Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders:A case report and review of literature

BACKGROUND The relation between orthodontic treatment and temporomandibular disorders(TMDs)is under debate;the management of TMD during orthodontic treatment has always been a challenge.If TMD symptoms occur during orthodontic treatment,an immediate pause of orthodontic adjustments is recommended;the treatment can resume when the symptoms are managed and stabilized.CASE SUMMARY This case report presents a patient(26-year-old,female)with angle class I,skeletal class II and TMDs.The treatment was a hybrid of clear aligners,fixed appliances and temporary anchorage devices(TADs).After 3 mo resting and treatment on her TMD,the patient’s TMD symptom alleviated,but her anterior occlusion displayed deep overbite.Therefore,the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves.After the levelling,the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion.After careful examination of temporomandibular joints(TMJ)position,the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion.Eventually,the improved facial appearance and relatively stable occlusion were achieved.The 1-year follow-up records showed there was no obvious change in TMJ morphology,and her occlusion was stable.CONCLUSION TMD screening and monitoring is of great clinical importance in the TMD susceptible patients.Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.

Expert consensus on pediatric orthodontic therapies of malocclusions in children

Malocclusion,identified by the World Health Organization(WHO)as one of three major oral diseases,profoundly impacts the dental-maxillofacial functions,facial esthetics,and long-term development of~260 million children in China.Beyond its physical manifestations,malocclusion also significantly influences the psycho-social well-being of these children.Timely intervention in malocclusion can foster an environment conducive to dental-maxillofacial development and substantially decrease the incidence of malocclusion or reduce the severity and complexity of malocclusion in the permanent dentition,by mitigating the negative impact of abnormal environmental influences on the growth.Early orthodontic treatment encompasses accurate identification and treatment of dental and maxillofacial morphological and functional abnormalities during various stages of dental-maxillofacial development,ranging from fetal stages to the early permanent dentition phase.From an economic and societal standpoint,the urgency for effective early orthodontic treatments for malocclusions in childhood cannot be overstated,underlining its profound practical and social importance.This consensus paper discusses the characteristics and the detrimental effects of malocclusion in children,emphasizing critical need for early treatment.It elaborates on corresponding core principles and fundamental approaches in early orthodontics,proposing comprehensive guidance for preventive and interceptive orthodontic treatment,serving as a reference for clinicians engaged in early orthodontic treatment.

Age-related alveolar bone maladaptation in adult orthodontics:finding new ways out

Compared with teenage patients,adult patients generally show a slower rate of tooth movement and more pronounced alveolar bone loss during orthodontic treatment,indicating the maladaptation of alveolar bone homeostasis under orthodontic force.However,this phenomenon is not well-elucidated to date,leading to increased treatment difficulties and unsatisfactory treatment outcomes in adult orthodontics.Aiming to provide a comprehensive knowledge and further inspire insightful understanding towards this issue,this review summarizes the current evidence and underlying mechanisms.The age-related abatements in mechanosensing and mechanotransduction in adult cells and periodontal tissue may contribute to retarded and unbalanced bone metabolism,thus hindering alveolar bone reconstruction during orthodontic treatment.To this end,periodontal surgery,physical and chemical cues are being developed to reactivate or rejuvenate the aging periodontium and restore the dynamic equilibrium of orthodontic-mediated alveolar bone metabolism.We anticipate that this review will present a general overview of the role that aging plays in orthodontic alveolar bone metabolism and shed new light on the prospective ways out of the impasse.

Effects of comprehensive nursing with cognitive behavioral therapy in orthodontic osteodilated arch treatment

