Evaluating the additional effects of arthrocentesis on the condylar pathways of temporomandibular joint in patients with internal derangement treated with stabilizing splint

ObjectivesThe purpose of this investigation is to find out the differences in the condylar pathways of the temporomandibular joint (TMJ) in patients treated with stabilizing splint and arthrocentesis accompanied by stabilizing splint in 6 months period.Study designForty patients who were assigned a clinical diagnosis of internal derangement of the TMJ were included in this study. Full arch stabilizing splints were made for all patients. Patients were divided into two groups; group A (patients who underwent arthrocentesis), group B (patients who did not underwent arthrocentesis). Computerized axiography was performed for each group before therapy (T₀), on the 3^rd month (T₁), after arthrocentesis (T_A) (for group A) and on 6th month (T₂). Curve parameters were recorded in three-dimension; X axis (posteroanterior), Y axis (mediolateral), Z axis (superoinferior). Also the distance from the starting point of the movement on sagittal plane (S) was calculated.ResultsThere was a significant increase in the value of Z (p = 0.014) and S (p = 0.038) in mediotrusion movement in group A. Also, there was a significant increase in the value of Z (p = 0.007) in protrusion/retrusion movement, value of Z (p = 0.019) and S value (p = 0.002) in mediotrusion movement and value of Y in open/close movement in group B.ConclusionsNo positive effects on condylar pathways of an additional arthrocentesis to splint therapy alone in patients with internal derangement were found in this study.     

Treatment measures of hemimandibular hyperplasia and associated facial deformities

This study aims to show our institute’s experience in the treatment of HH and its associated facial deformities in adults and growing adolescents and to investigate condylar remodeling and volumetric changes and long-term stability of orthognathic surgery in adults.The study included consecutive patients with clinical and radiological features of HH who underwent high condylectomy with or without simultaneous orthognathic surgery from 2013 to 2018. The clinical outcomes were assessed based on functional activities, TMJ pain, and recurrence. Postoperative 3D condylar remodeling and orthognathic stability were evaluated with the use of ITK-Snap and 3D Slicer.Thirteen patients (8 females and 5 males) with a mean age of 26.3 ± 5.79 years (range; 13–34 years) were included with facial asymmetry as the chief complaint. The patients were followed up for a minimum of 12 months and a maximum of 4 years (mean; 16.85 ± 10.04). There were no postoperative complications, and all patients achieved a satisfactory functional and aesthetic outcome using a one-stage surgical procedure. There was no incidence of recurrence or further asymmetries, with long-term stability at the selected points showing a mean difference of less than ±1 mm. The affected condylar volume was significantly reduced following high condylectomy, with mean changes between T1 and T2 of ?144. 80 mm³ (p = .012). However, the contralateral condylar volume remained stable, with a mean change of 2.54 mm³ (p = .881).One-stage high condylectomy and orthognathic surgery is a viable measure for the treatment of HH and associated deformities in adults. High condylectomy in early adolescence could result in termination of the disease, and aesthetic improvement with further constant orthodontist-surgeon follow-up is required.     

Preoperative and postoperative assessment of temporal and masseter muscle size with magnetic resonance imaging in patients undergoing unilateral temporomandibular joint surgery

