Çanakçi FG, Er N, Duygu G, Tanan Karaca G. Does Saline Irrigation at Different Temperatures Affect Pain, Edema, and Trismus After Impacted Third Molar Surgery: A Clinical Trial. J Oral Maxillofac Surg 2023; 81:88-94. [PMID: 36116545 DOI: 10.1016/j.joms.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Lower impacted third molar surgery is a very common oral-maxillofacial surgical procedure, which has complications such as facial swelling, pain, and trismus. This clinical trial aimed to compare the intensity of postoperative morbidity (pain, facial swelling, and trismus) following the third molar surgery performed using saline irrigation at different temperatures (4 °C, 10 °C, or 25 °C). MATERIALS AND METHODS This double-blind, single-center, split-mouth, randomized prospective clinical trial was conducted among 48 systemically and periodontally healthy patients who had bilaterally asymptomatic mandibular third molars. Patients were randomly allocated into 2 groups (n = 24) according to the temperature of the saline used. In each patient, one impacted third molar was determined as the test group (4 °C or 10 °C saline irrigation) and the other impacted third molar as the control group (25 °C saline irrigation). Trismus and swelling were evaluated on the 1st, 3rd, and 7th days postoperatively. Pain perception by visual analog scale (VAS) and the total number of analgesics taken during the 7 postoperative days were recorded. Data were analyzed using the Shapiro-Wilk test, the chi-square test, one-way analysis of variance, Duncan test, the Kruskal-Wallis test, the Dunn test, and the Friedman test (P < .05). RESULTS Forty-eight patients (28 females, 20 males) with a mean age of 24.6 ± 3.8 years were included in the study. The duration of operations was similar. VAS values of test groups [test group 1 (4 °C): 4.0, test group 1 (10 °C): 8.0] and the number of analgesics taken [test group 1 (4 °C): 0, test group 1 (10°) C): 3] were significantly lower (P < .001) than control groups (VAS, control group 1: 13.0, control group 2: 15.5, number of analgesic taken, control group 1: 5.5, control group 2: 4.0). Significant differences were found between the test groups in VAS values and the number of analgesics taken (P < .001). Also, the lowest trismus and facial swelling values were detected in the 4 °C test group at all time points (P < .001). CONCLUSION In the impacted third molar surgery, the use of cooled saline irrigation during bone removal may be a simple, inexpensive, and effective method for reducing early postoperative complaints.
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Affiliation(s)
- F Gülfeşan Çanakçi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Trakya University, Edirne, Turkey.
| | - Nilay Er
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Trakya University, Edirne, Turkey
| | - Gonca Duygu
- Associated Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tekirdağ Namik Kemal University, Tekirdağ, Turkey
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Razavi P, Jafari A, Vescovi P, Fekrazad R. Efficacy of Adjunctive Photobiomodulation in the Management of Medication-Related Osteonecrosis of the Jaw: A Systematic Review. Photobiomodul Photomed Laser Surg 2022; 40:777-791. [PMID: 36507770 DOI: 10.1089/photob.2022.0084] [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: 12/15/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse medication response that manifests as progressive bone necrosis in the craniofacial area. There is still no clear treatment protocol for the management of MRONJ. The purpose of this study was to conduct a systematic review to assess the efficacy of photobiomodulation (PBM) as an adjunct to MRONJ therapy. Methods: In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, a literature search was performed on PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases. Two examiners examined eligibility and risk of bias separately before extracting data. Results: Two hundred sixty-nine articles were found through electronic search, out of which only 11 met the inclusion criteria and were included in qualitative synthesis (9 retrospectives, 1 prospective, and 1 case series). A total number of 759 patients and a mean age ranging from 54 to 74 years were reviewed. Females were the most frequent gender in all of the selected studies (72% females to 28% males), and the most frequent stage in the studies mentioned above was stage II (66%). Most of the studies had shown a significant improvement when PBM was used as an adjunctive treatment. Conclusions: Based on the results of this study, PBM as an adjuvant therapy can significantly improve the outcomes of each treatment plan. However, surgical intervention for the complete healing of the lesions is suggested.
