Transplantation of Cryopreserved Teeth: A Systematic Review

The aim of this article was to examine the research articles regarding biological and mechanical properties of cryopreserved teeth for potential use in tooth transplantation. A systematic review of literatures was performed by Pubmed searching with assigned key words from January 1, 1990 to June 8, 2009. All articles were examined for inclusion criteria. Secondary search was conducted by hand-search through references of included articles from primary search.A total of 24 articles were obtained from both primary and secondary search and used as fundamental articles in this review. Periodontal ligament tissues of cryopreserved teeth were able to maintain their biological properties resulted in a satisfactory healing of periodontium. Dental pulp tissues,however, may be compromised by limitation of permeability of cryopreservative agent into pulp cavity. Therefore, an endodontic treatment of transplanted cryopreserved teeth was recommended. Cryopreserved teeth had comparable mechanical properties to those of normal teeth. Importantly, the success of cryopreserved tooth transplantation treatment in orthodontic patients was reported. The cryopreserved teeth for tooth banking have a potential clinical application for treatment of missing teeth. Case selection, however, is critical for treatment success. More studies and data regarding masticatory function and periodontal healing of transplanted cryopreserved teeth are needed.     

Reimplantation of 83 teeth

A total of 83 teeth were reimplanted after extraction and treatment of periapical or pulpoperiodontal lesions in 79 patients, age range 9 to 55 years. Only anterior teeth were immobilized by ligature and self-polymerizable resin. Follow up of from 1 to 5 years showed complete success in 69% clinical success but with root lysis in 11%, as shown by radiologic imaging, and failure of treatment, mainly in patients over 40 years, in 20%. Healing was usually by ankylosis but an alveolodental new ligament formation was noted in only 3 cases. Root lysis occurred in 28% of cases, including 1/3 rd of the compensated type with a very slow course and 2/3 rds of the inflammatory type with resulting failure of treatment.     

Comparative neuromuscular histopathology of cricopharyngeal achalasia patients with and without previous botulinum toxin treatment

OBJECTIVES: Botulinum toxin injection (BTX) and cricopharyngeal (CP) myotomy are performed in the treatment of CP achalasia (CA). The objective of this study was to examine the effects of BTX on neuromuscular histopathologic findings and to make direct comparisons between specimens of muscle from CA patients who had received BTX to the upper esophageal sphincter and from CA patients who had no previous exposure to BTX. METHODS: We performed a retrospective review (2001 to 2005) of CP muscle specimens from all patients who underwent myotomy for CA. Cases of Zenker's diverticulum were excluded. Patient demographics, clinical course, and neuromuscular pathology findings were noted from the chart. RESULTS: Nineteen patients with CA were identified: 10 male and 9 female, with a mean age of 57 years. Eleven had no prior BTX (6 male and 5 female; mean age, 62 years); 8 had previous treatment with BTX (4 male and 4 female; mean age, 51 years). Eight of the 11 BTX-naive patients revealed predominantly myopathic changes on histology. Those with previous BTX tended to be younger; 6 of the 8 had a clinical benefit from their BTX and ultimately went on to myotomy. The CP muscle specimens featured both mixed and neurogenic pathologic changes in 5 of the 8 patients with BTX. Although these findings suggest some impact of BTX on the CP muscle, the difference between the groups was not statistically significant (p < .20, chi2 test). CONCLUSIONS: Treatment with BTX may have some clinical and histopathologic impact on the upper esophageal sphincter of patients with CA. Although neuropathic changes were noted in the CP muscle of previously injected patients at the time of their CP myotomy, the neuromuscular pathologic findings overall were not significantly different from those of BTX-naive patients.     

