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  • Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 400-400.
  • Expert Forum
    PENG Xin, ZHANG Wenbo
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 401-410. https://doi.org/10.12016/j.issn.2096-1456.2024.06.001

    Oral and maxillofacial tumors are common oral and maxillofacial surgery-related diseases. Digital surgical technology, represented by virtual surgical design and surgical navigation, is the main auxiliary means of the surgical diagnosis and treatment of oral and maxillofacial tumors. However, the existing digital technology still has some problems and room for improvement in terms of 3D visualization imaging and intraoperative hand-eye coordination. At present, the application of 3D visualization technology represented by mixed-reality technology has been rapidly developing in the medical field. It assists in realizing the real-time stereoscopic presentation of medical images by superimposing 3D virtual images onto the real surgical environment. Mixed-reality technology has been gradually applied to the diagnosis and treatment of oral and maxillofacial tumors. Preoperatively, mixed-reality technology can be used to construct a 3D model of the tumor and its surrounding vital structures based on imaging data, at which point the medical team can personalize the preoperative assessment and design the surgical plan in the mixed-reality environment. Intraoperatively, the combination of mixed-reality technology and surgical navigation technology can be used to display the 3D virtual model in real time in the actual environment of the operation area, overcoming the hand-eye coordination problem associated with using navigation technology alone and further improving the accuracy and safety of oral and maxillofacial tumor surgery. The combination of mixed-reality technology and internet medical technology can provide a high-quality teaching platform to promote the development of regional oral and maxillofacial surgery practices. The limitations of mixed-reality technology include image occlusion, lack of accuracy when used alone, and long alignment times. In this review, the application of mixed-reality technology to the diagnosis and treatment of oral and maxillofacial tumors will be summarized and assessed by combining information from domestic and international literature reports with the practical clinical experience of the author group.

  • Basic Study
    TONG Qiaoying, SHAO Bo, XU Yingjie, JIA Mengying, MA Youyi, GONG Zhongcheng
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 411-419. https://doi.org/10.12016/j.issn.2096-1456.2024.06.002

    Objective To investigate the effect of fluid flow shear stress (FFSS) on the fluid mechanic threshold of high-mobility group box 1 (HMGB1) release by synovial cells and chondrocytes. Moreover, the mechanism of chondrocyte and synovial cell damage induced by abnormal mechanical force was investigated to provide an experimental basis for exploring the pathogenesis and pathology of temporomandibular joint osteoarthritis. Methods With the approval of the Ethics Committee for Animal Experiments of the hospital, synovial tissue and cartilage tissue blocks were obtained from the knee joints of Sprague-Dawley (SD) rats, and synovial cells and chondrocytes were cultured and digested for subsequent experiments. Synovial cells and chondrocytes of 3-4 generations were acquired, and FFSS was applied to synovial and cartilage cells using a fluid shear mechanical device. The cells were divided according to the FFSS values of different sizes. Synovial cells were stimulated for 1 h with 1, 3, 5, or 10 dyn/cm2 of FFSS, and chondrocytes were stimulated for 1 h with 4, 8, 12, or 16 dyn/cm2 of FFSS. Resting cultures (0 dyn/cm2) were used as the control group. Changes in the morphology of the cells were observed. The expression and distribution of HMGB1 and interleukin-1β (IL-1β) were observed by immunohistochemistry. The expression of HMGB1 and IL-1β in the supernatant was analyzed by ELISA. The protein expression levels of intracellular HMGB1 and IL-1β were detected by Western blot. Results With increasing FFSS, the synovial cells and chondrocytes gradually swelled and ruptured, and the number of cells decreased. With increasing FFSS, the localizationof HMGB1 and IL-1β gradually shifted from the nucleus to the cytoplasm. In synovial cells, compared with those in the control group, the expression levels of HMGB1 and IL-1β were increased both in the supernatant and cells in the 1, 3, 5 and 10 dyn/cm2 intervention groups (P<0.01). In chondrocytes, compared with those in the control group, the expression levels of HMGB1 in the supernatant were increased in the 4, 12 and 16 dyn/cm2 intervention groups (P<0.05), and the protein expression levels of HMGB1 were significantly increased (P<0.01). The expression levels of HMGB1 in the supernatant were significantly increased in the 8 dyn/cm2 intervention groups (P<0.01); however, the protein expression levels of HMGB1 were significantly decreased. Compared with those in the control group, the expression levels of IL-1β in the supernatant gradually increased in the 4, 8, 12 and 16 dyn/cm2 intervention groups (P<0.01). With the exception of those in the 4 dyn/cm2 group, the protein expression levels of IL-1β gradually increased with increasing FFSS (P<0.05). Conclusion With increasing FFSS, synovial cells and chondrocytes gradually swelled and burst, and the hydromechanical thresholds of HMGB1 release were 1 dyn/cm2 and 8 dyn/cm2, respectively. Therefore, upon stimulation with a mechanical force, synovial damage was damaged before chondrocytes.

