Binding of adeno-associated virus type 5 to 2,3-linked sialic acid is required for gene transfer

Recombinant adeno-associated viruses (AAV) are promising gene therapy vectors. Whereas AAV serotype 2-mediated gene transfer to muscle has partially replaced factor IX deficiency in hemophilia patients, its ability to mediate gene transfer to the lungs for cystic fibrosis is hindered by lack of apical receptors. However, AAV serotype 5 infects human airway epithelia from the lumenal surface. We found that in contrast to AAV2, the apical membrane of airway epithelia contains abundant high affinity receptors for AAV5. Binding and gene transfer with AAV5 was abolished by genetic or enzymatic removal of sialic acid from the cell surface. Furthermore, binding and gene transfer to airway epithelia was competed by lectins that specifically bind 2,3-linked sialic acid. These observations suggest that 2,3-linked sialic acid is either a receptor for AAV5 or it is a necessary component of a receptor complex. Further elucidation of the receptor for this virus should enhance understanding of parvovirus biology and expand the therapeutic targets for AAV vectors.

Frequent loss of chromosome arm 1p DNA in parathyroid adenomas

Two molecular defects have been described in parathyroid adenomas: rearrangement and overexpression of the PRAD1/cyclin D1 oncogene and allelic loss of chromosome 11 DNA, often including the multiple endocrine neoplasia type 1 (MEN1) putative tumor suppressor gene region. In an effort to identify additional parathyroid tumor suppressor genes, we examined 25 parathyroid adenomas for tumor-specific allelic loss of polymorphic DNA loci located near known or candidate tumor suppressor genes. Control leukocyte DNA from all 25 patients was heterozygous for 1 or more of the 9 chromosome 1 markers examined. Allelic loss at 1 or more of these informative loci on chromosome 1 was observed in 10 of 25 (40%) adenomas. Although many tumors lost extensive regions on chromosome 1, all but one of these tumors had allelic loss of distal 1p (1p32-pter); four tumors also lost loci on 1q. Allelic loss at 11q13, the site of the MEN1 gene, was detected in 5 of 21 (24%) informative cases, including 3 with 1p loss. In contrast, allelic loss was rarely observed at loci on 9q and 10p and was not observed at loci on 3p, 3q, 4p, 5q, 12q, 14q, 18q, 22q, or Xp. In summary, clonal allelic loss of loci on chromosome arm 1p is a frequent feature of parathyroid adenomas, implying that inactivation of a tumor suppressor gene(s) on 1p commonly contributes to their pathogenesis.

Targeting the urokinase plasminogen activator receptor enhances gene transfer to human airway epithelia

Developing gene therapy for cystic fibrosis has been hindered by limited binding and endocytosis of vectors by human airway epithelia. Here we show that the apical membrane of airway epithelia express the urokinase plasminogen activator receptor (uPAR). Urokinase plasminogen activator (uPA), or a 7-residue peptide derived from this protein (u7-peptide), bound the receptor and stimulated apical endocytosis. Both ligands enhanced gene transfer by nonspecifically bound adenovirus and adeno-associated virus vectors and by a modified adenovirus vector that had been coupled to the u7-peptide. These data provide the first evidence that targeting an apical receptor can circumvent the two most important barriers to gene transfer in airway epithelia. Thus, the uPA/uPAR system may offer significant advantages for delivering genes and other pharmaceuticals to airway epithelia.

Apical localization of the coxsackie-adenovirus receptor by glycosyl-phosphatidylinositol modification is sufficient for adenovirus-mediated gene transfer through the apical surface of human airway epithelia