Nasal mucus transportability in children with cleft palate

OBJECTIVES: Children with cleft palate (CP) have a high prevalence of sinusitis. Considering that nasal mucus properties play a pivotal role in the upper airway defense mechanism, the aim of the study was to evaluate nasal mucus transportability and physical properties from children with CP. SETTING: Hospital for Rehabilitation of Craniofacial Anomalies, School of Dentistry, University of S?o Paulo, Bauru, SP, Brazil and Laboratory of Experimental Air Pollution, School of Medicine, University of S?o Paulo, S?o Paulo, SP, Brazil. METHODS: Nasal mucus samples were collected by nasal aspiration from children with CP and without CP (non-CP). Sneeze clearance (SC) was evaluated by the simulated sneeze machine. In vitro mucus transportability (MCT) by cilia was evaluated by the frog palate preparation. Mucus physical surface properties were assessed by measuring the contact angle (CA). Mucus rheology was determined by means of a magnetic rheometer, and the results were expressed as log G* (vectorial sum of viscosity and elasticity) and tan delta (relationship between viscosity and elasticity) measured at 1 and 100 rad/s. RESULTS: Mucus samples from children with CP had a higher SC than non-CP children (67+/-30 and 41+/-24 mm, respectively, p<0.05). Mucus samples from children with CP had a lower CA (24+/-16 degrees and 35+/-11 degrees , p<0.05) and a higher tan delta 100 (0.79+/-0.24 and 0.51+/-0.12, p<0.05) than non-CP children. There were no significant differences in mucus MCT, log G* 1, tan delta 1 and log G* 100 obtained for CP and non-CP children. CONCLUSIONS: Nasal mucus physical properties from children with CP are associated with higher sneeze transportability. The high prevalence of sinusitis in children with CP cannot be explained by changes in mucus physical properties and transportability.     

Oral microbiota and host innate immune response in bisphosphonate-related osteonecrosis of the jaw

Bacterial biofilms have emerged as potential critical triggers in the pathogenesis of bisphosphonate（BP）-related osteonecrosis of the jaw（ONJ） or BRONJ. BRONJ lesions have shown to be heavily colonized by oral bacteria, most of these difficult to cultivate and presents many clinical challenges. The purpose of this study was to characterize the bacterial diversity in BRONJ lesions and to determine host immune response. We examined tissue specimens from three cohorts（n530）; patients with periodontal disease without a history of BP therapy（Control, n510）, patients with periodontal disease having history of BP therapy but without ONJ（BP, n55） and patients with BRONJ（BRONJ, n515）. Denaturing gradient gel electrophoresis of polymerase chain reaction（PCR）-amplified 16 S r RNA gene fragments revealed less bacterial diversity in BRONJ than BP and Control cohorts. Sequence analysis detected six phyla with predominant affiliation to Firmicutes in BRONJ（71.6%）, BP（70.3%） and Control（59.1%）. Significant differences（P,0.05） in genera were observed, between Control/BP, Control/BRONJ and BP/BRONJ cohorts. Enzyme-linked immunosorbent assay（ELISA）results indicated that the levels of myeloperoxidase were significantly lower, whereas interleukin-6 and tumor necrosis factor-alpha levels were moderately elevated in BRONJ patients as compared to Controls. PCR array showed significant changes in BRONJ patients with downregulation of host genes, such as nucleotide-binding oligomerization domain containing protein 2, and cathepsin G, the key modulators for antibacterial response and upregulation of secretory leukocyte protease inhibitor, proteinase 3 and conserved helix–loop–helix ubiquitous kinase. The results suggest that colonization of unique bacterial communities coupled with deficient innate immune response is likely to impact the pathogenesis of ONJ.     

Randomized‐controlled study comparing post‐operative pain between coblation palatoplasty and laser palatoplasty1

Objectives: This study aimed to evaluate differences in post‐operative pain comparing KTP laser‐assisted uvulopalatoplasty without tonsillectomy (LAUP) with a new described surgical method: coblation uvulopalatoplasty with tonsillectomy (CP). We also evaluate the impact of each surgical technique in reduction of snoring loudness. Material and methods: Single blind randomized‐controlled trial. From a population of 41 consecutive patients on the waiting list for uvulopalatoplasty for simple snoring, the study group was reduced to 17 CP and 13 LAUP. Post‐operative pain and reduction of snoring loudness were recorded using visual analogue scales (VAS) during the first 15 post‐operative days. Post‐operative snoring loudness was documented for 1‐year period. Results: Both groups had similar post‐operative pain during the first seven post‐operative days. A statistically significant reduction in post‐operative pain was observed in the CP group after day 8, and maintained until the end of the study. Reduction of snoring loudness was significant in both groups, but no differences were observed between them. Discussion: Coblation uvulopalatoplasty compared with LAUP demonstrates a reduction in post‐operative pain, significant after the first post‐operative week. The collateral thermal injury caused by laser is responsible for the slow‐healing rate and maintained post‐operative pain. Coblation dissociates tissue at lower temperatures with minimal collateral thermal injury and consequently faster and less painful recovery. Both surgical procedures have significant and similar reduction in snoring loudness. Conclusions: Both methods are adequate treatment options for snoring. The less painful recovery in CP promotes this surgical technique as our preferred choice for palate surgery.     