  • Basic Study
    ZHOU Keying, LI Yanping, LI Haiqing, HE Lina, PAN Shuang, NIU Yumei
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 420-427. https://doi.org/10.12016/j.issn.2096-1456.2024.06.003

    Objective To explore the effect of Morinda citrifolia juice (MCJ) combined with ethylene diamine tetraacetic acid (EDTA) on premolar bonding strength and nanoleakage and compare the results with those of the most commonly used root canal irrigation solution, sodium hypochlorite (NaClO), to provide a reference for clinical application. Methods This study was approved by the ethics review committee. Sixty-three human premolars extracted for orthodontic treatment were randomly divided into a control group (distilled water group) and 6 experimental groups according to the different rinsing solutions used after the surface enamel was removed. The experimental groups included Group A (2.5% NaClO), Group B (5.25% NaClO), Group C (6% MCJ), Group D (2.5% NaClO-17% EDTA), Group E (5.25% NaClO-17% EDTA), and Group F (6% MCJ-17% EDTA) (n = 9). After soaking in the corresponding rinsing solution for 20 minutes, they were layered and stacked on their surfaces to form 4 mm × 4 mm × 3 mm Z350 resin blocks. Six samples from each group were cut into 1 mm × 1 mm × 8 mm specimen strips for microtensile bonding strength testing. The fracture type was determined under a stereomicroscope, and the remaining 3 samples from each group were aged and cut into 1 mm thick slices for interface nanoleakage testing and scanning electron microscopy observation of the resin dentin bonding interface. Results There were significant differences in the microtensile bonding strength among the groups (P<0.05), and the control group had the highest bonding strength. Among experimental groups, Group B had the lowest bonding strength, mainly bonding interface fracture, and Group F had the highest bonding strength, mainly mixed fracture. There were significant differences in nanoleakage among all groups (P<0.05), and the control group had the lowest nanoleakage value. Among experimental groups, Group B had the highest nanoleakage, with resin protrusions being unaltered, and Group F had the lowest nanoleakage value, with resin protrusions being thick and dense. Conclusion The higher the concentration of NaClO was, the worse the bonding strength and edge sealing of the crown dentin were. The effects of root canal irrigation with MCJ and EDTA on the adhesive strength and edge sealing of crown dentin were less pronounced than those of root canal irrigation with NaClO and EDTA.