In well-differentiated human airway epithelia, the coxsackie B and adenovirus type 2 and 5 receptor (CAR) resides primarily on the basolateral membrane. This location may explain the observation that gene transfer is inefficient when adenovirus vectors are applied to the apical surface. To further test this hypothesis and to investigate requirements and barriers to apical gene transfer to differentiated human airway epithelia, we expressed CAR in which the transmembrane and cytoplasmic tail were replaced by a glycosyl-phosphatidylinositol (GPI) anchor (GPI-CAR). As controls, we expressed wild-type CAR and CAR lacking the cytoplasmic domain (Tailless-CAR). All three constructs enhanced gene transfer with similar efficiencies in fibroblasts. In airway epithelia, GPI-CAR localized specifically to the apical membrane, where it bound adenovirus and enhanced gene transfer to levels obtained when vector was applied to the basolateral membrane. Moreover, GPI-CAR facilitated gene transfer of the cystic fibrosis transmembrane conductance regulator to cystic fibrosis airway epithelia, correcting the Cl(-) transport defect. In contrast, when we expressed wild-type CAR it localized to the basolateral membrane and failed to increase apical gene transfer. Only a small amount of Tailless-CAR resided in the apical membrane, and the effects on apical virus binding and gene transfer were minimal. These data indicate that binding of adenovirus to an apical membrane receptor is sufficient to mediate effective gene transfer to human airway epithelia and that the cytoplasmic domain of CAR is not required for this process. The results suggest that targeting apical receptors in differentiated airway epithelia may be sufficient for gene transfer in the genetic disease cystic fibrosis.

Gender-specific association of androgenetic alopecia with metabolic syndrome in a middle-aged Korean population

BACKGROUND

Although several previous studies have investigated the association between metabolic syndrome (MetS) and androgenetic alopecia (AGA), the study results have been inconsistent.

OBJECTIVES

The aim of this study was to investigate the relationship between the presence of MetS and AGA according to gender in a middle-aged Korean population.

METHODS

A population-based cross-sectional study was conducted on a sample from the Korean Genome Epidemiology Study. In total, 3408 subjects (1707 men and 1701 women) were enrolled between January 2008 and February 2010. The Norwood classification for men and Ludwig classification for women were used for assessment of the degree of hair loss. Information on components of MetS together with other possible risk factors was collected.

RESULTS

In men, the risk of having Norwood type IV or greater was not increased for subjects with MetS compared with those without MetS. In women, the risk of having Ludwig type I or greater was significantly increased for subjects with MetS compared with those without MetS after controlling for age and smoking status (OR 1.68, 95% CI 1.14-2.48; P=0.01). Similar results were also observed for the number of fulfilled components of MetS [odds ratio (OR) 1.38, 95% confidence interval (CI) 1.00-1.91; P<0.05]. When each component of MetS was considered individually, associations between AGA and all five components of MetS (waist circumference, triglycerides, high-density lipoprotein-C, blood glucose, and blood pressure) were not statistically significant. When multiple regression was used to adjust for age, family history and smoking, there was no significant association between the prevalence of MetS and moderate to severe AGA in the male group. On the contrary, a statistically significant positive association was noted between the prevalence of MetS and AGA in the female group.

CONCLUSIONS

Our analysis of AGA and the prevalence of MetS in a large population-based cohort demonstrated quite different findings compared with previous reports. The different results according to gender suggest that there may be different mechanisms that are yet to be defined between male and female AGA.

Lectin binding and endocytosis at the apical surface of human airway epithelia

The specificity of lectin binding to distinct saccharides makes them valuable reagents for investigation and identification of cells within complex tissues and potentially for delivery of agents into cells. Therefore we examined lectin binding to airway epithelia. We used an in vitro model of primary cultures of well-differentiated human airway epithelia and applied the lectins to the apical surface of living epithelia. This approach limited binding specifically to the extracellular surface of the apical membrane. Of 32 lectins studied, we found 15 that bound to the apical membrane. The pattern varied from diffuse binding to the surface of nearly all the cells, to binding to a small subset of the cells. Our data combined with earlier studies identify lectins that may be used to detect specific populations of epithelial cells. Because lectins may be used to deliver a variety of agents, including gene transfer vectors, to airway cells, we examined endocytosis of lectins. We found that several lectins bound to the apical surface were actively taken up into the cells. These data may be of value for studies of airway epithelial structure and may facilitate the targeting of the epithelial apical surface.

Early wound complications in advanced head and neck cancer treated with surgery and Ir 192 brachytherapy

OBJECTIVES

Brachytherapy, either as primary or adjuvant therapy, is increasingly used to treat head and neck cancer. Reports of complications from the use of brachytherapy as adjuvant therapy to surgical excision have been limited and primarily follow Iodine 125 (I125) therapy. Early complications include wound breakdown, infection, flap failure, and sepsis, and late complications may include osteoradionecrosis, bone marrow suppression, or carotid injuries. The authors sought to identify the early wound complications that follow adjuvant interstitial brachytherapy with iridium 192 (IrS92).

