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Bartha V, Grünfeld D, Kopunic A, Klein C, Wolff D, Ratka-Krüger P, Woelber JP, Meller C. Increased safety in periodontal surgery: Doppler ultrasound for detection of relevant palatal blood vessels-A proof-of-concept and cross-sectional study. J Clin Periodontol 2024; 51:915-925. [PMID: 38508585 DOI: 10.1111/jcpe.13972] [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: 10/04/2023] [Revised: 01/30/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Abstract
AIM To evaluate the suitability of a Doppler ultrasound probe in detecting the greater palatine artery or its greater branches non-invasively. MATERIALS AND METHODS The palatal mucosa of 108 participants (median age 34 years, 51 female) was systematically divided into transversal sectors, each aligning with the positions of the upper molars (M), premolars (P) and canine teeth (C), aiming to facilitate precise and consistent localization of the detected palatal blood vessel across different patients. Blood flow of the palatal blood vessels, presumably, was located by scanning the palatal vault bilaterally using an 8-MHz ultrasound probe linked to a transducer. The distance to the corresponding tooth was measured using a millimetre-scale periodontal probe. RESULTS Within the regions of M2 to P1, the ultrasound transducer gave a delimitable acoustic pulse signal in 80%-98% of all measurements. The measured median distances between the determined position of the artery and the corresponding teeth ranged from 13 to 15 mm, with smaller distances in the anterior region. In several sectors, the distance was significantly higher for men (C: p = .048; P1: p = .041, M1: p < .01; M2: p = .034). CONCLUSIONS Use of the Doppler ultrasound transducer might be a promising approach to non-invasively detect relevant palatine blood vessels preoperatively. It, therefore, might have the potential to reduce the risk of accidental injury during palatal surgery.
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Affiliation(s)
- Valentin Bartha
- Department for Conservative Dentistry, School of Dental Medicine, University Heidelberg, Heidelberg, Germany
- Department for Conservative Dentistry, School of Dental Medicine, Eberhard-Karls University, Tübingen, Germany
| | - Dan Grünfeld
- Department for Conservative Dentistry, School of Dental Medicine, Eberhard-Karls University, Tübingen, Germany
- Private Practice, Dublin, Ireland
| | - Aleksandra Kopunic
- Department for Conservative Dentistry, School of Dental Medicine, Eberhard-Karls University, Tübingen, Germany
| | - Christian Klein
- Department for Conservative Dentistry, School of Dental Medicine, Eberhard-Karls University, Tübingen, Germany
- HealthCare Center Meller Zahngesundheit Schlauzahn MVZ GmbH, Waiblingen, Germany
| | - Diana Wolff
- Department for Conservative Dentistry, School of Dental Medicine, University Heidelberg, Heidelberg, Germany
| | - Petra Ratka-Krüger
- Department for Operative Dentistry and Periodontology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johan Peter Woelber
- Clinic of Operative Dentistry, Periodontology, and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Meller
- Department for Conservative Dentistry, School of Dental Medicine, Eberhard-Karls University, Tübingen, Germany
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Kim HJ, Noh HK, Park HS. Recovery bone formation on radiographic palatal bone dehiscences after incisor retraction with microimplants. Angle Orthod 2024; 94:168-179. [PMID: 38195052 PMCID: PMC10893923 DOI: 10.2319/081823-566.1] [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: 08/01/2023] [Accepted: 11/01/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVES To investigate the difference in labial and palatal alveolar bone thickness and height during the retention period after incisor retraction treatment with microimplant. MATERIALS AND METHODS A sample of 21 patients (mean age: 17.80 ± 4.38 years) who underwent incisor retraction treatment using microimplants after premolar extraction was investigated. The cone-beam computed tomography images at pretreatment, posttreatment, and retention were used to measure anterior alveolar bone thickness (labial, palatal, and total; at three vertical levels) and height (labial and palatal) and differences in the incisor position during treatment or retention. Repeated-measures analysis of variance with Bonferroni correction was performed to compare the variables at T0, T1, and T2. RESULTS The maxillary central incisor moved posteriorly by approximately 8.0 mm along with intrusive movement of 1.8 mm after treatment. The alveolar bone thickness significantly decreased on the palatal side and increased on the labial side after treatment. Thereafter, the palatal bone thickness significantly increased and labial bone thickness decreased during the retention period. The palatal interdental bone depressed by incisor retraction showed substantial bone deposition after retention. CONCLUSIONS Radiographic palatal bone dehiscences on the incisor root and palatal bone depression between the incisor roots were apparent after treatment. This palatal bone loss around the incisor roots noticeably recovered with newly formed bone during retention.
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Zhou Q, Yang F, Li N, Ren YF, Yu Y. Healing outcomes of open versus closed flap procedures for collagen membrane coverage following immediate dental implant placements with simultaneous guided tissue regeneration. J Dent 2024; 141:104735. [PMID: 37804939 DOI: 10.1016/j.jdent.2023.104735] [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: 07/07/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023] Open
Abstract
OBJECTIVE To compare the outcomes of open healing to complete closure for collagen membrane coverage for immediate implant placements with simultaneous guided bone regeneration (GBR) in two retrospective cohorts. METHODS The subjects included 118 patients who received Bio-Gide® collagen membrane coverage for immediate implant placements and GBR in 20 anterior and 98 posterior teeth. For 58 patients, gingival flaps were released to achieve full coverage of collagen membrane (CC group). For 60 patients, no efforts were made to release the gingival flaps and collagen membrane was left exposed for open healing (OH group). Antibiotics and analgesics were prescribed for 7 days after surgery. The width of crestal open wounds were measured after surgery (W0), and at 1, 2 and 16 weeks (W16). Changes in bone mass were assessed by cone-beam computed tomography after implant placement and again at W16. Gingival and bone tissues over the implant cover screws were harvested and assessed for 16 patients in the OH group at W16. RESULTS No wound dehiscence occurred in the CC group from W0 to W16. Both the vertical and horizontal bone dimension changes were not significantly different between the OH and CC group. For the OH group, soft tissue was completely healed at W16 when the initial wound widths were ≤6 mm. For those with initial wound widths ≥ 7 mm, the cover screws were exposed in 5/16 patients at W16 but did not affect the final restorations. Tissue staining showed keratinized mucosa and new bone formation above the dental implant in the OH group. CONCLUSION Open healing achieved healing outcomes similar to those of complete closure for collagen membrane coverage following immediate implant placements. CLINICAL SIGNIFICANCE For immediate implant placement requiring bone grafting and collagen membrane coverage, it is unnecessary to release the gingival flaps or use tissue grafts to achieve full coverage of the crestal wounds. Open healing with exposed membrane could achieve similar outcomes with less pain and swelling.
