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    20 May 2022, Volume 30 Issue 5
    Expert Forum
    Sequential treatment and prognostic factors of traumatic root fracture in permanent anterior teeth
    CHEN Lei, WANG Yingying
    2022, 30(5):  305-313.  DOI: 10.12016/j.issn.2096-1456.2022.05.001
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    Root fracture is a kind of dental trauma involving dentin, cementum, pulp tissue, periodontal membrane ligament and even the surrounding alveolar bone. It occurs frequently between the ages of 10-20, mostly in the area of the maxillary anterior teeth with high aesthetic requirements. The treatment goal for root fracture in permanent teeth is to maintain the physiological and functional integrity of the tooth as much as possible and to reduce the incidence of complications. Clinicians usually classify the affected teeth according to the position of the root fracture, including the apical, mid-root, cervical-mid-root and cervical segments, since it determines the treatment plan and the prognosis of the affected teeth. CBCT examination can avoid misdiagnosis and missed diagnosis of root fracture to the greatest extent. The sequential treatment plan of root fracture after permanent anterior tooth trauma includes initial emergency treatment, pulp vitality monitoring and complication management during follow-up. Emergency treatment mainly includes local anesthesia and repositioning, if displaced, the coronal segment of the tooth as soon as possible. Then, after checking its position radiographically, adjustment occlusion and flexible splinting for 4 weeks (4 months for cervical root fracture). The process of root fracture repair includes many tissues and is affected by many clinical factors. Timely and standardized treatment and close follow-up according to the Dental Trauma Guideline guarantee a good prognosis of root fracture. The closer the root fracture line is to the apex, the higher the survival rate is. In addition to the location of the root fracture line, the prognosis is affected by many other clinical factors, such as the displacement of the coronal fragment of the root fracture, the pathological state of the dental pulp, patient age, developmental stage of the root, timely and good replacement of the root fracture, splinting method, and the presence of other dental trauma complications. Pulp vitality should be monitored regularly, and root canal therapy of the coronal segment should be carried out only when infection of the pulp is established. This article reviews the classification, diagnosis, emergency treatment, sequential follow-up treatment, and prognostic assessment of root fracture trauma to provide suggestions for clinicians to manage root fracture trauma in permanent teeth.

    Basic Study
    D-methionine eradicates Porphyromonas gingivalis biofilms by suppressing the cyclic di-GMP level
    XIE Lili, ZHANG Huiyan, WANG Zixuan, LI Birong, LI Zhen, MENG Weiyan
    2022, 30(5):  314-320.  DOI: 10.12016/j.issn.2096-1456.2022.05.002
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    Objective To investigate the mechanisms by which D-methionine (D-Met) eradicates Porphyromonas gingivalis biofilms by suppressing cyclic dimeric GMP (c-di-GMP) levels. Methods Cell viability, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were measured to determine the effective concentrations of D-Met, which were subsequently used in the following experiments. During the P. gingivalis biofilm formation inhibition experiment and the mature biofilm disassembly experiment, biofilm biomass, exopolysaccharide (EPS), biofilm morphology, integrity of the cell membrane, and the level of c-di-GMP were determined. Results D-Met < 40 mmol/L was biocompatible. During the biofilm formation inhibition and mature biofilm disassembly experiments, D-Met ≥ 20 mmol/L decreased the biofilm biomass and the production of EPS. SEM analysis showed that the extracellular matrix and bacterial density were drastically reduced by D-Met ≥ 20 mmol/L. TEM detection showed that 35 mmol/L D-Met ruptured the cell membrane during biofilm formation and increased the permeability of the cell membrane in the disassembly phase of mature biofilms. C-di-GMP levels decreased with increasing concentrations of D-Met in a concentration-dependent manner. Conclusion D-Met ≥ 20 mmol/L could eradicate P. gingivalis biofilms by suppressing c-di-GMP levels.