The aim of this study was to assess any change between the preoperative and postoperative sizes of temporal and masseter muscles with magnetic resonance imaging (MRI) in patients undergoing unilateral temporomandibular joint surgery.This study was designed and implemented retrospectively. For clinical evaluation, a visual analog scale (VAS) and maximum mouth opening (MMO) were used. In order to make a preoperative diagnosis and perform a 6-month control, muscle size was measured in millimeters (mm) on T1 axial sections in MRI. Statistical analyses were performed using the SPSS 23.0 software package. Numeric variables were compared between two dependent groups using the Wilcoxon signed rank test. Statistical significance was set at p < 0.05.Twelve patients who underwent unilateral discectomy plus dermis-fat grafting, with classical preauricular inverse L incision, were included in the study, and data for eleven female patients were evaluated. The difference in size between the operated and non-operated sides was found to be statistically insignificant at the preoperative stage for both masseter muscle (operated side m^M: 13.264 ± 1.822 mm; non-operated side m^M: 13.264 ± 2.315 mm; p^M = 0.929) and temporal muscle (operated side m^T: 20.345 ± 2.609 mm; non-operated side m^T: 20.582 ± 2.366 mm; p^T = 0.594). There was a significant size reduction in the masseter muscle on the operated side in the postoperative period (preop m^M: 13.264 ± 1.822 mm; postop m^M: 12.036 ± 1.728 mm; p^M = 0.018). Although there was also a size reduction in the operated side of the temporal muscle in the postoperative period, that difference did not reach statistical significance (preop m^T: 20.345 ± 2.609 mm; postop m^T: 19.445 ± 1.603 mm; p^T = 0.182). On the non-operated side, there were no significant postoperative changes in the sizes of either the masseter muscle (preop m^M: 13.264 ± 2.315 mm; postop m^M: 12.682 ± 2.059 mm; p^M = 0.248) or the temporal muscle (preop m^T: 20.582 ± 2.366; postop m^T: 19.891 ± 3.487 mm; p^T = 0.625).Considering the study findings as a whole, a size reduction was observed in the operated side of the masseter muscle after TMJ surgery. The etiology of this change may be surgical trauma to the temporal and masseter muscles, skeletal alteration resulting from condylar change secondary to discectomy, and patients restraining themselves from application of maximum bite force as a result of a self-protection mechanism due to postoperative pain.     

Aetiology,pattern and treatment of mandibular condylar fractures in 549 patients: A 22-year retrospective study

PurposeThe purpose of this study was to retrospectively investigate the aetiology, pattern, and treatment of mandibular condylar fractures in our department over the past 22 years.Patients and methodsData of patients who sustained mandibular condylar fractures from 1988 to 2009 were recorded, including fracture aetiology, pattern of condylar fracture, time, age, sex, associated injury, patient transferred by other clinics, lag time and treatment method. Data analysis included X² test, Fisher exact test, t-test, Ridit analysis and Logistic regression analysis.ResultsThe sample was composed of 549 patients (749 condylar fractures), 404 male and 145 female (male:female = 2.79:1), with a mean age of 30.12 ± 14.44 years. Road traffic accidents were the most common cause (248, 45.2%). Condylar head fractures were significantly related to a fall at ground level (p = .001). A fall from a height had a 3.19-fold risk of bilateral condylar fractures (odds ratio, 3.19; 95% confidence interval, 1.33 to 7.65; p = .010). A majority of the condylar fractures (693, 92.5%) were treated by a surgical procedure. Condylar head were mostly removed (95.0%, p < .001), condylar neck and condylar base fractures were most frequently treated by open reduction and internal fixation with miniplates (74.4%, p < .001). Most of the dislocated condylar fractures were treated by open surgery (96.5%, p = .026).ConclusionsThe anatomic position and uni/bilateral pattern of mandibular condylar fractures were positively related to situations when considerable force is involved. Open condylar surgery was based on the level of fracture and degree of displacement or dislocation.     

Does glucosamine,chondroitin sulfate,and methylsulfonylmethane supplementation improve the outcome of temporomandibular joint osteoarthritis management with arthrocentesis plus intraarticular hyaluronic acid injection. A randomized clinical trial