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Affiliation(s)
- Qianrong Zhou
- Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fei Yang
- Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ni Li
- The College of Medical Technology, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yan-Fang Ren
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY 14620, USA.
| | - Youcheng Yu
- Department of Stomatology, Zhongshan Hospital, Fudan University, Shanghai, China.
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Tavelli L, Barootchi S, Stefanini M, Zucchelli G, Giannobile WV, Wang HL. Wound healing dynamics, morbidity, and complications of palatal soft-tissue harvesting. Periodontol 2000 2023; 92:90-119. [PMID: 36583690 DOI: 10.1111/prd.12466] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/17/2022] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
Palatal-tissue harvesting is a routinely performed procedure in periodontal and peri-implant plastic surgery. Over the years, several surgical approaches have been attempted with the aim of obtaining autogenous soft-tissue grafts while minimizing patient morbidity, which is considered the most common drawback of palatal harvesting. At the same time, treatment errors during the procedure may increase not only postoperative discomfort or pain but also the risk of developing other complications, such as injury to the greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, and inadequate graft size or quality. This chapter described treatment errors and complications of palatal harvesting techniques, together with approaches for reducing patient morbidity and accelerating donor site wound healing. The role of biologic agents, photobiomodulation therapy, local and systemic factors, and genes implicated in palatal wound healing are also discussed.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Martina Stefanini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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García-Caballero L, Gándara M, Cepeda-Emiliani A, Gallego R, Gude F, Suárez-Quintanilla J, Ramos-Barbosa I, Blanco-Carrión J. Histological and histomorphometric study of human palatal mucosa: Implications for connective tissue graft harvesting. J Clin Periodontol 2023; 50:784-795. [PMID: 36872046 DOI: 10.1111/jcpe.13800] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
AIMS To analyse the histological structure and histomorphometric characteristics of human hard palatal mucosa in order to determine the donor site of choice for connective tissue grafts from a histological point of view. MATERIALS AND METHODS Palatal mucosa samples from six cadaver heads were harvested at four sites: incisal, premolar, molar and tuberosity. Histological and immunohistochemical techniques were performed, as was histomorphometric analysis. RESULTS In the current study, we found that the density and size of cells were higher in the superficial papillary layer, whereas the thickness of the collagen bundles increased in the reticular layer. Excluding the epithelium, the mean percentage of lamina propria (LP) and submucosa (SM) was 37% and 63%, respectively (p < .001). LP thickness showed similar values in the incisal, premolar and molar regions, and a significantly greater thickness in tuberosity (p < .001). The thickness of SM increased from incisal to premolar and molar, disappearing in the tuberosity (p < .001). CONCLUSIONS As dense connective tissue of LP is the tissue of choice for connective tissue grafts, the best donor site from a histological point of view is tuberosity because it is composed only of a thick LP without the presence of a loose submucosal layer.
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Affiliation(s)
- Lucía García-Caballero
- Department of Morphological Sciences (Histology Area), School of Medicine and Dentistry, University of Santiago de Compostela and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Marina Gándara
- Department of Morphological Sciences (Histology Area), School of Medicine and Dentistry, University of Santiago de Compostela and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Alfonso Cepeda-Emiliani
- Department of Morphological Sciences (Histology Area), School of Medicine and Dentistry, University of Santiago de Compostela and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Rosalía Gallego
- Department of Morphological Sciences (Histology Area), School of Medicine and Dentistry, University of Santiago de Compostela and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Francisco Gude
- Epidemiology Unit, University Clinical Hospital and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
| | - Juan Suárez-Quintanilla
- Department of Morphological Sciences (Anatomy and Embryology Area), School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Isabel Ramos-Barbosa
- Orthodontic Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Blanco-Carrión
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, and Health Research Institute of Santiago (IDIS), Santiago de Compostela, Spain
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Yu S, Zhong M, Xu W. In vitro oral simulation based on soft contact: The importance of viscoelastic response of the upper jaw substitutes. J Texture Stud 2023; 54:54-66. [PMID: 36520339 DOI: 10.1111/jtxs.12738] [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: 08/22/2022] [Revised: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Real oral processing is the squeezing and shearing between two soft surfaces. The importance of soft palate surface cannot be ignored while focusing on tongue substitutes. Thus the effects of viscoelasticity, roughness of upper jaw substitutes, and fluid rheological properties on lubrication properties were explored by in vitro oral tribology experiments. Different palate substitutes significantly changed the friction curves of pure water, milk, and yogurt. The boundary friction coefficients of pure water and milk are higher under softer or smooth palate substitutes due to stronger viscoelastic responses of friction pairs. Their boundary friction coefficients are lowest at rigid upper jaw substitutes owing to smaller contact angles and deformation. However, the boundary friction coefficient of yogurt is lower owing to its high viscosity, low loss factor, and large particle size under soft friction pairs. In addition, it is highest at rigid palate friction pair because a smaller contact area reduces the entrainment of yogurt, resulting in poor lubricating performance.