STUDY DESIGN

A retrospective chart review of all patients receiving adjuvant brachytherapy at a tertiary medical center over a 4-year period.

METHODS

Nine patients receiving Ir192 brachytherapy via afterloading catheters placed during surgical resection for close or microscopically positive margin control were evaluated. It was used during primary therapy in six patients and at salvage surgery in three. Early complications were defined as those occurring within 6 weeks of surgical therapy.

RESULTS

The overall complication rate was 55% (5/9), and included significant wound breakdown in two patients, minor wound dehiscence in three, and wound infection, bacteremia, and local tissue erosion in one patient each. All complications occurred in patients receiving flap reconstruction and one patient required further surgery to manage the complication. Complication rates were not associated with patient age, site, prior radiotherapy, timing of therapy, number of catheters, or dosimetry.

CONCLUSIONS

The relatively high complication rate is acceptable, given the minor nature of most and the potential benefit of radiotherapy. Further study should be undertaken to identify those patients who will achieve maximum therapeutic benefit without prohibitive local complications.

Adenovirus calcium phosphate coprecipitates enhance squamous cell carcinoma gene transfer

OBJECTIVES/HYPOTHESIS

Adenoviral-mediated gene transfer offers a potential new treatment strategy for squamous cell cancer of the head and neck (SCCHN). Initial studies on some SCCHN cell lines have shown that these cells can be resistant to adenovirus-mediated gene transfer, requiring large amounts of vector and long infection times. The objectives of this study were to identify the barriers to gene transfer in three SCCHN lines, FaDu, SCC-9, and SCC-15, and to develop a method to circumvent the obstacles. We hypothesized that a low expression of adenovirus receptors may limit adenovirus infection and this may be overcome by using adenovirus complexed with calcium phosphate coprecipitates.

METHODS

Using standard cell and molecular biology techniques, the infectability of SCCHN cells was investigated.

RESULTS

Using Cy3-labeled adenovirus, we found minimal binding of adenovirus to FaDu cells and variable levels of binding among SCC-9 and SCC-15 cells. Northern blot analysis indicated that messenger RNA (mRNA) transcripts for coxsackie-adenovirus receptor, which binds adenovirus, were absent in FaDu cells but present in SCC-9 and SCC-15 cells. Integrin alphavbeta5, which binds and facilitates internalization of adenovirus, were expressed at low levels in all three cell types. We overcame these barriers by using adenovirus complexed with calcium phosphate precipitates. Total transgene expression and the number of cells expressing transgene were increased in all three cancer lines using adenovirus complexed with calcium phosphate precipitates compared with adenovirus that was not complexed.

CONCLUSIONS

Data in the present study suggest that adenovirus-mediated gene transfer to SCCHN cell lines is a result of limited viral receptors. Delivering adenovirus in a calcium phosphate coprecipitate enhanced gene transfer and, perhaps, the therapeutic index.

Parathion degradation and toxicity reduction in solar photocatalysis and photolysis

The solar photocatalytic degradation of methyl parathion was investigated using a circulating TiO2/solar light reactor. Under solar photocatalysis condition, parathion was more effectively degraded than solar photolysis and TiO2-only conditions. With solar photocatalysis, 20 mg/L of parathion was completely degraded within 60 min with a TOC decrease of 63% after 150 min. The main ionic byproducts during photocatalysis recovered from parathion degradation were mainly as NO3-, NO2- and NH4+, 80% of the sulphur as SO4(2-), and 5% of phosphorus as PO4(3-). The organic intermediates 4-nitrophenol and methyl paraoxon were also identified, and these were further degraded in solar photocatalytic condition. Two different bioassays (Vibrio fischeri and Daphnia magna) were used to test the acute toxicity of solutions treated by solar photocatalysis and photolysis. The Microtox test using V. fischeri showed that the toxicity expressed as EC50 (%) value increased from 5.5% to >82% in solar photocatalysis, indicating that the treated solution is non-toxic, but only increased from 4.9 to 20.5% after 150 min in solar photolysis. The acute toxicity test using D. magna showed that EC50 (%) increased from 0.05 to 1.08% under solar photocatalysis, but only increased to 0.12% after 150 min with solar photolysis, indicating the solution is still toxic. The pattern of toxicity reduction parallels the decrease in TOC and the parathion concentrations.