The purpose of this study was to compare clinical outcomes obtained with the use of glucosamine, chondroitin sulfate, and methylsulfonylmethane (GCM) supplementation after arthrocentesis plus intraarticular hyaluronic acid (HA) injection.A randomized clinical trial was implemented with adult participants with TMJ-OA who were referred to the author’s clinic between February 2014 and May 2015. The sample was entirely composed of patients with TMJ-OA who were treated randomly with a one-session arthrocentesis plus intraarticular HA injection only (control group), or an initial one-session arthrocentesis plus intraarticular HA injection followed by 3 months of GCM supplementation (study group). The predictor variable was management (treatment) technique. The outcome variables were visual analog scale evaluations (masticatory efficiency, pain complaint, joint sound) and mandibular mobility (maximal interincisal opening [MIO], and lateral and protrusive motions of the mandible). The outcome variables were recorded preoperatively and 12 months postoperatively.Thirty-one participants were enrolled in the study. Five were lost during follow-up. The final study sample consisted of 26 participants (age 28.35 ± 10.85 y): 14 in the control group (age 28.71 ± 10.94 y); and 12 in the study group (age 27.92 ± 11.20 y). Pain complaints (p < 0.001) and joint sounds (p = 0.030 for the control group; p = 0.023 for the study group) showed statistically significant decreases. Masticatory efficiency (p < 0.001 for the control group; p = 0.040 for the study group) and lateral mandibular motion (p = 0.040 for the control group; p = 0.004 for study group) showed statistically significant increases in both groups, whereas MIO and protrusive mandibular motion showed no significant changes in either group (p > 0.05). After estimating the differences between the follow-up and baseline outcomes, the mean changes in the primary outcome variables (VAS scores, MIO, and mandibular motion) showed no statistically significant differences between the two groups (p > 0.05).Progressions (reparative remodeling) of hard-tissue TMJ structures were observed on CBCT scans of some participants in both groups.These findings suggested that the use of GCM supplementation after arthrocentesis plus intraarticular HA injection produced no additional clinical benefits or improvements for patients with TMJ-OA compared with arthrocentesis plus intraarticular HA injection alone.     

Obwegeser II osteotomy (transoral angle osteotomy) for open bite with skeletal class III deformity

IntroductionThis study evaluated postoperative stability after Obwegeser II osteotomy (transoral angle osteotomy, first reported by Obwegeser 1973) for severe open bite with mandibular prognathism.Patients and methodsThis retrospective study reviewed 20 consecutive patients who underwent only mandibular Obwegeser II osteotomy to correct open bite and mandibular prognathism. Lateral cephalograms were evaluated preoperatively (T1), immediate postoperatively (T2) and at least 6 months after the surgery (T3). Surgical and postsurgical changes in cephalometric measurements were evaluated statistically.ResultsOpen bite with skeletal class III malocclusion was corrected by the Obwegeser II osteotomy alone. After an average of 9.9 ± 5.2 mm of mandibular setback with open bite closure (T2–T1, over-bite change, 5.7 ± 2.4 mm) by counter-clockwise rotation of the mandible, the patients showed 0.8 ± 1.7 mm of horizontal relapse (p > 0.05), 1.1 ± 1.7 mm of vertical relapse at the B point (p = 0.011) and −0.2 ± 1.6 mm of over-bite change postoperatively (T3–T2).DiscussionWith the adequate control of the condylar position with rigid internal fixation, Obwegeser II osteotomy showed acceptable stability after the correction of open bite with mandibular prognathism without a simultaneous maxillary osteotomy. An isolated Obwegeser II osteotomy can be considered a reliable option in cases with moderate to severe open bite with mandibular prognathism when the maxillary osteotomy is not needed if the patients have a well-positioned maxilla.     

Influence of different narrative instructions to record the occlusal contact with silicone registration materials

This study examined the influence of narrative instructions on the occlusal contact area, occlusal contact point and masticatory muscle activities in normal subjects. Twelve healthy men and 12 healthy women with no more than one missing tooth per quadrant participated. Surface EMG was recorded from the masseter and temporal muscle. As a control measurement, intercuspal position was maintained to produce a habitual clenching record (NCR) while the occlusal contact area and occlusal contact point was recorded by means of silicone material. Subsequently, the occlusal contact area was recorded with the narrative instruction for minimum clenching record (MCR), light clenching record (LCR) and strong clenching record (HCR). While the EMG activity (%MVC) increased modestly from MCR to LCR (from 9·3 ± 2·0% to 11·5 ± 1·5%), the occlusal contact area increased rapidly (from 17·2 ± 11·3 mm² to 26·8 ± 15·6 mm²) (P < 0·05). Both EMG activity and occlusal contact area increased gradually from LCR to NCR (to 17·7 ± 2·0% and to 31·4 ± 14·2 mm², respectively). Finally, EMG activity still increased from NCR to HCR (to 44·5 ± 3·7%) (P < 0·05), but the occlusal contact area remained stable (to 36·8 ± 16·6 mm²). Occlusal contact points at left posterior, right posterior, anterior and total area were not significantly different between each task. This study showed that narrative instructions while recording the bite can result in largely stable occlusal contact area. An adequate narrative instruction may therefore contribute to taking a stable occlusal recording in natural dentition.     