  • Clinical Study
    ZHOU Ying, XU Yafen, LUO Fen, HU Zhiyong, YANG Ruiting, ZHANG Jie
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 428-435. https://doi.org/10.12016/j.issn.2096-1456.2024.06.004

    Objective To analyze the ability of micro-implant nails placed in different locations in the posterior region to improve the hard and soft tissues of the labiodental region in patients with gummy smiles to provide a reference for clinicians. Methods This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Thirty young female patients with anterior tooth protrusions and gummy smiles were included in the retrospective study; 18 patients had micro-implant nails implanted between the premolars (group A), and 12 patients had implant nails placed between the roots of the premolar and the molar and an intraoperatively placed rocking-chair archwire (group B). The preoperative and postoperative distances from the incisal end of the upper mesial incisors to the lower point of the upper lip (U1-Stms), the vertical distance from the incisal end of the upper mesial incisors to the palatal plane (U1-PP), the vertical distance from the point of the alveolar ridge to the palatal plane (Spr-PP), the distance from the incisal end of the upper mesial incisors to the point of the alveolar margin (U1-Spr), and the vertical distance from the point of the proximal middle buccal cusp of the maxillary first molar to the palatal plane of the maxillary first molar (U6-PP) were measured in the cephalometric lateral radiographs of the two groups; additionally, the amount of hard and soft tissues of the upper anterior region exposedduring smiling and the maximum amount of gingiva exposed during smiling were assessed from the smile photograph. Results After correction, the lip-dentition relationship improved significantly in both groups, with an average reduction of 2.6 mm in U1-Stms, 2.4 mm in U1-PP, 1.4 mm in Spr-PP, and 0.9 mm in U1-Spr in Group A. In group B, the U1-Stms was reduced by an average of 2.3 mm, the U1-PPs by an average of 1.6 mm, the Spr-PPs by 1.4 mm, and the U1-Spr by 0.2 mm. The difference between pre- and postoperative U6-PP in both groups was not significant (P>0.05). Group A had greater ∆U1-PP and ∆U1-Spr changes than group B(P<0.05). There was no difference between the two groups in terms of ∆U1-Stms or ∆Spr-PP (P>0.05). The amount of soft and hard tissue exposed and maximum amount of gingiva exposed in the upper anterior region of the smile were reduced in 30 patients postoperatively, with group A having anaverage reduction of 70.19% of the preoperative amount of soft and hard tissue exposed in the upper anterior region and an average reduction of 24.12% of the preoperative maximum amount of gingiva exposed, and group B having an average reduction of 76.12% of the preoperative amount of hard and soft tissue exposed in the upper anterior region and an average reduction of 31.88% of the preoperative maximum gingiva exposed after the operation. The difference in the ratio between the two groups was not statistically significant (P>0.05). Conclusion For patients with proptosis and gummy smiles, placing micro-implant nails between the roots of maxillary premolars can effectively lead to retraction and intrusion of anterior teeth to improve the lip-dentition relationship and improve gummy smile, and placing micro-implant nails between the roots of the maxillary second premolar and the first molar together with the use of rocking chair arches can also achieve a good therapeutic effect.

  • Clinical Study
    GUHAIERNISHA·Kaihereman, WULAN·Jinensi, YAO Zhitao
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 436-443. https://doi.org/10.12016/j.issn.2096-1456.2024.06.005

    Objective To investigate the associations of multiple immunoinflammatory markers in peripheral blood before and after operation, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI), with postoperative recurrence and metastasis in oral squamous cell carcinoma (OSCC) patients, to provide a reference for predicting the prognosis of OSCC patients. Methods This study was approved by the hospital ethics committee, and informed consent was obtained from the patients. A total of 160 patients with primary OSCC who underwent radical surgery were grouped according to preoperative lymph node metastasis, degree of differentiation, clinical T stage, and postoperative recurrence and metastasis. The last preoperative and 1-month postoperative routine blood test results of all the patients were collected to analyze the relationship between peripheral blood inflammatory indicators, including the NLR, PLR, LMR, SII, and SIRI, before and after surgery.The above clinicopathological indicators and postoperative recurrence and metastasis were evaluated in OSCC patients. Results Among the 160 patients, there was a significant difference in the preoperative SII between the preoperative lymph node metastasis group and the no metastasis group (P<0.05); the preoperative NLR, LMR, SII and SIRI were significantly different among the different differentiation degree groups (P<0.05); and the preoperative SIRI in the different clinical T stage groups were significantly different (P<0.05). The preoperative NLR, SII and SIRI were significantly different between the postoperative recurrence and metastasis group and the no recurrence and metastasis group (P<0.05). Postoperative peripheral blood inflammatory markers were not associated with postoperative metastasis and recurrence. Univariate Cox analysis revealed that among the preoperative peripheral blood inflammatory indicators, the preoperative NLR, PLR, SII and SIRI were the factors influencing recurrence and metastasis in OSCC patients. Multivariate Cox analysis revealed that the preoperative NLR was the only independent risk factor for recurrence and metastasis in OSCC patients among the preoperative peripheral blood inflammatory indicators. Conclusion Among the peripheral blood inflammatory indicators, the preoperative NLR is an independent risk factor for postoperative recurrence and metastasis in OSCC patients and has certain predictive value.

