Recombinant human bone morphogenetic protein-2 (rhBMP-2) has shown potential in maxillofacial surgery owing to its osteoinductive properties. However, concerns about its safety and high cost have limited its widespread use. This review presents the status of rhBMP-2 use in maxillofacial surgery, focusing on its clinical application, efficacy, safety, and limitations. Studies have demonstrated rhBMP-2’s potential to reduce donor site morbidity and increase bone height in sinus and ridge augmentation; however, it may not outperform autogenous bone grafts. In medication-related osteonecrosis of the jaw treatment, rhBMP-2 has been applied adjunctively with promising results, although its long-term safety requires further investigation. However, in maxillofacial trauma, its application is limited to the restoration of large defects. Safety concerns include postoperative edema and the theoretical risk of carcinogenesis. Although postoperative edema is manageable, the link between rhBMP-2 and cancer remains unclear. The limitations include the lack of an ideal carrier, the high cost of rhBMP-2, and the absence of an optimal dosing regimen. In conclusion, rhBMP-2 is a promising graft material for maxillofacial surgery. However, it has not yet become the gold standard owing to safety and cost concerns. Further research is required to establish long-term safety, optimize dosing, and develop better carriers.
Maxillofacial skeletal surgery often involves the use of patient-specific implants. However, errors in obtaining patient data and designing and manufacturing patient-specific plates and guides can occur even with accurate virtual surgery. To address these errors, bespoke Snowman plates were designed to allow movement of the mandible. This study aimed to compare the stability of bespoke four-hole miniplates with that of a bespoke Snowman plate for bilateral sagittal split ramus osteotomy (SSRO), and to present a method to investigate joint cavity changes, as well as superimpose virtual and actual surgical images of the mandible. This retrospective study included 22 patients who met the inclusion criteria and underwent orthognathic surgery at a university hospital between 2015 and 2018. Two groups were formed on the basis of the plates used: a control group with four-hole bespoke plates and a study group with bespoke Snowman plates. Stability was assessed by measuring the condyle-fossa space and superimposing three-dimensional virtual surgery images on postoperative cone-beam computed tomography (CBCT) scans. No significant differences were observed in the condyle-fossa space preoperatively and 1 year postoperatively between the control and study groups. Superimposing virtual surgery and CBCT scans revealed minimal differences in the landmark points, with no variation between groups or timepoints. The use of bespoke Snowman plates for stabilizing the mandible following SSRO exhibited clinical stability and reliability similar to those with bespoke four-hole plates. Additionally, a novel method was introduced to evaluate skeletal stability by separately analyzing the condyle-fossa gap changes and assessing the mandibular position.
The objective of this retrospective study was to show results from platform-switched narrow-diameter implants in the posterior edentulous region, which we followed up for more than 1 year after functional loading.Ninety-eight narrow implants were inserted into 66 patients. After healing, fixed implant-supported prostheses were delivered to the patients, and Periotest and radiographic examinations were performed. After the first year of loading, the implant outcome was again evaluated clinically and radiographically using the Periotest analysis. Crestal bone loss and Periotest values (PTVs) were used to evaluate the effect of surgery, prosthesis, implant, and a host-related factor. A general linear model was used to statistically detect variables statistically associated with crestal bone loss and Periotest value.We followed up on the implants over 1 to 4 years after loading; their survival rate was 100 %, and pronounced differences from PTVs were noted among jaw location, bone quality, and loading period. No difference was detected in bone loss among the variables studied. Bone loss after functional loading was 0.14 ± 0.39 mm. The stability value from the Periotest was -3.29 ± 0.50.Within the limitations of this study, judicious use of platform-switched narrow implants with a conical connection must be considered an alternative for wide-diameter implants to restore a posterior edentulous region.
The aim of the present study is to evaluate the validity of orthodontic measurements including tooth width, Bolton ratio, overjet and overbite on the digital dental models. Dental models of the subjects aged 12 to 18 were obtained in 3 different forms, which were conventional stone model, digital model created with Freedom HD model scanner, and digital model produced with CS3600 intraoral scanner. After measurements were made on the models, reliability and reproducibility of the measurements were evaluated by using intraclass correlation coefficient, while validity was assessed with paired t-test. As a result, significant reliability and reproducibility were verified, with intraclass correlation coefficient exceeding 0.750 in all groups. Measurements of the model scanned group showed an adequate validity in overall and anterior Bolton ratio, overjet, and overbite. Intraoral scanned models showed an adequate validity in anterior Bolton ratio, and overjet. Measurement on intraoral scanned digital models can be considered as an alternative for young children who have difficulty in taking impression. Furthermore, careful considerations on measurement error should be made in clinical situations.
Objective: Orthognathic surgery (OGS) is a surgical intervention that corrects dentofacial deformities through the movement of maxillary and mandibular segments to achieve adequate masticatory function, joint health, and facial harmony. However, some patients present with occlusal discrepancies, condylar sag, and/or temporomandibular disorders after OGS. Various methods have been employed to solve these problems after surgery. This study aimed to evaluate the effectiveness of early screw removal in patients with occlusal discrepancies after OGS using three-dimensional cone-beam computed tomography (CBCT). Methods: In 44 patients with dentofacial deformities, patient-customized OGSs with customized plates were performed to correct facial deformities using customized guides with computer-aided surgical simulation. Of the 44 patients, eight patients complained of occlusal discrepancies and temporomandibular disorders after OGS. These eight patients underwent screw removal under local anesthesia around four weeks. The temporomandibular joint spaces at three time points (pre-surgical, post-surgical, and after screw removal) in the sagittal and coronal planes were compared using CBCT. Results: Eight patients showed an increase in joint space on CBCT images immediately after surgery (T1), but after early screw removal (T2), these spaces almost returned to their pre-surgical state, and the temporomandibular joint problem disappeared. Conclusions: The removal of screws located in the distal segment under local anesthesia between three and four weeks post-surgically may be a treatment option for patients with post-OGS occlusal discrepancies, condylar sag, and/or temporomandibular disorder.
