In the Department of Oral and Maxillofacial Surgery, Gunma University Hospital, relatively large radicular cysts extending over 3 or more teeth are treated with a combination of complete excision, endodontic microsurgery and Er: YAG laser irradiation, whereby favorable outcomes have been achieved. The purpose of this report is to describe our surgical procedure and discuss the therapeutic outcomes.Patients between December 2008 and December 2014 with radicular cysts pathologically extending over 3 or more teeth, who were followed up for 1 year or longer, participated in this study.
In this case report the author illustrates a protocol for post-extraction fullarch rehabilitation produced with the use of computerized virtual treatment planning and guided surgery. In a 74-year old man presenting a failed maxillary attachment-retained removable partial denture, a treatment plan focused on the immediate loading of a post-extraction full-arch prosthesis was developed. Starting from prosthetic analysis a modular scan template for CBCT examination was designed, with a 3D simulation software a protocol for guided implants placement and prosthetic rehabilitation was setup. With the support of this procedure, the author performed the extraction of eight teeth, the placement of eight implants (including extraction sites) with flapless approach, and the immediate load of a provisional screw retained prosthesis. At one year follow-up clinical and radiographic results were stable. In selected cases, this protocol may offer significant advantages, including one-day treatment, reduced post-surgical discomfort and immediate improvement in function and aesthetics.
Background: This article reports the treatment of a 15-year old male patient with anterior open bite and a severely narrowed upper dental arch. The young patient complained of occlusal and masticatory dysfunction due to the anterior open bite and difficulties in breathing normally through his nose. Case report: A posterior crossbite was present on both sides. For the correction of the posterior cross-bite, a surgically assisted rapid maxillary expansion and a presurgical straight wire multibracket tooth alignment was applied. The treatment plan included Le Fort I osteotomy and mandibular setback with a sagittal splitting ramus osteotomy. The total treatment time was 36 months, including five months of post-surgical observation. After treatment, a stable occlusion was achieved with a Class I molar relationship and a complete open-bite closure. The patient referred remarkable improvements in breathing. Conclusion: Surgically assisted rapid maxillary expansion and Le Fort 1 osteotomy can be regarded as a safe and effective approach for the treatment of skeletal divergence. Long-term observation of the maxillary arch width after retention is of the utmost importance for the maintenance of a successful treatment outcome. Giovanna Perrotti* Michele Izzo* Laura De Vecchi* Aldo B. Giannì** Massimo Del Fabbro***
We studied the in vivo antitumor effects of interleukin-2 (IL-2) and interferon-β(IFN-β) in combination with chemotherapy on murine syngeneic transplantable squamous cell carcinoma, NR-S 1.Tumors were inoculated subcutaneously by injecting NR-S 1 cells into the back of 5-weekold female C 3 H/He mice. The tumor-bearing mice were divided into eight groups, and the following agents and anticancer drugs were administered:(1) control (saline), (2) IL-2+IFN-β, (3) bleomycin (BLM), (4) cyclophosphamide (CY), (5) cisplatinum (CDDP), (6) BLM+IL-2+IFN-β, (7) CY+IL-2+IFN-β, and (8) CDDP+IL-2+IFN-β.Intratumoral injections of saline or IL-2 +IFN-β and intraperitoneal injections of anticancer drugs were continued daily for 14 days. Treatment effects were estimated by measuring the tumor diameter and calculating the survival rate. Fourteen days after treatment, cytotoxic activities (against YAC-1, P815 and NR-S 1 cells) and their splenocyte phenotypes (Thy1.2, L 3 T 4, Lyt-2, and asialo-GM 1) were determined. The excised tumor tissues were also examined histologically.Although tumor size decreased slightly in the IL-2+IFN-β group, the reductions in size were significantly greater in each of the chemotherapy groups (p<0.05). Furthermore, the combination of chemotherapy and IL-2+IFN-β was much more effective in tumor reduction than the corresponding chemotherapy alone. Survival rate was significantly longer in all experimental groups except for the IL-2+IFN-β group. Tumors disappeared completely in two mice in the BLM+IL-2+IFN-β treatment group, which survived for more than 100 days. NK activity was significantly enhanced in mice treated with CDDP, BLM, or CDDP+IL-2+IFN-β. Although low LAK activity and cytotoxic activity against syngeneic NR-S 1 tumor cells were observed in the IL-2+IFN-β grove or the chemotherapy alone group, both of these activities were enhanced when these treatments were combined. Histological examinations disclosed remarkable infiltration of mononuclear cells and tumor necroses in the chemotherapy +IL-2+IFN-β groups. The infiltrated mononuclear cells predominantly expressed Mac-1 or asialo-GM 1 phenotype.These results suggest that the combination of systemic chemotherapy with local administration of IL-2+IFN-β is feasible for cancer therapy. Furthermore, NK cells may play an important role in both antitumor effect and the prolongation of survival.