Finite Element Analysis of a New Non-Engaging Abutment System for Three-Unit Implant-Supported Fixed Dental Prostheses

(1) Background: The stability of implants plays a significant role in the success of osseointegration. The stability of the connection between the fixture and the abutment is one of the critical factors affecting osseointegration. When restoring multiple, non-parallel, and splinted implants, achieving a passive fit can be complicated and challenging. A new EZ post non-engaging abutment system of the BlueDiamond^® (BD) implant allows a wide connection angle while achieving a passive prosthesis fit. This study aimed to confirm the new abutment system's clinical applicability by evaluating its biomechanical characteristics using finite element analysis (FEA). (2) Methods: The implant-supported fixed three-unit dental prostheses model was reproduced for two groups of AnyOne^® (AO) and BD implants using FEA. The loading conditions were a preload of 200 N in the first step and loads of 100 N (axial), 100 N (15°), or 30 N (45°) in the second step. (3) Results: The peak Von Mises stress (PVMS) value of the fixture in the BD group was more than twice that in the AO group. In contrast, the PVMS values of the abutment and abutment screws were lower in the BD group than in the AO group. The AO group revealed higher maximal principal stress (MPS) values than that of the BD group in the cortical bone, cancellous bone, and crown. The average stress of the outer surface of the abutment was lower in the AO group than in the BD group. The stress distribution for the inner surface of the fixture confirmed that the BD group displayed a lower stress distribution than the AO group under axial and 15° loads; however, the average stress was 1.5 times higher at the 45° load. The stress values of the entire surface where the cortical and cancellous bone were in contact with the fixture were measured. The AO group showed a higher stress value than the BD group in both cortical and cancellous bone. (4) Conclusions: In the AO group, the PVMS value of the fixture and the stress distribution at the contact surface between the fixture and the abutment were lower than those of the BD group, suggesting that the stability of the fixture would be high. However, due to the high stress in the fastening area of the abutment and abutment screw, the risk of abutment fracture in the AO group is higher than that of the BD group. Therefore, the new EZ post non-engaging abutment of the BD implant can be used without any problems in clinics, similar to the non-engaging abutment of the AO implant, which has been widely used in clinical practice.

Efficacy of Constructing Digital Hybrid Skull-Dentition Images Using an Intraoral Scanner and Cone-Beam Computed Tomography

Cone-beam computed tomography (CBCT) can distort dentition, and additional imaging is often required. A plaster model to help digitize dental images has been widely used in clinical practice, but there are some inconveniences such as complexity of the process and the risk of damage. The aim of this study was to evaluate the potential for improving dentition imaging with CBCT scans using an intraoral scanner instead of a plaster model. The study used laser model-scanned images of plaster models, imaging from two intraoral scanners, and CBCT images from 20 patients aged 12-18 years. CS 3600 (Carestream Dental, Atlanta, USA) and i700 (Medit, Seoul, Korea) were used as intraoral scanners. The full arch was scanned at once or in three sections using intraoral scanners. The segmented scans were merged to obtain full-arch images. With i700, full-arch images were additionally acquired using its "smart stich" function. The virtual skull-dentition hybrid images obtained from intraoral scanners were superimposed with images obtained using a plaster cast. The difference and distance of coordinate values at each reference point were measured. The average distances from the images obtained with the plaster cast were smaller than 0.39 mm, which is the voxel size of CBCT. Scanning the complete or partial arch using CS 3600 or i700 satisfactorily complemented the CBCT when compared to the plaster model. The virtual skull-dentition hybrid image obtained from intraoral scanners will be clinically useful, especially for patients and surgeons who have difficulty in scanning the complete arch at once.

Comparative Analysis of Three Facial Scanners for Creating Digital Twins by Focusing on the Difference in Scanning Method

BACKGROUND

Multi-dimensional facial imaging is increasingly used in hospital clinics. A digital twin of the face can be created by reconstructing three-dimensional (3D) facial images using facial scanners. Therefore, the reliability, strengths, and weaknesses of scanners should be investigated and approved; Methods: Images obtained from three facial scanners (RayFace, MegaGen, and Artec Eva) were compared with cone-beam computed tomography images as the standard. Surface discrepancies were measured and analyzed at 14 specific reference points; Results: All scanners used in this study achieved acceptable results, although only scanner 3 obtained preferable results. Each scanner exhibited weak and strong points because of differences in the scanning methods. Scanner 2 exhibited the best result on the left endocanthion; scanner 1 achieved the best result on the left exocanthion and left alare; and scanner 3 achieved the best result on the left exocanthion (both cheeks); Conclusions: These comparative analysis data can be used when creating digital twins through segmentation, selecting and merging data, or developing a new scanner to overcome all shortcomings.

