Factors influencing the long-term results of autologous microvascular submandibular gland transplantation for severe dry eye disease

We assessed long-term outcomes of autologous microvascular submandibular gland (SMG) transplantation for severe dry eye disease and investigated factors influencing long-term results. From August 1999 to January 2015, 185 patients (200 eyes) with severe dry eye received SMG transplantation. Subjective assessments and ophthalmologic evaluations were performed before and after transplantation. Follow-up results showed successful transplantation in 180 of 200 eyes (success rate: 90%), resulting in marked symptomatic relief of xerophthalmia. Surgery failed due to vascular thrombosis (15 glands) and duct obstruction (5 glands). Follow-up data were available for 163 eyes. Epiphora occurred in 98 (60.1%) eyes and was effectively managed by surgical reduction of graft, topical atropine gel and botulinum toxin injection. Wharton’s duct obstruction occurred in 16 (10.6%) eyes and was treated by duct reconstruction. Subjective satisfaction was achieved in 143 (87.7%) eyes. Mean score of fluorescent staining reduced from 11.25 ± 1.42 to 7.25 ± 3.37. Postoperative best-corrected visual acuity improved in 85 (56.3%) eyes. Our clinical experience proved that SMG transplantation is effective and grants long-term improvement in severe dry eye. Secretory function of transplanted SMGs remains active and stable. Blood vessel thrombosis, Wharton’s duct obstruction, and epiphora are primary factors influencing results.     

Influence of chewing on expression level of human beta-defensin 2 and secretory immunoglobulin A in the epithelium

Purpose

This study aimed to clarify the influence of chewing on human β-defensin 2 (hBD-2) and secretory immunoglobulin A (SIgA) expression levels.

Botulinum toxin A for patients with orofacial dystonia: prospective,observational, single-centre study

The objective of this study was to demonstrate the efficacy of intramuscular botulinum toxin type A (BTX-A) as a method of controlling the symptoms of focal facial dystonia. A prospective, longitudinal, observational, pre–post (case-series) single-centre study was conducted over a period of 3 months, involving 30 patients with focal dystonia. The patients were enrolled on a first-come, first-served basis. For all patients, the abnormal movements were evaluated using the Abnormal Involuntary Movement Scale (AIMS). The AIMS results were recorded immediately before BTX-A injection (primary predictor variable) and after 3 months (the toxin reaches its maximum effect 2 weeks after injection, and the effect is maintained for 3 months). An improvement in AIMS score was the primary outcome variable. Treatment efficacy was evaluated using the Pearson correlation index with a level of significance of P < 0.05. The average age of the study subjects was 70.9 ± 12.7 years (20 female, 10 male). The mean dose of BTX-A used was 27.4 ± 20.5 U. The mean improvement in AIMS score after treatment was 5.2 ± 4.2. A significant correlation was found between the dose applied and the reduction in AIMS score (P < 0.05). BTX-A can be used in the treatment of focal dystonia and provides reproducible results.     

Acupuncture on anxiety and inflammatory events following surgery of mandibular third molars: a split-mouth,randomized, triple-blind clinical trial

The aim of this study was to compare the effects of acupuncture and placebo acupuncture on the control of pain, oedema, and trismus following the extraction of third molars and on the control of preoperative anxiety. Sixteen patients (mean age 22.5 ± 3.45 years) each underwent four acupuncture sessions, one prior to each surgery and the others at 24, 48, and 72 hours after each surgery (left and right tooth). Oedema was determined using measurements of the face and trismus was determined by maximum mouth opening at baseline and at 24, 48, 72 hours and 7 days following surgery. Postoperative pain was evaluated by the patients using a visual analogue scale (VAS) at 24, 48, and 72 hours following surgery. Anxiety was evaluated using the State–Trait Anxiety Inventory and a VAS at baseline and before and after acupuncture prior to surgery. The statistical analysis was performed using the paired t-test and Wilcoxon test. Acupuncture showed a better performance in the control of oedema at 48 hours (P = 0.026), 72 hours (P = 0.046), and 7 days (P = 0.040) when compared to placebo. There was no statistically significant difference between the acupuncture and placebo groups in the control of pain, trismus, or anxiety.     

Effect of a self-etching primer containing 4-META and sodium sulfite after phosphoric acid etching on bonding strength of MMA-TBB resin to human enamel

Purpose

The aim of this study was to evaluate the shear bond strength and durability of MMA-TBB resin to human enamel applied a self-etching primer with phosphoric acid etching.