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Affiliation(s)
- Pouyan Razavi
- Student Research Committee, Dental Faculty, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Aryan Jafari
- Student Research Committee, Dental Faculty, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Paolo Vescovi
- Unit of Oral Medicine, Oral Surgery and Laser therapy, Department of Medicine and Surgery, University Center of Dentistry, University of Parma, Parma, Italy
| | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran.,International Network for Photo Medicine and Photodynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Lopez EM, Leclerc K, Ramsukh M, Parente PE, Patel K, Aranda CJ, Josephson AM, Remark LH, Kirby DJ, Buchalter DB, Hadi T, Morgani SM, Ramkhelawon B, Leucht P. Modulating the systemic and local adaptive immune response after fracture improves bone regeneration during aging. Bone 2022; 157:116324. [PMID: 34998981 PMCID: PMC9016796 DOI: 10.1016/j.bone.2021.116324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 01/04/2023]
Abstract
Tissue injury leads to the well-orchestrated mobilization of systemic and local innate and adaptive immune cells. During aging, immune cell recruitment is dysregulated, resulting in an aberrant inflammatory response that is detrimental for successful healing. Here, we precisely define the systemic and local immune cell response after femur fracture in young and aging mice and identify increased toll-like receptor signaling as a potential culprit for the abnormal immune cell recruitment observed in aging animals. Myd88, an upstream regulator of TLR-signaling lies at the core of this aging phenotype, and local treatment of femur fractures with a Myd88 antagonist in middle-aged mice reverses the aging phenotype of impaired fracture healing, thus offering a promising therapeutic target that could overcome the negative impact of aging on bone regeneration.
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Affiliation(s)
- Emma Muiños Lopez
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Kevin Leclerc
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Malissa Ramsukh
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Paulo El Parente
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Karan Patel
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Carlos J Aranda
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Anna M Josephson
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Lindsey H Remark
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America; Department of Cell Biology, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - David J Kirby
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Daniel B Buchalter
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Tarik Hadi
- Department of Surgery, Division of Endovascular Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Sophie M Morgani
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Bhama Ramkhelawon
- Department of Surgery, Division of Endovascular Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America; Department of Cell Biology, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America
| | - Philipp Leucht
- Department of Orthopaedic Surgery, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America; Department of Cell Biology, NYU Robert I. Grossman School of Medicine, New York, NY, United States of America.
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Wang B, Xi W, Chen H, Shao J, Song A, Zhang F. Periodontal effect of augmented corticotomy-assisted orthodontics versus conventional orthodontics in treatment of adult patients with bialveolar protrusion. BMC Oral Health 2022; 22:81. [PMID: 35305642 PMCID: PMC8933887 DOI: 10.1186/s12903-022-02107-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/02/2022] [Indexed: 11/22/2022] Open
Abstract
Background The patients of bialveolar protrusion always demonstrate thin anterior alveoli which may aggravate subsequent gingival recession and bone loss during retraction. This study aimed to investigate the periodontal changes, including alveolar height, thickness, and area, and the width of keratinized gingiva, in mandibular anterior teeth after augmented corticotomy-assisted orthodontics (ACAO) compared with traditional orthodontics. Methods Twenty adult patients with skeletal class I bialveolar protrusion were selected from two groups: ACAO group (augmented corticotomy on the labial side of the anterior mandibular teeth, n = 10) and control group (conventional orthodontics, n = 10). In all patients, four first premolars were extracted and the incisors were retracted under the maximum anchorage. The measurements included the labial alveolar bone area, vertical alveolar bone height, alveolar bone thickness surrounding the mandibular anterior teeth, root length, gingival recession and width of keratinized gingiva after alignment (T0) and 3 months after space closure (T1). Results The labial alveolar height, area, and thicknesses all decreased after space closure in the control group but significantly increased in the ACAO group. The decrease in the lingual alveolar height was statistically less in the ACAO group than that in the control group. Besides, the width of keratinized gingiva increased in the ACAO group but decreased in the control group. There was no significant difference in the changes of root length between groups. The dentoalveolar changes between anterior teeth were consistent but with different scales. The lateral incisors gained the most labial bone height and area. Conclusion Compared to conventional orthodontics, ACAO provided a more favorable effect of improving periodontal status surrounding the mandibular anterior teeth for Class I maxillary protrusion patients.