Morphological Analysis of the Anatomical Mandibular Lingual Concavity Using Cone Beam Computed Tomography Scans in East Asian Population-A Retrospective Study

The rising demand for dental implants necessitates addressing anatomical challenges, particularly the shape of the mandible. Incorrectly angling implants can cause lingual perforations, risking damage to the inferior alveolar artery and nerve. This study analyzed 96 cone-beam computed tomography images from individuals aged 20 to 70 (8 males and 8 females) to evaluate mandibular anatomy in four areas: left and right sides and the first and second molars. Mandibular shapes were classified into U, C, and P types. U-shaped mandibles, with a wider crest width, pose the highest risk of lingual perforation. Measurements for U-shaped types included concavity angle, length, and depth. Statistical analyses (T-tests and ANOVA) with a 95% confidence interval showed no significant differences between the left and right sides. However, significant differences based on gender, age, and tooth type were found. The study found U-shapes in 34.6% of cases, P-shapes in 28.9%, and C-shapes in 36.5%, with U-shapes more common in second molars. Understanding these variations enhances the safety and effectiveness of implant procedures and oral surgeries.

Biomechanical Evaluation of a Novel Non-Engaging Abutment and Screw in Internal Implant Systems: Comparative Fatigue and Load Testing

Dental implants rely on precise prosthetic design and biomechanical stability to ensure long-term success. This study evaluates the mechanical performance of non-engaging abutments in multi-unit combined screw- and cement-retained prostheses (CSCRP) using two internal implant systems: the BlueDiamond (BD) and AnyOne (AO) systems. Unlike conventional implant systems that utilize the same type of screw for both engaging and non-engaging abutments, the BD system employs a distinct screw design for non-engaging abutments. A total of 80 implants were tested, with 40 in each group. Mechanical testing included static compressive load and fatigue tests following ISO 14801 standards. The BD system demonstrated significantly higher compressive strength (326.32 kgf vs. 231.82 kgf, p < 0.001) and 23.4% greater fatigue strength compared to the AO system. Precision fit analysis confirmed no significant deformation, microcracks, or fractures after 5 million loading cycles. These findings suggest that the BD system's unique screw design for non-engaging abutments contributes to improved mechanical performance and durability. Further clinical studies are needed to assess the long-term implications of this design on prosthetic stability and implant longevity.

Fracture and Fatigue of Dental Implants Fixtures and Abutments with a Novel Internal Connection Design: An In Vitro Pilot Study Comparing Three Different Dental Implant Systems

The aim of this study was to compare the mechanical behaviors of three dental implant fixtures with different abutment connection designs. Three implant systems were studied: the control (BLX implant), test group 1 (TORX++ implant), and test group 2 (IU implant). Three samples from each group were subjected to static compression to fracture tests to determine the maximum fracture load, and twelve samples were exposed to fatigue tests that measured how many cycles the implants could endure before deformation or fracture. Detailed images of the implant-abutment assemblies were obtained using micro-computed tomography imaging, and fractured or deformed areas were observed using a scanning electron microscope (SEM). The mean maximum breaking loads of 578.45 ± 42.46 N, 793.26 ± 57.43 N, and 862.30 ± 74.25 N were obtained for the BLX, TORX++, and IU implants, respectively. All samples in the three groups withstood 5 × 10⁶ cycles at 50% of the nominal peak value, and different fracture points were observed. All abutment connection designs showed suitable mechanical properties for intraoral use. Microscopic differences in the fracture patterns may be due to the differences in the fixture design or abutment connection, and mechanical complications could be prevented by lowering the overload reaching the implant or preventing peri-implantitis.