Uncultured undifferentiated adipose-derived nucleated cell fractions combined with inside-out artery graft accelerate sciatic nerve regeneration and functional recovery

Effects of transplantation of adipose-derived nucleated cell fractions (ADNCs) on sciatic nerve regeneration were studied. A 10-mm sciatic nerve defect was bridged using artery graft filled with ADNCs. In control group, artery graft was filled with saline alone. Regenerated nerve fibres were studied for 12 weeks. In sham-operated group, sciatic nerve was only exposed and manipulated. Behavioural and functional studies confirmed faster recovery of regenerated axons in ADNCs transplanted animals than in control group (P < 0.05). At the end of study period, animals in ADNCs transplanted group achieved a sciatic functional index (SFI) value of −31.6 ± −3.14, whereas in control group a value of −42.5 ± −3.7 was found. Gastrocnemius muscle mass in ADNCs transplanted animals was found to be significantly higher than that in control group (P = 0.001). Morphometric indices of regenerated fibres showed the number and diameter of myelinated fibres to be significantly higher in ADNCs transplanted animals than in control group (P = 0.001). On immunohistochemistry, there was more positive staining of S100 in the ADNCs transplanted animals than in control group. ADNCs transplantation into an artery graft could be considered a readily accessible technique that improves functional recovery of sciatic nerve.     

“Flipped classrooms” in training in maxillofacial surgery: preparation before the traditional didactic lecture?

While virtual learning environments (VLE) can be used in medical education as stand-alone educational interventions, they can also be used in preparation for traditional “face-to-face” training sessions as part of a “flipped classroom” model. We sought to evaluate the introduction of this model in a single module on maxillofacial radiology from a course on trauma skills. Course delegates were randomised into two groups: one was given access to an e-learning resource (test group) and the other attended a traditional didactic lecture (control group). Knowledge and confidence were assessed before and after the course with a 20-question single-best-answer paper and a 10-situation 100 mm visual analogue scale (VAS) paper, respectively. All participants were then given free access to the VLE for 30 days and were invited to take part in an e-survey. Neither group showed improvements in the single-best-answer scores, but both groups showed comparable improvements in VAS (control: median (range) values improved from 40.8 (17.7–82.5) mm to 62.8 (35.3–88.7) mm, p = 0.001; test group: from 47.7 (10.9–58.1) mm to 60.5 (32.4–75.6) mm, p = 0.005). Half of the respondents stated that they preferred the “flipped classroom” approach, and 22/22 stated that they would be “likely” or “very likely” to use an e-learning resource with expanded content. The “flipped classroom” approach was well received and there were comparable improvements in confidence. As maxillofacial radiology lends itself to online instruction with its reliance on the recognition of patterns, and problem-based approach to learning, a piloted e-learning resource could be developed in this area.     

Effect of matrix metalloproteinase 8 inhibitor and chlorhexidine on the cytotoxicity,oxidative stress and cytokine level of MDPC-23

Objective

This study investigated the effect of matrix metalloproteinase-8 inhibitor I (MMP8-I) and chlorhexidine (CHX) on the viability, oxidative stress and cytokine secretion of MDPC-23 under short-term (30 min) and long-term (3 days) culture.

Displacement comparison of CAD–CAM titanium and zirconia abutments to implants with different conical connections

Purpose

To compare the displacements of CAD–CAM zirconia and titanium abutments into different internal connection systems after torquing.

Influence of platelet rich fibrin on post-extraction socket healing: A clinical and radiographic study

Aim

The aim of this study was to evaluate clinically and radiographically, extraction socket healing using autologous platelet rich fibrin (PRF).

Profiling cytokine levels in chlorhexidine and EGCG-treated odontoblast-like cells

Objective

To screen the effect of two compounds, chlorhexidine diacetate (CHX) and epigallocatechin-gallate (EGCG), on the levels of cytokines produced by odontoblast-like cells (MDPC-23).

Deleterious effect of chronic continuous hypoxia on oral health

ObjectiveTo evaluate the effect of chronic continuous hypoxia (CCH) in alveolar bone and its correlation with the inflammatory markers which play a key role in the development of periodontitis.Material and methodsWistar rats were exposed to CCH (600 mbar, 3 months). Macroscopic and histological analyses of alveolar bone were performed, together with measurement of oxidative stress and inflammatory parameters in gums and submandibular glands (SMG).ResultsHCC induced cortical alveolar bone loss, decreased interradicular bone volume and increased the periodontal ligament height compared to control rats (p < 0.05). CCH enhanced iNOS activity in gums (from 2735,04 ± 662,96 nmol/min/mg proteins to 4289,58 ± 915,63 p < 0.05) and in SMG (from 56,71 ± 12,05 nmol/min/mg proteins to 90,15 ± 21,78 p < 0.05). PGE₂ did not change in gums or in SMG by means of CCH, while TNFα decreased in gums (p < 0.05). Regarding oxidative stress, thiobarbituric acid reactive species concentration in CCH animals was higher both in gums as in SMG, and catalase activity was decreased in SMG.ConclusionHigher iNOS activity both in gums and SMG under CCH could be associated with the alveolar bone loss observed. The increase in oxidative stress occurring in SMG and gums, together with a lower antioxidant capacity might indicate a deleterious effect of HX in oral health.     