BACKGROUND This work explored the effects of cognitive behavior therapy(CBT)-based comprehensive nursing intervention(CNI)mode in arch expansion to treat patients with orthodontic osteodilated arch(OOA).AIM To explore the application effect of CBT-based CNI model in orthodontic expansion arch treatment.METHODS Using convenient sampling method,81 patients with OOA were selected and rolled into a control group(Ctrl group,40 cases)and an observation group(Obs group,41 cases).During the treatment,patients in the Ctrl group received routine nursing intervention mode,and the those in the Obs group received CBT mode on the basis of this.Before and after intervention,the incidence of oral mucositis,the mastery rate of correct arch expansion method,self-rating anxiety scale score,soft scale index,and plaque index were compared for patients in different groups.In addition,satisfaction and complications were comparatively analyzed.RESULTS Incidence of oral mucositis in the Obs group was lower(14.6%vs 38.5%),and the mastery rate of correct arch expansion method was obviously higher(90.2%vs 55.0%)was obviously higher(all P<0.05).Meanwhile,the soft scale index and plaque index in the Obs group were much lower(P<0.05).The compliance(90.24%)and satisfaction(95.12%)in the Obs group were greatly higher(P<0.05).CONCLUSION The CBT-based CNI mode greatly improved the mastery rate of correct arch expansion method during arch expansion in treating patients with OOA and enhanced the therapeutic effect of arch expansion and the oral health of patients,improving the patient compliance.

Effects of interleukin-10 treated macrophages on bone marrow mesenchymal stem cells via signal transducer and activator of transcription 3 pathway

BACKGROUND Alveolar bone defects caused by inflammation are an urgent issue in oral implant surgery that must be solved.Regulating the various phenotypes of macrophages to enhance the inflammatory environment can significantly affect the progression of diseases and tissue engineering repair process.AIM To assess the influence of interleukin-10(IL-10)on the osteogenic differentiation of bone marrow mesenchymal stem cells(BMSCs)following their interaction with macrophages in an inflammatory environment.METHODS IL-10 modulates the differentiation of peritoneal macrophages in Wistar rats in an inflammatory environment.In this study,we investigated its impact on the proliferation,migration,and osteogenesis of BMSCs.The expression levels of signal transducer and activator of transcription 3(STAT3)and its activated form,phos-phorylated-STAT3,were examined in IL-10-stimulated macrophages.Subsequently,a specific STAT3 signaling inhibitor was used to impede STAT3 signal activation to further investigate the role of STAT3 signaling.RESULTS IL-10-stimulated macrophages underwent polarization to the M2 type through substitution,and these M2 macrophages actively facilitated the osteogenic differentiation of BMSCs.Mechanistically,STAT3 signaling plays a crucial role in the process by which IL-10 influences macrophages.Specifically,IL-10 stimulated the activation of the STAT3 signaling pathway and reduced the macrophage inflammatory response,as evidenced by its diminished impact on the osteogenic differentiation of BMSCs.CONCLUSION Stimulating macrophages with IL-10 proved effective in improving the inflammatory environment and promoting the osteogenic differentiation of BMSCs.The IL-10/STAT3 signaling pathway has emerged as a key regulator in the macrophage-mediated control of BMSCs’osteogenic differentiation.

Applications of stem cells in orthodontics and dentofacial orthopedics:Current trends and future perspectives

A simple overview of daily orthodontic practice involves use of brackets, wires and elastomeric modules. However, investigating the underlying effect of orthodontic forces shows various molecular and cellular changes. Also, orthodontics is in close relation with dentofacial orthopedics which involves bone regeneration. In this review current and future applications of stem cells(SCs) in orthodontics and dentofacial orthopedics have been discussed. For craniofacial anomalies, SCs have been applied to regenerate hard tissue(such as treatment of alveolar cleft) and soft tissue(such as treatment of hemifacial macrosomia). Several attempts have been done to reconstruct impaired temporomandibular joint. Also, SCs with or without bone scaffolds and growth factors have been used to regenerate bone following distraction osteogenesis of mandibular bone or maxillary expansion. Current evidence shows that SCs also have potential to be used to regenerate infrabony alveolar defects and move the teeth into regenerated areas. Future application of SCs in orthodontics could involve accelerating tooth movement, regenerating resorbed roots and expanding tooth movement limitations. However, evidence supporting these roles is weak and further studies are required to evaluate the possibility of these ideas.