    Effects of a red light-emitting diode on the proliferation and osteogenic differentiation of stem cells from the apical papilla
    SU Yutong, HOU Lan, JIANG Bing, ZHENG Genzi, LIU Yuan, WANG Yao
    2022, 30(5):  321-329.  DOI: 10.12016/j.issn.2096-1456.2022.05.003
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    Objective To explore the effects of red LEDs on the proliferation and osteogenic differentiation of human stem cells from apical papilla (hSCAPs). Methods hSCAPs were obtained by isolation, culture and flow cytometry in vitro and irradiated with 1, 3, 5, and 7 J/cm2 red LEDs. The proliferation of hSCAPs was detected using a CCK-8 assay. The osteogenic differentiation of hSCAPs was evaluated using alkaline phosphatase (ALP) staining, ALP activity assay and Alizarin red quantitative detection. The effect of 5 J/cm2 red LEDs on the expression levels of the ALP, Runx2, OCN, OPN and BSP genes and proteins was detected by RT-PCR and western blot, respectively. Results Red LEDs at 1, 3, 5, and 7 J/cm2 promoted the proliferation of hSCAPs (P < 0.05). The effects of red LEDs with different light energies on the proliferation of hSCAPs were different at different time points (P < 0.05). On the 7th and 14th days after irradiation, red LEDs promoted the osteogenic differentiation of hSCAPs, and the effect of 5 J/cm2 red LEDs was the most obvious under osteogenic induction culture conditions (P<0.05). Red LEDs (5 J/cm2) promoted the expression of the ALP, Runx2, OCN, OPN and BSP genes and proteins (P < 0.05). Conclusion Red LEDs promoted the proliferation and osteogenic differentiation of hSCAPs.

    Clinical Study
    Clinical problems and outcome indicators in the expert consensus determined by the Delphi method of 5-aminolevulinic acid photodynamic therapy for the treatment of oral potential malignant diseases
    LIU Zijian, WANG Xing, HAN Ying, LIU Hongwei
    2022, 30(5):  330-337.  DOI: 10.12016/j.issn.2096-1456.2022.05.004
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    Objective To determine the clinical problems and outcome indicators that need to be included in the expert consensus of 5-aminolevulinic acid (ALA) photodynamic therapy in the treatment of oral potential malignant diseases. Methods Based on the relevant literature, the clinical problems and outcome indicators were drafted during the meeting. The Delphi method was used for expert consultation and expert opinion collection. The average and standard deviation of the voting results were calculated to determine the importance of the indicators, and the positive coefficient, variation coefficient and coordination coefficient were calculated for quality control. Results In the first round of the Delphi method, 12 outcome indicators (the main reference elements include photon integral flux, power density, illumination time, and spot diameter were identified; the specific parameters are photon integral flux of 100 J/cm2 and power density of 100-600 mW/cm2. A diode laser of (630 ± 5) nm wavelength should be chosen. The analgesic regimen is local anesthesia supplemented by hypothermia and intermittent laser irradiation before treatment. Lesions with hyperkeratotic require pretreatment. The concentration of ALA administered was set at 20%. Eight clinical problems (main reference elements of photodynamic irradiation dose, specific parameters, choice of light source, evaluation criteria of efficacy, prevention of adverse effects, dosing concentration, whether oral potentially malignant diseases with hyperkeratosis should be pretreated, administration of photosensitizers) were included according to the literature and expert discussion. In the second round, 89 experts completed the questionnaire and gave very important evaluations of 9 outcome indicators (the main reference elements included photon integral flux, power density and illumination time; the specific parameters were a photon integral flux of 100 J/cm 2 and a power density of 100-600 mW/cm2). A diode laser of (630 ± 5)nm wavelength should be chosen. The concentration of ALA administered was set at 20%. Six clinical problems (main reference elements of photodynamic irradiation dose, specific parameters, choice of light source, evaluation criteria of efficacy, dosing concentration, administration of photosensitizers), and the remaining 3 were given important evaluations, with good consistency. Conclusion In this study, the irradiation dose, mode of administration and concentration, evaluation criteria of efficacy, prevention of adverse effects and pretreatment regimen of ALA photodynamic therapy for oral potentially malignant diseases determined by the Delphi method had good agreement among experts.

