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Treatment of dentofacial deformities secondary to condylar hyperplasia
Luo En.
West China Journal of Stomatology    2023, 41 (4): 369-376.   DOI: 10.7518/hxkq.2023.2023059
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Dentofacial deformities secondary to condylar hyperplasiais a kind of disease presenting facial asymmetry, malocclusion, temporomandibular joint dysfunction, and other symptoms caused by non-neoplastic hyperplasia of the condyle. The etiology is still unknown, and currently, pre- and post-operative orthodontics accompanied by orthognathic surgery, temporomandibular joint surgery and jawbone contouring surgery are the main treatment methods. A personalized treatment plan was developed, considering the active degree of condyle hyperplasia, the severity of the jaw deformity, and the patient’s will, to correct deformity, obtain ideal occlusal relationship, and regain good temporomandibular joint function. Combined with the author’s clinical experience, the etiology, clinical and imageological features, treatment aims, and surgical methods of condylar hyperplasia and secondary dentofacial deformities were discussed in this paper.

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From “Empirical Surgery” to “Precision Surgery”: establishment and clinical application of precision orthognathic surgery system
Wang Xudong, Wei Hongpu, Li Biao.
West China Journal of Stomatology    2023, 41 (5): 491-501.   DOI: 10.7518/hxkq.2023.2023152
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Orthognathic surgery, which involve osteotomy and repositioning of the maxillomandibular complex, has recently emerged as a crucial method of correcting dentofacial deformities. The optimal placement of the maxillomandibular complex holds utmost significance during orthognathic surgery because it directly affects the surgical outcome. To accurately achieve the ideal position of the maxillomandibular complex, with the rapid advancements in digital surgery and 3D-printing technology, orthognathic surgery has entered an era of “Precision Surgery” from the pervious “Empirical Surgery.” This article provides comprehensive insights into our extensive research and exploration of the treatment modality known as “precision orthognathic surgery” over the years. We also present the technical system and application in“Ortho+X” treatment modality to offer valuable references and assistance to our colleagues in the field.

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Developments and trends of endoscopic salivary gland resection: from endoscope-assisted to full endoscopic
Zhu Guiquan, Li Chunjie.
West China Journal of Stomatology    2023, 41 (4): 377-384.   DOI: 10.7518/hxkq.2023.2023116
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More than 30 years of rapid development of endoscopic surgery has led to the mainstreaming of this procedure in many surgical departments in China. Since the first report on endoscopy, it has been used in salivary gland resection for more than 20 years. The overall development of endoscopic surgery indicates that its use in oral and maxillofacial surgery is still in the early exploration stage; it has not yet been maturely developed or applied. Owing to the advancement of other disciplines and corresponding widening experiences in those fields, the development of endoscopic technology in oral and maxillofacial surgery will likely achieve a leapfrogging. Learning from the general development pattern of endoscopy, this research explores the application history, current situation, and future direction of the application of endoscopy in salivary gland surgery.

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Clinical decision and related factors influencing implant direction in the esthetic area
Liu Yuting, Yuan Quan.
West China Journal of Stomatology    2023, 41 (5): 512-520.   DOI: 10.7518/hxkq.2023.2023151
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Implant treatment in the esthetic area requires stable osseointegration and successful esthetic outcomes. Achieving this goal requires careful consideration of accurate implant axis and ideal three-dimensional position. Owing to the high esthetics and the special anatomical structure of the maxillary, a successful implant means a synthesized deli-beration of the residual bone dimensions, soft-tissue thickness, and the relationship of the residual alveolar ridge with the planned restoration. This article offers an in-depth analysis of the clinical decisions and key factors affecting the implant direction in the esthetic area.

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Clinical solutions for natural abutments with preexisting defected crown margin in the aesthetic area
Liu Feng, Zhan Yalin, Liu Xinran.
West China Journal of Stomatology    2023, 41 (6): 641-646.   DOI: 10.7518/hxkq.2023.2023281
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Crown replacement has remained one of the difficult methods for installing fixed prosthesis but is often performed because of aesthetic factors and invasion of biological width. This article focuses on the clinical scenario in which preexisting crown margin has defects. Given that clinical decisions regarding restoration management and perio-dontal tissues have to be made with caution, a decision tree of the decision making process for natural abutments in aesthetic area with preexisting defected crown margin is presented. The re-establishment of a new crown margin is the key to the success of a new restoration, and the new margin should be located at the proper esthetic position and right biological position. It should have fine, smooth, and continuous morphology.

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Imaging analysis of 1 138 supernumerary teeth by using cone-beam computed tomography
Liu Xiaolin, Ren Qun, Bai Jiuping, Kang Pei, Ren Guiyun, Li Xiangjun, Feng Xiaowei.
West China Journal of Stomatology    2023, 41 (6): 671-677.   DOI: 10.7518/hxkq.2023.2023110
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Objective This study aims to analyze and summarize the characteristics of supernumerary teeth by using cone-beam computed tomography (CBCT). Methods A total of 718 patients with 1 138 supernumerary teeth were retrospectively collected. Age, gender, number, location, morphology, eruption status, and accompanying symptoms of the supernumerary teeth were statistically analyzed. The relationship relative to jaws, gender, and eruption status were analyzed and discussed. Results The average age of the patients was 9.54±5.32 years, and the male to female ratio was 2.88∶1. About 77.02% of the patients sought medical advice during the mixed dentition period, and 50.70% had one supernumerary tooth. These supernumeraries were most commonly conical in shape, and 85.76% of them were in the incisor region, 92.09% in the upper jaw, 46.75% in inverted position, and 86.20% unerupted. Overall, 65.29% of them had fully developed roots, and 60.63% had an impact on adjacent structures. Significant differences were found in eruption status, morphology, zoning, direction, root development, and impact on adjacent structures between the supernumerary teeth located in the upper and lower jaws (P<0.05). Significant differences were also detected in gender, morphology, zoning, orientation, root development, and impact on adjacent structures between erupted and unerupted teeth (P<0.05). The incidence of supernumerary teeth in the incisor region was higher in males than that in females. Moreover, the root of supernumeraries was more completely developed in males than in females (P<0.05). Conclusion For supernumerary teeth, CBCT images can provide accurate three-dimensional radiographic data and are valuable for clinical diagnosis and treatment planning.