Periodontally accelerated osteogenic orthodontics with platelet-rich fibrin in an adult patient with periodontal disease:A case report and review of literature

BACKGROUND In the clinical scenario,adult patients with periodontal diseases and dental malformation,characterized by dental crowding in lower anterior teeth with the thin biotype,often require orthodontic treatment.This case report aimed to evaluate the clinical and radiographic outcomes of periodontally accelerated osteogenic orthodontics(PAOO)combined with autologous platelet-rich fibrin(PRF)in an adult patient with class I malocclusion along with dental crowding,a thin periodontal biotype,and buccal plate deficiency.CASE SUMMARY A 32-year-old female complaining of dental crowding and gingival bleeding was referred to the orthodontic clinic.The patient underwent periodontal risk assessment prior to orthodontic treatment.She was diagnosed with a high risk of gingival recession due to dental crowding,root prominence,loss of buccal plates,and a thin gingival tissue biotype.The treatment regimen included PAOO combined with autologous PRF for alveolar augmentation and interproximal enamel reduction for moderate dental crowding.Clinically,PAOO-assisted orthodontic tooth movement in this case showed enhanced periodontium remodeling.Radiographic outcomes also showed statistically significant improvements(P<0.01)in the mandibular buccal alveolar bone.CONCLUSION This case report suggests the combination of autologous PRF with PAOO to enhance bone augmentation and long-term tissue support in adult orthodontic patients with periodontal disease.

Role of third molars in orthodontics

The role of third molars in the oral cavity has been extensively studied over the years. Literature includes numerous diagnostic and treatment alternatives regarding the third molars. However, an issue that has not been discussed at the same level is their involvement in orthodontic therapy. The aim of this study is to present a review of the contemporary literature regarding the most broadly discussed aspects of the multifactorial role of third molars in orthodontics and which are of general dental interest too.

Effect of maxillary expansion on orthodontics

Objective:To explore the effect of maxillary expansion on orthodontics.Methods:Eight beagle dogs were randomly divided into two groups,with 4 dogs in each group.Dogs in group1 were executed immediately and received the direct physical measurement.The magnetic expansion appliance was used in group 2 for the maxillary expansion.After the expansion,the model was taken again and they were executed after cone beam CT(CBCT) scanning.The model measurement method was adopted in group 1 to measure the dental measurement indicators and width of base bone arch.The CBCT measurement method was employed to measure the above dental indicators and bone indicators.The difference in the indicators measured by different methods was compared and analyzed.Results:Before the expansion,there was no significant difference in the bone measurement indicators between the CBCT measurement method and direct physical measurement method.After the expansion,there was no significant difference in indicators between the CBCT measurement method and direct physical measurement.But there was significant difference among the model measurement method,CBCT measurement method and direct physical measurement method.There was the significant difference in the dental indicators between the CBCT measurement method and model measurement,as well as the bone indicators of posterior marginal spacing of greater palatine foramen,posterior marginal spacing of incisive foramen,width of base bone arch and spacing of implant anchorage.Conclusions:There is no significant difference between the effect of CBCT measurement method and direct physical measurement method,but CBCT is significantly better than the model measurement.

Craniofacial therapy:advanced local therapies from nano-engineered titanium implants to treat craniofacial conditions

Nano-engineering-based tissue regeneration and local therapeutic delivery strategies show significant potential to reduce the health and economic burden associated with craniofacial defects,including traumas and tumours.Critical to the success of such nano-engineered non-resorbable craniofacial implants include load-bearing functioning and survival in complex local trauma conditions.Further,race to invade between multiple cells and pathogens is an important criterion that dictates the fate of the implant.In this pioneering review,we compare the therapeutic efficacy of nano-engineered titanium-based craniofacial implants towards maximised local therapy addressing bone formation/resorption,soft-tissue integration,bacterial infection and cancers/tumours.We present the various strategies to engineer titanium-based craniofacial implants in the macro-,micro-and nano-scales,using topographical,chemical,electrochemical,biological and therapeutic modifications.A particular focus is electrochemically anodised titanium implants with controlled nanotopographies that enable tailored and enhanced bioactivity and local therapeutic release.Next,we review the clinical translation challenges associated with such implants.This review will inform the readers of the latest developments and challenges related to therapeutic nano-engineered craniofacial implants.