Abstract Distortion of dentition may occur in cone-beam computed tomography (CBCT) scans due to artifacts, and further imaging is frequently required to produce digital twins. The use of a plaster model is common; however, it has certain drawbacks. This study aimed to assess the feasibility of different digital dentition models over that of plaster casts. Plaster models, alginate impressions, intraoral scan (IOS) images, and CBCT images of 20 patients were obtained. The desktop model scanner was used to scan the alginate impression twice, five minutes and two hours after impression-making. Using an IOS, the full arch was scanned in segments using CS 3600 and simultaneously with i700 wireless. The digital twins obtained from the alginate impression and IOS were superimposed with those obtained from the plaster cast. The differences and distances at each reference point were measured. Scans of alginate impressions after two hours showed the greatest discrepancies, but these were all less than the CBCT voxel size of 0.39 mm. Alginate impression scans and IOS are suitable supplements to CBCT compared to the plaster model. Accuracy can be improved by scanning the alginate impression within five minutes or by intraoral scanning of the entire arch with segmentation.
This study assayed regional distribution of dental hospital & dental clinics, the number of population & households per one dental hospital & clinic, operation condition & duration. This study used public data that display from 1946 years(the first dental clinic open in republic of korea) to 2016 years. We collected present condition of 21,686 dental hospital and clinics available in public data portal site on 28. Feb.2016. Data were classified by scale, location, permission year, operation duration of dental hospital & clinics and were analyzed using SPSS 20.0 program. Surveyed on Feb. 2016. Best top 10 regions of permission dental clinics are (1) Gangnam-gu, Seoul(1,337), (2) Seongnamsi, Gyeonggi-do(555), (3) Songpa-gu, Seoul(491), (4) Yeongdeungpo-gu, Seoul(472), (5) Suwon-si, Gyeonggi-do(443), (6) Seocho-gu, Seoul(428), (7) Nowon-gu, Seoul(417), (8) Goyang-si, Gyeonggi-do(413), (9) Jung-gu, Seoul(380), (10) Yongin-si, Gyeonggi-do(353). Whereas best top 10 regions of operating dental clinics are (1) Gangnam-gu, Seoul(581), (2) Seongnamsi, Gyeonggi-do(415), (3) Suwon-si, Gyeonggi-do(382), (4) Seocho-gu, Seoul(320), (5) Changwon-si, Gyeongsangnam-do(303), (6) Songpa-gu, Seoul(295) (7) Goyang-si, Gyeonggi-do(290), (8) Bucheon-si and Yongin-si, Gyeonggi-do(262), (9) Jeonju-si, Jeollabuk-do(224). Average population per one dental hospital & clinic by regional local government are 3,120 people. Best five region of population per one dental hospital & clinic are (1) Sejong-si(5,272), (2) Gangwon-do(4,653), (3) Chungcheongbuk-do(4,513), (4) Gyeongsangbuk-do(4,490), (5) Chungcheongnam-do(4,402). Average households per one dental hospital & clinic by regional local government are 1,316 households. Best three region of households per one dental hospital & clinic are (1) Sejong-si(2,126), (2) Gangwon-do(2,057), (3) Gyeongsangbuk-do(1,946). From 1946 to 1986, permission and operating dental hospital and clinics was steadily increasing. On 1986-1990, 1991-1995, permission, operation and closure of dental hospital and clinics increase rapidly. From the 2011-2015 to 2016(present), permission, operation and closure of dental hospital and clinics is decreasing. Average operating duration of closured dental hospital and clinics are 14.054 years. We need to map of dental hospital and clinics for open and operation of one, base on analyzed results. In an era of 30,000 dentist, we should to be concerned about operation of dental clinics in the light of past operating condition.
In this study, we evaluated the bone regenerative capability of a customizable hydroxyapatite (HA) and tricalcium phosphate (TCP) scaffold using a digital light processing (DLP)-type 3D printing system. Twelve healthy adult male beagle dogs were the study subjects. A total of 48 defects were created, with two defects on each side of the mandible in all the dogs. The defect sites in the negative control group (sixteen defects) were left untreated (the NS group), whereas those in the positive control group (sixteen defects) were filled with a particle-type substitute (the PS group). The defect sites in the experimental groups (sixteen defects) were filled with a 3D printed substitute (the 3DS group). Six dogs each were exterminated after healing periods of 4 and 8 weeks. Radiological and histomorphometrical evaluations were then performed. None of the groups showed any specific problems. In radiological evaluation, there was a significant difference in the amount of new bone formation after 4 weeks (p < 0.05) between the PS and 3DS groups. For both of the evaluations, the difference in the total amount of bone after 8 weeks was statistically significant (p < 0.05). There was no statistically significant difference in new bone between the PS and 3DS groups in both evaluations after 8 weeks (p > 0.05). The proposed HA/TCP scaffold without polymers, obtained using the DLP-type 3D printing system, can be applied for bone regeneration. The 3D printing of a HA/TCP scaffold without polymers can be used for fabricating customized bone grafting substitutes.
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