Complications and loss of free flaps after reconstructions for oral cancer

The aim of this retrospective study was to analyse the incidence of complications and loss of flaps after primary reconstructions for oral cancer in 191 patients at our hospital over the five years 2005–2010. The patients’ clinical and personal details, characteristics of the tumours, types of microvascular flap, complications, and outcomes were recorded. The soft tissue flaps used most often were the fasciocutaneous radial forearm free flap (RFFF) (n = 86, 45%) and the anterolateral thigh free flap (ALTFF) (n = 48, 25%) while the most commonly used osseous flap was the deep circumflex iliac artery flap (DCIA) (n = 25, 13%). There were postoperative complications that required intervention in a quarter of the patients, most often in the age group 41–50 years (p = 0.018). Older age was not associated with the development of complications. The overall survival of all free flaps was 181/191 (95%), and the only significant individual predictor of loss of a flap was reconstruction with a DCIA (p = 0.016), five of the 25 of which were lost. We conclude therefore that DCIA free flaps are associated with an increased risk of failure; the method of osseous reconstruction for maxillofacial reconstruction should be selected carefully; and carefully chosen older patients do not seem to be at increased risk of morbidity.     

Does platelet-rich fibrin increase the stability of implants in the posterior of the maxilla? A split-mouth randomized clinical trial

The effect of platelet-rich fibrin (PRF) on bone healing around dental implants in areas of poor bone quality has not been studied. The aim of this study was to evaluate the stability of implants placed in the posterior maxilla, with or without the use of PRF, during the healing period. A split-mouth randomized clinical trial was performed. Twenty patients with missing teeth in the molar region of the maxilla, requiring bilateral implants, were included. PRF was used on one side (group 1); no PRF was used on the other (group 2). Implant stability was assessed by resonance frequency analysis (RFA) at 2, 4, and 6 weeks after placement. At 2 weeks, the mean ISQ was 60.60 ± 3.42 in group 1 and 58.25 ± 3.64 in group 2; at 4 weeks it was 70.30 ± 3.36 in group 1 and 67.15 ± 4.33 in group 2; at 6 weeks it was 78.45 ± 3.36 in group 1 and 76.15 ± 2.94 in group 2. Significant differences in RFA were found between the groups at 2 weeks (P = 0.04), 4 weeks (P = 0.014), and 6 weeks (P = 0.027) after placement. The study results suggest that the use of PRF may enhance the post-insertion stability of dental implants placed in the posterior maxilla during the healing period.     

Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial

To evaluate the effect of postoperative irrigation with chlorhexidine on inflammatory complications after the extraction of lower third molars under local anaesthesia, we recruited 100 patients to participate in a controlled, single-blind, randomised clinical trial. They were assigned to one of two groups: the intervention group (postoperative irrigation of the surgical site with chlorhexidine for seven days) or the control group (postoperative chlorhexidine mouth rinse for seven days). The primary outcome variables were pain, swelling, trismus, infection, and alveolar osteitis. The secondary outcome variables were wound dehiscence and food impaction. A total of 95 participants completed the study (47 in the irrigation group and 48 in the rinse group). In the irrigation group, alveolar osteitis and facial swelling had reduced significantly at seven days postoperatively (both p < 0.01). Pain scores had also reduced significantly at seven days (p < 0.01), but not at 48 hours, and patients had lower levels of food impaction (p < 0.01) and less severe symptoms (p = 0.02). Routine irrigation with chlorhexidine after the extraction of third molars helps to reduce pain and lowers the incidence of alveolar osteitis.     

Properties of tonic episodes of masseter muscle activity during waking hours and sleep in subjects with and without history of orofacial pain

Purpose

To provide a scientific data related to the tonic activity of masseter muscle in subjects with and without history of orofacial pain during their normal daily life.