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Correlation between differences in intraoperative jumping gaps and soft tissue changes around immediate implant placement and provisionalization in the maxillary anterior region
Zhang Sui, Sun Yi, Huang Changbo, He Dongning
West China Journal of Stomatology    2023, 41 (6): 678-685.   DOI: 10.7518/hxkq.2023.2023153
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Objective This study aims to evaluate the correlation between differences in intraoperative jumping gaps and soft tissue changes around immediate implant placement and provisionalization (IIPP) in the maxillary anterior region. Results will provide a basis for clinical evaluation of the change trend and long-term stability of the labial soft tissue contours of patients with different jumping gaps. Methods Thirty-two patients with single tooth loss in the maxillary aesthetic area were enrolled, and they all received immediate implant placement and restoration. All patients were divided into three groups: A, B, and C according to the size of the jumping gap, group A: horizontal defect dimension (HDD) ≤2 mm; group B: 2 mm<HDD≤3 mm; group C: HDD>3 mm. Geomagic studio 2013 was used to quantitatively analyze the contour volume of the soft tissue around the implant and the level of the labial gingival margin. The pink esthetic score (PSE) was used for the final aesthetic evaluation. Results All implants had osseointegration within 6 months after the surgery. The average thickness of soft tissue contour volume changed by 0.62 mm±0.15 mm, and the average PES was 11.09±0.99. The changes in the gingival mucosa levels in the three groups at 6 months after operation were 0.45 mm±0.11 mm, 0.40 mm±0.12 mm, and 0.35 mm± 0.11 mm, respectively. The changes in the average thickness of the soft tissue contour volume in the three groups at 6 months after the operation were 0.77 mm±0.16 mm, 0.63 mm±0.17 mm, and 0.54 mm±0.11 mm. A moderate negative correlation was found between the jumping gap size and the gingival mucosa level, and the average thickness changed. No significant correlation was found between size of jumping gap and PES. Conclusion Although the contour volume of the labial soft tissue continuously decreased within 6 months after IIPP in the maxillary anterior region, the surgical procedure can achieve a satisfactory aesthetic effect, and the level of soft tissue around the implant can be well maintained.

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Three-dimensional finite element stress analysis of surface-mounted inlays in repairing pulp-penetrating non-carious cervical lesion of maxillary first premolar
Ma Dian, Qian Jie.
West China Journal of Stomatology    2023, 41 (5): 541-553.   DOI: 10.7518/hxkq.2023.2023123
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Objective This study aimed to explore the stress distribution of surface-mounted inlays with two ceramic materials and different strategies for fiber post-restoration on pulp-penetrating non-carious cervical lesion in a maxillary first premolar to provide minimally invasive and reasonable restorative methods. Methods The cone beam computed tomography data of the standard right upper first premolar were selected. Healthy control (HC) and defective control (DC) finite element models were established. Then, eight experimental models were established according to two different ceramic materials (IPS e.max CAD [LD] and Lava Ultimate [LU]) and different locations of fiber post (without fiber post [NP], fiber post in buccal root canal [B], fiber post in palatal root canal [P], fiber post in both root canals [BP]), namely, LDNP, LDB, LDP, LDBP, LUNP, LUB, LUP, and LUBP. Axial load F1 and lateral load F2 were applied. Maximum principal stress and displacement of the buccal tip were investigated using finite element analysis software. Then, the percentage change of the following indicators in each experimental group was analyzed: stress of defective tip with group DC, stress of enamel and dentine, and displacement of buccal tips with group HC. It was considered similar when the percentage change was less than 5%. Results LD and LU groups could effectively reduce the stress of the defective tip, but the decreasing amplitude in the former was greater than that of the latter. For the stress of surface-mounted inlays and resin adhesive layer, LD groups were higher than LU groups, and no significant difference in stress peak was found among different experimental groups in the same material. In addition, fiber posts in double root canals could significantly reduce buccal tip displacement. Conclusion For pulp-penetrating non-carious cervical lesions, the restorative strategy of surface-mounted inlays could be applied. Compared with Lava Ultimate, IPS e.max CAD could better protect the defective tip tooth. Furthermore, fiber posts in double root canals could decrease overall deformation and increase the retention of surface-mounted inlays.

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Simultaneous implantation and tooth preparation technology guided by 3D-printed guide
Hu Nan, Liu Chunxu, Gao Jing, Xie Chenyang, Yu Jiayi, Jia Luming, Yu Haiyang.
West China Journal of Stomatology    2023, 41 (4): 483-490.   DOI: 10.7518/hxkq.2023.2022027
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Using digital technologies in concurrently performing missing tooth implantation and preparation of remaining teeth is a solution to reduce the number of visits and improve efficiency. This paper proposes a digital process for simultaneously implanting and preparing teeth. It integrates implant surgical guide and 3D-printed tooth preparation guide into a single guide and completes guided implant placement and precise tooth preparation. Based on “repair-oriented” virtual implant planning, the implant surgical guide can improve the efficiency and predictability of implant placement, and its linear accuracy is about 1 mm. The tooth preparation guide precisely guides tooth preparation and restoration space visualization, ensuring the quality of the tooth preparation. The two guides have different design accuracy requirements, and thus their combination improves the overall guiding accuracy requirements. The concurrent application of the two guides minimizes the clinical operation time, number of visits, and economic burden of patients.

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Treatment strategies for periodontitis patients with systemic disease
Lin Li, Li Zhaorong, Jin Yining, Yin Shou-cheng.
West China Journal of Stomatology    2023, 41 (5): 502-511.   DOI: 10.7518/hxkq.2023.2023181
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Periodontitis is a chronic inflammatory disease that destroys the integrity of tooth-supporting tissue. Periodontitis is listed as a major oral disease by the World Health Organization and is a public-health problem affecting global oral and systemic health. The fourth national oral health epidemiological survey has revealed that periodontitis is one of the most common oral problems in China. With the development of science and medicine, increased attention is being paid to the importance of oral health and its influence on general health. Accordingly, stomatologists are required to master more relevant information on clinical diagnosis and treatment, as well as to pay more attention to the diagnosis and treatment methods of patients with different systemic diseases. This article expounds the diagnosis and treatment strategy of patients with systemic disease periodontitis. We aimed to help stomatologists make more reasonable diagnosis and treatment decisions.

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The removal of three kinds of occlusal veneers by Er: Yag laser
Zhu Jianyu, Hong Feifei, He Lianghang, Wen Wei, Lei Xianlin, Zhang Zhisheng, Yin Lu
West China Journal of Stomatology    2023, 41 (5): 568-572.   DOI: 10.7518/hxkq.2023.2023038
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Objective This study aimed to remove occlusal veneers of varied thicknesses and compositions by Er:Yag laser in vitro and analyze the interfacial microstructure between veneers and tooth that irradiated by laser, by which experimental evidence could be provided to support the non-invasive removal of occlusal veneerby laser. Methods Fresh mandibular premolars extracted for orthodontic requirements were collected for tooth preparation. Three kinds of ceramic materials (Vita Suprinity, Vita Mark Ⅱ, and Upcera Hyramic) were selected to fabricate occlusal veneer with different thicknesses (1.0, 1.5, and 2.0 mm). One week later, Er:Yag laser (2.5 W and 3.5 W) was used to irradiate and remove the occlusal veneer and recorded the timespan. After the removal operation, the micro-morphologies of samples were examined by scanning electron microscope. Results Upcera Hyramic veneer failed to be removed (>20 min); the operation span at 2.5 W, Vita Suprinity (96.0 s±16.0 s) was longer than Vita MarkⅡ(84.5 s±19.5 s) in the 1.0 mm group (P<0.05), and Vita Suprinity (246.5 s±13.5 s) was longer than Vita MarkⅡ(170.0 s±14.0 s) in the 1.5 mm group (P<0.05). At 3.5 W, Vita Suprinity (381.0 s±24.0 s) was longer than Vita MarkⅡ(341.5 s±26.5 s) in the 2.0 mm group. Conclusion Increasing laser power could shorten the operation span and facilitate the removal of occlusal veneers with the same thickness and composition. The occlusal veneer was sustained when insufficient laser power was applied. With the same laser power and ceramic thickness, laser penetration could interfere with the integral of the ceramic structure when the laser interacted with the bonding layer. With the same ceramic composition and laser power, the operation span and laser power increased with the thickness of the occlusal veneer. However, the laser was incapable of removing occlusal resin veneer directly.