    Endoscope-assisted subgingival scaling and root planing in the treatment of periodontitis: systematic evaluation of effects
    XU Ruonan, WEI Yiru, LIU Ke, GULINUER Awuti
    2022, 30(5):  338-344.  DOI: 10.12016/j.issn.2096-1456.2022.05.005
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    Objective To evaluate the clinical effect of endoscopic-assisted subgingival scaling and root planning (SRP) in the treatment of periodontitis. Methods PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were searched for randomized controlled trials (RCTs) related to endoscopy-assisted SRP. The search time limit was from the establishment of the database to September 15, 2021. The outcome indicators included in the study included the plaque index (PLI), probing depth (PD), attachment loss (AL), and bleeding index (BI). Review Manager 5.4 and Stata 12.0 software were used for the meta-analysis. Results A total of 111 studies were retrieved, and 5 quantitative studies were included after screening. Meta-analysis showed that for sites with 4 mm ≤ PD < 6 mm, 3 and 6 months after treatment, there was no significant difference in the PD value between the endoscope assisted group and the simple SRP group (P > 0.05); for sites with PD ≥ 6 mm, the PD value of the endoscope assisted group was smaller than that of the simple SRP group 3 and 6 months after treatment. The difference between the two groups was statistically significant (P < 0.05), but there was no significant difference in PLI, Al or BI between the two groups (P > 0.05). Conclusion Compared with simple SRP, the auxiliary use of endoscopy has a better effect on reducing PD in deep periodontal pockets (PD ≥ 6 mm). However, for clinical indicators such as PLI, AL, and BI, there was no difference between the therapeutic effects of the two methods.

    Effect of tension on recovery of the donor site of a modified forearm flap
    WANG Haoran, WANG Ying, GE Liangyu, LI Zhiping, SHAO Cuiling, MENG Jian
    2022, 30(5):  345-349.  DOI: 10.12016/j.issn.2096-1456.2022.05.006
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    Objective To investigate the effect of tension on donor site recovery of modified forearm flaps (closed forearm donor site skin flaps). Methods From October 2018 to April 2021, 12 patients with oral cancer underwent forearm flap repair at Xuzhou Central Hospital. Handgrip strength and wrist motion were recorded before surgery. During the surgical incision at the donor site of the forearm, the triangular full-thickness skin of the donor site was used to close part of the surgical incision, and the other part of the surgical incision was directly closed and sutured. Tension was measured with a tension meter during the surgical incision at the donor site. Patients were followed up after surgery to observe whether there were postoperative complications such as necrosis and poor healing of donor site wounds, as well as forearm grip strength, wrist range of motion and appearance satisfaction. Results Among the 12 patients, there was only one elderly patient with postoperative necrosis near the wrist in the donor site skin, and the average tension of the patient was 0.65 kg; the lesion healed after dressing changes. All of the other patients recovered well without postoperative complications. The mean tension of 12 patients was (0.51 ± 0.05) kg. The preoperative and postoperative grip strength of 12 patients was (23.7 ± 10.3) kg and (22.3 ± 10.7) kg, respectively, and the difference was not statistically significant (t=5.872, P<0.001). The mean range of motion of the wrist was (47.6 ± 8.3)°, (45.8 ± 5.8)°; dorsiflexion (54.6 ± 3.2)°, (53.9 ± 2.3)°; radial deviation (37.0 ± 2.3)°, (36.1 ± 2.2)°; ruler deviation (27.1 ± 1.9)°, (26.4 ± 1.3)°, respectively. The t values were 1.64, 1.636, 2.116 and 1.412, and the P values were 0.129, 0.130, 0.058 and 0.186, respectively. All 12 patients were satisfied with the appearance of the donor site of the forearm. Conclusion When the average tension during suturing is less than 0.5 kg, there is a lower risk of complications at the donor site of the forearm one month after surgery, a lower risk of impaired donor site function, and a greater possibility of patient satisfaction with the appearance of the donor site.

