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Panneerselvam E, Ravikumar C, Rajan TA, Balasubramanian S, Krishnakumar Raja VB. Management of multiple and displaced mandibular fractures in a pediatric patient sans mandibular immobilization, sans open reduction and internal fixation. Chin J Traumatol 2024:S1008-1275(24)00031-2. [PMID: 38531714 DOI: 10.1016/j.cjtee.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/12/2023] [Accepted: 02/18/2024] [Indexed: 03/28/2024] Open
Abstract
Maxillofacial fractures in the pediatric population are generally managed by conservative approaches such as soft diet and medication or semi-invasive procedures namely inter-maxillary fixation or circum-mandibular wiring. These approaches are preferred over any invasive treatment to minimize injury to the growing skeleton and tooth germs. Displaced fractures that cause functional problems such as restricted mouth opening, malocclusion or impaired breathing, mandate open reduction and internal fixation. However, surgical management is associated with morbidity related to general anesthesia, risk of injury to vital structures, and potential, skeletal or dental growth disturbances. This case report describes a non-invasive method of managing displaced, multiple fractures of the mandible in a pediatric patient, with the use of low intensity pulsed ultrasound to achieve favorable clinical outcomes and nil complications. Neither immobilization of the mandible with inter-maxillary fixation nor open reduction and internal fixation was used. Low intensity pulsed ultrasound therapy is painless and patient-friendly.
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Affiliation(s)
- Elavenil Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India.
| | - Chandini Ravikumar
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India
| | - Trishala Annamalai Rajan
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India
| | - Sasikala Balasubramanian
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India
| | - V B Krishnakumar Raja
- Department of Oral and Maxillofacial Surgery, SRM Dental College and Hospital, Ramapuram, Chennai, 600089, Tamil Nadu, India
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Meral SE, Koç O, Tosun E, Tüz HH. Effects of sagittal split Ramus osteotomy on condylar position and Ramal orientation in patients with mandibular asymmetry. Clin Oral Investig 2023; 28:65. [PMID: 38158456 DOI: 10.1007/s00784-023-05400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE The purpose of this study is to assess the impact of Sagittal Split Ramus Osteotomy (SSRO) on the alignment of the condyle and orientation of the Ramal segment following surgery in patients operated for the correction of mandibular asymmetry. METHODS A total of 27 patients who underwent SSRO were enrolled in this study, and study groups were defined as asymmetric (study group) and symmetric (control group) using linear measurements from the dental midline based on a three-dimensional coordinate system. Differences on preoperative and postoperative values of anterior (AJS), posterior (PJS) and superior joint spaces (SJS), condylar axial angle (CAA), Sagittal Ramal Angle (SRA), and Coronal Ramal Angles (CRA) of study and control groups were measured and compared. The data was analyzed using the "Wilcoxon signed-ranks test" to identify differences between groups. RESULTS Differences between preoperative and postoperative values of CRA and SRA of the contralateral group showed statistically significant results with p-values of 0.007 and 0.005, respectively. A statistically significant change in CAA angle was found in the control and deviation groups (p = 0.018 and p = 0.010, respectively). CONCLUSIONS SSRO has inevitable effects on the condylar and ramal orientation. Individuals with asymmetry require particular attention throughout the planning process and beyond. Conjunctive modalities and modifications should be considered and utilized when necessary. Future studies with larger sample sizes, homogenous follow-up periods, and more comprehensive clinical data are needed to substantiate understanding of the response of the condylar segment. CLINICAL RELEVANCE Orthognathic surgeries inevitably alter the alignment and harmony of temporomandibular structures and may result in change of AJS, PJS, SJS, CAA, SRA, and LRA, which may change the biomechanics of joint and lead to several complications like temporomandibular disorders. Especially in cases with midline asymmetry needs special consideration from planning till the end of the treatment to achieve best results. In severe cases, conjunctive modalities and modifications and other alternatives such as inverted-L osteotomies should be considered.