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Li Z, Yuan X, Arioka M, Bahat D, Sun Q, Chen J, Helms JA. Pro-osteogenic Effects of WNT in a Mouse Model of Bone Formation Around Femoral Implants. Calcif Tissue Int 2021; 108:240-251. [PMID: 32990765 DOI: 10.1007/s00223-020-00757-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/08/2020] [Indexed: 02/05/2023]
Abstract
Wnt signaling maintains homeostasis in the bone marrow cavity: if Wnt signaling is inhibited then bone volume and density would decline. In this study, we identified a population of Wnt-responsive cells as osteoprogenitor in the intact trabecular bone region, which were responsible for bone development and turnover. If an implant was placed into the long bone, this Wnt-responsive population and their progeny contributed to osseointegration. We employed Axin2CreCreERT2/+;R26mTmG/+ transgenic mouse strain in which Axin2-positive, Wnt-responsive cells, and their progeny are permanently labeled by GFP upon exposure to tamoxifen. Each mouse received femoral implants placed into a site prepared solely by drilling, and a single-dose liposomal WNT3A protein was used in the treatment group. A lineage tracing strategy design allowed us to identify cells actively expressing Axin2 in response to Wnt signaling pathway. These tools demonstrated that Wnt-responsive cells and their progeny comprise a quiescent population residing in the trabecular region. In response to an implant placed, this population becomes mitotically active: cells migrated into the peri-implant region, up-regulated the expression of osteogenic proteins. Ultimately, those cells gave rise to osteoblasts that produced significantly more new bone in the peri-implant region. Wnt-responsive cells directly contributed to implant osseointegration. Using a liposomal WNT3A protein therapeutic, we showed that a single application at the time of implant placed was sufficient to accelerate osseointegration. The Wnt-responsive cell population in trabecular bone, activated by injury, ultimately contributes to implant osseointegration. Liposomal WNT3A protein therapeutic accelerates implant osseointegration in the long bone.
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Affiliation(s)
- Zhijun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Xue Yuan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Masaki Arioka
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
- Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Daniel Bahat
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Qiang Sun
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
- Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, 110001, China
| | - Jinlong Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, 94305, USA.
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Abstract
Our understanding of the mechanisms underlying fracture healing is rapidly developing and is contributing to new therapeutic strategies to enhance repair. To gain new insights, animal models must also evolve. From initially imprecise, uncontrolled bone defects we now have precise injury models that still capture all of the stages and phases of bone repair yet do so in a highly reproducible manner. The simple mono-cortical defect model allows assessment of bone repair through a cartilage intermediate, e.g., endochondral ossification, as well as direct bone repair, e.g., intramembranous healing. Cellular contributions of the periosteum can be distinguished from contributions originating in the bone marrow. In this chapter, we focus on the advantages of this bone repair model, as well as its limitations.
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Affiliation(s)
- Zhijun Li
- School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Jill A Helms
- School of Medicine, Stanford University, Palo Alto, CA, USA.
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Chen CH, Coyac BR, Arioka M, Leahy B, Tulu US, Aghvami M, Holst S, Hoffmann W, Quarry A, Bahat O, Salmon B, Brunski JB, Helms JA. A Novel Osteotomy Preparation Technique to Preserve Implant Site Viability and Enhance Osteogenesis. J Clin Med 2019; 8:jcm8020170. [PMID: 30717291 PMCID: PMC6406409 DOI: 10.3390/jcm8020170] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 01/26/2019] [Accepted: 01/27/2019] [Indexed: 12/27/2022] Open
Abstract
The preservation of bone viability at an osteotomy site is a critical variable for subsequent implant osseointegration. Recent biomechanical studies evaluating the consequences of site preparation led us to rethink the design of bone-cutting drills, especially those intended for implant site preparation. We present here a novel drill design that is designed to efficiently cut bone at a very low rotational velocity, obviating the need for irrigation as a coolant. The low-speed cutting produces little heat and, consequently, osteocyte viability is maintained. The lack of irrigation, coupled with the unique design of the cutting flutes, channels into the osteotomy autologous bone chips and osseous coagulum that have inherent osteogenic potential. Collectively, these features result in robust, new bone formation at rates significantly faster than those observed with conventional drilling protocols. These preclinical data have practical implications for the clinical preparation of osteotomies and alveolar bone reconstructive surgeries.