  • Clinical Study
    LIU Xin, DING Ziling, YANG Xiaoyu, LIU Chufeng, LIANG Zhonglang, HUANG Leyi
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 444-450. https://doi.org/10.12016/j.issn.2096-1456.2024.06.006

    Objective To analyze the spatial relationship between the roots of maxillary anterior premolars and the maxillary sinus, thus providing an anatomical basis for timing, planning, surgical approaches, and implant selection at this site. Methods Cone beam CT (CBCT) images were collected from 264 patients (aged 20-65 years) who visited the Ruihua Dental Clinic between January 2017 and March 2023. The minimum distance from the apex of the maxillary anterior premolar roots to the lower wall of the maxillary sinus was measured on the coronal plane. The classification of the vertical relationship between the tooth root and the lower wall of the maxillary sinus was performed, and comparisons were made bilaterally, between genders, and among different age groups. Results The minimum distance (Q50) from the apex of the first maxillary premolar root to the lower wall of the maxillary sinus was 7.34 mm for the single-root type, 7.80 mm for the buccal root of the double-root type, and 7.36 mm for the palatal root. For the second maxillary premolar, the median distance was 2.56 mm for the single root type, 1.73 mm for the buccal root type, and 1.23 mm for the palatal root type. There was a significant difference in the shortest distance from the apex of the right second maxillary premolar single root to the lower wall of the maxillary sinus among the different age groups (P<0.05), with the 20-29-year-old group having the smallest median distance (1.52 mm) and the ≥ 40-year-old group having the largest (4.44 mm). There was no significant difference in the effect of sex or laterality on distance (P>0.05). The most common vertical relationship between the apex of the maxillary anterior premolar roots and the lower wall of the maxillary sinus was noncontact. There was no significant difference in the vertical relationship classification between the single-root and double-root types (P>0.05). Conclusion Most maxillary first premolar roots can provide sufficient bone height, which makes it easy to achieve immediate implantation. The maxillary second premolar root frequently involves insufficient bone, which is necessary to make full use of the bone wall of the extraction socket or the sinus floor cortical bone to achieve initial stability. The vertical relationship between the premolar root and maxillary sinus was influenced by age and dental position. Younger age groups often exhibit inadequate bone height, and the indication for immediate implantation should be carefully considered. The number of roots does not significantly affect the relationship between the sinus and root; however, double-rooted premolars offer more support for immediate implantation and socket healing due to the small root diameter and bony separation between the roots.