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Vital pulp therapy of permanent teeth with irreversible pulpitis
Wang Jun.
West China Journal of Stomatology    2023, 41 (6): 622-627.   DOI: 10.7518/hxkq.2023.2023193
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Traditionally, vital pulp therapy (VPT) is mainly indicated for young permanent teeth. However, in recent years, VPT has been increasingly applied to mature permanent teeth. VPT was previously thought to be effective only for teeth with normal pulp or reversible pulpitis. However, an increasing body of evidence has demonstrated that VPT can successfully manage permanent teeth with irreversible pulpitis or apical periodontitis. This work discusses which teeth with irreversible pulpitis or apical periodontitis are suitable for VPT, the recommended method to evaluate and select this kind of case, and the clinical procedure involved to operate such a case.

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Feasibility analysis of digital method for measuring supracrestal tissue height crest around implant
Li Luxin, Liu Honghong, Chen Jia, Zhang Zhihong, Sang Xiao, Zhang Lili, Wang Yuantian.
West China Journal of Stomatology    2023, 41 (4): 426-433.   DOI: 10.7518/hxkq.2023.2023089
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Objective This study aimed to investigate the feasibility of measuring the soft tissue height of bone cristae around implant by digital method. Methods A total of 36 patients with dental implants were selected from the Dental Medicine Center of the First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital) from August 2022 to December 2022. A total of 43 dental implants were enrolled. All postoperative cone beam CT (CBCT) imaging data and intraoral digital impressions obtained before surgery were immediately obtained by the patients on the day of completion of oral implant surgery and they were imported into oral implant surgery planning software for image fitting. Then, virtual implants of the same specification were placed in the planting area, and the implant position was adjusted to overlap with the implant shadow in the CBCT image. Supracrestal tissue height (STH) was measured at the implant view interface (digital group). During the operation, implant holes were prepared step by step in accordance with the standard preparation method, and implants were implanted. The upper edge of the implant was flushed with the crest of the alveolar ridge. STH was measured by perio-dontal probing (periodontal probe group). Paired t-test was used to compare the STH differences between the digital and periodontal probe groups. Bland-Altman test was used to analyze the consistency of the two methods. Intra-group correlation coefficient (ICC) was used to verify the reliability of the results measured by different surveyors using di-gital methods. Results No statistical significance was observed in the STH difference between the two methods (P>0.05). Bland-Altman test showed good consistency between the two methods, but the measurement of mandibular posterior teeth showed that the results of periodontal probe were greater than those of digital method. The ICC and 95%CI of the STH results measured digitally by different surveyors are 0.992 (0.986-0.996). Conclusion The digital me-thod is in good agreement with the periodontal probe method in measuring the soft tissue height of the bone cristae around the implant.

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Orthodontic program design based on aesthetic
Ma Yanning, Jin Zuolin.
West China Journal of Stomatology    2023, 41 (6): 628-634.   DOI: 10.7518/hxkq.2023.2023231
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Orthodontics is a discipline that is based on aesthetics. It coordinates the relationship among nose, lip, and chin through the movement of teeth and the adjustment of jaw relationship. Orthodontists need to fully analyze the patient’s soft tissue profile before treatment. They also need to analyze the existing problems and those that may be solved or caused during orthodontics to guide the design of orthodontic treatment and effectively improve the clinical effect of orthodontics. This article reviews the aesthetic preconditions that guide the design of orthodontic treatment from the perspective of orthodontists.

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Clinical application principles and new developments of zirconia crown
Wang Jian, Yang Linxin
West China Journal of Stomatology    2024, 42 (2): 135-141.   DOI: 10.7518/hxkq.2024.2023404
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Zirconia crown has been widely used in the field of prosthodontics. Traditional zirconia exhibits excellent mechanical properties but lacks translucency. The introduction of transparent zirconia significantly enhances its aesthetic performance. In clinical applications, factors affecting the aesthetic results of full zirconia crown should be comprehensively considered, and the most suitable restoration should be chosen. Additionally, clinicians need to design appropriate tooth preparation dimensions and methods based on an individual patient’s actual situation. During the clinical bonding process of zirconia, proper surface treatment of the tooth and restoration is essential. The selection of suitable adhesives is crucial for achieving optimal bonding strength and aesthetics.

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The chance and challenge of creating virtual patients in prosthodontics
Shen Jiefei
West China Journal of Stomatology    2024, 42 (1): 1-11.   DOI: 10.7518/hxkq.2024.2023317
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In the field of prosthodontics, the use of virtual patients for biomimetic restoration holds great promise for various applications. Virtual patients consist of digitized data that encompasses details on the morphology, structure, and spatial relationships within the maxillofacial and intraoral regions. Nonetheless, there are several challenges associated with acquiring digital data, achieving accurate alignment, and recording and transferring dynamic jaw movements. This paper aims to concentrate on the process of constructing virtual patients, highlight the key and challenging aspects of virtual patient construction, and advocate for the extensive adoption and utilization of virtual patient technology.

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Application of intentional replantation in advanced periodontitis involving teeth preservation
Ye Changchang, Yang He, Huang Ping
West China Journal of Stomatology    2024, 42 (1): 12-18.   DOI: 10.7518/hxkq.2024.2023206
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With the development of periodontal regenerative technology, an increasing number of scholars reported that advanced periodontitis involving teeth can be preserved through intentional replantation. Intentional replantation has become the last possible method to preserve natural teeth for advance periodontitis with signs of tooth extraction. However, the indications of intentional replantation are strict, and the success of the operation is closely related to the condition of cases and the operation skills of doctors. In this article, the operation steps and criteria of intentional replantation were summarized by introducing three success cases of advanced periodontitis involving teeth preserved by intentional replantation. The relevant factors that affect the prognosis of intentional replantation in advanced periodontitis involving teeth preservation were analyzed to help clinicians preserve natural teeth.

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A retrospective study on iRoot BP Plus full pulpotomy for primary molars with partial irreversible pulpitis
Hu Xiaoyan, Zhao Chunhui, Wang Lu, Zhang Zheng, Yang Fan, Zhang Hongyan
West China Journal of Stomatology    2024, 42 (2): 242-248.   DOI: 10.7518/hxkq.2024.2023308
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Objective This study aimed to observe the outcomes of iRoot BP Plus full pulpotomy in primary molars with partial irreversible pulpitis retrospectively. Methods Collect 102 cases of primary molars with partial irreversible pulpitis undergoing iRoot BP Plus full pulpotomy from January 2019 to August 2023, with a follow-up period of 24-47 months. Based on the presence of irreversible pulpitis symptoms before surgery, the included cases will be divided into asymptomatic group (n=53) and symptomatic group (n=49). Observe the clinical and imaging success rates of both groups. Results Clinical success rates were 96.2% and 97.9% in asymptomatic and symptomatic groups, and radiographic success rates were 96.2% and 93.9% respectively. Conclusion iRoot BP Plus full pulpotomy can be used for the treatment of primary molars with partial irreversible pulpitis under an enhanced pulpotomy protocol.