The healing effects of tissue glues and healing agent locally applied on esophageal anastomoses

Objective

This study aimed to investigate the effects of cyanoacrylate (C), fibrin glue (FG), and natrium hyaluronate (NH) on the healing of esophageal anastomosis (EA).

Methods

Twenty-four rabbits were divided equally into 4 groups: primary anastomosis (PA), C, FG, and NH. A 1-cm-length of the cervical esophagus was resected through a cervical incision and then anastomosis was performed. C, FG, and NH were instilled into anastomosis lines in the respective groups. The animals were fed orally on postoperative day 7 on the condition that there was no esophageal leakage. The rabbits were sacrificed 8 weeks later to evaluate bursting pressure (BP), tissue hydroxyproline (HP) levels and wound healing scores (WHSs) in the anastomosis lines.

Results

BP was significantly higher in the C group than in the PA, FG, and NH groups, and HP was significantly lower than in the other groups. WHSs in the PA and NH groups were lower than in the C and FG groups.

Conclusions

C and NH appear to be beneficial in EA healing with respect to increased BP and decreased HP when they are used simultaneously with PA prophylactically to prevent esophageal leakages and stricture.     

Piezoelectric osteotomy: applications in periodontal and implant surgery

Reverse piezoelectricity is currently used in Dentistry for ultrasonic scaling devices. Using this technology, increasingly more powerful ultrasonic surgical lancets were developed within a few years, and these new tools have provided many practical solutions in oral and maxillofacial surgery. This article reviews the basic principles of piezosurgery, and its numerous clinical applications: in oral surgery (atraumatic extractions, wisdom teeth exposure, periapical cyst debridement, pre-prosthetic surgery), more specifically in periodontal (root planning and bone remodeling, crown lengthening) and implant surgery (sinus lift, removal of fractured implants, bone ridge augmentation, bone graft harvesting (crestal, retromolar, chin or tori)). The recent increased power of these instruments allows emphasizing a much wider range of clinical applications, extending to all surgical fields.     

创伤性鼓膜穿孔不同修复方式的临床观察

目的:探讨创伤性鼓膜穿孔自然愈合及贴膜修复对穿孔愈合的影响。方法:将2007-06-2009-03共112例创伤性鼓膜穿孔患者随机分为2组,分别予以自然修复(自然愈合组,57例)及贴膜处理(贴膜组,55例),内镜下动态观察穿孔愈合情况。结果:随访3个月,贴膜组55例,失访9例,穿孔边缘肉芽增生36例,小、中、大穿孔愈合率分别为100.00%、90.48%、93.33%,愈合时间分别(9.0±2.8)d、(13.0±2.6)d、(22.0±4.7)d。自然愈合组57例,失访11例,小、中、大穿孔愈合率分别为91.67%、95.24%、84.62%,愈合时间分别为(11.0±3.7)d、(24.0±3.8)d、(36.0±2.1)d,其中,5例上皮错向移行,2例手术。2组中、大穿孔愈合时间比较均差异有统计学意义(均P<0.05)。结论:创伤性鼓膜穿孔贴膜处理可促进穿孔缘水肿、肉芽增生,加速穿孔愈合,肉芽增生程度与愈合时间密切相关;自然愈合过程上皮错向移行可抑制穿孔愈合。     

Dental aspects of maxillofacial injuries

The chief progress of maxillofacial surgery in recent years has been the preservation and the retention of functional tissue. The recent advances in microvascular and reimplantation surgery are examples. Similarly the preservation of the masticatory apparatus is best served by the retention of all viable components. Additional benefits derived from this approach include the facilitation with alignment of the bony fragments, proper occlusion of the teeth and maintenance of the vertical relationship between the upper and lower jaws; in addition to the restoration of appearance and the functions of mastication and speech. Although injuries of the teeth and their supporting structures at first glance may seem to be simple problems, frequently they turn out to be complicated. The most common injury is partial avulsion of the alveolar bone with loss of attached teeth, which may produce a severe defect in the jaw bone. During healing there is additional resorbtion of alveolar bone, which is quite a normal physiologic phenomenon. Therefore, the eventual defect is likely to be more severe yet. For this reason more concern should be shown for these lesser injuries.     