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Affiliation(s)
- Chih-Hao Chen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
- Craniofacial Research Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University School of Medicine, Taoyuan 33305, Taiwan.
| | - Benjamin R Coyac
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Masaki Arioka
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
- Department of Clinical Pharmacology, Faculty of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
| | - Brian Leahy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - U Serdar Tulu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Maziar Aghvami
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Stefan Holst
- Nobel Biocare Services AG P.O. Box, CH-8058 Zürich-Flughafen, Switzerland.
- Department of Prosthodontics, School of Dentistry, Johann-Wolfgang Goethe University, Frankfurt, Germany.
| | - Waldemar Hoffmann
- Nobel Biocare Services AG P.O. Box, CH-8058 Zürich-Flughafen, Switzerland.
| | - Antony Quarry
- Nobel Biocare Services AG P.O. Box, CH-8058 Zürich-Flughafen, Switzerland.
| | - Oded Bahat
- Private Practice, Beverly Hills, CA 90210, USA.
| | - Benjamin Salmon
- Paris Descartes-Sorbonne Paris Cité University, EA2496, Montrouge, France.
- Dental Medicine Department, Bretonneau Hospital, HUPNVS, AP-HP, Paris 75018, France.
| | - John B Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Jill A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Effects of Piezoelectric Surgery on Bone Regeneration Following Distraction Osteogenesis of Mandible. J Craniofac Surg 2017; 28:74-78. [PMID: 27906844 DOI: 10.1097/scs.0000000000003213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study is to compare the bone healing in the distraction gap following the osteotomy performed with piezoelectric and conventional devices for the distraction osteogenesis in the rabbit mandibles. Twelve rabbits were randomly divided into 2 groups; 6 for piezoelectric device and 6 for rotary instruments. After 3 days of latency period, distraction was started at a rate of 1 mm per day for 10 days. All the animals were sacrificed after 4 weeks of consolidation phase for histological and histomorphological evaluation. Histological evaluation revealed thick trabecular bone formation in all of the specimens. Inflammation scores were chronic minimal. The mean percentages of the bone area in distraction gap are 62% in group P and 57% in group R. However, the difference between 2 groups was not statistically significant (P > 0.05). Our results revealed a slight increase in bone formation in the distraction gap in piezo-osteotomy groups histologically though not statistically supported. However, there is still a need for more histological studies with larger sample sizes evaluating the bone structure following piezo-osteotomies.
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Wang L, Aghvami M, Brunski J, Helms J. Biophysical regulation of osteotomy healing: An animal study. Clin Implant Dent Relat Res 2017; 19:590-599. [PMID: 28608504 DOI: 10.1111/cid.12499] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/01/2017] [Accepted: 05/02/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Osteotomies have been performed for centuries yet there remains a remarkable lack of consensus on optimal methods for cutting bone. There is universal agreement, however, that preserving cell viability is critical. PURPOSE To identify mechanobiological parameters influencing bone formation after osteotomy site preparation. MATERIALS AND METHODS A murine maxillary osteotomy model was used to evaluate healing. Computational modeling characterized stress and strain distributions in the osteotomy, as well as the magnitude and distribution of heat generated by drilling. The impact of osteocyte death and bone composition were assessed using molecular and cellular assays. RESULTS The phases of osteotomy healing in mice align closely with results in large animals; in addition, molecular analyses extended our understanding of osteoprogenitor cell proliferation, differentiation, and mineralization. Computational analyses provided insights into temperature changes caused by drilling and the mechanobiological state in the healing osteotomies, while concomitant cellular assays correlate drill speed with osteocyte apoptosis and bone resorption. Even when drilling was controlled, trabeculated, spongy (Type III) bone healed faster than densely lamellar (Type I) bone because of the abundance of Wnt responsive osteoprogenitor cells in the former. CONCLUSIONS These data provide a mechanobiological framework for evaluating tools and technologies designed to improve osteotomy site preparation.
