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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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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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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 infection control of post-and-core crown restoration
Huang Cui, Zhu Jiakang, Wang Qian
West China Journal of Stomatology    2023, 41 (3): 247-253.   DOI: 10.7518/hxkq.2023.2023030
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Post-and-core crown is one of the most common forms of restoration of tooth after root canal therapy (RCT). Infection control is the core objective of RCT, which is usually well realized by endodontists. However, many prosthodontists often neglect the infection control of the tooth and the maintenance of the curative effect of RCT during the process of post-and-core crown, which may lead to the failure of the final restoration. The concept of integrated crown-root treatment advocated recently requires clinicians to consider the RCT and final restoration as a whole, rather than simply divided into two parts—endodontic treatment and restorative treatment. As the core content of integrated crown-root treatment, infection control should be taken seriously by clinicians and implemented throughout the whole treatment process, especially in the restorative treatment that is easily overlooked after RCT. Therefore, this article describes the infection control of post-and-core crown restoration, classifies the tooth requiring post-and-core crown restoration, and puts forward the measures of infection control before and during post-and-core crown restoration, in order to provide reference and guidance for clinical practice.

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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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Modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction
Tang Hui, Wang Lang, Wang Lei, Rao Pengcheng, Luo Daowen, Fu Guangxin, Xiao Jingang
West China Journal of Stomatology    2023, 41 (3): 290-296.   DOI: 10.7518/hxkq.2023.2022496
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Objective This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction. Methods Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction. Results At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations. Conclusion The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.

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Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it
Jing Bingshuai, Shi Bing, Zheng Qian, Li Chenghao.
West China Journal of Stomatology    2023, 41 (3): 284-289.   DOI: 10.7518/hxkq.2023.2022446
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Objective To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it. Methods A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated. Results Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036). Conclusion The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

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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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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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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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Audit to assess the quality of 916 prosthetic prescriptions of removable partial dentures
Zhang Na, Mao Bochun, Dai Yunhan, Chen Shengkai, You Ziying, Zhang Junjing, Chen Xin, Dong Haoyue, Yue Li, Yu Haiyang
West China Journal of Stomatology    2023, 41 (3): 315-322.   DOI: 10.7518/hxkq.2023.2021565
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Objective The objectives of this study were to assess the quality of prosthetic prescriptions of removable partial dentures (RPDs) and to analyze the current situation of the communication and information delivery between clinicians and technicians. Methods All RPD prosthetic prescriptions received by a major dental laboratory in 4 weeks were involved in a quality audit, and the prescriptions were divided into three groups in accordance with the grades of clients. The filling of prosthetic prescriptions was recorded. The items in the prescriptions for audit included the general information of the patient, the general information of the clinician, the design diagram information, other detailed information, and the return date. The prescriptions were categorized into four levels on the basis of their quality by two quality inspectors who have been working for more than 10 years. Results A total of 916 prescriptions were collected and assessed. The names in the general information of the patient and the clinician were filled out best, both at the rate of 97.6% (n=894). The return date was filled out worst, only at the rate of 6.4% (n=59). Of those prescriptions, 86.8% (n=795) exhibited inadequate design diagram information. The results of the quality assessment demonstrated that 74.2% of prescriptions were assessed as noncompliant ones and failed to meet the acceptable clinical quality standard. Conclusion At present, the overall quality of RPD prosthetic prescriptions is poor. The responsibilities of clinicians and technicians are unclear, and the communication between them is not ideal.

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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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Malignant peripheral nerve sheath tumor of tongue: a case report
Liu Yibo, Wu Di, Lun Xiaohan, Dai Wei.
West China Journal of Stomatology    2023, 41 (3): 361-364.   DOI: 10.7518/hxkq.2023.2022402
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Malignant peripheral nerve sheath tumor (MPNST) is a rare neurogenic malignant tumor. MPNST has aty-pical clinical symptoms and imaging presentations, difficult diagnosis, a high degree of malignancy, and poor prognosis. It usually occurs in the trunk, approximately 20% in the head and neck, and rarely in the mouth. This paper reports a case of MPNST of the tongue. A summary of the clinical features, diagnosis, and treatment of MPNST is presented in combination with a literature review to provide a reference for the diagnosis and treatment of this disease.

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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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Diagnosis and treatment of apical cyst of deciduous teeth with infection: a case report
Zhang Yue, Liu Xiaowen, Yang Ran
West China Journal of Stomatology    2023, 41 (3): 356-360.   DOI: 10.7518/hxkq.2023.2022428
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There is a high incidence of chronic periapical periodontitis of deciduous teeth, however, there is a low incidence of the apical cyst. This paper reports a 7-year-old child with deciduous periodontitis caused by chronic periapical periodontitis of deciduous teeth. Through literature review, the etiology, imaging characteristics, diagnosis, differential diagnosis, and treatment methods were discussed to provide the basis for clinical diagnosis and treatment.