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Affiliation(s)
- Shuaike Yu
- Department of Mechanical Engineering, Key Laboratory of Tribology, Nanchang University, Nanchang, Jiangxi, China
| | - Min Zhong
- Department of Mechanical Engineering, Key Laboratory of Tribology, Nanchang University, Nanchang, Jiangxi, China
| | - Wenhu Xu
- Department of Mechanical Engineering, Key Laboratory of Tribology, Nanchang University, Nanchang, Jiangxi, China
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Kurtzman JT, Sayegh C, Mendonca S, Chowdhury M, Kerr P, Pagan C, Zoccali MB, Brandes SB. Is colorectal mucosa a reasonable graft alternative to buccal grafts for urethroplasty?: A comparison of graft histology and stretch. Int Braz J Urol 2022; 49:41-49. [PMID: 36512454 PMCID: PMC9881816 DOI: 10.1590/s1677-5538.ibju.2022.0278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/01/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare the histological properties and stretch of colorectal mucosal grafts (CMG) and buccal mucosal grafts (BMG) and to evaluate the impact of age, medical comorbidity and tobacco use on these metrics. MATERIALS AND METHODS Samples of BMGs from patients undergoing augmentation urethroplasty were sent for pathologic review. CMGs were collected from patients undergoing elective colectomy. CMGs were harvested fresh, at full thickness from normal rectum/sigmoid. Patients with inflammatory bowel disease, prior radiation, or chemotherapy were excluded. RESULTS Seventy two BMGs and 53 CMGs were reviewed. While BMGs and CMGs were both histologically composed of mucosal (epithelium + lamina propria) and submucosal layers, the mucosal layer in CMG had crypts. The outer epithelial layers differed significantly in mean thickness (BMG 573μm vs. CMG 430μm, p=0.0001). Mean lamina propria thickness and submucosal layer thickness also differed significantly (BMG 135μm vs. CMG 400μm, p<0.0001; BMG 1090μm vs. CMG 808μm, p = 0.007, respectively). Mean delta stretch, as to length and width, was greater for CMG (118% x 72%) compared to BMGs (22% x 8%), both p<0.001. CONCLUSION CMGs and BMGs significantly differ histologically in layer composition, width and architecture, as well as graft stretch. Given its elastic properties, CMG may be useful in covering large surface areas, but its thin epithelium, thick lamina propria and additional muscularis mucosal layer could impact graft take and contracture.
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Affiliation(s)
- Jane T. Kurtzman
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Christopher Sayegh
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Shawn Mendonca
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mahveesh Chowdhury
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Preston Kerr
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Carlos Pagan
- Columbia University Irving Medical CenterDepartment of Pathology and Cell BiologyNew YorkNYUSADepartment of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Marco B. Zoccali
- Columbia University Irving Medical CenterDivision of Colorectal SurgeryDepartment of SurgeryNew YorkNYUSADivision of Colorectal Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Steven B. Brandes
- Columbia University Irving Medical CenterDepartment of UrologyNew YorkNYUSADepartment of Urology, Columbia University Irving Medical Center, New York, NY, USA,Correspondence address: Steven B. Brandes, MD, Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, New York, NY 10032, USA. Fax: +1 212 305-0139 E-mail:
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Seidel A, Schmitt C, Matta RE, Buchbender M, Wichmann M, Berger L. Investigation of the palatal soft tissue volume: a 3D virtual analysis for digital workflows and presurgical planning. BMC Oral Health 2022; 22:361. [PMID: 35999531 PMCID: PMC9400256 DOI: 10.1186/s12903-022-02391-z] [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: 07/05/2022] [Accepted: 08/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background In mucogingival and implant surgery, an autologous soft tissue graft from the palate is the gold standard for reconstructing missing keratinised soft tissue and volume. Previously, presurgical measurements of the graft harvesting site were described with two-dimensional (2D) linear measurements. The present observational clinical study aimed to evaluate a three-dimensional (3D) measurement method for determining the present palatal soft tissue volume for each patient individually. Methods Pre-existing cone beam computed tomography (CBCT) scans of 20 patients were converted into 3D Standard Tessellation Language models of the bone surface. Intraoral impressions of the maxilla were taken and digitised to visualise the gingival surface. The resulting virtual models of bone (reference value) and gingival (actual value) surfaces were merged, with tooth surfaces used for registration. The region between the central incisors and the hard palate was subdivided into 5 regions of interest (ROIs). The distance between palatal bone and gingival surface was analysed both volumetrically and linearly, and the results were statistically evaluated for the ROIs.
Results The average gingival surface area on the palate was 19.1 cm2, and the mean volume was 58.2 cm3 (± 16.89). Among the ROIs, the mean linear value was highest in the most distal region, from the second molar to the hard palate (4.0 ± 1.09 mm) and lowest in the canine region (1.9 ± 0.63 mm). For mean distance, significant differences were found for the anterior palate and the most posterior palate in comparison with all other ROIs (p < 0.01). The volume measurements also declined significantly and steadily between the posterior (1.9 ± 1.0 cm3) and anterior palates (0.4 ± 0.2 cm3). Conclusions By merging digital data, palatal soft tissue could be quantified virtually. The results were reliable and comparable to previous findings with linear measurement methods. This 3D soft tissue volume analysis method fully exploited the diagnostic potential of data that are frequently collected for presurgical planning in oral surgery (i.e., CBCT + surface scans). This evaluation method might be useful for volumetric and linear measurements in other applications in anatomy and for determining palatal soft tissue dimensions in the planning stage before surgical interventions. Trial registration This observational clinical trial was retrospectively registered in the German Clinical Trials Register, reference number: DRKS00023918.