    Adverse drug reactions induced by hydroxychloroquine in the treatment of oral lichen planus: a report of 13 cases
    LIN Yao, HUANG Jing, XUE Xiaojuan, ZHANG Huan, FENG Bin
    2022, 30(5):  350-354.  DOI: 10.12016/j.issn.2096-1456.2022.05.007
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    Objective To analyze the adverse drug reaction(ADR) reports of hydroxychloroquine for clinical medication safety. Methods The ADR reports of hydroxychloroquine between May 2019 and May 2021 were analyzed. Age, reasons for drug use, time of ADR, combined drug use, and ADR outcomes were statistically analyzed. Results No severe ADR was reported. Patients over 60 years old accounted for 53.85% of the total cases, and the time of ADR appearance was significantly earlier among those under 60 years old. A total of 61.54% of ADRs were involved in multiple organs, and optic neurotoxicity was reported in 46.15% of cases. Conclusion In the treatment of oral lichen planus with hydroxychloroquine, adverse drug reactions should be monitored, and increased attention should be given to patients over 60 years old to ensure the safety of this medication.

    Prevention and Treatment Practice
    Cost-effectiveness analysis of the oral health promotion model in rural primary schools in Guangxi Zhuang Autonomous Region
    WU Zhijing, HE Haoyu, YU Xueting, MA Fei, LIU Qiulin, ZENG Xiaojuan
    2022, 30(5):  355-360.  DOI: 10.12016/j.issn.2096-1456.2022.05.008
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    Objective To evaluate the caries preventive effect and economic outcome of an oral health promotion model in rural primary schools in Guangxi Zhuang Autonomous Region. Methods In November 2015, a baseline survey was conducted on the caries prevalence of rural first graders in program areas, and then a program intervention was carried out on the first graders of target primary schools. The intervention methods included the distribution of oral health care products, oral health education, teacher training, etc. In 2020, the method of cluster random sampling was adopted to include the sixth graders who received the program intervention as first graders and were still available in 2020 as the intervention group. During this period, the sixth graders transferred from foreign schools who failed to receive the program intervention as first graders were included in the non-intervention group. The caries preventive effect was evaluated by analyzing the caries epidemiological data of 2 652 children aged 11-13 years, comparing the intervention and non-intervention group. The cost of the program was estimated by the structural analysis method. A decision tree model was established by TreeAge pro2019 and incorporated into the effect parameters and cost parameters for cost-effectiveness analysis and sensitivity analysis. Results The prevalence of caries in the intervention group was 54.8%, and the mean DMFT was 1.36 ± 1.64, both of which were lower than those in the non-intervention group. The difference in prevalence and mean DMFT between the two groups was statistically significant (P < 0.05). It costs CNY 319.83 per child to reduce suffering from caries. The number of patients with caries in the intervention group was the most sensitive indicator of an economic effect. The probability of a cost-effectiveness advantage for the program was 92.2%. Conclusion This oral health promotion model used in rural schools demonstrated a caries preventive effect that was very likely economically advantageous. It is of practical significance to improve and promote this model in the Guangxi Zhuang Autonomous Region.

    Review Articles
    Research progress on the application of artificial intelligence technology in the diagnosis of oral and maxillofacial tumors
    DU Wen, PENG Xin
    2022, 30(5):  361-365.  DOI: 10.12016/j.issn.2096-1456.2022.05.009
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    With the improvement of computer computing capability and the accumulation of a large amount of medical data, artificial intelligence is gradually being applied in the diagnosis of oral and maxillofacial tumors. Artificial intelligence technology can assist doctors in clinical diagnosis and improve the efficiency of clinical work and the accuracy of diagnosis. In recent years, researchers have focused primarily on the recognition of medical images. The commonly used method is to annotate a large number of images by experts for learning image features by machines. The available literature has been able to utilize artificial intelligence technology to diagnose tumors by analyzing medical images, pathological sections, and tumor photos. The main issues in the current research are uneven labeling data quality, small data size, limited research problems, and single data modalities. These problems need to be solved through the continuous improvement of algorithms and the accumulation of high-quality data. The future direction of artificial intelligence applications should be to integrate medical data from multiple sources, assist doctors in diagnosis, and explore a variety of noninvasive and easy-to-use new methods for the early diagnosis of tumors. This may completely change the existing diagnosis and treatment model of oral and maxillofacial tumors.