Digital technology revolutionizing mandibular fracture treatment: a comparative analysis of patient-specific plates and conventional titanium plates

OBJECTIVES

The treatment of fractures prioritizes the restoration of functionality through the realignment of fractured segments. Conventional methods, such as titanium plates, have been employed for this purpose; however, certain limitations have been observed, leading to the development of patient-specific plates. Furthermore, recent advancements in digital technology in dentistry enable the creation of virtual models and simulations of surgical procedures. The aim was to assess the clinical effectiveness of patient-specific plates utilizing digital technology in treating mandibular fractures compared to conventional titanium plates.

MATERIALS AND METHODS

Twenty patients diagnosed with mandibular fractures were included and randomly assigned to either the study or control groups. The surgical procedure comprised reduction and internal fixation utilizing patient-specific plates generated through virtual surgery planning with digital models for the study group, while the control group underwent the same procedure with conventional titanium plates. Assessment criteria included the presence of malunion, infection, sensory disturbance, subjective occlusal disturbance and occlusal force in functional maximum intercuspation (MICP). Statistical analysis involved using the Chi-square test and one-way repeated measures analysis of variance.

RESULTS

All parameters showed no statistically significant differences between the study and control groups, except for the enhancement in occlusal force in functional MICP, where a statistically significant difference was observed (p = 0.000).

CONCLUSION

Using patient-specific plates using digital technology has demonstrated clinical effectiveness in treating mandibular fractures, offering advantages of time efficiency and benefits for less experienced surgeons.

CLINICAL RELEVANCE

Patient-specific plates combined with digital technology can be clinically effective in mandibular fracture treatment.

Current Status of Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) in Maxillofacial Surgery: Should It Be Continued?

Recombinant human bone morphogenetic protein-2 (rhBMP-2) has shown potential in maxillofacial surgery owing to its osteoinductive properties. However, concerns about its safety and high cost have limited its widespread use. This review presents the status of rhBMP-2 use in maxillofacial surgery, focusing on its clinical application, efficacy, safety, and limitations. Studies have demonstrated rhBMP-2's potential to reduce donor site morbidity and increase bone height in sinus and ridge augmentation; however, it may not outperform autogenous bone grafts. In medication-related osteonecrosis of the jaw treatment, rhBMP-2 has been applied adjunctively with promising results, although its long-term safety requires further investigation. However, in maxillofacial trauma, its application is limited to the restoration of large defects. Safety concerns include postoperative edema and the theoretical risk of carcinogenesis. Although postoperative edema is manageable, the link between rhBMP-2 and cancer remains unclear. The limitations include the lack of an ideal carrier, the high cost of rhBMP-2, and the absence of an optimal dosing regimen. In conclusion, rhBMP-2 is a promising graft material for maxillofacial surgery. However, it has not yet become the gold standard owing to safety and cost concerns. Further research is required to establish long-term safety, optimize dosing, and develop better carriers.

Three-Dimensional Digital Image Analysis of Skeletal and Soft Tissue Points A and B after Orthodontic Treatment with Premolar Extraction in Bimaxillary Protrusive Patients

Aim. To investigate the effect of changes in incisor tip, apex movement, and inclination on skeletal points A and B and characterize changes in skeletal points A and B to the soft tissue points A and B after incisor retraction in Angle Class I bimaxillary dentoalveolar protrusion. Methods. Twenty-two patients with Angle Class I bimaxillary dentoalveolar protrusion treated with four first premolar extractions were included in this study. The displacement of skeletal and soft tissue points A and B was measured using cone-beam computed tomography (CBCT) using a three-dimensional coordinate system. The movement of the upper and lower incisors was also measured using CBCT-synthesized lateral cephalograms. Results. Changes in the incisal tip, apex, and inclination after retraction did not significantly affect the position of points A and B in any direction (x, y, z). Linear regression analysis showed a statistically significant relationship between skeletal point A and soft tissue point A on the anteroposterior axis (z). Skeletal point A moved forward by 0.07 mm, and soft tissue point A moved forward by 0.38 mm, establishing a ratio of 0.18: 1 (r = 0.554, p < 0.01). Conclusion. The positional complexion of the skeletal points A and B was not directly influenced by changes in the incisor tip, apex, and inclination. Although the results suggest that soft tissue point A follows the anteroposterior position of skeletal point A, its clinical significance is suspected. Thus, hard and soft tissue analysis should be considered in treatment planning.