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Affiliation(s)
- Liao Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, 94305
| | - Maziar Aghvami
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, 94305
| | - John Brunski
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, 94305
| | - Jill Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, California, 94305
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Huang L, Salmon B, Yin X, Helms JA. From restoration to regeneration: periodontal aging and opportunities for therapeutic intervention. Periodontol 2000 2016; 72:19-29. [PMID: 27501489 PMCID: PMC6190904 DOI: 10.1111/prd.12127] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
With the march of time our bodies start to wear out: eyesight fades, skin loses its elasticity, teeth and bones become more brittle and injuries heal more slowly. These universal features of aging can be traced back to our stem cells. Aging has a profound effect on stem cells: DNA mutations naturally accumulate over time and our bodies have evolved highly specialized mechanisms to remove these damaged cells. Whilst obviously beneficial, this repair mechanism also reduces the pool of available stem cells and this, in turn, has a dramatic effect on tissue homeostasis and on our rate of healing. Simply put: fewer stem cells means a decline in tissue function and slower healing. Despite this seemingly intractable situation, research over the past decade now demonstrates that some of the effects of aging are reversible. Nobel prize-winning research demonstrates that old cells can become young again, and lessons learned from these experiments-in-a-dish are now being translated into human therapies. Scientists and clinicians around the world are identifying and characterizing methods to activate stem cells to reinvigorate the body's natural regenerative process. If this research in dental regenerative medicine pans out, the end result will be tissue homeostasis and healing back to the levels we appreciated when we were young.
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Affiliation(s)
- Lan Huang
- Orthodontic Department, Stomatology Hospital of Chongqing Medical University; Chongqing Key Laboratory of Oral Disease and Biomedical Sciences; Chongqing Municipal Key Laboratory, Chongqing, 401147, China
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305
| | - Benjamin Salmon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305
- Dental School, University Paris Descartes PRES Sorbonne Paris Cite, EA 2496, Montrouge, France and AP-HP Odontology Department Bretonneau, Hopitaux Universitaires Paris Nord Val de Seine, Paris, France
| | - Xing Yin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Jill A. Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305
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Rajitha Gunaratne GD, Khan R, Fick D, Robertson B, Dahotre N, Ironside C. A review of the physiological and histological effects of laser osteotomy. J Med Eng Technol 2016; 41:1-12. [DOI: 10.1080/03091902.2016.1199743] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Dolan EB, Vaughan TJ, Niebur GL, Casey C, Tallon D, McNamara LM. How bone tissue and cells experience elevated temperatures during orthopaedic cutting: an experimental and computational investigation. J Biomech Eng 2014; 136:021019. [PMID: 24317222 DOI: 10.1115/1.4026177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/09/2013] [Indexed: 11/08/2022]
Abstract
During orthopaedic surgery elevated temperatures due to cutting can result in bone injury, contributing to implant failure or delayed healing. However, how resulting temperatures are experienced throughout bone tissue and cells is unknown. This study uses a combination of experiments (forward-looking infrared (FLIR)) and multiscale computational models to predict thermal elevations in bone tissue and cells. Using multiple regression analysis, analytical expressions are derived allowing a priori prediction of temperature distribution throughout bone with respect to blade geometry, feed-rate, distance from surface, and cooling time. This study offers an insight into bone thermal behavior, informing innovative cutting techniques that reduce cellular thermal damage.