We studied the in vivo antitumor effects of interleukin-2 (IL-2) and interferon-β(IFN-β) in combination with chemotherapy on murine syngeneic transplantable squamous cell carcinoma, NR-S 1.Tumors were inoculated subcutaneously by injecting NR-S 1 cells into the back of 5-weekold female C 3 H/He mice. The tumor-bearing mice were divided into eight groups, and the following agents and anticancer drugs were administered:(1) control (saline), (2) IL-2+IFN-β, (3) bleomycin (BLM), (4) cyclophosphamide (CY), (5) cisplatinum (CDDP), (6) BLM+IL-2+IFN-β, (7) CY+IL-2+IFN-β, and (8) CDDP+IL-2+IFN-β.Intratumoral injections of saline or IL-2 +IFN-β and intraperitoneal injections of anticancer drugs were continued daily for 14 days. Treatment effects were estimated by measuring the tumor diameter and calculating the survival rate. Fourteen days after treatment, cytotoxic activities (against YAC-1, P815 and NR-S 1 cells) and their splenocyte phenotypes (Thy1.2, L 3 T 4, Lyt-2, and asialo-GM 1) were determined. The excised tumor tissues were also examined histologically.Although tumor size decreased slightly in the IL-2+IFN-β group, the reductions in size were significantly greater in each of the chemotherapy groups (p<0.05). Furthermore, the combination of chemotherapy and IL-2+IFN-β was much more effective in tumor reduction than the corresponding chemotherapy alone. Survival rate was significantly longer in all experimental groups except for the IL-2+IFN-β group. Tumors disappeared completely in two mice in the BLM+IL-2+IFN-β treatment group, which survived for more than 100 days. NK activity was significantly enhanced in mice treated with CDDP, BLM, or CDDP+IL-2+IFN-β. Although low LAK activity and cytotoxic activity against syngeneic NR-S 1 tumor cells were observed in the IL-2+IFN-β grove or the chemotherapy alone group, both of these activities were enhanced when these treatments were combined. Histological examinations disclosed remarkable infiltration of mononuclear cells and tumor necroses in the chemotherapy +IL-2+IFN-β groups. The infiltrated mononuclear cells predominantly expressed Mac-1 or asialo-GM 1 phenotype.These results suggest that the combination of systemic chemotherapy with local administration of IL-2+IFN-β is feasible for cancer therapy. Furthermore, NK cells may play an important role in both antitumor effect and the prolongation of survival.