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Classified diagnosis and treatment scheme of oral cosmetic restoration based on aesthetic analysis (part Ⅱ): Chinese aesthetic connotation and analysis scheme
Yu Haiyang, Zhao Junyi, Sun Manlin
West China Journal of Stomatology    2024, 42 (2): 154-162.   DOI: 10.7518/hxkq.2024.2023462
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At present, the commonly used clinical protocols of oral cosmetic restoration are mostly based on the oral aesthetic indexes proposed by Western developed countries (referred to as Western aesthetics), which are different from the oral aesthetic indexes unique to Chinese people (referred to as Chinese aesthetics). In the design of restoration schemes and the evaluation of restoration effects, these differences have a large or small effect on the doctor-patient-technology triad. Improper handling could directly weaken the cooperation efficiency of the three parties, reduce patient satisfaction, and even lead to medical disputes in serious cases. From doing a good job of oral cosmetic restoration in China, the connotative characteristics of Chinese oral aesthetics are introduced in this paper, and the value of oral aesthetic analysis in diagnosis and treatment is discussed. The process and method of aesthetic analysis and assessment through the modified Chinese psychosocial impact of dental aesthetics questionnaire and the evaluation ruler of the expected value of oral cosmetic restoration are further introduced in detail.

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Clinical considerations of emergent oral manifestations during pregnancy
Zhang Xuefeng, Liu Xian, Liu Chang, Hua Chengge
West China Journal of Stomatology    2024, 42 (2): 142-153.   DOI: 10.7518/hxkq.2024.2023367
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Pregnancy is a special period for developing and treating oral diseases. Oral emergencies during pregnancy need to be handled appropriately. Changes in the physiological environments and personal habits of pregnant women increase susceptibility to some oral diseases. However, clinical treatment strategies are limited due to the need to ensure the safety of pregnant women and fetuses. Pregnant women should obtain oral health knowledge and enhance their awareness. Dentists should adhere to the principle of “prevention before pregnancy, controlling symptoms during pregnancy, and treating diseases after pregnancy” for different pregnancy periods. They should also formulate appropriate treatment plans to control emergencies, prevent disease progression, and avoid harmful effects on pregnant women by using the safest, simplest, and most effective strategies that avoid adverse effects on fetuses. Pregnant women and dentists should combine prevention and treatment while collaborating in maintaining oral health during pregnancy. This article focuses on the principles of treatment during pregnancy, and the treatment timing, clinical management, and treatment strategies of different diseases causing oral emergencies during pregnancy are reviewed.

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Classified diagnosis and treatment scheme of oral cosmetic restoration based on aesthetic analysis (part Ⅰ): basic concept, decision tree and clinical pathway
Yu Haiyang, Zhao Junyi, Sun Manlin
West China Journal of Stomatology    2024, 42 (1): 19-27.   DOI: 10.7518/hxkq.2024.2023212
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At present, the commonly used clinical protocols of oral comestic restoration are mostly based on the aesthetic indicators proposed by Western developed countries (referred to as Western aesthetics). Mechanically copying the Western aesthetic scheme, ignoring the difference between it and the Chinese oral aesthetic indicators (referred to as Chinese aesthetics), is unable to effectively support personalized cosmetic restoration diagnosis and treatment. In addition, new technologies and new solutions for cosmetic restoration, which are developing rapidly in recent years, are emerging one after another, but many popular concepts are confusing and lack of proper hierarchical diagnosis and treatment norms, and there is indeed an urgent need for discussion and clarity. From the perspective of serving clinical application, this paper discusses the deficiencies of the Chinese translation of the word “aesthetics”, the diffe-rence and connection between aesthetics and cosmetology, and the relationship between cosmetic restoration and fixed restoration. It also discusses the difference between anterior teeth, esthetic zone and exposed zone, the diagnostic and therapeutic value of oral aesthetic analysis, as well as the application methods of desensitization, suggestion, and other therapies in difficult oral cosmetic restoration cases. We further introduce the decision tree and the clinical pathway for restoration and reconstruction of teeth in exposed zone guided by aesthetic analysis, and introduce the clinical process of aesthetic analysis and evaluation, the clinical triclassification of oral cosmetic restoration, and the corresponding clinical classification diagnosis and treatment points.

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Formation of dentinal microcracks after root canal preparation with four kinds of mechanical nickel-titanium files
Wang Zi, Xue Ming
West China Journal of Stomatology    2024, 42 (1): 75-81.   DOI: 10.7518/hxkq.2023.2023257
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Objective This study aimed to compare the differences among four kinds of mechanical Ni-Ti files including T-Flex, Reciproc Blue (RB), ProTaper Gold (PTG), and ProTaper Universal (PTU) in dentinal microcrack generation after root canal preparation in vitro by using micro-computed tomography (micro-CT) analysis. Methods A total of 32 freshly extracted double-root-canal premolars with an angle not exceeding 10° were selected and established as root canal preparation models in vitro. Then, the specimens were randomly assigned to four experimental groups (n=8) according to the different Ni-Ti systems used for root canal preparation: group T-Flex, group RB, group PTG, and group PTU. The voxel size of the micro-CT was set at 17.18 μm. Pre- and post-operative cross-sectional images of roots (n=56 940) were scanned and analyzed to identify the presence of dentinal microcracks. The results of each group were expressed by the quantity and percentage of sectional images with microcracks. McNemar test was used to determine whether a significant difference existed in the existence of dentinal microcracks before and after instrumentation. The level of significance was set at P<0.05. Results Overall, 11.04% of the images presented dentinal defects (n=6 288). Dentinal microcracks were observed in 9.82%, 10.79%, 12.27%, and 11.25% of the post-instrumentation images from groups T-Flex, RB, PTG, and PTU, respectively. However, all these dentinal microcracks were already present in the corresponding pre-operative images. No new microcrack of premolars were generated after the root canal preparation utilizing the aforementioned systems. Conclusion Denti-nal microcracks already existed in advance in extracted teeth before root canal preparation. Root canal preparation using the T-Flex, RB, PTG, and PTU systems did not induce the formation of new dentinal microcracks on the straight root canals of premolars.

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Chinese surgical robot-assisted surgery for parotid tumor: a case report
Zhu Guiquan, Ma Zhongkai, Cao Chang, He Jialu, Hong Jiawei, Ren Ruiting, Xia Hui, Yan Bing, Wang Xiaoyi, Li Long-jiang, Li Chunjie
West China Journal of Stomatology    2024, 42 (2): 262-267.   DOI: 10.7518/hxkq.2024.2023393
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Robotic surgery is known as the “third technological revolution” in the field of surgery, and is an important milestone in the development of modern surgery. However, our country’s innovative surgical robot industry is still in its early stages, and it is only being utilized in certain surgical fields. To explore the effectiveness of the application of domestic surgical robot in oral and maxillofacial surgery, the author successfully completed a case of benign parotid tumor resection with the assistance of a domestic autonomous robot. The operation was successful, facial nerve function was preserved, and postoperative wound healing was good.