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Affiliation(s)
- Anna Seidel
- Department of Prosthodontics, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany.
| | - Christian Schmitt
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
| | - Ragai Edward Matta
- Department of Prosthodontics, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
| | - Mayte Buchbender
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
| | - Manfred Wichmann
- Department of Prosthodontics, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
| | - Lara Berger
- Department of Prosthodontics, University Hospital Erlangen of Friedrich-Alexander University Erlangen-Nürnberg (FAU), Glueckstrasse 11, 91054, Erlangen, Germany
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An Oral-mucosa-on-a-chip sensitively evaluates cell responses to dental monomers. Biomed Microdevices 2021; 23:7. [PMID: 33426594 DOI: 10.1007/s10544-021-00543-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 12/11/2022]
Abstract
Knowledge of human gingival cell responses to dental monomers is critical for the development of new dental materials. Testing standards have been developed to provide guidelines to evaluate biological functionality of dental materials and devices. However, one shortcoming of the traditional testing platforms is that they do not recapitulate the multi-layered configuration of gingiva, and thus cannot evaluate the layer-specific cellular responses. An oral mucosa-chip with two cell layers was previously developed as an alternative platform to assess the oral mucosa responses to dental biomaterials. The mucosa-chip consists of an apical keratinocyte layer attached to a fibroblast-embedded collagen hydrogel through interconnecting pores in a three-microchannel network. Here, cell responses in the mucosa-chip were evaluated against 2-hydroxyethyl methacrylate (HEMA), a common monomer used in restorative and aesthetic dentistry. The response of mucosal cell viability was evaluated by exposing the chip to HEMA of concentrations ranging from 1.56 to 25 mM and compared to cells in conventional well-plate monoculture. The co-cultured cells were then stained and imaged with epifluorescence and confocal microscopy to determine the layer-specific responses to the treatment. Mucosa-chips were demonstrated to be more sensitive to assess HEMA-altered cell viability than well-plate cultures, especially at lower doses (1.56 and 6.25 mM). The findings suggest that the mucosa-chip is a promising alternative to traditional platforms or assays to test a variety of biomaterials by offering a multi-layered tissue geometry, accessible layer-specific information, and higher sensitivity in detecting cellular responses.
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Technical Note on Root Coverage of Lower Anterior Teeth Using a Partially Deepithelialized Connective Tissue Graft (PE-CTG) Aided by a High-Speed Handpiece. Case Rep Dent 2020; 2020:8815176. [PMID: 32953183 PMCID: PMC7481965 DOI: 10.1155/2020/8815176] [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: 06/29/2020] [Revised: 08/15/2020] [Accepted: 08/23/2020] [Indexed: 11/17/2022] Open
Abstract
Root coverage in the mandibular anterior region is challenging because of a thin gingival biotype, shallow vestibule, and high frenum attachment. Several methods have been introduced to predict the root coverage in this area. Stimmelmayr proposed a method of performing root coverage using a combination epithelialized-subepithelial connective tissue graft (CTG). However, it is difficult to precisely acquire connective tissue according to this method. Therefore, in this case report, we would like to introduce a technique to harvest a partially deepithelialized CTG (PE-CTG) aided by a high-speed handpiece, which helps in procuring the graft easily and quickly. This method could lower the patient's morbidity at donor sites and enhance the healing process. Additionally, it could increase the amount of keratinized gingiva in the mandibular anterior region without reducing the vestibular depth. Therefore, PE-CTG using a high-speed handpiece can be a promising treatment option for the root coverage of the mandibular anterior teeth.
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Fan R, Gou H, Wang X, Li L, Xu Y, Svensson P, Wang K. Microcirculation and somatosensory profiling of patients with periodontitis: a preliminary case control report. Clin Oral Investig 2020; 25:1223-1233. [PMID: 32613435 DOI: 10.1007/s00784-020-03427-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The purpose of this preliminary study was to explore blood microcirculation and somatosensory profiles in periodontitis patients before and after non-surgical periodontal therapy. MATERIALS AND METHODS Twenty patients (10 men and 10 women, 20 to 30 years old) and 20 age- and gender-matched healthy controls were included. Non-surgical periodontal therapy was performed for all patients. Clinical examination including pocket probing depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) were performed at baseline (BL), 1 week (1W), and 4 weeks (4W) after non-surgical periodontal therapy on 6 sites of tooth 32 and 42. Laser Doppler flowmetry (LDF) and quantitative sensory testing (QST) were applied at the attached gingiva of tooth 32 and 42 at BL, 1W, and 4W after non-surgical periodontal therapy. Data were analyzed with a two-way mixed-model of ANOVA. RESULTS The PPD, CAL and BOP significantly improved after non-surgical periodontal therapy (p < 0.001). Periodontitis patients demonstrated a higher tissue microvascular blood cell concentration (p = 0.015) and a significant gain in thermal (p = 0.037) and mechanical (p = 0.003) somatosensory function compared to controls. After non-surgical periodontal therapy, the flux (p = 0.002) and speed (p = 0.008) of blood flow decreased significantly and thermal (p = 0.029) and mechanical (p < 0.001) somatosensory function were reversed. CONCLUSION Gingival microcirculation and somatosensory function seem impaired in patients with periodontitis and are reversed following non-surgical periodontal therapy. CLINICAL RELEVANCE LDF and QST may be appropriate tools to further characterize gingival inflammation and treatment responses in periodontitis.
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Affiliation(s)
- Ruyi Fan
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, People's Republic of China
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China
| | - Huiqing Gou
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, People's Republic of China
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaoqian Wang
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China
| | - Lu Li
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yan Xu
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, People's Republic of China.
- Department of Periodontics, Affiliated Hospital of Stomatology, Nanjing Medical University, 136 Hanzhong Road, Nanjing, 210029, People's Republic of China.
- Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, People's Republic of China.