Standards for stored autologous blood transfusion were established recently based on the clinical experience and research data for 140 autologous blood transfusions, which have been carried out in orthognathic surgery patients between 1985 and 1992 at the First Department of Oral and Maxillofacial Surgery, Kagoshima University Dental Hospital, Japan. Regarding standards designed to avoid anemia after phlebotomy, one time collection volume was decided using the following formula: predicted Hb level after collection=(circulating blood volume-one time collection volume) ÷circulating blood volume×Hb level before collection ≥10 g/dl. Fifteen female patients with mandibular prognathism were studied hematologically following a 400 ml autologous blood collection and a transfusion to evaluate the efficiency of this new standard.Two units of whole blood were collected 15 days before each patient's operation. All units of collected blood were transfused without homologous blood transfusion. RBCs, Hb and Hct, which were reduced after the phlebotomy, normalized the day before operation. The rate of reticulocytes was tended to increase during the period of blood storage and for one week after operation. The iron level in the serum was minimum on the day following operation, suggesting the need for postoperative iron supplementation. Increased serum erythropoietin levels, similar to reticulocytes, showed high erythropoietic activity from the first day following the phlebotomy to the postoperative period. There were no differences between the actual minimum Hb level and the predicted Hb level after blood collection of 400 ml. The Hb level on the first day after operation was significantly higher than the calculated Hb level on the same day without blood transfusion (p<0.01).These results suggested the usefulness of our standards.
The following results were obtained for the development of the upper lip and the pathogenesis of cleft lip based on studies using whole embryo cultures of A/WySnj mouse from D. 11. 5 (T. S.=19) for 24 hours.1. Complete cleft lip occurred in embryos with underdeveloped facial prominences and a long distance between prominences.2. Complete cleft lip occurred in embryos with a deep nasal groove due to tearing off of the nasal groove.3. Incomplete cleft lip occurred in embryos with a normal nasal groove and a short distance between facial prominences.4. Normal primary palates resulted in the development of a normal upper lip or an incomplete cleft lip with a persistent labial groove between the medial nasal and the maxillary prominences.5. These results suggested that the pathogenesis of cleft lip is due to insufficient development of the facial prominences. Early onset of underdevelopment resulted in a severe cleft lip, while later onset resulted in a mild cleft lip.
We have analysed 93 patients with mandibular angle fractures, with special re-ference to the treatment of wisdom teeth in the fracture line, during the past 6 years (1985-1990) at the Department of Oral Surgery, Ryukyu University Hospital.The results were as follows:1) Among 97 fracture lines in 93 cases, there were 89 wisdom teeth (91. 8%) and 31 of these were extracted.2) Erupted teeth tended to be extracted, while premature teeth tended to be preserved.3) There were few differences in prognosis of fractures between preserved cases and ex-tracted cases. These results suggest that the treatment of wisdom teeth should be consideedon an individual basis.
A case of bilateral condlar neck fractures caused by indirect impact from the mental region in a 4-year-old boy is reported. The patient was hospitalized immediately after sustaining injury. On the third hospital day, manipulative reduction and intermaxillary fixation were performed under general anesthesia. Postoperative radiography revealed poor reduction of the right condyle, although the left condyle was favorably positioned. Intermaxillary fixation was done for a days without any postoperative complications. Both occlusion and mandibular motility during mouth opening were good by the 13 th hospital day. The patient has been followed up by physical and radiographic examinations for more than 3 years. The deviated right condyle was found to be correctly positioned within the glenoid fossa 16 months postoperatively. The upright position of the condylar neck was enabled by repositioning and osteo-remodelling.
Skeletal malocclusion and orthognathic surgery may significantly influence the morphology and function of the temporomandibular joint and the position or direction of the mandibular condyle, thereby altering temporomandibular joint symptoms and signs or jaw function.Forty patients (15 males and 25 females, aged 18-36 years and followed for 18-46 months) with facial deformities and major malocclusions were studied. The subjects included 37 cases of mandibular prognathia, 10 cases of facial asymmetry and 7 cases of open bite. All cases underwent sagittal splitting osteotomy. Each patient was reviewed to elucidate the factors involved in temporomandibular joint symptoms and mandibular dysfunction by Type I and Type 11 quantitative theory.All signs and symptons of temporomandibular joint and mandibular dysfunction were recorded just before orthognathic surgery and at more than 18 months after surgery.Analyses were performed using the external criterion of 'TMJ score' for Type I quantification and three categories of external criteria (i. e., 'no symptoms', 'mainly TMJ symptoms'.'mainly muscle symptoms') for Type II quantification. The explanatory variables were 'surgical method', 'bone fixation', 'operator', 'increase of overjet', 'increase of overbite', 'increase of difference between upper and lower jaw midlines', 'presurgical mandibular deviation of jaw opening', 'presurgical TMJ sound', 'presurgical TMJ pain' and 'presurgical muscular pain'.The results were as follows:1. Type I quantitative theory analysis revealed that postsurgical TMJ scores were most closely related to the factor of 'operator', and strongly related to increase of difference between upper and lower jaw midlines.2. Type 11 quantitative theory analysis showed that the main symptoms of the cases were affected dominantly by the factor of 'operator', followed by the factors of 'presurgical muscle pain' and 'increase of difference between upper and lower midlines'.3. Strong correlation of the 'operator' and 'increase of difference between upper and lower midlines' with temporomandibular joint symptoms and dysfunction suggests that technical factors of the surgical procedure and facial asymmetry significantly affect the quantity and quality of temporomandibular joint symptoms.