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Mouraret S, Houschyar KS, Hunter DJ, Smith AA, Jew OS, Girod S, Helms JA. Cell viability after osteotomy and bone harvesting: comparison of piezoelectric surgery and conventional bur. Int J Oral Maxillofac Surg 2014; 43:966-71. [PMID: 24721169 DOI: 10.1016/j.ijom.2013.11.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 09/29/2013] [Accepted: 11/11/2013] [Indexed: 01/27/2023]
Abstract
The aim of this study was to evaluate and compare the influence of a piezoelectric device versus a conventional bur on osteocyte viability and osteoblast and osteoclast activity using an in vivo mouse model. Osteotomies were created and bone grafts were harvested using either a conventional bur or a piezoelectric device; the resulting injuries and bone grafts were evaluated over an extended time-course using molecular and cellular assays for cell death (TUNEL assay), cell viability (4',6-diamidino-2-phenylindole (DAPI) staining), the onset of mineralization (alkaline phosphatase activity), and bone remodelling (tartrate-resistant acid phosphatase activity). Osteotomies created with a piezoelectric device showed greater osteocyte viability and reduced cell death. Bone grafts harvested with a piezoelectric device exhibited greater short-term cell viability than those harvested with a bur, and exhibited slightly more new bone deposition and bone remodelling. The difference in response of osteocytes, osteoblasts, and osteoclasts to bone cutting via a bur and via a piezoelectric device is negligible in vivo. Given the improved visibility and the margin of safety afforded by a piezoelectric device, they are the instrument of choice when cutting or harvesting bone to preserve soft tissue.
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Affiliation(s)
- S Mouraret
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA; Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7 - Denis, Diderot University, U.F.R. of Odontology, Paris, France
| | - K S Houschyar
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
| | - D J Hunter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
| | - A A Smith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
| | - O S Jew
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA
| | - S Girod
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA; Stanford Oral Medicine & Maxillofacial Surgery Service, Stanford School of Medicine, Stanford, CA 94305, USA
| | - J A Helms
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA 94305, USA; Stanford Oral Medicine & Maxillofacial Surgery Service, Stanford School of Medicine, Stanford, CA 94305, USA.
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14
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Sotsuka Y, Nishimoto S, Tsumano T, Kawai K, Ishise H, Kakibuchi M, Shimokita R, Yamauchi T, Okihara SI. The dawn of computer-assisted robotic osteotomy with ytterbium-doped fiber laser. Lasers Med Sci 2013; 29:1125-9. [PMID: 24241973 DOI: 10.1007/s10103-013-1487-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 11/03/2013] [Indexed: 11/25/2022]
Abstract
Currently, laser radiation is used routinely in medical applications. For infrared lasers, bone ablation and the healing process have been reported, but no laser systems are established and applied in clinical bone surgery. Furthermore, industrial laser applications utilize computer and robot assistance; medical laser radiations are still mostly conducted manually nowadays. The purpose of this study was to compare the histological appearance of bone ablation and healing response in rabbit radial bone osteotomy created by surgical saw and ytterbium-doped fiber laser controlled by a computer with use of nitrogen surface cooling spray. An Ytterbium (Yb)-doped fiber laser at a wavelength of 1,070 nm was guided by a computer-aided robotic system, with a spot size of 100 μm at a distance of approximately 80 mm from the surface. The output power of the laser was 60 W at the scanning speed of 20 mm/s scan using continuous wave system with nitrogen spray level 0.5 MPa (energy density, 3.8 × 10(4) W/cm(2)). Rabbits radial bone osteotomy was performed by an Yb-doped fiber laser and a surgical saw. Additionally, histological analyses of the osteotomy site were performed on day 0 and day 21. Yb-doped fiber laser osteotomy revealed a remarkable cutting efficiency. There were little signs of tissue damage to the muscle. Lased specimens have shown no delayed healing compared with the saw osteotomies. Computer-assisted robotic osteotomy with Yb-doped fiber laser was able to perform. In rabbit model, laser-induced osteotomy defects, compared to those by surgical saw, exhibited no delayed healing response.