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Faculty of Odontology, Malmø University, Malmø, Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark
| | - Kelun Wang
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, People's Republic of China
- Section of Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
- Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
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12
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Marques de Mattos P, Papalexiou V, Tramontina VA, Kim SH, Luczyszyn SM, Bettega PVC, Batista Rodrigues Johann AC. Evaluation of 2 techniques of epithelial removal in subepithelial connective tissue graft surgery: a comparative histological study. J Periodontal Implant Sci 2020; 50:2-13. [PMID: 32128269 PMCID: PMC7040442 DOI: 10.5051/jpis.2020.50.1.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 09/12/2019] [Accepted: 10/11/2019] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Subepithelial connective tissue grafts (SCTGs) are commonly performed for the treatment of gingival recession due to their high predictability. This study evaluated and histologically compared connective tissue grafts in terms of the presence of epithelial remnants and composition of the tissue types that were present (epithelium, lamina propria, and submucosa). METHODS Ten patients underwent epithelium removal using 2 different techniques: the use of a blade (group B) and through abrasion (group A). Twenty samples were collected and each tissue type was analyzed histologically in terms of its area, thickness, and proportion of the total area of the graft. RESULTS In 4 samples (40%) from group B (n=10) and 2 samples (20%) from group A (n=10), the presence of an epithelial remnant was observed, but the difference between the groups was not statistically significant (P>0.05). Likewise, no statistically significant differences were observed between the groups regarding the area, mean thickness, or proportion of the total area for any of the tissue types (P>0.05). CONCLUSIONS Histologically, SCTGs did not show statistically significant differences in terms of their tissue composition depending on whether they were separated from the epithelial tissue by abrasion or by using a blade.
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Affiliation(s)
- Paola Marques de Mattos
- Department of Dentistry, Life Sciences School, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Vula Papalexiou
- Department of Dentistry, Life Sciences School, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | - Sung Hyun Kim
- Department of Dentistry, Life Sciences School, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Sônia Mara Luczyszyn
- Department of Dentistry, Life Sciences School, Pontifical Catholic University of Paraná, Curitiba, Brazil
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Rahimi C, Rahimi B, Padova D, Rooholghodos SA, Bienek DR, Luo X, Kaufman G, Raub CB. Oral mucosa-on-a-chip to assess layer-specific responses to bacteria and dental materials. BIOMICROFLUIDICS 2018; 12:054106. [PMID: 30310527 PMCID: PMC6158033 DOI: 10.1063/1.5048938] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/06/2018] [Indexed: 05/24/2023]
Abstract
The human oral mucosa hosts a diverse microbiome and is exposed to potentially toxic biomaterials from dental restoratives. Mucosal health is partly determined by cell and tissue responses to challenges such as dental materials and pathogenic bacteria. An in vitro model to rapidly determine potential layer-specific responses would lead to a better understanding of mucosal homeostasis and pathology. Therefore, this study aimed to develop a co-cultured microfluidic mucosal model on-a-chip to rapidly assess mucosal remodeling and the responses of epithelial and subepithelial layers to challenges typically found in the oral environment. A gingival fibroblast-laden collagen hydrogel was assembled in the central channel of a three-channel microfluidic chamber with interconnecting pores, followed by a keratinocyte layer attached to the collagen exposed in the pores. This configuration produced apical and subepithelial side channels capable of sustaining flow. Keratinocyte, fibroblast, and collagen densities were optimized to create a co-culture tissue-like construct stable over one week. Cells were stained and imaged with epifluorescence microscopy to confirm layer characteristics. As proof-of-concept, the mucosal construct was exposed separately to a dental monomer, 2-hydroxylethyl methacrylate (HEMA), and the oral bacteria Streptococcus mutans. Exposure to HEMA lowered mucosal cell viability, while exposure to the bacteria lowered trans-epithelial electrical resistance. These findings suggest that the oral mucosa-on-a-chip is useful for studying oral mucosal interactions with bacteria and biomaterials with a histology-like view of the tissue layers.
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Affiliation(s)
- Christopher Rahimi
- Department of Biomedical Engineering, The Catholic University of America, 620 Michigan Avenue NE, Washington, District of Columbia 20064, USA
| | - Benjamin Rahimi
- Department of Biomedical Engineering, The Catholic University of America, 620 Michigan Avenue NE, Washington, District of Columbia 20064, USA
| | - Dominic Padova
- Department of Biomedical Engineering, The Catholic University of America, 620 Michigan Avenue NE, Washington, District of Columbia 20064, USA
| | - Seyed A. Rooholghodos
- Department of Mechanical Engineering, The Catholic University of America, 620 Michigan Avenue NE, Washington, District of Columbia 20064, USA
| | - Diane R. Bienek
- ADA Foundation, Volpe Research Center, 100 Bureau Drive, Stop #8546, Gaithersburg, Maryland 20899, USA
| | - Xiaolong Luo
- Department of Mechanical Engineering, The Catholic University of America, 620 Michigan Avenue NE, Washington, District of Columbia 20064, USA
| | - Gili Kaufman
- ADA Foundation, Volpe Research Center, 100 Bureau Drive, Stop #8546, Gaithersburg, Maryland 20899, USA
| | - Christopher B. Raub
- Department of Biomedical Engineering, The Catholic University of America, 620 Michigan Avenue NE, Washington, District of Columbia 20064, USA
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14
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Hilgenfeld T, Kästel T, Heil A, Rammelsberg P, Heiland S, Bendszus M, Schwindling FS. High-resolution dental magnetic resonance imaging for planning palatal graft surgery-a clinical pilot study. J Clin Periodontol 2018; 45:462-470. [PMID: 29334405 DOI: 10.1111/jcpe.12870] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 11/28/2022]
Abstract
AIM To evaluate whether high-resolution, non-contrast-enhanced dental magnetic resonance imaging (MRI) can be used for accurate determination of palatal masticatory mucosa thickness (PMMT) and to locate the greater palatal artery (GPA). MATERIALS AND METHODS In five volunteers (four males, one female; mean age 30.2 ± 0.4 years), two independent raters measured PMMT by use of dental MRI in 180 positions. For comparison, clinical bone sounding was performed. The GPA was identified in time-of-flight (TOF) angiography and MSVAT-SPACE-prototype sequence. Intra- and inter-observer agreement for MRI measurements, agreement between MRI and bone sounding were analysed by intra-class correlation coefficient (ICC) and Cohen's kappa (κ). RESULTS Reliability of dental MRI measurements was high (intra-observer-ICC 0.962; inter-observer ICC 0.959). Agreement of MRI measurements with bone sounding was moderate (ICC 0.744), and the GPA could be identified in 60% of measurement points using the TOF-angiography alone and in 85% with additional information of the MSVAT-SPACE. Good intra-observer agreement was observed for GPA identification (κ: 0.778). CONCLUSION Palatal masticatory mucosa thickness measured by high-resolution, non-contrast enhanced dental MRI is comparable with that obtained by bone sounding. Dental MRI enables reliable, non-invasive and radiation-free planning of palatal tissue harvesting and can also be used for location of the GPA at 85% of measurement points, which might help reduce complications during surgery.