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Mandibular advancement with clear aligners and functional appliances in the treatment of skeletal ClassⅡmalocclusion: a systematic review and meta-analysis
Yu Lei, Li Ziwei, Kang Fujia, Wang Songqing, Xie Zunxuan, Zhu Xianchun.
West China Journal of Stomatology    2023, 41 (3): 305-314.   DOI: 10.7518/hxkq.2023.2022453
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Objective This study aimed to conduct a meta-analysis of the efficacy of mandibular advance clear alig-ners with traditional functional appliances as the control group. Methods PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Abstracts Database, China Knowledge Network Database, Wanfang Database, and Weipu Database were used in this study. The two groups of researchers screened the literature and extracted data based on the inclusion and exclusion criteria established by PICOS entries, and used the ROBINS-I scale for quality evaluation. Revman 5.4 and Stata 17.0 software were used for meta-analysis. Results Nine clinical controlled trials were included in this study with a total sample size of 283 cases. No significant difference was found in SNA, SNB, ANB, Go-Pog, U1-SN, Overjet, and other aspects between the invisible group and the traditional group in the treatment of skeletal class Ⅱ ma-locclusion patients; there was a 0.90° difference in mandibular plane angle between the two groups; the growth of the mandibular ramus (Co-Go) in the traditional group was 1.10 mm more than that in the invisible group; the lip inclination of the lower teeth in the invisible group was better controlled, 1.94° less than that in the control group. Conclusion The invisible group can better control the lip inclination of the mandibular anterior teeth when guiding the mandible. Furthermore, the mandibular plane angle (MP-SN) can remain unchanged, but the growth of the mandibular ramus is not as good as the traditional group, and auxiliary measures should be taken to improve it in clinical practice.

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A comparative study based on the mandibular movement track and the movement parameters of the virtual articulator in simulating occlusal adjustment
Ma Liya, Chao Jiarui, Liu Fei, Mei Jiansong, Shen Jiefei.
West China Journal of Stomatology    2023, 41 (3): 254-259.   DOI: 10.7518/hxkq.2023.2022452
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Objective This study aimed to compare the effects of virtual adjustment on occlusal interferences in mandibular posterior single crown and three-unit bridge restorations by using the mandibular movement track and the movement parameters of a virtual articulator. Methods Twenty-two participants were recruited. Digital casts of the maxillary and mandibular arches were obtained using an intraoral scanner, and the jaw registration system was used to record the data of the mandibular movement track and the movement parameters of the articulator. Four kinds of restorations with 0.3 mm occlusal interferences were designed with dental design software. In particular, single crowns were designed for teeth 44 and 46, whereas three-unit bridges were designed for teeth 44-46 and 45-47, and the corresponding natural teeth were virtually extracted. Virtual adjustment of the restorations was performed using two dynamic occlusal recordings, namely, the mandibular movement track and the movement parameters of the virtual articulator. A reverse-engineering software was used to measure the root-mean-square of the three-dimensional deviation of the occlusal surfaces between natural teeth and the adjusted restorations. The differences between the two methods of virtual-occlusion adjustment were compared and analyzed. Results For the same group of restorations, the three-dimensional deviation of the mandibular movement track group were lower than those of the virtual articulator group, and the differences were statistically significant (P<0.05). For the four groups of restorations adjusted by the same method, the three-dimensional deviation of the 46-tooth single crown was the largest and the smallest three-dimensional deviation was that of the 44-tooth single crown. Statistical differences existed between the 44-tooth single crown and the other groups (P<0.05). Conclusion For the occlusal design of posterior single crown and three-unit bridge, the mandibular movement track could be a more effective approach to virtual occlusal adjustment than the movement parameters of the virtual articulator.