Surgical and non-surgical, these two treatments of condylar neck fracture have long been a matter of controversy.The purpose of this paper is to evaluate the prognosis of the condylar neck fractures which were treated by each way.We recalled the patients of the condylar neck fracture to our clinics from a starting period of 6 months after initial treat-ment.Out of 187 cases we recalled, 142 cases were unilateral and 45 cases were bilateral. We evaluated unilateral cases.Out of 142, 89 were treated non-surgically and 53 surgically.We classified the fracture levels and conditions by the radiograms and compared those with the clinical prognosis and morphological results.The results were as follows.1. Regarding morphological results on the condition of dislocated or disarticulated fracture of TMJ, the surgical group was better than the non-surgical group.2. The case with better morphological results showed less deviation and pain on TMJ.3. In the surgical group, Kirschner-wire pinning showed the best morphological result.
We have previously reported an exact three-dimensional repositioning technique for external ramus fragments in sagittal split ramus osteotomy using screw fixation. Eighteen patients with mandibular prognathism who underwent sagittal split ramus osteotomy were studied. In one-half of these cases, a circumferential wire fixation (circum group) was performed, and in the other half a screw fixation with this repositioning technique (screw group) was used. These cases were studied with regard to preoperative, postoperative and one-year postoperative changes in lateral roentogenographic cephalometry. The following results were obtained: 1. There was no clockwise rotation of external fragments in the screw group. 2. Internal fragments relapsed anteriorly in the circum, group. 3. At one-year postoperative follow-up, the mandibular length relapsed 15% in the circum group and 4 % in the screw group.It was suggested that this repositioning technique is effective for preventing postoperative relapse.
MRI studies were performed on 29 patients with tongue tumors.26 cases were fresh, others were recurrent.Signal intensity of tongue tumor was not characteristic and specific, and it was a low-iso signal on T1 weighted image (WI), heterogeneously iso-high signal intensity on T2 WI, heterogeneous enhancement on gadolinium-DTPA enhanced image compared to muscle signal intensity.In 3 of 29 patients, the tongue tumor invaded to the mandible.With regard to the grasping tumor invasion to the mandible, the STIR method was superior to T1, T2 WI of the spin echo method.Dynamic enhanced MR images were performed in 6 of 29 patients. Dynamic.change of signal intensity after gadolinium-DTPA administeration were assessed with fast low angle shot imaging.On dynamic study at about 20 seconds after gadolinium-DTPA injection, the first signal intensity in the periphery of the tumor gradually began to increase.Maximum signal intensity of the tumor showed at about 70 seconds after gadolinium-DTPA injection. In search from 0 to 5 minutes, after the tongue tumor showed maximum signal intensity, its signal maintain the maximum.Necroic and peritumorous edema showed a significantly lower and more gradual increase in signal intensity than adjacent neoplastic tissue on dynamic enhanced MRI.