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Affiliation(s)
- Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thorsten Kästel
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Heil
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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15
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Yaprak E, Kayaalti-Yuksek S. Preliminary evaluation of near-infrared vein visualization technology in the screening of palatal blood vessels. Med Oral Patol Oral Cir Bucal 2018; 23:e98-e104. [PMID: 29274151 PMCID: PMC5822547 DOI: 10.4317/medoral.21996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/10/2017] [Indexed: 11/24/2022] Open
Abstract
Background Avoidance from palatal blood vessel rupture is a major concern during the palatal soft tissue graft surgery. There is no defined chair-side and case-specific palatal blood vessel detection approach to facilitate the harvesting process. The objective of this pilot study is to assess the feasibility of a near-infrared vein visualization system in the screening process of palatal blood vessels. Material and Methods An extraoral vein visualization device (AccuVein AV400) was applied to a total of 304 hemi-maxilla of 152 individuals by two blind examiners. The study groups were classified according to their maximum inter-incisal measurements. The distances between the coronal border of the vessel image and the mid-palatal gingival margins of the adjacent teeth were measured and in each group. The correlations among the measurements were evaluated within groups. Results The blood vessel to the adjacent teeth measurements exhibited no statistical difference between both examiners in all subjects (p<0.001). Correlations between the examiners gradually increased in all groups as the mouth opening rates of the subjects were increased (p<0.001). Conclusions In the current state, screening of the palatal blood vessels via near-infrared vein visualization technology seems to be not suitable for every individual due to the restrictive effect of mouth opening. However, the promising results of this preliminary study demonstrated increasing consistency between the measurements of the examiners as the inter-incisal distance increase which emphasized the need an intraoral version of the device. Considering the lack of local decision-making technology for the detection of palatal blood vessels, further studies are required for development and optimization of these systems. Key words:Near-infrared vein visualization, palatal graft harvesting, surgical complications.
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Affiliation(s)
- E Yaprak
- Kocaeli University, Faculty of Dentistry, Department of Periodontology, Yuvacik, Basiskele, Kocaeli, Turkey,
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16
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Kouadio AA, Jordana F, Koffi NJ, Le Bars P, Soueidan A. The use of laser Doppler flowmetry to evaluate oral soft tissue blood flow in humans: A review. Arch Oral Biol 2017; 86:58-71. [PMID: 29182953 DOI: 10.1016/j.archoralbio.2017.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023]
Abstract
The objective of this work is to define the conditions for improving the use of laser Doppler flowmetry (LDF) and to determine the limits for the use of this technique. This article systematically reviews the literature on the evaluation of oral soft tissue blood microcirculation by LDF. We analysed the available literature through October 2016 using the database resources Medline/PubMed, the Cochrane Oral Health Group Specialist Trials Register and the ISI Web of Knowledge. Several points emerged from this literature review The use of LDF involves specific constraints; however, the influence of different factors (temperature, tobacco, pressure etc.) must be adequately controlled when using LDF. LDF measurements of soft tissue within the oral cavity vary depending on the anatomical site. In dentistry, LDF can be used to track healing progress in periodontal surgery and to diagnose vascular flow changes in the connective tissue of mucosae covered by a removable prosthesis at an early stage prior to the onset of clinical inflammation signs.
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Affiliation(s)
- Ayepa Alain Kouadio
- Department of Prosthetic, UIC Odontology, Nantes Dental school 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France; UFR d'Odonto-stomatologie, Université Félix Houphouët Boigny, 22 BP 612 Abidjan 22, Cote d'Ivoire.
| | - Fabienne Jordana
- Department of Prosthetic, UIC Odontology, Nantes Dental school 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France.
| | - N'goran Justin Koffi
- UFR d'Odonto-stomatologie, Université Félix Houphouët Boigny, 22 BP 612 Abidjan 22, Cote d'Ivoire.
| | - Pierre Le Bars
- Department of Prosthetic, UIC Odontology, Nantes Dental school 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France.
| | - Assem Soueidan
- Department of Periodontology, UIC Odontology, Nantes Dental School 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France.
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Bentz BZ, Wu TC, Gaind V, Webb KJ. Diffuse optical localization of blood vessels and 3D printing for guiding oral surgery. APPLIED OPTICS 2017; 56:6649-6654. [PMID: 29047957 PMCID: PMC5652004 DOI: 10.1364/ao.56.006649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Diffuse optical imaging through centimeters of tissue has emerged as a powerful tool in biomedical research. However, applications in the operating theater have been limited in part due to data set requirements and computational burden. We present an approach that uses a small number of optical source-detector pairs that allows for the fast localization of arteries in the roof of the mouth and has the potential to reduce complications during oral surgery. The arteries are modeled as multiple-point absorbers, allowing localization of their complex shapes. The method is demonstrated using a printed tissue-simulating mouth phantom. Furthermore, we use the extracted position information to fabricate a custom surgical guide using 3D printing that could protect the arteries during surgery.