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Imaging study on the relationship between anterior and posterior occlusal planes and temporomandibular osteoarthrosis
Zhong Jiawei, Fan Peidi, Hu Shoushan, Gao Xinlin, Li Yijun, Wang Jun, Xiong Xin.
West China Journal of Stomatology    2023, 41 (3): 297-304.   DOI: 10.7518/hxkq.2023.2023032
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Objective The aim of this study was to compare the anterior and posterior occlusal plane characteristics of patients with different temporomandibular joint osseous statuses. Methods A total of 306 patients with initial cone beam CT (CBCT) and cephalograms were included. They were divided into three groups on the basis of their temporomandibular joint osseous status: bilateral normal (BN) group, indeterminate for osteoarthrosis (I) group, and osteoarthrosis (OA) group. The anterior and posterior occlusal planes (AOP and POP) of the different groups were compared. Then, the regression equation was established after adjusting for confounding factors, and a correlation analysis between the occlusion planes and other parameters was performed. Results SNA, SNB, FMA, SN-MP, Ar-Go, and S-Go were correlated with the occlusal planes. Relative to the BN and I groups, the FH-OP of the OA group increased by 1.67° on the average, FH-POP increased by 1.42° on the average, and FH-AOP increased by 2.05° on the average. Conclusion The occlusal planes were steeper in the patients with temporomandibular osteoarthrosis than in the patients without it, and the mandible rotated downward and backward. The height of the mandibular ramus, the mandibular body length, and the posterior face height were small. In clinical practice, attention should be given to the potential risk of temporomandibular joint osteoarthrosis in such patients. In addition, SNB, FMA, SN-MP, Ar-Go, S-Go, and occlusal planes had moderate correlations.

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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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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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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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Anesthesia management for patient with bipolar disorder complicated with hypothyroidism during oral surgery: a case report
Li Yue, Ji Yang, Luo Qiang.
West China Journal of Stomatology    2023, 41 (3): 365-368.   DOI: 10.7518/hxkq.2023.2022448
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Bipolar disorder is a major mental illness that is difficult to treat and has a high degree of recurrence. This article reports general anesthesia for oral surgery in a patient with bipolar disorder complicated with hypothyroidism. It also discusses the rational application of antipsychotic drugs and anesthetics with reference to the literature to improve the understanding of the disease and help patients with mental disorders complete the surgical treatment quietly and smoothly.

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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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Cognition about emergency management of avulsed incisor in children among dentists in Guangdong province
Zhang Li, Xie Jing, Chen Ying, Deng Shuman, Chen Luyi, Gao Qi
West China Journal of Stomatology    2023, 41 (3): 323-332.   DOI: 10.7518/hxkq.2023.2022473
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Objective This study aimed to evaluate and analyze the current situation of dentists in Guangdong pro-vince regarding the management of avulsed incisors, thereby providing a reference for making treatment strategies for avulsed incisors in the future. Methods A total of 712 dentists with different educational backgrounds and working conditions in Guangdong province were randomly selected to conduct an online questionnaire survey on the cognition of children with avulsed incisors from April 2022 to May 2022. The data were recorded by Excel software and statistics were analyzed on Stata/SE 15.1. Results A total of 712 dentists were investigated and 701 questionnaires were collected (98.46%). In addition, 65.9% of investigators came from the Department of Stomatology in a First-class Hospital or Stomatological Hospital. The results showed that the average number of avulsed teeth consulted by dentists was less than 20 per year. Although 99.7% of respondents considered normal saline as a suitable storage medium, 3.1% and 23.8% of them had a misunderstanding that the tap/alcohol could be used for root cleaning. Moreover, 93.4% was the correct selection rate of the treatment plan for processing on root surfaces before replanting by investigators. The correct selection rate of the duration using elastic fixation was only 10.7%. Meanwhile, 42.9% of investigators refused to inoculate tetanus immunoglobulin after teeth replanting. Emergency management of dental avulsion (EM) and clinical management of dental avulsion (CM) answered correctly with average scores of 14.60±11.85 and 14.48±2.67, respectively. Multivariate linear regression analysis revealed that working years were negatively correlated with EM and CM scores (P<0.05). There was a positive correlation between CM and EM scores with the number of avulsion cases treated by physicians each year (P<0.05). In terms of the EM score of dentists’ learning attitude, investigators who had received enough knowledge were higher than those who had not and insufficient knowledge reserved, and the difference was statistically significant (P<0.05). The scores of investigators who thought they had a certain degree of knowledge about dental trauma were higher than those who thought they “did not understand”, and the difference was statistically significant (P<0.05). In terms of CM scores, investigators who thought the knowledge of dental trauma was “very helpful” had higher scores than those who thought it was “not helpful”, and the difference was statistically significant (P<0.05). The scores of the investigators who thought they had “relatively sufficient knowledge” of dental trauma were higher than those who thought they had “no knowledge” or “insufficient know-ledge”, and the difference was statistically significant (P<0.05). Conclusion The overall accuracy of the management of avulsed incisors among dentists was low in Guangdong province. Dentists were more likely to have a higher rate of accuracy choice in treatment options for luxation injury and avulsion to enhance the prognosis of replanted teeth.

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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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