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One case of complicated crown root fracture of upper anterior teeth managed by multidisciplinary joint approaches
Zhang Baize, Chen Yujiang, Wang Junhui, Liu Jiajia, Wu Li’an
West China Journal of Stomatology    2024, 42 (2): 249-255.   DOI: 10.7518/hxkq.2024.2023342
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Complicated crown root fracture is a serious combined fracture of the enamel, dentin, and cementum in dental trauma. The treatment method is complicated. During the procedure, the condition of pulp, periodontal, and tooth body should be thoroughly evaluated, and a multidisciplinary approach combined with sequential treatment is recommended. This case reported the different treatment and repair processes of one case of two affected teeth after complicated crown root fracture of upper anterior teeth, including regrafting of broken crown after flap surgery at the first visit, direct resin repair to remove broken fragments, and pulp treatment and post-crown repair at the second visit. After 18 months of follow-up, the preservation treatment of the affected teeth with complicated crown root fracture was achieved. Therefore, fragment reattachment and post-crown restoration are feasible treatment options for children with complicated crown root fracture.

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Structural design of gradient porous dental implant based on orthogonal test
Wang Liangtao, Li Shan, Lu Doudou, Chen Zheng.
West China Journal of Stomatology    2023, 41 (6): 647-652.   DOI: 10.7518/hxkq.2023.2023188
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Objective To solve the current problems of loosening and dislodging caused by the high elastic modulus of solid implants, we attempted to study a gradient porous dental implant that can lower the stress concentration and reduce the elastic modulus. Methods SolidWorks software was utilized to design the abutment and mechanical structure of the gradient porous implant. The mechanical properties of the gradient porous implant were evaluated by an orthogonal experimental design from four aspects: pore shape, pore diameter, porous layer height, and circumferential distribution. ANSYS software was used to evaluate the distribution of Von-Mises stress in the implant and its surrounding bone tissues under different structural combination parameters to derive the optimal combination of gradient porous implant parameters. Results The effects of the four factors, namely, pore shape, pore diameter, porous layer height and pore distribution, on the maximum Von-Mises stress on the implant were as follows. As the pore shape became smaller and the circumferential distribution decreased, the Von-Mises stress decreased significantly. The pore diameter went from 500 μm to 600 μm and then to 700 μm. The Von-Mises stress decreased and then increased. It increased with the increase in the height of the porous layer. Conclusion The final optimal combination of parameters for the gradient porous implant was as follows: square pore shape, pore diameter of 600 μm, porous layer height of 3 mm, and quadratic step in pore distribution.

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Prediction model of dental caries in 12-year-old children in Sichuan Province based on machine learning
Yan Xinmiao, Sun Taolan, Lu Yuhang, Tan Xin, Wang Zhuo, Li Miaojing
West China Journal of Stomatology    2023, 41 (6): 686-693.   DOI: 10.7518/hxkq.2023.2023124
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Objective The machine learning algorithm was used to construct a prediction model of children’s dental caries to determine the risk factors of dental caries in children and put forward targeted measures and policy suggestions to improve children’s oral health. Methods Stratified cluster random sampling was adopted in this study. In accordance with different policies and measures in Sichuan Province, 12-year-old students from 3-4 middle schools in eight cities of Sichuan Province were randomly selected for questionnaire survey, oral examination, and physical examination. Multivariate logistic regression analysis of risk factors for dental caries in 12-year-old children was conducted. The dataset was randomly divided into training set and validation set at a ratio of 7∶3. Four machine learning algorithms, including random forest, decision tree, extreme gradient boosting (XGBoost), and Logistic regression, were constructed using R version 4.1.1, and the prediction effects of the four prediction models were evaluated using the area under receiver operating characteristic curve (AUC). Results A total of 4 439 children aged 12 years were included in this study. The incidence of permanent teeth caries was 50.93%. The results of multivariate logistic regression analysis showed that body mass index, highest educational background of the father, highest educational background of the mother, whether to brush teeth, how many times a day, use of toothpaste when brushing teeth, duration of brushing teeth, mouthwash after meals, eating before going to bed after brushing teeth, sweet drinks, snacks, going to dental clinic to examine teeth, and age of brushing teeth were the factors influencing children’s dental caries (P<0.05). The AUC values predicted by random forest, decision tree, Logistic regression, and XGBoost were 0.840, 0.755, 0.799, and 0.794, respectively. In the random forest model, the variable with the highest contribution was eating before bed after brushing. Conclusion A prediction model of dental caries in children was established on the basis of random forest, showing good prediction effect. Taking preventive measures for the main factors affecting the occurrence of dental caries in children is beneficial.

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Three-dimensional finite element study of mandibular first molar distalization with clear aligner
Kang Fujia, Yu Lei, Zhang Qi, Li Xinpeng, Hu Zhiqiang, Zhu Xianchun.
West China Journal of Stomatology    2023, 41 (4): 405-413.   DOI: 10.7518/hxkq.2023.2023021
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Objective This study aimed to construct the finite element model of the mandibular first molar with the invisible appliance and explore the dentition movement characteristics of the mandibular first molar when using micro-implant anchorage and different initial positions of the first molar. Methods Models of the mandible, tooth, periodontal membrane, and invisible appliance were constructed using cone beam computed tomography (CBCT) data. The two groups were divided into the non-anchorage group and the micro-implant group (between the roots of the first molar and the second molar) based on whether the elastic traction of the micro-implant was assisted or not. The two groups were divided into the following conditions based on the starting position of the first molar: Working condition 1: the distance between the first molar and the second premolar was 0 mm; working condition 2: the distance between the first molar and the second premolar was 1 mm; working condition 3: the distance between the first molar and the second premolar was 2 mm; working condition 4: the distance between the first molar and the second premolar was 3 mm. The data characte-ristics of total displacement and displacement in each direction of dentition were analyzed. Results In the non-ancho-rage group, all the other teeth showed reverse movement except for the first molar which was moved distally. Meanwhile, in the micro-implant group, except for a small amount of mesial movement of the second molar in wor-king condition 1, the whole dentition in other working conditions presented distal movement and anterior teeth showed lingual movement, among which the distal displacement of the first molar in working condition 4 was the largest. With the change of the initial position of the first molar to the distal, the movement of the first molar to the distal, the premolar to the mesial, and the anterior to the lip increased, while the movement of the second molar to the mesial decreased. Conclusion The micro-implant can effectively protect the anterior anchorage, increase the expression rate of molar distancing, and avoid the round-trip movement of the second molar. The initial position of the first molar movement is related to the amount of distancing and the remaining tooth movement.