Preservation of the non-rectangular cuticular plate/cell axis angle of outer hair cells

Motile properties of outer hair cells (OHCs) may contribute to sharp tuning and amplification in the mammalian cochlea. Shape changes of isolated OHCs in response to various physical and chemical influences have been investigated intensively. However, determinations of shape may have been influenced by unanticipated effects of preparation and preservation of the OHCs investigated. Thus, in a first step, lengths of freshly isolated OHCs from the guinea pig cochlea were determined using a video-enhancing magnification system. The cuticular plate/cell axis angle (CP/CA angle) was then measured in native cells and under the influence of potassium chloride and potassium gluconate incubation. To show the influence of glutaraldehyde (GA) fixation on the isolated OHCs, fixative dependent changes on cell length and CP/CA angle were recorded in native and preincubated OHCs. In these experiments, the cell length of vital isolated OHCs was between 41.5 m, in the basal turn, and 103.7 m, in the apical turn. The average CP/CA angle was 106° ± 4.2° (n = 324 cells, turns 1–4) with no statistically significant differences for the four turns. Under the influence of potassium chloride, cell length was reduced by 8.1%. Potassium gluconate incubation led to a shortening of cell length, followed by a 5.3% increase after 5 min. The CP/CA angle under potassium chloride was decreased (97.0°) and was then increased under the influence of potassium gluconate (110.7°) as a result of cuticular plate tilting. Cell shrinkage after fixation depended on the fixative's osmolarity and on the GA concentration. Increased GA levels amplified cell shrinkage from 34% for hypo-osmolar solutions to 15% in iso-osmolar and 29% in hyperosmolar solutions. The CP/CA angle of native and incubated OHCs was not different from those fixed with GA. The present data provide a rational basis for isolated OHC shape parameters. Moreover, functionally induced changes can be better interpreted when OHCs are influenced by fixatives, as shown in the GA experiments.     

Periodontal status at diagnosis predicts non-disease-specific survival in a geographically defined cohort of patients with oropharynx squamous cell carcinoma

Background: The aim of this study was to examine periodontal status with a time-efficient screening method from a cohort of newly diagnosed oropharynx squamous cell carcinoma (OPSCC) patients and to study to what extent dental disease level predicted survival.

Aims/objective: Can measuring level of dental pathology based on a blind investigation of a routine orthopantogram (OPG) obtained during diagnostic workup reveal prognostic information?

Materials and methods: We included 97 patients diagnosed between 2003 and 2010. Radiographic alveolar bone loss was measured. At least 4?mm bone loss from cement–enamel junction on at least two teeth was registered as periodontal pathology. The number of missing and filled teeth (MFT), residual roots and apical radiolucencies were noted. Clinical data were determined through hospital patient records.

Results: The horizontal bone loss discriminated between hr-HPV(+) versus hr-HPV(?) status, but secondary to age and smoking history at diagnosis. Vertical and horizontal bone loss predicted survival directly, and adjusted by gender, patient, smoking history, TN stage and hr-HPV tumor infection at diagnosis.

Conclusions: Degree of periodontal OPG pathology at the time of OPSCC diagnosis to some extent predicted hr-HPV infection, but predicted non-disease-specific long-term survival.

Significance: Degree of periodontal OPG pathology at diagnosis predicts prognosis.     

The effects of early and late feeding on healing of esophageal anastomoses: an experimental study

Objective

To investigate the effects of postoperative late and early feeding on the healing of experimental esophageal anastomosis (EA).