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Affiliation(s)
- Salih Eren Meral
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey.
| | - Onur Koç
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
| | - Emre Tosun
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
| | - Hakan H Tüz
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Hacettepe University, Ankara, Turkey
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Tahchy D, Husseini B, Ghosn N, Younes R, Khoury N, Bouserhal J, Riachi F. Three-dimensional radiographic assessment of the mandibular retromolar donor site in different vertical facial growth types. J Stomatol Oral Maxillofac Surg 2023; 124:101457. [PMID: 36972788 DOI: 10.1016/j.jormas.2023.101457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To assess volumetrically, the impact of vertical facial growth types (VGFT) on the retromolar area as a bone donor site MATERIAL AND METHODS: 60 cone beam computed tomography (CBCT) scans of adult individuals were classified in three groups according to their SN-GoGn angle: hypodivergent group (hG) (33.33%), normodivergent group (NG) (30%) and hyperdivergent group (HG) (36.67%). Total harvestable bone volume and surface (TBV and TBS respectively), total cortical and cancellous bone volume (TCBV and TcBV respectively) and the percentage of cortical and cancellous bone volume (CBV and cBV respectively) were evaluated. RESULTS The whole sample showed a mean TBV of 1220.99±448.81mm³ and a mean TBS of 940.29±259.93mm². Statistically significant differences were found between the different outcome variables and the vertical growth patterns (p<0.001). TBS differs for the different vertical growth patterns with the highest mean of TBS observed in the hG group. TBV also significantly differs between the different vertical growth patterns (p<0.001) with the highest mean observed for the hG individuals. Significant differences in percentages of cBV and CBV were present between the hyper-divergent groups and the other groups (p<0.001) with the hyper-divergent group having the lowest percentage of CBV and the highest percentage of cBV. CONCLUSION hypodivergent individuals tend to have thicker bone blocks that can be used in onlay technique while thinner bone blocks harvested from hyperdivergent and normodivergent individuals can be used in three-dimensional grafting approach.
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Affiliation(s)
- Daniel Tahchy
- Department of Oral Surgery, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States.
| | - Bachar Husseini
- Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States
| | - Nabil Ghosn
- Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States
| | - Ronald Younes
- Department of Oral Surgery, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States
| | - Nicolas Khoury
- Department of Oral Surgery, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States
| | - Joseph Bouserhal
- Cranio-Facial Research Laboratory, Faculty of Dental Medicine, Saint-Joseph, United States; Department of Orthodontics, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon; Department of orthodontics, Henry M. Goldman School of Dental Medicine, Boston, United States
| | - Faouzi Riachi
- Department of Oral Surgery, Faculty of Dental Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
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Al-Dawoody AD, Hamad SA, Kheder Khrwatany KA, Saleem TH. Does osteotomizing the lower border of the mandible affect the lingual split pattern in a sagittal split ramus osteotomy? Head Face Med 2023; 19:49. [PMID: 37936216 PMCID: PMC10629200 DOI: 10.1186/s13005-023-00396-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
AIM The purpose of this study was to evaluate the effect of adding a fourth osteotomy at the lower border of the mandible on the lingual cortical fracture pattern in bilateral sagittal split ramus osteotomies. PATIENTS AND METHODS The sample of the study consisted of 20 patients (12 male and 8 female, with a mean age of 26.79 ± 7.12 years) with mandibular deformities who needed bilateral sagittal split ramus osteotomy. One side underwent a traditional sagittal split ramus osteotomy, and the procedure was modified on the other side by adding a 1 cm horizontal osteotomy at the lower border of the mandible, just distal to the caudal end of the vertical buccal osteotomy cut. A 3D CBCT was used to identify the split pattern. RESULTS In the total sample, 40% of the lingual splits ran vertically toward the lower border of the mandible (LSS1), 20% of the splits passed horizontally to the posterior border of the mandible (LSS2), 32.5% of the splits took place along the inferior alveolar canal (LSS3), and 7.5% of the splits were unfavourable fractures (LSS4). On the inferior border osteotomy sides, the distribution of LSS1, LSS2, LSS3, and LSS4 was 10 (25%), 6 (15%), 4 (10%), and 0 (00), respectively. Their distribution on the sides without inferior border osteotomy was 6 (15%), 8 (20%), 13 (32.5%), and 3 (7.5%), respectively. Statistical analysis revealed a significant difference between the two groups (p < 0.05). CONCLUSION Inferior border osteotomy tends to direct the lingual split fracture line toward the lower and posterior borders of the mandible and minimizes bad splits; however, further studies are needed to confirm our findings.