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Personal understanding of the extraction or rescue on severe periodontitis teeth
Wang Qintao, Ma Zhiwei, Wang Jinjin.
West China Journal of Stomatology    2023, 41 (6): 635-640.   DOI: 10.7518/hxkq.2023.2023274
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To keep or extract severe periodontitis damaged teeth is one of the controversial topics in the dentistry from ancient times to present. From different perspectives, professions, technologies, time, and economics, there may be different choices with unidentified consensus. Based on the author’s own understanding, experience, literature review, and other aspects, this article proposes some exchange views on influencing factors, abandoning consideration, preserving possibility, and how to detect and prevent the development of lesions. The aim is to stimulate more thinking and accumulate clinical evidence-based data among peers, in order to facilitate cooperation and promote oral health.

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Study on the effect of chin morphology on orthodontic treatment
Fu Yu, Li Ziwei, Zhao Menghan, Shi Ruixin.
West China Journal of Stomatology    2023, 41 (4): 443-449.   DOI: 10.7518/hxkq.2023.2022508
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Objective To investigate the effect of different soft-tissue morphologies on the treatment of skeletal class Ⅰ malocclusion patients by analyzing measurement data before and after treatment. Methods Pre- and post-treatment lateral cephalograms of 55 adult female Angle class Ⅰ patients were collected in the Department of Orthodontics, Hospital of Stomatology, Jilin University from January 2012 to December 2020. Chin soft-tissue morphologies in the lateral cranial radiographs were used to divide the patients into an abnormal chin morphology group (flat and retracted chins, n=27) and a normal chin morphology group (rounded and prominent chins, n=28). Relevant soft- and hard-tissue indexes were selected to study in-group varieties and intergroup differences in the varying chin morphologies before and after treatment. Results The chin-lip angle, mandibular chin angle, mandibular chin vertex angle, PP-MP, LL-E, UL-E, Po-Pos, and B-B’ thickness in the abnormal chin morphology group were significantly higher than those in the normal chin morphology group (P<0.05). Furthermore, m∶BMe and n∶B’Mes in the abnormal chin morphology group were signi-ficantly lower than those in the normal chin morphology group (P<0.05). After treatment, the mandibular chin angle, mandibular chin vertex angle, U1-SN, L1-MP, LL-E, UL-E, SNA, SNB, and B-B’ thickness of the abnormal chin morphology group significantly decreased (P<0.05), whereas the nasolabial angle, m∶BMe, n∶B’ Mes, and Po-Pos significantly increased (P<0.05). In the normal chin morphology group, the U1-SN, L1-MP, LL-E, UL-E, and B-B’ thicknesses decreased significantly (P<0.05), whereas the nasolabial angle significantly increased (P<0.05). Among them, m∶BMe and n∶B’ Mes were positively correlated. Conclusion Chin morphology affects the formulation of treatment plans. Compared with the normal chin morphology group, the abnormal chin morphology group required a larger retraction of incisors. Although the chin of soft-tissue morphology is related to the morphology of bones, the changes in soft tissue chin after treatment cannot be directly predicted according to the bone changes. Soft-tissue chin morphology affects the aesthetic assessment of the soft-tissue lateral profile and the change in soft tissue before and after treatment. The method of predicting the change in soft-tissue chin after treatment should consider the morphology of the soft-tissue chin.

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Effect of the application of digital technology-assisted optimization in the process of adjusting jaw position
Gong Yanji, Liu Yang, Yin Deqiang
West China Journal of Stomatology    2024, 42 (2): 268-276.   DOI: 10.7518/hxkq.2024.2023327
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Objective The aim of this study was to demonstrate a novel jaw position adjustment technique derived from digital twins and evaluate the application effect of digital technology-assisted optimization in the process of adjusting jaw position on patients with temporomandibular disorders (TMD). Methods A total of 74 patients with TMD who attended the Department of Temporomandibular Joint, West China Hospital of Stomatology, Si-chuan University, between June 2022 and May 2023 were selected. The patient’s initial computed tomography (CT) and bilateral temporomandibular joint data obtained by magnetic resonance imaging (MRI) were collected. The 148 joints were divided into the normal disc-condyle relationship (N) group, disc displacement with reduction (DDWR) group, and disc displacement without reduction (DDWoR) group. Assisted by digital technology, the patient’s CT data were reconstructed, and a personalized reference plane was established to adjust the jaw position. A three-point bite guiding splint was designed by the adjusted occlusal space and then fabricated by 3D printing technology. It was worn by the patients and then reviewed by MRI. Before and after the adjustment of jaw position, the amount and direction of condyle and disc displacement and the angle between condyle and disc were measured as the evaluation indexes of the effect of the adjustment. The correlation with condylar displacement was evaluated. Results In the N group, the disc moved backward and downward along the X and Z axes by (-0.60±0.62) and (0.51±0.71) mm, respectively. In the DDWR group, the disc moved backward and upward along the X and Z axes by (-1.33±1.38) and (-0.09±1.31) mm, respectively. In the DDWoR group, the disc moved forward and downward along the X and Z axes by (0.49±1.76) and (1.35±1.76) mm, respectively. The angle between the condyle and the disc decreased after adjustment of the jaw position in all three groups. All patients showed improvement in symptoms after adjustment. Conclusion Digital technology-assisted jaw position adjustment can simplify the process, reduce the sensitivity of the technique, and improve patients’ disc-condyle structure and symptoms. Therefore, its application in the treatment of patients with TMD is of great clinical significance.

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Facial nerve function training in patients with peripheral facial paralysis: an expert consensus
Chen Yunmei, Liu Yan, Huang Qiuyu, Luo Jiang, Wu Hongmei, Wang Yehua, Wu Ling, Li Xiu’e, Bi Xiaoqin
West China Journal of Stomatology    2023, 41 (6): 613-621.   DOI: 10.7518/hxkq.2023.2023200
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Facial nerve training can prevent facial expression muscle atrophy and promote the recovery of facial para-lysis in patients with peripheral facial paralysis. However, there is still a lack of specific and unified technical standards for facial nerve training, which results in a variety of clinical training methods and uneven levels. In order to standardize the application of facial nerve function training technology for nursing staff, the study convened relevant domestic experts, based on evidence-based combination with the disease characteristics of peripheral facial paralysis and expert clinical experience, conducted in-depth interviews with experts, expert correspondence and expert meetings, and finally formulated the expert consensus on facial nerve function training in patients with peripheral facial paralysis. Overall, suggestions for standardizing the timing, training methods, evaluation methods, health education and other aspects were provided for clinical reference.