Radiographic evaluation in three dimensions of condylar fractures with closed treatment in children and adolescents

The study aimed at investigating a new three-dimensional classification of healing morphology in condylar fractures in children and adolescents after closed treatment, and establish its association with fracture type and clinical outcomes.The medical records of children and adolescents with condylar fracture were reviewed, retrospectively. The clinical outcomes were assessed by mandibular deviation during mouth opening, Helkimo anamnestic index (Ai), and Helkimo clinical dysfunction index (Di). The condylar healing morphology was evaluated through three-dimensional CT images after 1–2 years of follow-up.In total, 96 patients with 142 condylar fracture sites were included in the study. Condylar healing morphology was classified into three main patterns: unchanged (21.13%), spherical (62.68%), and irregular (16.19% — including the three subtypes triangular, L-shaped, and Y-shaped). There was a significant difference in the distribution of the three main healing patterns among various fracture types (p = 0.0227). Irregular patterns occurred more frequently in adolescents than in children. In unilateral fractures, no obvious association was found between condylar healing morphology and clinical outcomes, including mandibular deviation during mouth opening (p = 0.162), Ai (p = 0.0991) and Di (p = 0.25). Most patients healing in different condylar patterns reached a good clinical outcome after 1–2 years.Although the healing morphology of condylar fractures in children and adolescents remained abnormal, good clinical outcome was achieved over the 2-year follow-up. Therefore, closed treatment remains a good approach.     

Efficacy of tissue engineered bone grafts containing mesenchymal stromal cells for cleft alveolar osteoplasty in a rat model

The development of sufficient tissue engineered bone grafts for alveolar cleft osteoplasty could reduce the necessity of autogenous bone grafts and its donor site morbidity. The aim of the study was to evaluate tissue engineered bone grafts in an artificially created bone defect.Bone grafts were created in vitro colonizing a synthetic hydroxyapatite–tricalciumphosphate scaffold (BONITmatrix^®) with either undifferentiated mesenchymal stromal cells (group 1) or osteogenic differentiated mesenchymal stromal cells (group 2). Cells were multiplied from bone marrow of donor rats. Unmodified scaffolds (group 3) and the tissue engineered bone grafts were inserted into artificial maxillary defects of 54 Lewis rats. In 18 animals the defects remained unfilled (control). After one, three and six weeks the rats were sacrificed. The defect was evaluated radiologically and histologically with regard to the remaining defect volume and diameter. Statistical analysis followed.The bone grafts led to a specific bone formation at the defect margin. No complete reunion of any defect was observed within the healing time. After six weeks, the remaining defect volume was 6.86 ± 3.21 mm³ (control), 4.08 ± 1.36 mm³ (group 1), 5.00 ± 0.84 mm³ (group 2) 5.50 ± 1.05 mm³ (group 3). The remaining defect diameter measured 2.63 ± 0.52 mm (control), 2.39 ± 0.23 mm (group 1), 2.53 ± 0.22 mm (group 2) and 2.70 ± 0.66 mm (group 3). In all experimental groups the defect volume and diameter decreased over time, which was significant for group 1 (p = 0.014), group 2 (p = 0.025) and group 3 (p = 0.048). The defect volume and width was significantly reduced for bone grafts containing undifferentiated cells compared to control (p = 0.035) or scaffolds only (p = 0.05).ConclusionTissue engineered bone grafts induce a pronounced bone formation in artificial bone defects compared to unfilled controls or scaffolds only.     