Bone Morphogenetic Protein (BMP) was extracted from bovine corticalbone and was bound to hydroxyapatite (HAP), which was synthesized by the wet method inorder to produce fine primary particles. Precipitate of the synthesized HAP was dried at 80°C, fired at 800°C for 3 hours, pulverized then sintered at 1200°C for 8 hours with the addition of resin beads, gclatin and hydrogenperoxide to make porous powder HAP and block HAP. For the combination of BMP and HAP, two different kinds of methods were performed.(Procedure 1) BMP was suspended in distilled water, and HAP was immersed in it, then lyophilized.(Procedure 2) BMP was solubilized in 0.01 M phosphate buffer (pH 7.2) with 6 M urea, and HAP was immersed in it, then dialyzed and lyophilized. HAP-BMP complexes were implanted in the thigh muscle pouch of mice (conventional male ddy, 5 weeks) which were sacrificed 3 weeks later to investigate the osteoinductive activity and biocornpatibility of the implants. All implanted HAP-BMP complex showed better osteoinductive activity than the implantation of BMP only, especially in the group made by prccedure 2, all implants induced fairly large amounts of new bone. No inflammatory cells were observed, and HAP and induced new bone were attached directly together without any connective tissues.
In mass screening for temporomandibular dysfunction a simple method for examiningtemporomandibular joint function is needed because examination time for individuals islimited. Moreover, examinees should be classified according to the degree of temporomandibulardysfunction. NVe developed a new examination method which classified the dysfunctionaccording to (1) maximal mouth opening, (2) TM J sound, (3) muscle pain, (4) TMJ painon palpation, and (5) pain on movement of mandible. One score point was given to eachpositive symptom, and a total score was added together. Therefore, each individual could beclassified into 6 dysfunction grades from 0 to 5 points. The results were compared to thoseby the conventional TMJ examination method reported by Helkimo in 272 Japanese.The result showed that our examination method evaluated individual TMJ function moreaccurately than Helkimo's method, because the values for maximal horizontal movement anddeviation during opening or closing movement were not correctly measured by Helkimo'sexamination method in the limited time.
The intermaxillary fixation (IMF) has been frequently applied to maxillofacial fractures. The period of the fixation is however, determined empirically because we have no barometers to judge the bone unions. Thus, a method capable of determining an appropriate time of IMF removal in each case has been sought.The authors developed a new measurement apparatus for analyzing the transmission of vibration based on Coherence function, and bound that this apparatus could be a useful tool for the determination of the time of IMF removal. The apparatus is characterized by its abilities to judge the bone unions and to evaluate the healing process of mandibular fractures through a non-invasive and periodical measurement.In this paper, we report that our method was quite useful in evaluating the healing process, even in the mandibular fracture case of abnormal hone healing which was bruised and infected at the fracture site during IMF.
The energy metabolism of human malignant melanoma from gingiva into nude mouse (HMG tumor) was studied by a 31P-NMR spectroscopy. The spectra of HMG tumor showed peaks of phosphomonoester, inorganic phosphate, phosphodiester, phosphocreatine, γ-phosphate of adenosine 5'-triphosphate, α-phosphate of adenosine 5'-triphosphate and βphosphate of adenosine 5'-triphosphate. Phosphomonoester and adenosine 5'-triphosphate were high.Phosphomonoester, adenosine 5'-triphosphate and phosphocreatine decreased and inorganic phosphate increased after i.p. injection of pepleomycin. However, there were no observable changes in the spectra of muscle.The results suggested that 31P-NMR spectroscopy was valuable to investigate the energy metabolism in tumor tissue and to evaluate the effects of chemotherapy.
Verruciform xanthoma arising from the gingival mucosa of the upper left first premolar to first molar area of a 59-year-old female is presented. It is a rare lesion of the oral cavity which has a warty or papillary appearance. It was first described by Shafer in 1971 with histopathological characteristics of verruciform growth and proliferation of xanthoma cells in the lamina propia.In Japan Kikuchi et al. reported the first case in 1977. Since then almost 40 cases have so far been published.This article described a case of Verruciform xanthoma together with its light, immunochemical and and electron microscopic fingings. Judging from the immunochemical finding, foamy cells were negative for S-100 protein and positive for lysozyme and NCA (non-specific cross reacting antigen with carcinoembryonic antigen), all of which were suggested that they were derived from monocyte-macrophage cell lines.