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Correlation between health literacy and life quality in elderly patients with chronic periodontitis
Jiang Jianhong, Shi Xinglian, He Quanmin, Gao Li, Yang Kun, Wang Taiping, Li Zhezhen, Liu Mei
West China Journal of Stomatology    2023, 41 (6): 694-700.   DOI: 10.7518/hxkq.2023.2023184
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Objective This study aims to explore the status quo of health literacy and quality of life in elderly patients with chronic periodontitis and determine their correlation to understand the influencing factors of health literacy and quality of life. Methods A total of 150 elderly patients with chronic periodontitis were investigated using the general information questionnaire, Oral Health Literacy-Adult Questionnaire, and Oral Health Impact Profile for Chronic Periodontitis. Results The total scores of health literacy and quality of life of elderly patients with chronic periodontitis were 6.59±4.11 and 29.25±9.42, respectively. The total score of health literacy was negatively correlated with the total score of quality of life (r=-0.234, P<0.01). Regression analysis showed that age, place of residence, education level, and disease understanding were the influencing factors of health literacy. Family history, smoking, and education level were the influencing factors of quality of life. Conclusion The health literacy level of elderly patients with chronic periodontitis is insufficient, and their quality of life needs to be improved. Improving the health literacy of patients is an effective way to improve their quality of life. Nursing staff must formulate corresponding health education strategies to improve the health literacy of patients and improve their quality of life.

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Association between serum Galectin-3 and periodontitis in patients with type 2 diabetes mellitus
Zhang Yanbiao, Wei Meirong, Xia Tianyong, Yin Wenting, Mao Shumei
West China Journal of Stomatology    2023, 41 (6): 653-661.   DOI: 10.7518/hxkq.2023.2023192
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Objective This study aims to investigate the correlation between serum Galectin-3 levels and the risk of periodontitis in patients with type 2 diabetes mellitus (T2DM). Methods A total of 140 patients with T2DM admitted to the endocrinology department of Weifang People’s Hospital, Affiliated to Weifang Medical College from July 2021 to November 2022 were selected and divided into T2DM without periodontitis group (T2DM group, n=67) and T2DM with periodontitis group (T2DMP group, n=73) according to whether they were combined with periodontitis. In the same period, 65 non-periodontitis volunteers with normal blood glucose were selected as healthy control group (NC group). Blood samples of all subjects were collected, and serum Galectin-3 levels and related laboratory indices were detected and compared among the three groups. Results Serum Galectin-3 levels in the NC, T2DM, and T2DMP groups were 3.81 (3.49, 4.15), 4.82 (4.25, 5.26), and 6.83 (5.19, 7.28) ng/mL, respectively. After adjusting for the influence of baseline data by multiple linear regression, serum Galectin-3 levels in the T2DMP and T2DM groups were significantly higher than those in the NC group (all P<0.05). Multiple linear regression analysis showed that serum Galectin-3 levels were positively correlated with homeostatic model of the insulin resistance index (β=0.254, 95%CI:0.089-0.419, P=0.003), glycosylated hemoglobin A1c (β=0.397, 95%CI: 0.049-0.745, P=0.026), and clinical attachment loss (β=0.298, 95%CI: 0.024-0.572, P=0.033). After adjusting for the effects of covariates, binary logistic regression showed that serum Galectin-3 levels were significantly associated with the risk of periodontitis in patients with T2DM (OR=2.146, 95%CI: 1.260-3.655, P=0.005). Trend test showed that the risk of periodontitis in patients with T2DM increased with increasing serum Galectin-3 levels (Ptrend=0.011). Receiver operating characteristic (ROC) curve analysis showed that the area under the curve (AUC) of serum Galectin-3 in predicting T2DM periodontitis was 0.861 (95%CI: 0.801-0.920, Z=11.806, P<0.001). Conclusion Serum Galectin-3 levels were elevated in patients with T2DM and pe-riodontitis and associated with the risk of periodontitis.

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Intentional replantation for the retreatment of mandibular second molar: a case report
Cai Meijuan, Xiang Shaowen, Xie Chengjie, Ouyang Chuhong, Tong Fangli
West China Journal of Stomatology    2023, 41 (4): 471-477.   DOI: 10.7518/hxkq.2023.2022487
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When the use of root canal retreatment and apical surgery experiences difficulty in treating endodontic diseases, intentional replantation is an optional clinical technique used to retain the tooth. A 28-year-old female complained of chewing discomfort at the mandibular second molar after undergoing root canal treatment 3 month ago. History record and radiographic examination revealed that a C-shaped root canal system was filled with gutta-percha in the mandibular second molar. A radiolucency area existed at the root furcal area with a thin canal wall in the distal and mesial roots. Intentional replantation was used to treat this tooth. The clinical and radiographic results showed that intentional replantation and nano-biomaterial application facilitated infection control, tooth retention, and periodontal tissue regeneration.

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Stevens-Johnson syndrome secondary to massive inflammatory hyperplasia of bilateral lingual margins: a case report and literature review
Lin Juan, Yu Fan, Li Xiaona, Li Bingyan, Zhang Ruipu, Xie Weihong.
West China Journal of Stomatology    2023, 41 (5): 599-603.   DOI: 10.7518/hxkq.2023.2023086
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Stevens-Johnson syndrome (SJS), also known as the multifactorial erythematous drug eruption, is a class of adverse reactions of the skin and mucous membranes primarily caused by drug allergy often involving the oral cavity, eyes, and external genital mucosa, generally accompanied by fever, and can be life-threatening in severe cases. In February 2022, the Department of Stomatology, the First Affiliated Hospital of Zhengzhou University admitted a patient with huge inflammatory hyperplasia of bilateral lingual margins secondary to SJS. Upon admission, no other obvious symptoms were observed except for tongue hyperplasia. The patient suffered from a severe adverse drug reaction caused by acetaminophen 2 months ago and was complicated by liver dysfunction and pulmonary infection. After 1 month of treatment and rehabilitation, he developed a secondary tongue mass and was subsequently admitted to Dept. of Oral and Maxillofacial Surgery Ward 2, the First Affiliated Hospital of Zhengzhou University. After completing the examination, the tongue mass was surgically removed. After a follow-up of 11 months, the patient’s condition was satisfactory and no temporary discomfort was observed. The case of tongue mass secondary to SJS is extremely rare. If a stomatologist encounters a similar case, we should carefully inquire about the drug allergy history and recent medication history, and be alert to whether or not they had adverse drug reactions recently.