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Li L, Acharya K, Ghimire B, Li Y, Xing X, Hou X, Hou L, Hu X. Conservative management of mandibular fractures in pediatric patients during the growing phase with splint fiber and ligature arch wire. BMC Oral Health 2023; 23:601. [PMID: 37641075 PMCID: PMC10463483 DOI: 10.1186/s12903-023-03309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE The purpose of this article is to discuss the effective management of mandibular fractures in pediatric patients during the growing phase of the mandible using splint fiber and ligature wire. METHODS A retrospective study examined pediatric patients with mandibular fractures who were treated using the splint (Quartz) fiber and ligature wire technique at the Stomatology Hospital of Xi'an Jiaotong University from August 2021 to January 2023. Data on gender, age, location or site of the fracture, and development of tooth stage were collected from the patient's medical records. Descriptive statistics were used to analyze the data and evaluate the effectiveness of the splint (Quartz) fiber technique for treating mandibular fractures in pediatric patients. RESULTS Out of 256 subjects, 6 pediatric patients with mandibular fractures were selected, resulting in an incidence rate of 2.34% with an equal sex ratio. Mental or symphysis fracture was the most common site for fracture in children, accounting for 100% of cases. Right mandibular angle fracture was observed in 16.7% of patients, while 50% of the group (3 individuals) suffered from left condylar fracture and 16.7% had a bilateral condylar fracture. Treatment with Quartz splint fiber and circumdental arch wiring using ligature wire was successful with no observed post-treatment complications or malocclusion. The splint fiber was worn for 30 days and the circumdental arch wiring was for the same. Healing of bone fracture yields good results after 12 weeks. Follow-up care is crucial to monitor for complications, in this study, no post-treatment complications were observed. CONCLUSION The treatment of pediatric mandibular fractures is complex and requires careful consideration of various factors. Conservative management should be the first choice, with open reduction and internal fixation reserved for specific cases. The use of quartz splint fiber and ligature wire is an effective treatment option for stabilizing the mandible and providing occlusal stability in growing children. A fiber splint along with ligature wire can also be used as an alternative treatment to avoid any adverse effects on the growth and development of the mandible and permanent teeth. A multidisciplinary approach is essential to achieving the best outcomes for pediatric patients with mandibular fractures.
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Affiliation(s)
- Lifeng Li
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Cranio-Maxillofacial Trauma and Plastic Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Kiran Acharya
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Cranio-Maxillofacial Trauma and Plastic Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Bedana Ghimire
- Shree Birendera Sainik (Army Hospital), Kathmandu, Nepal
| | - Yanqiu Li
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Cranio-Maxillofacial Trauma and Plastic Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Xiaotao Xing
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Cranio-Maxillofacial Trauma and Plastic Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoru Hou
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Cranio-Maxillofacial Trauma and Plastic Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Lingnan Hou
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of Cranio-Maxillofacial Trauma and Plastic Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Xiaoyi Hu
- Key laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
- Clinical Research Center of Shaanxi Province for Dental and Maxillofacial Diseases, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
- Department of Cranio-Maxillofacial Trauma and Plastic Surgery, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.
- Department of Cranio-Maxillofacial Trauma and Plastic Surgery, College of Stomatology, Xi'an Jiaotong University, No 98 Xiwu Road, 710004, Xi'an, Shaanxi, People's Republic of China.