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Affiliation(s)
- Brian Z. Bentz
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana 47907, USA
| | - Timothy C. Wu
- Private Practice in Periodontology, Mountain View, California 94040, USA
| | | | - Kevin J. Webb
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana 47907, USA
- Corresponding author:
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18
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Ioannidis A, Cathomen E, Jung RE, Fehmer V, Hüsler J, Thoma DS. Discoloration of the mucosa caused by different restorative materials - a spectrophotometric in vitro study. Clin Oral Implants Res 2016; 28:1133-1138. [PMID: 27452796 DOI: 10.1111/clr.12928] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the discoloration of the mucosa caused by different ceramic and metal-based materials. MATERIAL AND METHODS On six pig maxillae, trap-door flaps were prepared bilaterally. Different ceramic and metal-based specimens were placed underneath the flap. To simulate increasing mucosal thicknesses (MC), connective tissue grafts (CTGs) were harvested. Spectrophotometric measurements were performed prior to flap elevation (TBL ) and for each material under the flap alone (1 mm MC) (TMC1 ), with a 1-mm CTG (2-mm MC) (TMC2 ) and with a 2-mm CTG (3-mm MC) (TMC3 ). Tested materials were as follows: Zr1 (zirconia), Zr2 (zirconia + pink ceramic), Zr3 (zirconia), Zr4 (fluorescent zirconia), Zr5 (zirconia), Zr6 (high translucent zirconia), Zr7 (low translucent zirconia) and Zr8 (low translucent zirconia), Gol (gold alloy), Ti1 (titanium alloy), Ti2 (anodized gold-shaded titanium alloy) and Ti3 (anodized pink-shaded titanium alloy). Color differences (ΔE) were calculated comparing the measurement of the native tissue (TBL ) and the measurements with varying mucosal thicknesses (TMC1-3 ). RESULTS For ceramic materials, the median ΔE values for the different time-point comparison ranged as follows: 3.80 (Zr4) - 7.47 (Zr2) (pooled); 3.15 (Zr4) - 8.13 (Zr2) (TBL -TMC1 ); 3.39 (Zr4) - 7.24 (Zr2) (TBL -TMC2 ); 4.31 (Zr8) - 6.99 (Zr2) (TBL -TMC3 ). For metal-based materials, the median ΔE values were as follows: 4.20 (Gol) - 5.82 (Ti3) (pooled); 3.21 (Gol) - 13.56 (Ti1) (TBL -TCM1 ); 4.0 (Ti1) - 5.27 (Gol) (TBL -TCM2 ); 3.11 (Ti1) - 5.11 (Gol) (TBL -TCM2 ). The comparison of the materials and the time points showed in the nonparametric linear mixed model a significant interaction effect between material and time point (P < 0.001). The side was not a significant main effect, nor as term in an interaction with the other two effects. CONCLUSIONS Reconstructive materials result in an evident discoloration of the mucosal tissue, tending to decrease with increasing mucosal thickness. The use of fluorescent zirconia (ceramic materials) or gold alloy (metal-based materials) lead to the least discoloration.
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Affiliation(s)
- Alexis Ioannidis
- Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Elena Cathomen
- Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, Center of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Jürg Hüsler
- Institute of Mathematical Statistics and Actuarial Science, University of Berne, Berne, Switzerland
| | - Daniel S Thoma
- Clinic for Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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19
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Pilot Study of Laser Doppler Measurement of Flow Variability in the Microcirculation of the Palatal Mucosa. BIOMED RESEARCH INTERNATIONAL 2016; 2016:5749150. [PMID: 27340663 PMCID: PMC4908244 DOI: 10.1155/2016/5749150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 11/18/2022]
Abstract
Background. Histopathological alterations can arise when the denture-supporting mucosa experiences microbial and mechanical stress through the denture base and diagnosis of these diseases usually follows microvascular changes. Microcirculation measurement could allow for detection of such dysfunction and aid in the early diagnosis of palatal mucosa pathologies. Materials and Methods. We tested the sensitivity of laser Doppler for measuring the microcirculation of the palatal mucosa, assessing the median raphe (MR), Schroeder area (SA), and retroincisive papilla (RP). A Doppler PeriFlux 5000 System, containing a laser diode, was used. 54 healthy participants were recruited. We compare the measurements of PU (perfusion unit) using ANOVA test. Results. The numerical values for palatal mucosa blood flow differed significantly among the anatomical areas (p = 0.0167). The mean value of Schroeder area was 92.6 (SD: 38.4) and was significantly higher than the retroincisive papilla (51.9) (SD: 20.2) (p < 0.05), which in turn was higher than that of median raphe (31.9) (SD: 24.2) (p < 0.0001). Conclusion. Schroeder area appeared to have the greatest sensitivity, and vascular flow variability among individuals was also greatest in this region. We suggest that analysis of blood stream modification with laser Doppler of the palatal mucosa can help to detect onset signs of pathological alterations.