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Application of modified articular disc anchorage in treating the perforation and rupture of temporomandibular joint disc
Wang Tiebiao, Zhou Wuchao, Xiao Yin, Cheng Jialong, Ouyang Zhoucheng, Cheng Chen, Xi Weihong.
West China Journal of Stomatology    2023, 41 (4): 434-442.   DOI: 10.7518/hxkq.2023.2022495
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Objective This study aimed to use modified articular disc anchorage in treating old irreducible temporomandibular joint (TMJ) disc displacement with perforation and rupture, as well as to explore its efficacy. Methods A total of 31 patients (34 sides) with 47 TMJ disc perforations who underwent surgical treatment in the Affiliated Stomatolo-gical Hospital of Nanchang University from January 2018 to December 2021 were selected. According to the location of disc perforation, it has five types: posterior disc perforation (typeⅠ), anterior disc perforation (typeⅡ), lateral disc perforation (type Ⅲ), composite disc perforation, and destruction disc perforation. The modified methods of disc anchoring were divided into two types according to the location of the perforation. TypesⅠandⅢ disc perforation were trea-ted by posterior anchoring method. For posterior ancho-ring, a screw was implanted into the posterolateral side of the condylar neck, and the disc was fixed on the screw by horizontal mattress suture. TypeⅡdisc perforation and compo-site disc perforation combined typeⅡperforation were treated by anterior and posterior double-anchoring method. For anterior anchoring, anchor screws or holes were placed at the anterior edge of the condylar neck, and horizontal mattress suture was performed at the posterior edge of the anterior perforation with an anchor wire. The articular disc was then fixed on the anchor screws or holes. For the posterior anchoring method, it was the same as the previous one. Paired t test was used to analyze the visual analog scale (VAS), maximum interincisal opening (MIO), and TMJ disorder index (CMI) of the patient before surgery and 1, 3, and 6 months after surgery. Disk-condyle position relationship by magnetic resonance imaging and postoperative quality of life in postoperative were analyzed. Results The incidence of perforation was 41.2% (14/34) in typeⅠ, 11.8% (4/34) in typeⅡ, 8.8% (3/34) in typeⅢ, 29.4% (10/34) in composite type, and 8.8% (3/34) in destruction type. The VAS, MIO, and CMI at 3, 6 months after operation significantly improved compared with those before operation (P<0.05). The effective reduction rate of disc was 96.77% (30/31). The quality of life at 6 months after surgery was 47.22±2.13, and the rate of excellent evaluation was 96.4% (27/28). Conclusion Modified articular disc anchorage achieves a good curative effect for treating temporomandibular joint disc perforation and rupture. Nevertheless, its long-term effect requires further observation.

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Comparison of the efficacy and long-term stability of tunnel technique and coronally advanced flap in the treatment of gingival recession: a Meta-analysis
Cheng Xiaoming, Tang Rui, Ge Zili
West China Journal of Stomatology    2023, 41 (4): 450-462.   DOI: 10.7518/hxkq.2023.2023045
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Objective This study aimed to evaluate the efficacy and long-term stability of tunnel technique (TUN) and coronally advanced flap (CAF) combined with connective tissue graft (CTG) in treating gingival recession. Methods Databases including PubMed, Web of Science, Embase, and CNKI were electronically searched to collect randomized controlled trial (RCT) of CAF+CTG compared to TUN+CTG in the treatment of Miller class Ⅰ or Ⅱ gingival recession on September 1, 2022. Results There were 8 RCTs with 305 patients (454 recession sites) participating. The results of the Meta-analysis revealed that, in terms of mean root coverage (MRC) of main indicators, no significant difference was found between the CAF group and the TUN group in both short- and long-term results, which were [MD: 1.45%, 95%CI (-2.93%, 5.82%), P=0.52] and [MD: -0.70%, 95%CI (-6.41%, 5.00%), P=0.81]. However, the CAF group outperformed the TUN group in the long term [MD: 5.69%, 95%CI (0.87%, 10.50%), P=0.02], and the results of complete root coverage (CRC) analysis were similar to those of MRC. In the short term, the TUN group grew keratinized gingiva significantly faster than the CAF group [MD: -0.38 mm, 95%CI (-0.67 mm, -0.10 mm), P=0.008]. Long-term findings revealed no significant difference between the two groups [MD: -0.26 mm, 95%CI (-0.94 mm, 0.43 mm), P=0.46]. The TUN group’s secondary index root coverage esthetic score (RES) was statistically significantly higher than the CAF group’s [MD: 0.62, 95%CI (0.28, 0.96), P=0.000 3]. Given that there were few results included in the literature and the heterogeneity was too great, no significant difference was observed in the postoperative VAS pain index score [MD: 0.53, 95%CI (-1.96, 3.03), P=0.68]. Conclusion This study discovered that both CAF+CTG and TUN+CTG can achieve good root coverage in treating gingival recession, with CAF outperforming TUN and both groups achie-ving good long-term stability. After the operation, the TUN group had a higher RES than the CAF group. Given the limitations of this study, more high-quality studies are needed in the future to demonstrate the efficacy of TUN in gingival retraction surgery.

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Meta-analysis of condylar changes produced by a Twin-block appliance in Class Ⅱ malocclusion
Li Yulin, Xu Jingchen, Jiang Xiaoge, Chen Song.
West China Journal of Stomatology    2023, 41 (4): 463-470.   DOI: 10.7518/hxkq.2023.2023052
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Objective To evaluate the effects of a Twin-block appliance on the condyles of patients with ClassⅡmalocclusion by conducting a systematic review and a Meta-analysis. Methods Pubmed, Embase, Cochrane Library, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and VIP Database were electronically searched. Randomized controlled trials, controlled clinical trials, and single-arm trials on condylar changes produced by a Twin-block appliance in patients with ClassⅡmalocclusion were included. Two reviewers independently extracted and assessed the risk of bias. Meta-analyses were conducted with Review Manager 5.3. Results Eight studies were included; among which, seven were of high quality. After treatment with a twin block appliance, condyles moved anteriorly. The anterior joint spaces decreased (P<0.000 01), whereas the posterior spaces increased (P<0.000 01). The superior spaces were not changed (P=0.11). Moreover, a significant difference was observed in the increase of the condylar space index (P<0.000 01). After treatment, the anteroposterior diameters of the condyles and condylar height increased (P=0.000 2 and P<0.000 01, respectively). By contrast, no significant changes were discovered in the medial external diameters of the condyles (P=0.42). Conclusion A Twin-block appliance can promote the growth of a condyle in the posterior and upper direction and move it forward in favor of the correction of Class Ⅱ malocclusion.

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Oral mucosal lesions with transient self-healing of Langerhans cell histiocytosis: a case report
Zhang Xiaoling, Xue Ningning, Ruan Minhui, Zeng Xin.
West China Journal of Stomatology    2023, 41 (5): 592-598.   DOI: 10.7518/hxkq.2023.2023084
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Langerhans cell histiocytosis (LCH) is a group of unexplainable abnormal proliferation and aggregation of Langerhans cell. LCH can be classified into four clinical variants: Letterer-Siwe disease, Hand-Schüller-Christian disease, eosinophilic granuloma, and congenital self-healing LCH. LCH is most prevalent in children. Lesions can be localized in a single system or multiple organs, and clinical manifestations vary depending on the affected organs. The skin and mucocutaneous tissues are the starting point of the affected tissue. This study presents a LCH case characterized by transient self-healing. This case can further provide references for the clinical diagnosis and treatment of LCH.

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A case of intramandibular epidermoid cyst and literature analysis
Ren Bihui, Dai Jieting, Xu Yehao, Guo Shuigen, Wei Hongwu, Mao Weihua.
West China Journal of Stomatology    2023, 41 (4): 478-482.   DOI: 10.7518/hxkq.2023.2022465
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Epidermoid cysts are generally benign neoplastic lesions, the etiology of which is unclear and is mainly related to epithelial cells left in the tissues during the embryonic period and traumatically implanted in the tissues. The most common intraosseous sites are the phalanges and the skull. Epidermoid cysts occurring in the jaws are clinically rare. In this paper, we report a case of epidermoid cyst occurring in the mandible with embedded teeth and discuss the etiology, clinical manifestations, diagnosis, and treatment of epidermoid cysts in the jaws in the context of the relevant literature.

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