Fabrication of chitosan/silica hybrid coating on AZ31 Mg alloy for orthopaedic applications

Biocompatible conversion of chitosan and chitosan/silica hybrid coating were prepared to enhance the biocompatibility and corrosion resistance of biodegradable AZ31 Mg alloy. The coatings were optimized and analysed with potentiodynamic polarization, SEM, ATR-IR and XPS studies. Potentiodynamic polarization studies, revealed that the coatings exhibited high corrosion resistance. The surface morphology of the Ch-3/Si coating showed small globular rough structure. The presence of functional groups was confirmed by ATR-IR. For a better understanding of chitosan/silica hybrid coating, the chemical states were examined by XPS studies. The in-vitro bioactivity of the coated samples was evaluated in Earle’s solution, which formed a dense layer of coral-like structure and calcium-deficient apatite with less stoichiometric ratio than the hydroxyapatite. In-vitro cell culture studies exhibited a good cell proliferation rate and the fabricated Ch-3/Si coating was found to be non-hemolytic. The bacterial studies proved that Ch-3/Si coating possessed inherent antibacterial activity.

Microbiological Advances in Orthodontics:An Overview and Detailed Analysis of Temporary Anchorage Devices

Dental biofilm is the initiating factor of oral diseases,such as periodontitis and caries.Orthodontic treatment could alter the microbiome structure balance,and increase the risk of such diseases.Furthermore,fixed appliances can induce temporary changes in the microbiome community,and the changes that clear aligners bring are smaller by comparison.Temporary anchorage devices(TADs)are skeletal anchorages that are widely used in orthodontic treatment.Microorganisms affect the occurrence and development of inflammation surrounding TADs.At present,existing researches have verified the existence of plaque biofilm on the surface of TADs,but the formation of plaque biofilm and plaque composition under different stable conditions have not been fully understood.The development of high-throughput sequencing,molecular biology experiments,and metabonomics have provided new research ideas to solve this problem.They can become an effective means to explore the microbiome surrounding TADs.

Study of the inflammatory activating process in the early stage of Fusobacterium nucleatum infected PDLSCs

Fusobacterium nucleatum(F.nucleatum)is an early pathogenic colonizer in periodontitis,but the host response to infection with this pathogen remains unclear.In this study,we built an F.nucleatum infectious model with human periodontal ligament stem cells(PDLSCs)and showed that F.nucleatum could inhibit proliferation,and facilitate apoptosis,ferroptosis,and inflammatory cytokine production in a dose-dependent manner.The F.nucleatum adhesin Fad A acted as a proinflammatory virulence factor and increased the expression of interleukin(IL)-1β,IL-6 and IL-8.Further study showed that Fad A could bind with PEBP1 to activate the Raf1-MAPK and IKK-NF-κB signaling pathways.Time-course RNA-sequencing analyses showed the cascade of gene activation process in PDLSCs with increasing durations of F.nucleatum infection.NFκB1 and NFκB2 upregulated after 3 h of F.nucleatum-infection,and the inflammatory-related genes in the NF-κB signaling pathway were serially elevated with time.Using computational drug repositioning analysis,we predicted and validated that two potential drugs(piperlongumine and fisetin)could attenuate the negative effects of F.nucleatum-infection.Collectively,this study unveils the potential pathogenic mechanisms of F.nucleatum and the host inflammatory response at the early stage of F.nucleatum infection.

Treatment of severe open bite and mandibular condyle anterior displacement by mini-screws and four second molars extraction:A case report

BACKGROUND Temporomandibular joint(TMJ)disorders are closely related to high-angle and skeletal Class II malocclusion.Sometimes pathological changes in the mandibular condyle can cause open bite to occur after growth is complete.CASE SUMMARY This article is about the treatment of an adult male patient with a severe hyperdivergent skeletal Class II base,an unusual and gradually occurring open bite and an abnormal mandibular condyle anterior displacement.Because the patient refused surgery,four second molars with cavities and root canal therapy were extracted,and four mini-screws were used for intrusion of the posterior teeth.The treatment duration was 22 mo,and after the treatment,the open bite was corrected and the displaced mandibular condyles were seated back to the articular fossa as shown by cone-beam computed tomography(CBCT).Based on the patient’s open bite history,the result of clinical examinations and CBCT comparisons,we believe it is possible that the occlusion interference was eliminated after the four second molars were extracted and the posterior teeth were intruded,and the patient's condyle spontaneously returned to its physiologic position.Finally,a normal overbite was established,and stable occlusion was achieved.CONCLUSION This case report suggested that identifying the cause of open bite is essential,and the TMJ factors for hyperdivergent skeletal Class II cases should be particularly examined.For these cases,intruding posterior teeth may place the condyle in a more appropriate position and provide an environment suitable for TMJ recovery.