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Affiliation(s)
- Yohei Sotsuka
- Department of Plastic Surgery, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya City, Hyogo Prefecture, 663-8501, Japan,
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15
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Lo DD, Mackanos MA, Chung MT, Hyun JS, Montoro DT, Grova M, Liu C, Wang J, Palanker D, Connolly AJ, Longaker MT, Contag CH, Wan DC. Femtosecond plasma mediated laser ablation has advantages over mechanical osteotomy of cranial bone. Lasers Surg Med 2012. [PMID: 23184427 DOI: 10.1002/lsm.22098] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although mechanical osteotomies are frequently made on the craniofacial skeleton, collateral thermal, and mechanical trauma to adjacent bone tissue causes cell death and may delay healing. The present study evaluated the use of plasma-mediated laser ablation using a femtosecond laser to circumvent thermal damage and improve bone regeneration. METHODS Critical-size circular calvarial defects were created with a trephine drill bit or with a Ti:Sapphire femtosecond pulsed laser. Healing was followed using micro-CT scans for 8 weeks. Calvaria were also harvested at various time points for histological analysis. Finally, scanning electron microscopy was used to analyze the microstructure of bone tissue treated with the Ti:Sapphire laser, and compared to that treated with the trephine bur. RESULTS Laser-created defects healed significantly faster than those created mechanically at 2, 4, and 6 weeks post-surgery. However, at 8 weeks post-surgery, there was no significant difference. In the drill osteotomy treatment group, empty osteocyte lacunae were seen to extend 699 ± 27 µm away from the edge of the defect. In marked contrast, empty osteocyte lacunae were seen to extend only 182 ± 22 µm away from the edge of the laser-created craters. Significantly less ossification and formation of irregular woven bone was noted on histological analysis for drill defects. CONCLUSIONS We demonstrate accelerated bone healing after femtosecond laser ablation in a calvarial defect model compared to traditional mechanical drilling techniques. Improved rates of early regeneration make plasma-mediated ablation of the craniofacial skeleton advantageous for applications to osteotomy.
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Affiliation(s)
- David D Lo
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Plastic and Reconstructive Surgery Division, Stanford University School of Medicine, Stanford, California 94305-5427, USA
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16
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Dolan EB, Haugh MG, Tallon D, Casey C, McNamara LM. Heat-shock-induced cellular responses to temperature elevations occurring during orthopaedic cutting. J R Soc Interface 2012; 9:3503-13. [PMID: 22915633 DOI: 10.1098/rsif.2012.0520] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Severe heat-shock to bone cells caused during orthopaedic procedures can result in thermal damage, leading to cell death and initiating bone resorption. By contrast, mild heat-shock has been proposed to induce bone regeneration. In this study, bone cells are exposed to heat-shock for short durations occurring during surgical cutting. Cellular viability, necrosis and apoptosis are investigated immediately after heat-shock and following recovery of 12, 24 h and 4 days, in osteocyte-like MLO-Y4 and osteoblast-like MC3T3-E1 cells, using flow cytometry. The regeneration capacity of heat-shocked Balb/c mesenchymal stem cells (MSCs) and MC3T3-E1s has been investigated following 7 and 14 day's recovery, by quantifying proliferation, differentiation and mineralization. An immediate necrotic response to heat-shock was shown in cells exposed to elevated temperatures (45°C, 47°C and most severe at 60°C). A longer-term apoptotic response is induced in MLO-Y4s and, to a lesser extent, in MC3T3-E1s. Heat-shock-induced differentiation and mineralization by MSCs. These findings indicate that heat-shock is more likely to induce apoptosis in osteocytes than osteoblasts, which might reflect their role as sensors detecting and communicating damage within bone. Furthermore, it is shown for the first time that mild heat-shock (less than equal to 47°C) for durations occurring during surgical cutting can positively enhance osseointegration by osteoprogenitors.