Advancements in computer-assisted orthognathic surgery: A comprehensive review and clinical application in South Korea

OBJECTIVES

Orthognathic surgery (OS) has evolved with technological advancements, notably through the implementation of computer-assisted orthognathic surgery (CAOS). This article aims to elucidate various types of CAOS and their efficiency and accuracy, supplemented by a thorough literature review focusing on their clinical applications in South Korea.

STUDY SELECTION, DATA, AND SOURCES

A comprehensive search strategy was employed, including systematic reviews, meta-analyses, randomized controlled trials, and observational studies published until December 2023 in the PubMed, MEDLINE, and Google Scholar databases. The literature search was limited to articles written in English.

RESULTS

Static CAOS demonstrated high precision, reduced operative time, and high accuracy, suggesting its potential reliability in orthognathic procedures. Dynamic CAOS presented a promising avenue for exploration, showing an accuracy comparable to that of traditional methods. The critical considerations for CAOS include accuracy, time efficiency, and cost-effectiveness. Recent studies have indicated advancements in the time efficiency of static CAOS. Static CAOS requires less equipment and is more cost-effective than dynamic CAOS.

CONCLUSIONS

CAOS offers clear advantages over conventional OS in terms of surgical convenience and accuracy in implementing the surgical plan. To achieve recognition as the gold standard method for maxillofacial deformity treatment, CAOS must overcome its limitations and undergo continuous verification via well-designed studies.

CLINICAL SIGNIFICANCE

The introduction of CAOS, mainly static CAOS with high precision and reduced surgical time, signifies a notable advancement in OS. However, rigorous studies are warranted to validate CAOS as the gold standard for treating maxillofacial deformities.

The land use plan and water quality prediction for the Saemangeum reclamation project

As the final closure of the world's longest sea dike of 33 km, the use of the Saemangeum reclaimed land becomes an issue in Korea. The Korean government has proclaimed that the Saemangeum Reclamation Project will be handled in an environmentally friendly manner but its effect on the water quality of reservoirs has always been controversial. This study was conducted to estimate the water quality of the Saemangeum reservoir using WASP5 according to the new land use plan adopted in 2007. Predictions on water quality shows that Dongjin reservoir would meet the standards for COD, T-P, and Chl-a if the wastewater from the Dongjin region was properly managed. However, T-P and Chl-a in Mangyeong reservoir would exceed the standards even without releasing the treated wastewater into the reservoir. With further reductions of 20% for T-P and Chl-a from the mouth of Mangyeong river, the water quality standards in the reservoir were achieved. This means that additional schemes, as well as water quality management programs established in the Government Master Plan in 2001, should be considered. Although the Saemangeum reservoir would manage to achieve the standards, it will enter a eutrophic state due to the high concentration of nutrients.

Chat Generative Pre-Trained Transformer (ChatGPT) in Oral and Maxillofacial Surgery: A Narrative Review on Its Research Applications and Limitations

Objectives: This review aimed to evaluate the role of ChatGPT in original research articles within the field of oral and maxillofacial surgery (OMS), focusing on its applications, limitations, and future directions. Methods: A literature search was conducted in PubMed using predefined search terms and Boolean operators to identify original research articles utilizing ChatGPT published up to October 2024. The selection process involved screening studies based on their relevance to OMS and ChatGPT applications, with 26 articles meeting the final inclusion criteria. Results: ChatGPT has been applied in various OMS-related domains, including clinical decision support in real and virtual scenarios, patient and practitioner education, scientific writing and referencing, and its ability to answer licensing exam questions. As a clinical decision support tool, ChatGPT demonstrated moderate accuracy (approximately 70-80%). It showed moderate to high accuracy (up to 90%) in providing patient guidance and information. However, its reliability remains inconsistent across different applications, necessitating further evaluation. Conclusions: While ChatGPT presents potential benefits in OMS, particularly in supporting clinical decisions and improving access to medical information, it should not be regarded as a substitute for clinicians and must be used as an adjunct tool. Further validation studies and technological refinements are required to enhance its reliability and effectiveness in clinical and research settings.