The transcriptome analysis of cleft lip/palate-related PTCH1 variants in GMSM-K cells show carcinogenic potential

Cancer progression involves the sonic hedgehog(SHH)pathway,in which the receptor PTCH1 actives the downstream pathways.Dysfunction of PTCH1 can lead to nevoid basal cell carcinoma Syndrome(NBCCs)including neoplastic disease and congenital disorder.To evaluate the relationship between PTCH1 and cancer,we applied the CRISPR/Cas9 system to knock out PTCH1 in oral nontumorous epithelial cells(GMSM-K).Then we screened six PTCH1 variants associated with cleft lip/palate(CL/P),one of the congenital disorders in NBCCs,and generated PTCH1 variant and wild-type recombinant PTCH1^(−/−)GMSM-K cell lines.Transcriptome sequencing was conducted in these cell lines.The results revealed that differentially expressed genes(DEGs)in PTCH1^(−/−)GMSM-K were enriched in extracellular compartments,contributing epithelial diseases by pathway enrichment analysis.RT-PCR confirmed that KRT34,KRT81,KRT86,PDGFB,and WNT10B genes,associated with extracellular compartments were highly expressed in PTCH1^(−/−).The Kyoto Encyclopedia of Genes and Genomes analysis also suggested that DEGs are closely related to focal adhesion,transcriptional misregulation,and proteoglycans in breast and gastric cancers.Comparative analysis of samples revealed that the CL/P-associated PTCH1 variants A443G and V908G are potentially carcinogenic.These findings provide new insights into the carcinogenic potential of PTCH1 dysfunction.

Molecular events in the jaw vascular unit:A traditional review of the mechanisms involved in inflammatory jaw bone diseases

Inflammatory jaw bone diseases are common in stomatology,including periodontitis,peri-implantitis,medication-related osteonecrosis of the jaw,radiation osteomyelitis of the jaw,age-related osteoporosis,and other specific infections.These diseases may lead to tooth loss and maxillofacial deformities,severely affecting patients'quality of life.Over the years,the reconstruction of jaw bone deficiency caused by inflammatory diseases has emerged as a medical and socioeconomic challenge.Therefore,exploring the pathogenesis of inflammatory diseases associated with jaw bones is crucial for improving prognosis and developing new targeted therapies.Accumulating evidence indicates that the integrated bone formation and dysfunction arise from complex interactions among a network of multiple cell types,including osteoblast-associated cells,immune cells,blood vessels,and lymphatic vessels.However,the role of these different cells in the inflammatory process and the'rules'with which they interact are still not fully understood.Although many investigations have focused on specific pathological processes and molecular events in inflammatory jaw diseases,few articles offer a perspective of integration.Here,we review the changes and mechanisms of various cell types in inflammatory jaw diseases,with the hope of providing insights to drive future research in this field.

Registration of the Seated Condylar Position (SCP/CR): Part I: Rationale

The purpose of this paper is to present the rationale for registration of the Seated Condylar Position (SCP)/Centric Relation (CR) position of the condyles.

Registration of the Seated Condylar Position (SCP/CR): Part II: Technique: The Two-Piece Wax Bite Registration

The purpose of this paper is to present the technique for registration of the Seated Condylar Position (SCP)/Centric Relation (CR) position of the condyles: a two-piece wax bite registration with deprogramming and no mandibular manipulation.