Bisphosphonate application and volumetric effects on MRONJ lesions

The purpose of this investigation was to analyze the volume of medication-related osteonecrosis of the jaw (MRONJ) lesions by semi-automatic segmentation of cone-beam computed tomography images, and correlate the results with the underlying diseases and applied medication.MRONJ lesions detected in cone-beam computed tomography images were assessed. The open-source software ITK-Snap enabled volumetric measurements of MRONJ lesions based on semi-automatic segmentation. Results were analyzed according to necrosis volume, localization, and gender. In addition, the underlying disease and the type of application of antiresorptive medication were investigated.Cone-beam computed tomography images of 66 patients were studied. 34 male and 32 female patients were included, with ages ranging from 50 to 93 years at the time of diagnosis. The mean volume was 993.24 ± 620.94 mm³: 484.73 ± 230.97 mm³ for the upper jaw and 1084.04 ± 625.74 mm³ for the lower jaw. The results indicated statistically significant differences between lesions of the upper and lower jaw, regardless of gender (p = 0.003). The analysis of differences between males and females did not show any significant results (p = 0.464), although males presented slightly larger lesions than females. With regard to the underlying disease, patients with osteoporosis presented larger volumes, whereas patients with malignant tumors presented smaller volumes. Nevertheless, no statistically significant differences according to the underlying disease (p = 0.313) were detected. However, patients with intravenous (iv) application showed statistically significantly larger lesions than patients who underwent oral or subcutaneous (s.c.) applications (p = 0.004).It seems that the osteonecrosis volume correlates with the applied antiresorptive agents. Larger MRONJ lesions should be expected in patients who receive intravenous antiresorptive therapy.     

Three-dimensional evaluation of condylar morphology after closed treatment of unilateral intracapsular condylar fracture in children and adolescents

PurposeTo investigate the condylar morphology after closed treatment of unilateral intracapsular condylar fracture in children and adolescents through three-dimensional evaluation and to explore the influence of age, types of fracture, follow-up period, treatment methods, and concomitant fractures on the treatment effectiveness.Materials and methodsThe medical records of patients who underwent closed treatment for condylar fractures from January 2006 to December 2018 were reviewed. The fractured sides were included in the study group and the opposite healthy joints were included in the control group. The height of articular eminence, depth of glenoid fossa, length & width & thickness of condylar process, length & width of the ramus, and deviation of pogonion were measured three-dimensionally.Results31 participants were included in the study. The length of condylar process was 2.10 ± 3.77 mm (P = 0.004) shorter, the depth of glenoid fossa was 1.09 ± 2.13 mm (P = 0.040) shallower, and the length of ramus was 1.55 ± 2.49 mm (P = 0.002) longer in fractured side than the ones in healthy side after closed treatment. The pogonion deviated 0.48 ± 1.7 mm to the fractured side, but no statistical significance was found (P = 0.129).ConclusionsChildren had great growth potential to compensate the shortening of condylar process after intracapsular condylar fracture, so closed treatment could be an effective therapy for young children and adolescents.     

Clinical comparison between arthrocentesis and conventional conservative treatment with maxillomandibular fixation for unilateral high condylar fractures

This study aimed to compare the effects of arthrocentesis and conventional closed reduction for unilateral mandibular condyle fractures. A total of 30 patients with unilateral condylar fractures were evaluated. Patients with a high condylar fracture and magnetic resonance evidence of joint effusion (JE) were divided into two groups: those treated with intra‐articular irrigation and betamethasone injection (group I) and those given conservative treatment and rigid maxillomandibular fixation (MMF) (group II). All patients were assessed for mandibular range of motion (ROM), protrusive movements, lateral excursion movements on the fractured and non‐fractured sides, pain in the temporomandibular joint and malocclusion, both before and after treatment. There were no significant differences in regard to protrusion, lateral excursion movement and incidence of malocclusion at 12 months after treatment between the groups (P > 0·05). In group I, ROM and joint pain showed good improvement from the early stages of treatment, and those patients had better outcomes as compared to group II for those parameters at 1 and 3 months after injury. The present findings indicate that arthrocentesis may be more effective and provide faster healing than conventional closed reduction.     