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20
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Eguchi T, Ishida R, Ara H, Hamada Y, Kanai I. A diffuse traumatic neuroma in the palate: a case report. J Med Case Rep 2016; 10:116. [PMID: 27165640 PMCID: PMC4863315 DOI: 10.1186/s13256-016-0908-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A traumatic neuroma is not a true neoplasm but a reactive proliferation of neural tissue that commonly occurs after the transection or damage of a nerve bundle. Traumatic neuromas are rare in the oral region and usually occur as a solitary nodule of the mental foramen, lower lip, or tongue. This is the first report of a diffuse traumatic neuroma of the palate. CASE PRESENTATION A 30-year-old Japanese man was referred to our clinic complaining of painful swelling of the left side of his palate. The swelling was diffuse and his pain increased with palpation of his palate. He had no noteworthy medical or family history, and was not aware of any history of trauma or inflammation in his head or neck area. We administered antibiotics and non-steroidal anti-inflammatory drugs because we suspected that his symptoms were the result of inflammation caused by an infection. However, his symptoms did not change. An incisional biopsy was performed, and histopathologic examination indicated that the lesion was a traumatic neuroma. Under general anesthesia the lesion was resected with a 5-mm margin using an electric scalpel because of the diffuse expansion and indistinct borders of the mass. Some tumor cells were observed within the surgical margins of the resected specimen, but there has been no recurrence of either the pain or mass in the 3 years since the surgery. CONCLUSIONS The location and diffuse nature of this traumatic neuroma are both very rare. While we were initially unsure about the diagnosis and treatment of this mass, the treatment outcome has been good. However, a postoperative recurrence can occur at any time following the excision of a traumatic neuroma, and close long-term follow-up will continue.
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Affiliation(s)
- Takanori Eguchi
- Department of Oral and Maxillofacial Surgery, Toshiba Rinkan Hospital, 7-9-1 Kamitsuruma Minami-ku, Sagamihara, 252-0385, Japan. .,Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-1-3 Tsurumi Tsurumi-ku, Yokohama, 230-8501, Japan.
| | - Rikuma Ishida
- Department of Oral and Maxillofacial Surgery, Toshiba Rinkan Hospital, 7-9-1 Kamitsuruma Minami-ku, Sagamihara, 252-0385, Japan.,Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-1-3 Tsurumi Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Hironori Ara
- Department of Oral and Maxillofacial Surgery, Toshiba Rinkan Hospital, 7-9-1 Kamitsuruma Minami-ku, Sagamihara, 252-0385, Japan.,Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-1-3 Tsurumi Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Yoshiki Hamada
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-1-3 Tsurumi Tsurumi-ku, Yokohama, 230-8501, Japan
| | - Ikuyo Kanai
- Department of Oral and Maxillofacial Surgery, Toshiba Rinkan Hospital, 7-9-1 Kamitsuruma Minami-ku, Sagamihara, 252-0385, Japan.,Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Tsurumi University, 2-1-3 Tsurumi Tsurumi-ku, Yokohama, 230-8501, Japan
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21
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Rossell-Perry P. Flap Necrosis after Palatoplasty in Patients with Cleft Palate. BIOMED RESEARCH INTERNATIONAL 2015; 2015:516375. [PMID: 26273624 PMCID: PMC4529936 DOI: 10.1155/2015/516375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 12/04/2014] [Indexed: 11/17/2022]
Abstract
Palatal necrosis after palatoplasty in patients with cleft palate is a rare but significant problem encountered by any cleft surgeon. Few studies have addressed this disastrous complication and the prevalence of this problem remains unknown. Failure of a palatal flap may be attributed to different factors like kinking or section of the pedicle, anatomical variations, tension, vascular thrombosis, type of cleft, used surgical technique, surgeon's experience, infection, and malnutrition. Palatal flap necrosis can be prevented through identification of the risk factors and a careful surgical planning should be done before any palatoplasty. Management of severe fistulas observed as a consequence of palatal flap necrosis is a big challenge for any cleft surgeon. Different techniques as facial artery flaps, tongue flaps, and microvascular flaps have been described with this purpose. This review article discusses the current status of this serious complication in patients with cleft palate.
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Affiliation(s)
- Percy Rossell-Perry
- Post Graduate Studies, School of Medicine, San Martin de Porres University, Lima, Peru
- “Outreach Surgical Center Lima PERU” ReSurge International, Schell Street No. 120 Apartment 1503 Miraflores, Lima, Peru
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22
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Wagner F, Dvorak G, Pillerstorff R, Traxler H, Nemec S, Pietschmann P, Seemann R. Anatomical preconditions for the palatal sinus floor augmentation—A three-dimensional feasibility study. J Craniomaxillofac Surg 2015; 43:1303-8. [PMID: 26169998 DOI: 10.1016/j.jcms.2015.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/26/2015] [Accepted: 06/08/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the anatomical feasibility of palatal sinus floor augmentation. MATERIAL AND METHODS In 100 men and 100 women, both sinuses were analyzed using computed tomography. The patients were divided into four anatomical groups according to the remaining alveolar bone height: group 1 (0 ≤ × < 4), group 2 (4 ≤ × < 8), group 3 (8 ≤ × < 12), and group 4 (≥12). RESULTS The 400 maxillary sinuses consisted of 23.5% (n = 94) group 1, 42.75% (n = 171) group 2, 23.5% (n = 98) group 3, and 9.25% (n = 37) group 4 sinuses. Optimal anatomical preconditions for palatal sinus floor augmentations (i.e., ≥5 mm height and <5 mm thickness of the window lid) were found in 93.6% of group 1 sinuses, 73.7% of group 2 sinuses, 23.5% of group 3 sinuses, and 5.4% of group 4 sinuses. CONCLUSION The palatal approach is feasible in 93.6% of patients with remnant alveolar height of up to 4 mm. Limitations are alveolar heights of ≤5 mm as well as great palatal thickness and thus limited dimensions for a possible palatal window.
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Affiliation(s)
- F Wagner
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University Vienna, Austria
| | - G Dvorak
- Bernhard Gottlieb Dental University Clinic, Medical University Vienna, Austria.
| | - R Pillerstorff
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University Vienna, Austria
| | - H Traxler
- Department for Systematic Anatomy, Medical University Vienna, Austria
| | - S Nemec
- University Clinic for Radiology, Medical University Vienna, Austria
| | - P Pietschmann
- Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria
| | - R Seemann
- University Clinic for Cranio- and Maxillofacial Surgery, Medical University Vienna, Austria
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