  • Clinical Study
    WANG Xinlin, TANG Wenjun, JIANG Yiyang, SHI Yan, YAN Ziqi, WANG Dongqing
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 451-456. https://doi.org/10.12016/j.issn.2096-1456.2024.06.007

    Objective To investigate the efficacy of antibacterial photodynamic therapy (aPDT) as an adjunct to subgingival scaling and root planning in the treatment of chronic periodontitis. Methods This study followed medical ethics guidelines, and informed consent was obtained from all patients. Sixteen patients were recruited for this randomized split-mouth controlled trial. The control group underwent subgingival scaling and root planning (SRP), while the experimental group received subgingival scaling and root planing plus aPDT treatment using Perowave® with a toluidine blue O solution photosensitizer. The probing pocket depth (PD), recession, plaque index (PLI), bleeding index (BI) and proportion of positive sites of bleeding on probing (BOP) (BOP%) at all sites were examined at baseline (before treatment) and at 1, 3 and 6 months after treatment. Results Follow-up was completed for 13 patients. On the control side, 356 teeth were tested at 2 136 sites. A total of 360 teeth on the test side and 2 160 sites were included in the study. Before treatment, there was no significant difference in the baseline indicators between the two groups. After treatment, both groups showed significant improvement in clinical parameters, including PD, PLI, BI, and BOP%,compared with baseline. At 3 months, the BOP% and PLI in the experimental group were significantly lower than those in the control group (P<0.05). The improvement in BOP% and PLI in the experimental group was significantly greater than that in the control group 3 months after treatment (P<0.05). Conclusion aPDT, as an adjuvant treatment to SRP for chronic periodontitis, can improve gingival bleeding and control periodontal inflammation in the early stage.

  • Prevention and Treatment Practice
    LIU Siqi, CHEN Yiyang
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 457-462. https://doi.org/10.12016/j.issn.2096-1456.2024.06.008

    Objective To investigate the clinical features, diagnosis and treatment of congenital epulis, to provide a reference for clinical diagnosis and treatment. Methods Two cases of congenital epulis in the mandible and maxilla of a newborn were reported, and the boundary and size of the tumor were determined by ultrasonography and MRI. The tumor was resected under general anesthesia. The previous literature on congenital epulis was reviewed and analyzed. Results Patient 1 (male) had a hard mass of approximately 20 mm × 15 mm × 10 mm in the right mandible immediately after birth. MRI was performed, and the mass was removed. In Patient 2 (female), a mass approximately 24 mm × 23 mm × 20 mm in the oral cavity of the anterior maxillary region was shown on ultrasound at 29 gestational weeks, and the mass grew rapidly in the last trimester. The mass was removed after birth. Postoperative pathological examination revealed congenital epulis. The results of the literature review showed that the incidence of congenital epulis is greater in females than in males, and it mainly occurs in the maxillary incisor area. Congenital epulis does not invade bone and does not affect tooth development. When a mass affects a child's breathing or swallowing, it must be surgically removed in a timely manner. Recent studies have shown that there is no evidence of recurrence after surgical resection. The histological origin and etiology of the disease are not clear. Clinically, it is often necessary to distinguish between teratomas and congenital epulis. Regarding the clinical manifestations, teratomas and congenital epulis are similar in appearance, and the main distinguishing point lies in pathological manifestations. Under the microscope, teratomas are observed as mature or immature tissue from various embryonic layers, while congenital epulis involves tightly arranged, homogeneous, polygonal to microspindle-shaped, medium to large cell compositions of nest-like and ribbon-like cells. Conclusion Congenital epulis is a rare oral tumor in neonates. The diagnosis should be based on the location, age, clinical manifestations, and imaging findings. The final diagnosis depends on pathological examination. When congenital epulis tumors affect children's breathing and eating, they should be surgically removed as soon as possible, and there is almost no recurrence after surgery.