Relapse of skeletal class III with anterior open bite after bimaxillary orthognathic surgery depending on maxillary posterior impaction and mandibular counterclockwise rotation

The goal of this study is to evaluate relapse after orthognathic surgery of skeletal class III with anterior open bite depending on the posterior impaction and mandibular counterclockwise rotation. Patients (n = 29) were divided into two groups according to the change of mandibular occlusal plane angle (MnOP): Group A had a clockwise change of MnOP > 0° (n = 11) and Group B had a counterclockwise change of MnOP < −2° (n = 18). Lateral cephalograms were analyzed preoperatively, and at immediate stage, six weeks, six months, and one year after surgery. One year after surgery, the stability of the maxilla was good in both groups. Upward movement of the mandible was observed six weeks after surgery due to mandibular autorotation. The amount of mean relapse was small, although a significant difference was observed horizontally between groups. Group B demonstrated more forward movement of B point, pogonion, and menton than Group A (p < 0.05). SNB angle increased in both groups (p < 0.05). At one year follow up, good occlusal stability was observed in both groups with positive overbite. Our study suggested that bimaxillary procedures with clockwise and counterclockwise rotation of mandibular occlusal planes for correction of mandibular prognathism with anterior open bite appeared to be relatively stable procedures.     

Is arthrocentesis plus hyaluronic acid superior to arthrocentesis alone in the treatment of disc displacement without reduction in patients with bruxism?

PurposeThis study was designed to investigate the efficacy of arthrocentesis with and without intra-articular injection of hyaluronic acid (HA) in the treatment of disc displacement without reduction (DDwoR) in patients with bruxism.Materials and methodsA retrospective cohort study was conducted using the files of patients with DDwoR, limited mouth opening, and bruxism. Patients were divided into two groups according to the treatment method: arthrocentesis alone (group 1) and arthrocentesis plus intra-articular HA injection (group 2). To evaluate the clinical outcomes for the groups, maximum mouth opening (MMO) and visual analog scale (VAS) values before treatment, immediately after the operation, and at 1, 3, 6, 9, and 12 months postoperatively were analyzed.ResultsThe study consisted of 40 patients (34 female and 6 male, mean age 36.0 ± 11.95 years). MMO values increased and VAS scores decreased in both groups at all follow-ups after the treatment compared with pretreatment values (p < 0.001). The increase in MMO in group 2 was greater than in group 1 only at 3 and 6 months postoperatively (p = 0.013 and 0.009, respectively).ConclusionsIntra-articular HA injection is not a relevant addition when arthrocentesis is performed and a stabilizing splint is used.     

Three-dimensional analysis of condylar remodeling and skeletal relapse following LeFort-I osteotomy: A one-year follow-up bicenter study

The aim of the study was to quantify the postoperative condylar remodeling after Le Fort I surgery.Patients treated with a Le Fort I osteotomy were investigated. CBCT scans were acquired preoperatively, one week and one year postoperatively. A preoperative 3D cephalometric analysis was performed on the preoperative CBCT. Surgical movements were quantified using a voxel-registration based method (OrthoGnaticAnalyser). After rendering of the condyles from the CBCT, a volumetric analysis was performed. The correlation between the surgical movement of the maxilla and the postoperative condylar volume changes was determined with analysis of variance.ResultsA total of 45 subjects were included in this study. 47 of 90 condyles (52%) showed a mean volume reduction of 93 mm³ (4.9 volume-%) postoperatively. The maxilla was impacted in 12 patients (2.44 ± 2.49 mm) and extruded in 33 patients (1.78 ± 1.29 mm). The maxillary impaction group showed a volume reduction of 50 ± 122 mm³ and the extrusion group showed a mean volume gain of 21 ± 139 mm³ (p = 0.028).ConclusionClinicians should be aware of potential condylar remodeling following solitary Le Fort I osteotomies, particularly in female patients with maxillary impaction.     