Morphological study of the changes after sagittal split ramus osteotomy in patients with facial asymmetry: measurements of 3-dimensional modelling

The effects of bilateral sagittal split ramus osteotomy (BSSRO) on the temporomandibular joint (TMJ) are still not well understood. The aim of this study was to compare the morphological differences among unaffected subjects on the one hand, and patients with facial asymmetry before and after BSSRO on the other. Ten Chinese patients (preoperative and postoperative groups, mean (SD) age 25 (5) years) diagnosed with facial asymmetry and 10 unaffected subjects (control group, mean (SD) age 27 (5) years) were recruited prospectively. The 3-dimensional morphological measurements made on 3-dimensional models in each group were assessed by analysis-of-variance (ANOVA) and Student’s t test, and probabilities of <0.05 were accepted as significant. The horizontal condylar angle (HCA), coronal condylar angle (CCA), sagittal ramus angle (SRA), medial joint space (MJS), lateral joint space (LJS), and superior joint space (SJS) differed significantly between the preoperative and control groups (HCA: p = 0.000, CCA: p = 0.000, SRA(left/undeviated side): p = 0.002, MJS(left/undeviated side): p = 0.000, MJS(right/deviated side): p = 0.007, LJS(right/deviated side): p = 0.000, SJS(left/undeviated side): p = 0.000, SJS(right/deviated side): p = 0.000). The SRA, MJS, LJS, and SJS differed significantly between the preoperative and postoperative groups (SRA(left/undeviated side): p = 0.012, MJS(left/undeviated side): p = 0.002, LJS(right/deviated side): p = 0.021, SJS(left/undeviated side): p = 0.000, SJS(right/deviated side): p = 0.001), And the SRA, MJS, and LJS in the preoperative group differed significantly between the deviated and undeviated side (SRA: p = 0.006; MJS: p = 0.003; LJS: p = 0.011). However, there were no significant differences in the postoperative and control groups between the deviated and undeviated sides. BSSRO improved the asymmetrical morphology of the TMJ and alleviated the symptoms.     

Use of a microvascular coupler device for end-to-side venous anastomosis in oral and maxillofacial reconstruction

The aim of this study was to compare the use of a microvascular coupler device (MCD) for end-to-side venous anastomosis (ETS group) and phleboplasties combined with MCD for end-to-end venous anastomosis (ETE group) in free tissue transfer for oral and maxillofacial reconstruction, with regard to the anastomosis time and occurrence of postoperative vascular crisis. The ETS group included 22 patients and the ETE group included 40 patients. Patient demographic data, anastomotic time, coupler size, microvascular complications, and flap survival rates were collected and analyzed. In the ETS group, the most suitable donor vessel size was greater than 2 mm, varying from 2 mm to 4 mm. The average anastomosis time was 3.35 ± 0.89 min in the ETS group and 7.80 ± 2.93 min in the ETE group; the difference between the groups was statistically significant (p < 0.0001). There were no statistically significant differences in complications or outcomes between the two groups. The ETS venous anastomosis with MCD technique is a better choice for anastomosis when the donor vessel size is greater than 2 mm. In those cases with mismatched veins, ETS venous anastomosis with MCD could significantly reduce the anastomosis time compared to ETE venous anastomosis with MCD after phleboplasties.     

Apical U-shape splitting technique for undercut areas of the anterior alveolar ridge: a prospective non-randomized controlled study

The aim of this study was to investigate a novel apical U-shape splitting technique for horizontal bone augmentation in undercut areas and to compare its efficacy with that of guided bone regeneration (GBR). This was a prospective non-randomized controlled clinical trial. A total of 36 patients, who presented with a labial undercut that was not able to house a normally inclined implant, underwent the new technique or GBR. Radiographic and clinical data were obtained preoperatively, immediately after surgery, and 12 months after surgery. Pairwise comparisons of changes in ridge width gain, marginal bone loss, and pink aesthetic score were performed; correlations with pristine ridge morphology were investigated. The results showed similar marginal bone loss in the two groups. The overall ridge width gains in the new technique group (2.56 ± 1.92 mm) and GBR group (0.73 ± 1.21 mm) differed significantly (P < 0.05). The pink aesthetic score was higher for the new technique group (11.75 ± 1.22) than for the GBR group (9.25 ± 1.86) (P < 0.01). The morphology of the concavity had different impacts on regeneration in the two groups. The apical U-shape splitting technique, as a safe and effective alternative to GBR, provided a significant increase in bone volume gain where labial fenestration was inevitable during implant placement.     

Surface morphology of silicone soft relining material after mechanical and chemical cleaning

Purpose

The objective was to investigate the influence of chemical and mechanical cleaning on the surface morphology of a silicone soft relining material.