Methods

Twelve New Zealand rabbits were divided equally into 2 groups: late feeding (LF) and early feeding (EF). A 1-cm-length of the cervical esophagus was resected through a cervical incision, and then anastomosis was performed. The LF group was fed parenterally for 6 days and orally (per oral route) after esophagography on postoperative day 7 as long as there was no esophageal leakage. The EF group was fed orally (per oral route) 24 h after esophageal repairs (ERs), and esophagography was carried out on postoperative day 7 to check the ERs. The rabbits were sacrificed to evaluate bursting pressure (BP), diameter of the esophageal lumen (DOTEL), tissue hydroxyproline (HP), and wound healing scores (WHSs) in the anastomosis lines 8 weeks later.

Results

In the LF group, BP and DOTEL were significantly lower than they were in the EF group, and HP was significantly higher than it was in the EF group. WHSs in the LF group were not higher than they were in the EFgroup.

Conclusions

Early feeding is superior after EA as shown by increased DOTEL and BP levels, but causes decreased HP levels.     

Marginal bone loss around non-submerged implants is associated with salivary microbiome during bone healing

Marginal bone loss during bone healing exists around non-submerged dental implants. The aim of this study was to identify the relationship between different degrees of marginal bone loss during bone healing and the salivary microbiome. One hundred patients were recruited, and marginal bone loss around their implants was measured using cone beam computed tomography during a 3-month healing period. The patients were divided into three groups according to the severity of marginal bone loss. Saliva samples were collected from all subjected and were analysed using 16S MiSeq sequencing. Although the overall structure of the microbial community was not dramatically altered, the relative abundance of several taxonomic groups noticeably changed. The abundance of species in the phyla Spirochaeta and Synergistetes increased significantly as the bone loss became more severe. Species within the genus Treponema also exhibited increased abundance, whereas Veillonella, Haemophilus and Leptotrichia exhibited reduced abundances, in groups with more bone loss. Porphyromonasgingivalis, Treponemadenticola and Streptococcus intermedius were significantly more abundant in the moderate group and/or severe group. The severity of marginal bone loss around the non-submerged implant was associated with dissimilar taxonomic compositions. An increased severity of marginal bone loss was related to increased proportions of periodontal pathogenic species. These data suggest a potential role of microbes in the progression of marginal bone loss during bone healing.     

Mesenchymal Stem Cells and Tooth Engineering

Tooth loss compromises human oral health. Although several prosthetic methods, such as artificial denture and dental implants, are clinical therapies to tooth loss problems, they are thought to have safety and usage time issues. Recently, tooth tissue engineering has attracted more and more attention. Stem cell based tissue engineering is thought to be a promising way to replace the missing tooth. Mesenchymal stem cells （MSCs） are multipotent stem cells which can differentiate into a variety of cell types. The potential MSCs for tooth regeneration mainly include stem cells from human exfoliated deciduous teeth （SHEDs）, adult dental pulp stem cells （DPSCs）, stem cells from the apical part of the papilla （SCAPs）, stem cells from the dental follicle （DFSCs）, periodontal ligament stem cells （PDLSCs） and bone marrow derived mesenchymal stem cells （BMSCs）. This review outlines the recent progress in the mesenchymal stem cells used in tooth regeneration.     

Guided-tissue regeneration in endodontic surgery

AIM: Endodontic surgery has for aim to treat bone lesions due to dental-canal infections. The authors investigated the success rate of guided-tissue regeneration (GTR) in endodontic surgery for large periapical lesions. METHODOLOGY: Both bone defects with eroded lingual/palatal and buccal cortex (two-wall defect: transosseous) and lesions with noneroded lingual/palatal cortex (four-wall defect) were assessed. All lesions had a diameter of least 10mm. A total of 73 teeth in 55 patients were included according to specific selection criteria. Full mucoperiosteal tissue flap were used. A straight fissure bur in a hand-piece was positioned apically and 2.5 to 3mm of the root-end were shaved away. Root-end cavities, 2.5 to 3mm deep, were prepared with ultrasonic tips. Root-ends were sealed using Super EBA. The choice of using or not GTR associated with deproteinized bovine bone for each patient wax made by a computer-generated randomized table. For cases allocated to the GTR group, the defect was filled with anorganic bovine-bone mineral and then covered with a resorbable collagen membrane. The outcome was assessed by clinical and radiographic evaluation at one-year follow-up. RESULTS: Sixty-nine teeth were evaluated at one year follow-up. Twenty-six cases were transosseous lesions. At the one-year follow-up, 56 teeth had successfully healed (81.2%), healing was uncertain for 10 teeth and three were classified as failure. The cases classified as uncertain healing were scheduled for another follow-up three years later. DISCUSSION: According to published data, GTR as a complement of periapical surgery is not necessary for four-wall defects. However, it may be an indication for transosseous lesions.     