    Research progress on electrode technology for dental plaque pH detection
    CHE Huiling, HU Shunming, LIN Si, WANG Xuan, HUANG Yuanyuan, YIN Wei
    2022, 30(5):  366-371.  DOI: 10.12016/j.issn.2096-1456.2022.05.010
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    Plaque pH detection technology can detect the risk of caries and assist in the prevention of caries, with a mature theory and a relatively simple operation. With the increasing demand for clinical caries risk detection technology and the rapid development of microelectrode techniques, there is an increasing variety of types of microelectrodes that can detect the pH of dental plaque, including glass microelectrodes, metal oxide microelectrodes and ion-sensitive field effect transistors. The glass microelectrode was the first microelectrode to be applied in this field, but its structure is weak. Among the various options, the iridium oxide microelectrode has become the most promising caries risk detection electrode in recent years because of its high strength and excellent response. Metal oxide microelectrodes can also effectively compensate for the insufficient strength of glass microelectrodes. With advances in electrode technology, miniaturized, sensitive ion-sensitive field effect transistors have attracted the attention of researchers. Scientists have also recently developed a way to detect the pH of dental plaque with an optical no-contact technique. Optical contactless detection technology will not damage the dental plaque structure, so it has great research and clinical prospects. Future research will further improve the strength and performance of these electrodes on the premise of ensuring miniaturization and achieving noncontact detection.

    Research progress on the application of Er: YAG laser removing all-ceramic restorations
    CHEN Youren, LUO Yun, WANG Min, HAO Liang, YUE Yuan
    2022, 30(5):  372-376.  DOI: 10.12016/j.issn.2096-1456.2022.05.011
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    All-ceramic restorations are widely used in oral restoration because of their beauty and high strength. Glass ceramics and zirconia all-ceramic materials are the two most widely used all-ceramic materials in the clinic. However, when all-ceramic restorations need to be removed due to marginal microleakage and secondary caries, its high strength and high bonding strength greatly increase the difficulty of removal. In recent years, clinicians have tried to use Er: YAG lasers to remove all-ceramic restorations. The Er: YAG laser can be safely and efficiently applied to the removal of glass restorations, and it can also play a role in thinner zirconia restorations. Various factors, such as the material and thickness of the all-ceramic restoration, the type of cement, and the laser power, can affect the speed of removal of the Er: YAG laser. However, the current research is limited to case reports and in vitro studies, lacking systematic clinical research. The specific mechanism of Er: YAG laser removal of all-ceramic restorations and the influence of laser frequency, adhesive type, and abutment on the removal speed need to be further demonstrated by follow-up research.

    Research progress on Ti-Cu alloys regulating macrophage polarization
    LOU Jingyang, GENG Xinrong, GAO Huimeng, FAN Dongyang, ZHAO Xin, WANG Qiang
    2022, 30(5):  377-380.  DOI: 10.12016/j.issn.2096-1456.2022.05.012
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    As a new type of antibacterial material, copper-containing titanium alloys have good biological and mechanical properties and are expected to be widely used in clinical orthopedics and dental implants. Macrophages are the main cells that mediate the immune response after the alloy is implanted into the human body, and they directly affect the stability of the alloy in long-term service. Due to the addition of copper, the copper-containing titanium alloy gives the alloy antibacterial properties. On the one hand, this promotes the phagocytosis of macrophages and kills bacteria. On the other hand, copper promotes the polarization activation of macrophages, which then express a variety of cytokines and trigger inflammation in the body. However, at present, there is no definitive conclusion about the type of copper-containing titanium alloys that regulate the polarization of macrophages, and the mechanism of copper ions regulating the polarization of macrophages is still not fully clear. This article summarizes the published studies on the regulation of macrophage polarization by copper-containing titanium alloys and reviews the relevant literature in terms of material types, surface treatments, processing methods, cell culture methods, and culture density. The application of medical copper-containing titanium alloys has prospects. It is hoped that by changing the properties of copper-containing titanium alloys, such as the processing methods or surface treatments, the polarization direction of macrophages can be adjusted, with a view to the design and clinical application of medical copper-containing titanium alloys.