Three-dimensional assessment of accuracy for open reduction and internal fixation of the subcondylar fracture and its implications on the TMJ function

This study used three-dimensional cone beam computed tomography (CBCT) to assist the accuracy of open reduction and internal fixation (ORIF) for the unilateral subcondylar fracture and the long-term temporomandibular joint (TMJ) function impairment.Bilateral TMJs were analyzed postoperatively on CBCT images, involving the following three-dimensional (3D) parameters: condylar position and inclination; circumferential joint space, ramus, and mandible length; and the volumetric joint space. The inclusion criteria for adult patients included having a displaced fracture >5°, a shortening in ramus length >2 mm, and mouth opening limitation. The non-fracture side was used as the comparison group. The Helkimo index was employed for the clinical assessment of the outcomes, while the paired student t-test and Pearson coefficient test were used to compare both sides.The study included 60 joints in 30 consecutive patients. The condylar inclination to the horizontal plane on the fracture and non-fracture sides was 9.29 ± 3.9°, 12.46 ± 4.2°, (p < 0.001) and was positively related to the subjective (Helkimo Hi) and objective (Helkimo Di) clinical outcomes. In contrast, the condylar position to the midsagittal plane in the fracture and non-fracture sides was 51.95 ± 3.5 mm, 50.17 ± 3.6 mm (P = 0.038), and was positively related to the objective outcomes. Additionally, the objective outcome was negatively related to the change of the posterior joint space.ConclusionThe three-dimensional assessments seem to demonstrate that the ORIF is an accurate approach for obtaining a three-dimensional reduction to the displaced subcondylar fracture.     

Cotransplantation of mesenchymal stromal cells and endothelial cells on calcium carbonate and hydroxylapatite scaffolds in vivo

This study investigated the cotransplantation of bone marrow mesenchymal stromal cells (BMSC) and human umbilical cord endothelial cells (HUVEC), and evaluated their contribution to vascular and bone tissue engineering in vivo.To evaluate the success of osteogenic differentiation and timely vascularization of different osteoconductive scaffolds in vivo, we transferred BMSC and HUVEC pre-cultivated calcium carbonate (CaCO₃) and hydroxylapatite (HA) matrices into immunocompromised RNU-rats, and analyzed mineralization, expression of osteopontin, and vascular integration via new vessel formation.After in vivo transplantation, pre-cultivated scaffolds demonstrated overall improved mineralization of 44% for CaCO₃ (p = 0.01, SD ± 14.3) and 34% for HA (p = 0.001, SD ± 17.8), as well as improved vascularization of 5.6 vessels/0.1 mm² on CaCO₃ (p < 0.0001, SD ± 2.0) and 5.3 vessels/0.1 mm² on HA (p < 0.0001, SD ± 2.4) compared with non-pre-cultivated controls. However, no significant differences between the implantation of BMSC-only, HUVEC-only, or BMSC + HUVEC cocultures could be observed.There is an increasing demand for improved bone regeneration in tissue engineering. Cotransplantation of mesenchymal stromal cells and endothelial cells often demonstrates synergistic improvements in vitro. However, the benefits or superiority of cotransplantation was not evident in vivo and so will require further investigation.     

Changes in the occlusal function of orthognathic patients with vertical malformations after combined orthodontic surgical therapy: a prospective clinical study

The aim of this study was to assess the changes in occlusal patterns during combined surgical and orthodontic therapy in patients with vertical jaw malformations. Twenty-six orthognathic patients (18 female, eight male; median age 25 years, interquartile range 11.5 years) and 10 control patients (five female, five male; median age 29.8 years, interquartile range 13.5 years) recruited from neutral configured patients attending the Department of Orthodontics, were investigated. Based on cephalometry, the patients were grouped into vertical skeletal configurations of either open, deep, or natural bite cases. Registrations of the occlusal contacts were taken using a digital occlusal sensor immediately before surgery and at 9 months after the surgical intervention. Before the intervention, open and deep bite patients showed significantly less efficient occlusal patterns than the untreated controls regarding total tooth contact (P < 0.001), time of occlusion (P = 0.002), occlusal asymmetry (P = 0.001), anterior tooth contact (P < 0.001), and posterior tooth contact (P < 0.001). After surgery, the parameters in the deep bite patients were similar to those in the controls; however, in open bite patients, total tooth contact (P = 0.003), occlusal asymmetry (P = 0.011), and posterior tooth contact (P = 0.035) differed significantly. In conclusion, combined orthodontic and surgical correction of vertical malocclusions was found to improve occlusal function in patients with deep bite to the level of controls.