Anti-proteolytic capacity and bonding durability of proanthocyanidin-biomodified demineralized dentin matrix

Our previous studies showed that biomodification of demineralized dentin collagen with proanthocyanidin（PA） for a clinically practical duration improves the mechanical properties of the dentin matrix and the immediate resin–dentin bond strength. The present study sought to evaluate the ability of PA biomodification to reduce collagenase-induced biodegradation of demineralized dentin matrix and dentin/adhesive interfaces in a clinically relevant manner. The effects of collagenolytic and gelatinolytic activity on PA-biomodified demineralized dentin matrix were analysed by hydroxyproline assay and gelatin zymography. Then, resin-/dentin-bonded specimens were prepared and challenged with bacterial collagenases. Dentin treated with 2% chlorhexidine and untreated dentin were used as a positive and negative control, respectively. Collagen biodegradation, the microtensile bond strengths of bonded specimens and the micromorphologies of the fractured interfaces were assessed. The results revealed that both collagenolytic and gelatinolytic activity on demineralized dentin were notably inhibited in the PA-biomodified groups, irrespective of PA concentration and biomodification duration. When challenged with exogenous collagenases, PA-biomodified bonded specimens exhibited significantly less biodegradation and maintained higher bond strengths than the untreated control. These results suggest that PA biomodification was effective at inhibiting proteolytic activity on demineralized dentin matrix and at stabilizing the adhesive/dentin interface against enzymatic degradation, is a new concept that has the potential to improve bonding durability.     

中青年突发性聋患者与全身性低血压的相关性研究

目的：综合评估中青年突发性聋（SSHL）患者与全身低血压的关系。方法：选择28例确诊为SSHL未经治疗的中青年（50岁以下）患者为实验组,均行听力学、即时血压、心率、24h动态血压连续监测、脂质代谢参数等检查。同时选择30例年龄、性别相匹配的正常血压非SSHL者为对照组进行同等处理。结果：实验组平均的即时和动态血压（SBP、DBP）都显著低于对照组。两组在心血管疾病高危因子的统计差异不显著。实验组的低血压患病率显著高于对照组。结论：全身性低血压的存在可引起耳蜗微循环的低灌注,而耳蜗缺血很可能是中青年SSHL患者的发病机制之一,尤其是耳蜗末梢顶转的血供会直接影响到低频听力。对此类患者的血压动态监测和限制使用血管扩张药是很有必要的。     

Interposition arthroplasty in temporomandibular joint ankylosis

We report a series of 60 cases of post- traumatic temporomandibular joint ankylosis that were treated at our unit from 1992 to 2002 by temporalis fascia flap interposition arthopiasty. Majority of these patients (21 patients, 35%) were in the age group of 15–20 years, with 39 males (65%) and 21 females (35%). The duration of ankylosis varied from 6 months to more than 4 years with 32 patients (54.32%) having a duration of 6 months to 2 years. 44 patients (73.33%) had unilateral white 16 patients (26.67%) had bilateral involvement of temporomandibular joint. Pedicled temporalise fascia axial flap based on superficial temporal artery was used for interpositional arthopiasty. The advantage is that it is available at the operative site, easy to raise, well vascularized, reliable and with better long term results. Adequate mouth opening was achieved in all cases and a long follow up, of up to 10 years for the earlier operated cases, showed no recurrence of ankylosis in any of the patients.     

In vivo biofilm formation on stainless steel bonded retainers during different oral health-care regimens

Retention wires permanently bonded to the anterior teeth are used after orthodontic treatment to prevent the teeth from relapsing to pre-treatment positions. A disadvantage of bonded retainers is biofi...