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Affiliation(s)
- E B Dolan
- Department of Mechanical and Biomedical Engineering, Biomechanics Research Centre (BMEC), National University of Ireland, Galway, Ireland
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17
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Bisphosphonate-related osteonecrosis: laser-assisted surgical treatment or conventional surgery? Lasers Med Sci 2011; 26:815-23. [DOI: 10.1007/s10103-011-0974-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 07/18/2011] [Indexed: 11/26/2022]
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18
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Cloutier M, Girard B, Peel SA, Wilson D, Sándor GK, Clokie CM, Miller D. Calvarial bone wound healing: a comparison between carbide and diamond drills, Er:YAG and Femtosecond lasers with or without BMP-7. ACTA ACUST UNITED AC 2010; 110:720-8. [DOI: 10.1016/j.tripleo.2010.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/21/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022]
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19
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Advances in bone surgery: the Er:YAG laser in oral surgery and implant dentistry. Clin Cosmet Investig Dent 2010; 2:47-62. [PMID: 23662082 PMCID: PMC3645460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The erbium-doped yttrium aluminium garnet (Er:YAG) laser has emerged as a possible alternative to conventional methods of bone ablation because of its wavelength of 2.94 μm, which coincides with the absorption peak of water. Over the last decades in several experimental and clinical studies, the widespread initial assumption that light amplification for stimulated emission of radiation (laser) osteotomy inevitably provokes profound tissue damage and delayed wound healing has been refuted. In addition, the supposed disadvantage of prolonged osteotomy times could be overcome by modern short-pulsed Er:YAG laser systems. Currently, the limiting factors for a routine application of lasers for bone ablation are mainly technical drawbacks such as missing depth control and a difficult and safe guidance of the laser beam. This article gives a short overview of the development process and current possibilities of noncontact Er:YAG laser osteotomy in oral and implant surgery.
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20
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Stübinger S, Dissmann JP, Pinho NC, Saldamli B, Seitz O, Sader R. A preliminary report about treatment of bisphosphonate related osteonecrosis of the jaw with Er:YAG laser ablation. Lasers Surg Med 2009; 41:26-30. [DOI: 10.1002/lsm.20730] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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21
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Tracing and ablation of single cells in the mammalian blastocyst using fluorescent DNA staining and multi-photon laser microscopy. Histochem Cell Biol 2008; 131:521-30. [DOI: 10.1007/s00418-008-0548-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2008] [Indexed: 10/21/2022]
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22
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Kim JB, Leucht P, Lam K, Luppen C, Ten Berge D, Nusse R, Helms JA. Bone regeneration is regulated by wnt signaling. J Bone Miner Res 2007; 22:1913-23. [PMID: 17696762 DOI: 10.1359/jbmr.070802] [Citation(s) in RCA: 169] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Tissue regeneration is increasingly viewed as reactivation of a developmental process that, when misappropriated, can lead to malignant growth. Therefore, understanding the molecular and cellular pathways that govern tissue regeneration provides a glimpse into normal development as well as insights into pathological conditions such as cancer. Herein, we studied the role of Wnt signaling in skeletal tissue regeneration. INTRODUCTION Some adult tissues have the ability to regenerate, and among these, bone is one of the most remarkable. Bone exhibits a persistent, lifelong capacity to reform after injury, and continual bone regeneration is a prerequisite to maintaining bone mass and density. Even slight perturbations in bone regeneration can have profound consequences, as exemplified by conditions such as osteoporosis and delayed skeletal repair. Here, our goal was to determine the role of Wnts in adult bone regeneration. MATERIALS AND METHODS Using TOPgal reporter mice, we found that damage to the skeleton instigated Wnt reporter activity, specifically at the site of injury. We used a skeletal injury model to show that Wnt inhibition, achieved through adenoviral expression of Dkk1 in the adult skeleton, prevented the differentiation of osteoprogenitor cells. RESULTS As a result, injury-induced bone regeneration was reduced by 84% compared with controls. Constitutive activation of the Wnt pathway resulting from a mutation in the Lrp5 Wnt co-receptor results in high bone mass, but our experiments showed that this same point mutation caused a delay in bone regeneration. In these transgenic mice, osteoprogenitor cells in the injury site were maintained in a proliferative state and differentiation into osteoblasts was delayed. CONCLUSIONS When considered together, these data provide a framework for understanding the roles of Wnt signaling in adult bone regeneration and suggest a feasible approach to treating clinical conditions where enhanced bone formation is desired.
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Affiliation(s)
- Jae-Beom Kim
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Stanford University, Stanford, CA 94305-5148, USA
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