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Xi T, Vinayahalingam S, Bergé S, Maal T, Kwon TG. Skeletal structure of asymmetric mandibular prognathism and retrognathism. Maxillofac Plast Reconstr Surg 2023; 45:27. [PMID: 37556073 PMCID: PMC10412507 DOI: 10.1186/s40902-023-00393-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND This study aimed to compare the skeletal structures between mandibular prognathism and retrognathism among patients with facial asymmetry. RESULTS Patients who had mandibular asymmetry with retrognathism (Group A) in The Netherlands were compared with those with deviated mandibular prognathism (Group B) in Korea. All the data were obtained from 3D-reformatted cone-beam computed tomography images from each institute. The right and left condylar heads were located more posteriorly, inferiorly, and medially in Group B than in Group A. The deviated side of Group A and the contralateral side of Group B showed similar condylar width and height, ramus-proper height, and ramus height. Interestingly, there were no inter-group differences in the ramus-proper heights. Asymmetric mandibular body length was the most significantly correlated with chin asymmetry in retrognathic asymmetry patients whereas asymmetric elongation of condylar process was the most important factor for chin asymmetry in deviated mandibular prognathism. CONCLUSION Considering the 3D positional difference of gonion and large individual variations of frontal ramal inclination, significant structural deformation in deviated mandibular prognathism need to be considered in asymmetric prognathism patients. Therefore, Individually planned surgical procedures that also correct the malpositioning of the mandibular ramus are recommended especially in patients with asymmetric prognathism.
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Affiliation(s)
- Tong Xi
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Shankeeth Vinayahalingam
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Stefaan Bergé
- Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Thomas Maal
- 3D Imaging Lab, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
| | - Tae-Geon Kwon
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, 2177 Dalgubeol-Daero, Jung-Gu, Daegu, 41940 Republic of Korea
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Kadkhodazadeh M, Shafizadeh M, Rahmatian M, Safi Y, Amid R. Determination of the Volume and Density of Mandibular Ramus as a Donor Site Using CBCT. J Maxillofac Oral Surg 2022; 21:1140-1147. [PMID: 36896092 PMCID: PMC9989044 DOI: 10.1007/s12663-021-01546-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction This study aimed to assess the quantity and quality of available bone to provide the autologous bone graft from mandibular ramus. Material and Methods CBCT scans were collected and mandibular ramus was evaluated by measuring a variety of parameters including volume, bone height, cortical, and cancellous bone thickness. Data analysis was performed using descriptive statistics and inferential statistics. We used the Kolmogorov-Smirnov test for the evaluation of data normality. We then applied Pearson correlation and independent t-test for normal variables, and Spearman and Mann-Whitney correlation tests for abnormal variables. Statistical analysis was performed using SPSS version 19 and P value < 0.05 was considered significant. Results A total of 52 women and 32 men (aged 21 to 70) were included in this study. The mean bone volume was 2.7 ± 0.70 cm3 [95%confidence interval (CI) 1.3-4.5]. The mean bone density in the middle section was 1016.36 ± 231.58 Gy value (95% CI 475.6-1520.9). Kolmogorov-Smirnov test revealed that the variables such as apical cortical/cancellous ratio (P = 0.005), middle-cancellous bone thickness (P = 0.016), and middle cortical/cancellous ratio (P = 0.005) were abnormal and the rest were normal. Bone density, as well as the amount of cortical bone in the middle and apical regions, had a significant reverse correlation with age (P < 0.001). Conclusion The volume, density, and cortical/cancellous ratio are independent of sex. The reverse relationship between age and bone density, as well as the amount of cortical bone in several parts, indicates a decrease in bone quality with aging.
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Affiliation(s)
- Mahdi Kadkhodazadeh
- Dental Research Center, Periodontics Department, Dental School, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Marziyeh Shafizadeh
- Dental Research Center, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Mohammadreza Rahmatian
- Dental Research Center, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Yaser Safi
- Radiology Department, Dental School, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
| | - Reza Amid
- Periodontics Department, Dental School, Shahid Beheshti University of Medical Sciences, Evin, Tehran, Iran
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