  • Review Articles
    LUO Yuchuan, LI Feifei, YU Fanyuan, YIN Bei, YE Ling
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 463-469. https://doi.org/10.12016/j.issn.2096-1456.2024.06.009

    Histone acetylation and methylation can affect chromatin conformation and regulate a variety of biological activities. Abnormal histone acetylation and methylation modifications are related to the occurrence and development of a variety of oral diseases. Histone acetylation and methylation increase or decrease in an orderly manner to regulate the development of teeth. Fluoride ions can destroy the balance between histone acetylation and methylation, which may be related to the occurrence of dental fluorosis. In addition, histone acetylation and methylation are involved in the regulation of oral inflammatory diseases. In the inflammatory microenvironment, the expression of histone acetyltransferase GCN5 decreases, and the expression of Dickkopf 1 (DKK1) decreases, activating the Wnt/β-catenin pathway and ultimately inhibiting the osteogenic differentiation of periodontal ligament stem cells. Enhancer of zeste homolog 2 (EZH2) and H3K27me3 levels were decreased in inflamed dental pulp tissues and cells. EZH2 inhibition inhibited the expression of interleukin (IL)-1b, IL-6 and IL-8 in human dental pulp cells under inflammatory stimulation. Histone acetylation/methylation modifications can interact with multiple signaling pathways to promote the occurrence and development of oral tumors and are related to the high invasiveness of salivary gland tumors. Small molecule drugs targeting histone acetylation and methylation-related enzymes can regulate the level of histone methylation/acetylation and have shown potential in the treatment of oral and maxillofacial diseases. For example, the histone deacetylase inhibitor vorinostat can inhibit the secretion of inflammation-related cytokines; it also promotes the maturation of odontoblasts and the formation of dentin-related matrix, demonstrating its potential in pulp preservation. Understanding the role of histone acetylation/methylation modifications in the occurrence and development of oral diseases will help promote research on epigenetic modifications in oral diseases and provide new perspectives for disease diagnosis and treatment.

  • Review Articles
    CHEN Yifan, TANG Liangchen, CHEN Min’er, ZHANG Xiao, TANG Kuangyun, LI Zhiyong
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 470-477. https://doi.org/10.12016/j.issn.2096-1456.2024.06.010

    Myogenous temporomandibular disorder (M-TMD) is one of the main subtypes of temporomandibular disorder (TMD) and typically manifests as masticatory myofascial pain; the incidence of TMD has been increasing annually in recent years. Botulinum toxin type A (BTX-A) is a potent neurotoxin produced by Clostridium botulinum. BTX-A inhibits the release of acetylcholine from the presynaptic membrane, thereby blocking neuromuscular junction signaling. The noncosmetic application of BTX-A in the oral and maxillofacial regions is a prominent research topic. In recent years, an increasing number of studies have focused on the application of BTX-A in the treatment of M-TMD. The results of a literature review revealed that an appropriate dose (10-50 U unilaterally) of BTX-A administered in a single injection into the masticatory muscles can effectively treat myalgia over a period of 3-6 months. Common adverse effects, such as masticatory weakness and facial paralysis, are transient and can be avoided by standardized injection techniques. However, there is a lack of standardized guidelines for injection techniques in clinical practice.

  • Review Articles
    YUAN Rui, SI Minmin, ZHANG Yin, FENG Zhiyuan
    Journal of Prevention and Treatment for Stomatological Diseases. 2024, 32(6): 478-484. https://doi.org/10.12016/j.issn.2096-1456.2024.06.011

    In recent years, artificial intelligence (AI), such as image recognition and fixed-point and digital scanning, has been increasingly applied in dental orthodontics. ChatGPT is an emerging artificial intelligence technology that has attracted a considerable amount of attention from people of all walks of life since its introduction. This paper discusses the application potential of ChatGPT in the field of orthodontics from two perspectives—education and clinical practice—and analyzes its limitations. Current reports show that ChatGPT can improve the efficiency of teaching in orthodontic education as well as assist users in completing medical mock exams training, writing papers and conducting academic research, etc. In the clinic, ChatGPT can be used to engage patients in medical dialog, simplify clinical procedures and improve diagnostic and treatment efficiency. However, because ChatGPT is still in the early stages of research and application, there are problems such as insufficient data, inaccurate answers, and poor academic ethics and privacy. In the future, additional studies, training and optimization are needed to ensure the safety, ethics and benefit of AI, laying the foundation for improving the use of AI in the field of orthodontics.