A novel mutation in ROR2 led to the loss of function of ROR2 and inhibited the osteogenic differentiation capability of bone marrow mesenchymal stem cells(BMSCs)

Receptor tyrosine kinase-like orphan receptor 2(ROR2)has a vital role in osteogenesis.However,the mechanism underlying the regulation of ROR2 in osteogenic differentiation is still poorly comprehended.A previous study by our research group showed that a novel compound heterozygous ROR2 variation accounted for the autosomal recessive Robinow syndrome(ARRS).This study attempted to explore the impact of the ROR2:c.904C>T variant specifically on the osteogenic differentiation of BMSCs.Methods:Coimmunoprecipitation(CoIP)-western blotting was carried out to identify the interaction between ROR2 and Wnt5a.Double-immunofluorescence staining was used for determining the expressions and co-localization of ROR2 and Wnt5a in bone marrow mesenchymal stem cells(BMSCs).Western blot(WB)analysis and quantitative reverse transcription polymerase chain reaction(RT-qPCR)were conducted to identify the expression levels of ROR2 in the BMSCs transfected with LV-shROR2 or LV-ROR2-c.904C>T.The alkaline phosphatase(ALP)activity was detected,and Alizarin Red S staining was done for evaluating the osteogenic differentiation of BMSCs.RT-qPCR was employed to identify the expression of the sphingomyelin synthase 1(SMS1)mRNA in the BMSCs transfected with LV-shROR2 or LV-ROR2-c.904C>T and the mRNA expression levels of Runt-related transcription factor 2(RUNX2),osteocalcin(OCN),and osteopontin(OPN).WB was performed to confirm the protein expressions of extracellular regulated protein kinases1(ERK),P-ERK,Smad family member1/5/8(Smad1/5/8),P-Smad1/5/8,P-P38,P38,RUNX2,OCN,and OPN in the BMSCs transfected with LV-shROR2/LV-ROR2-c.904C>T and sphingomyelin(SM).Results:The ROR2:c.904C>T mutant altered the subcellular localization of the ROR2 protein,which caused an impaired interaction between ROR2 and Wnt5a.The depletion of ROR2 restricted the osteogenic differentiation capability of BMSCs and downregulated the expression of SMS1.SM treatment could reverse the inhibition of osteoblastic differentiation in ROR2-depleted BMSCs.Conclusion:The findings of this work revealed that the ROR2:c.904C>T variant led to the loss of function of ROR2,which impaired the interaction between ROR2 and Wnt5a and also controlled the osteogenic differentiation capability of BMSCs.Furthermore,SM was revealed to be engaged in the osteoblastic differentiation of BMSCs regulated by ROR2,which renders SM a potential target in the therapy for ARRS.

Etiology, Prevalence, and Management of Oral and Maxillofacial Soft Tissue Injuries in Children at the Komfo Anokye Teaching Hospital, Kumasi-Ghana

Background: Maxillofacial injury may vary from simple soft tissue lacerations to complex fractures of the orofacial region. Soft tissue injuries, whether isolated or in combination with other injuries, form part of the frequent traumatic craniofacial injuries seen at the emergency department. The force of impact and the injury type is directly related to the severity of the injury sustained. This study aimed to analyze the etiological factors, prevalence, and management of oral and maxillofacial soft tissue injuries at the Komfo Anokye Teaching Hospital. Methods: This was a prospective study that involved children presenting with oral and maxillofacial injuries at the Accident and Emergency Department and the Oral and Maxillofacial Surgery unit of the Komfo Anokye Teaching Hospital in Kumasi between the period of April to October 2020 (6 months). Patient selection was by convenience sampling targeting all children with injuries who met the inclusion criteria. Inclusion criteria were children below the age of 18 years whose parents or caregivers consent to participation. Children with maxillofacial injuries as a result of burns were excluded from the study. Results: During the study period a total of 134 children were reviewed with oral and maxillofacial injuries at KATH. Of these, 107 (78.9%) were recorded cases of orofacial soft tissue injuries. There were 63 (58.9%) males and 44 (41.1%) females and the male-to-female ratio was 1.5:1. The age range of patients studied was 8 months – 17 years, with mean age ± SD being 9.5 ± 5.3 years. Road Traffic Crash (50.5%) was the most common etiology of which Motor cycle crash constituted 24.3% and Pedestrian knockdown was 19.6%. Falls (42.1%) were the next most common etiology. The lips (19.8%) and the forehead (18.5%) were the most frequently injured sites on the face whiles the tongue (3.3%) had the most injuries intraorally. Laceration (45.7%) was the most frequent injury reviewed, followed by abrasions (35.8%). Most of the soft tissue injuries underwent primary closure (56.3%). A complication rate of 21.2% was recorded in this study and hypertrophic scarring (11.3%) was the most observed.