Clinical Stability of Bespoke Snowman Plates for Fixation following Sagittal Split Ramus Osteotomy of the Mandible

Maxillofacial skeletal surgery often involves the use of patient-specific implants. However, errors in obtaining patient data and designing and manufacturing patient-specific plates and guides can occur even with accurate virtual surgery. To address these errors, bespoke Snowman plates were designed to allow movement of the mandible. This study aimed to compare the stability of bespoke four-hole miniplates with that of a bespoke Snowman plate for bilateral sagittal split ramus osteotomy (SSRO), and to present a method to investigate joint cavity changes, as well as superimpose virtual and actual surgical images of the mandible. This retrospective study included 22 patients who met the inclusion criteria and underwent orthognathic surgery at a university hospital between 2015 and 2018. Two groups were formed on the basis of the plates used: a control group with four-hole bespoke plates and a study group with bespoke Snowman plates. Stability was assessed by measuring the condyle-fossa space and superimposing three-dimensional virtual surgery images on postoperative cone-beam computed tomography (CBCT) scans. No significant differences were observed in the condyle-fossa space preoperatively and 1 year postoperatively between the control and study groups. Superimposing virtual surgery and CBCT scans revealed minimal differences in the landmark points, with no variation between groups or timepoints. The use of bespoke Snowman plates for stabilizing the mandible following SSRO exhibited clinical stability and reliability similar to those with bespoke four-hole plates. Additionally, a novel method was introduced to evaluate skeletal stability by separately analyzing the condyle-fossa gap changes and assessing the mandibular position.

A Comparative Analysis of Artificial Intelligence and Manual Methods for Three-Dimensional Anatomical Landmark Identification in Dentofacial Treatment Planning

With the growing demand for orthognathic surgery and other facial treatments, the accurate identification of anatomical landmarks has become crucial. Recent advancements have shifted towards using three-dimensional radiologic analysis instead of traditional two-dimensional methods, as it allows for more precise treatment planning, primarily relying on direct identification by clinicians. However, manual tracing can be time-consuming, mainly when dealing with a large number of patients. This study compared the accuracy and reliability of identifying anatomical landmarks using artificial intelligence (AI) and manual identification. Thirty patients over 19 years old who underwent pre-orthodontic and orthognathic surgery treatment and had pre-orthodontic three-dimensional radiologic scans were selected. Thirteen anatomical indicators were identified using both AI and manual methods. The landmarks were identified by AI and four experienced clinicians, and multiple ANOVA was performed to analyze the results. The study results revealed minimal significant differences between AI and manual tracing, with a maximum deviation of less than 2.83 mm. This indicates that utilizing AI to identify anatomical landmarks can be a reliable method in planning orthognathic surgery. Our findings suggest that using AI for anatomical landmark identification can enhance treatment accuracy and reliability, ultimately benefiting clinicians and patients.

Evaluation of low-crystallinity apatite as a novel synthetic bone graft material: In vivo and in vitro analysis

OBJECTIVES

To overcome the shortcomings of sintered bone graft materials, low-crystallinity apatite (LCA) was developed using a non-heated approach to enhance resorption and integration during bone regeneration. This study aimed to evaluate the efficacy of LCA as a synthetic bone graft material for bone reconstruction.

METHODS

LCA was compared to three conventional synthetic bone graft materials: biphasic calcium phosphate (BCP) 37, BCP 64, and octacalcium phosphate (OCP). Crystalline structure and surface morphology were examined using X-ray diffraction (XRD) and scanning electron microscopy (SEM). In vivo testing was conducted using a rabbit calvarial augmentation model, in which the grafts were placed into standardized defects. Bone formation and graft resorption were analyzed using micro-computed tomography (micro-CT) and histomorphometric analyses at three and six weeks post-implantation.

RESULTS

LCA exhibited structural similarities to the allograft material and enhanced surface properties. Micro-CT and histomorphometric evaluations at three and six weeks post-implantation demonstrated higher rates of bone formation and substantial volumetric changes with LCA, indicating efficient graft resorption and bone regeneration.

CONCLUSIONS

LCA exhibited superior integration, osteoconductivity, and biodegradability compared to other synthetic grafts, suggesting the potential for improved clinical outcomes with its use. Although the efficacy of LCA has been validated, further studies in diverse biological environments are necessary to confirm its safety and effectiveness for broader clinical use.

CLINICAL SIGNIFICANCE

LCA, which mimics natural bone structure and has superior integration and osteoconductivity, has the potential for clinical applications requiring rapid and effective bone healing.