Hydroxyapatites (HAPs), which are synthetic ceramics (complex calcium phosphates), are very similar to bone and tooth minerals in their complex and have a biocompatibility. Recently, HAPs are used as a bone implant material in variety of situations, eg, surgical reconstruction, augmentation of the facial skeleton, also used to fill acquired and congenital bone defects.Autogenous particulate cancellous bone and marrow (PCBM) had been known to have an active osteogenesis. These implant materials produce desirable effects on regeneration in osseous defects.The aim of this investigation was to ascertain experimentally the biocompatibility, osteoinductive and/or conductive ability of a combined implant material with HAP and autogenous bone in an ectopic situation. Mixed type of materials, porous HAP granules and PCBM (volume ratio, HAP: PCBM=2: 1), were implanted into adult dogs using an vessel attached type incubating chamber which enabled to make the circumstances being free from the influences of recipient site. This chamber was attached to bilateral carotid artery, HAP-PCBM mixed group was implanted on one side and HAP alone group on the other side. Periodical (7, 14, 28, 60, 90 days) histopathological examinations were carried out by light and electron microscopies after implantation.The results were as follows:New bone formation was not observed in HAP alone group throughout the experimental period (90 days). Implanted HAP was encapsulated with fibrous tissue and these tissues were infiltrated with a few inflammatory cells. Macrophages and multinuclear giant cells (MGC) were observed on the HAP-tissue interface (MGC, I supposed to be a fusion cell type of macrophage). HAP resorption occurred by the activities of macrophage and MGC.After 28 days, a newly formed calcified bone matrix surrounded by transplanted trabecular bone chips was observed in HAP·PCBM group. These new bones, initially grew toward the HAP granules, were formed along with the HAP's surface. The osteoconductive ability of HAP in an ectopic site was also confirmed with this results. Under the same experimental conditions, a lamellar bone formation, which was a matured type of bone formation, was confirmed after 90 days.MGC have a different ultramicroscopical features depending on the contact materials. Namely, MGC surrounding a newly formed bone matrix had a ruffled border and clear zone, which were characteristic in osteoclast, but N1GC around HAP or transplanted bone chips had not such organelles.
In recent years several basic and clinical researches on new synthetic biomaterials, such as hydroxyapatite (HAP), have been reported. It is well known that HAP is available for bone augmentation and has osteoconductive ability. But the use of HAP is not always free of problems, because it is difficult to be handled, to be shaped and to maintain the implanted site. After implantation of granular HAP, some prognoses are poor due to infection at the implanted site and inflammation occasionally appears. The cause is tought that granular HAP easily spills from the implantation site and then is contaminated by some microorganisms. Above all, the use of HAP is limited by its physical properties. Zinc-oxide eugenol cement (ZOE), which has been used extensively in dentistry, has sedative and antimicrobial properties. HAP and ZOE were mixed (HAP-ZOE complex) in order to overcome the above faults.The pH value and the concentrations Ca2+ and Zn2+ of HAP, ZOE and HAP-ZOE complex, which were sunk in the Ringer's solution, were examined. Their ultrastractures were observed with scanning electron microscope.The results were summarized as follows: HAP-ZOE, complex was a paste like substance with easy handling. The pH value of HAP-ZOE complex was 9.4, that of HAP was 6.4 and that of ZOE was 7.4. The concentration of the Ca2+ of HAP-ZOE complex was 103. 6 ppm, that of HAP was 95.3 ppm and that of ZOE was 101.5 ppm. The concentration of the Zn2+ of HAP-ZOE complex was O.2 ppm, that of HAP was 0.4 ppm and that of ZOE was O.7 ppm. The ultrastracture of HAP-ZOE complex indicated that HAP as core and ZOE as matrix contacted closely, and there was an affinity between them.In conclusion, these results suggested that HAP-ZOE complex markedly improved granular HAP's practical use and HAP-ZOE complex is thus expected as a good implantable material.
