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Postextraction infections, prevention, and treatment
Cao Yubin, Ye Li, Pan Jian
West China Journal of Stomatology    2024, 42 (4): 426-434.   DOI: 10.7518/hxkq.2024.2023427
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Postoperative infection is one of the most common complications of tooth extraction. It may manifest as localized infection or develop to systemic infection. Clinically, oral surgeons can prevent postoperative infections by urging patients to strengthen oral hygiene, applying antibiotics in a rational and compliant manner, and choosing appropriate surgical methods for tooth extraction. For the treatment of infection, the oral surgeon should formulate a response strategy on the basis of different diagnoses. For local infections such as dry socket, delayed alveolar osteitis, gap infection, and marginal osteomyelitis of the jaws, the infection can be controlled by local debridement, therapeutic use of antibiotics, and incise and drain if necessary. For patients suspected of necrotizing fasciitis, timely extensive debridement should be made to reduce the area of tissue necrosis. For those who have received radiotherapy or anti-resorptive drugs, tooth extraction should follow the recommendations of the relevant clinical guidelines or expert consensus to minimize the risk of osteonecrosis of the jaws. For patients with poor systemic health or dysfunction of the immune system, attention should be paid to identifying infective endocarditis and intracranial infection to ensure the life safety of patients. In this study, the author intends to combine literature review and clinical experience to tackle postextraction infection and its prevention to provide a reference for colleagues on oral and maxillofacial surgery.

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Research status and prospects of biodegradable magnesium-based metal-guided bone regeneration membranes
Chen Liangwei, Han Jianmin, Guo Chuanbin
West China Journal of Stomatology    2024, 42 (4): 415-425.   DOI: 10.7518/hxkq.2024.2024140
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Biodegradable magnesium-based metal-guided bone regeneration (GBR) membranes possess excellent mechanical properties, biodegradability, and osteopromotive capabilities, making them ideal implants for the treatment of maxillofacial bone defects. This review summarizes the current status and future research trends related to magnesium-based GBR membranes. First, the research history and application fields of magnesium-based metals are introduced, and the advantages of the use of magnesium-based materials for GBR membranes, including their mechanical properties, biocompatibility, osteopromotive performance, and underlying mechanisms are discussed. Finally, this review addresses the current limitations of magnesium-based GBR membranes and their applications and prospects in the field of dentistry. In conclusion, considerable advancements have been in fundamental and translational research on magnesium-based GBR membranes, which lays a crucial foundation for the treatment of maxillofacial bone defects.

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Expert consensus on classification and diagnosis of congenital orofacial cleft
Li Chenghao, An Yang, Duan Xiaohong, Guo Yingkun, Liu Shanling, Luo Hong, Ma Duan, Ren Yunyun, Wang Xudong, Wu Xiaoshan, Xie Hongning, Zhu Hongping, Zhu Jun, Shi Bing
West China Journal of Stomatology    2025, 43 (1): 1-14.   DOI: 10.7518/hxkq.2025.2024306
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Congenital orofacial cleft, the most common birth defect in the maxillofacial region, exhibits a wide range of prognosis depending on the severity of deformity and underlying etiology. Non-syndromic congenital orofacial clefts typically present with milder deformities and more favorable treatment outcomes, whereas syndromic congenital orofacial clefts often manifest with concomitant organ abnormalities, which pose greater challenges for treatment and result in poorer prognosis. This consensus provides an elaborate classification system for varying degrees of orofacial clefts along with corresponding diagnostic and therapeutic guidelines. Results serve as a crucial resource for families to navigate prenatal screening results or make informed decisions regarding treatment options while also contributing significantly to preventing serious birth defects within the development of population.

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Multidisciplinary clinical decision-making of anterior diastema closure
Yu Haiyang, Shui Yusen, Jiang Qingsong
West China Journal of Stomatology    2024, 42 (3): 277-285.   DOI: 10.7518/hxkq.2024.2023460
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Anterior diastema is a common esthetic defect in China. The general treatment for a patient with diastemata, including orthodontics and direct and indirect restorations, is a multidisciplinary clinical procedure covering the orthodontics, operative dentistry, general dentistry, and prosthodontics department. Given the diversity of departments and the complex etiology of this defect, decision-making regarding the closing methods and time selection is undefined and unintegrated, which makes the long-term stability of closure unpredictable. This article proposed an etiology-based decision tree with actual measurement of diastemata width for diastemata closure. The decisional steps include classifying the etiological factors based on patients' medical history and clinical manifestation to evaluate the stability of diastemata. After maintaining the stability of diastemata, contemporary and multidisciplinary treatment plans were selected in accordance with the measured width of diastemata and patients' cosmetic psychology, economics, and available time. These decision trees focus on the challenges of collaboration among dental departments, propose an objective and efficient ways for connections, and promote efficient and effective diastemata closure.

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Clinical decision of centric relation
Yu Haiyang, Yan Zhebin, Xie Chenyang, Wu Qin
West China Journal of Stomatology    2024, 42 (5): 558-565.   DOI: 10.7518/hxkq.2024.2024147
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Centric relation (CR) was used in the complete dentures for edentulous jaws firstly. Then, CR was gradually applied in the clinical diagnosis and treatment of dentate jaws. Regarding the application of CR in dentate jaws, there are many doubts about its rationality. For instance, should CR be the core of diagnosis and treatment of temporomandibular disorders? Should CR be used as the jaw position of establishing occlusion in occlusal reconstruction? Should CR serve as the target jaw position in orthodontic treatment? Meanwhile, varieties of CR clinical applications are objective. According to the existing evidence, this paper summarizes the applicable conditions of several main clinical situations with little controversy. We preliminarily put forward the decision tree for the clinical application of CR, which can be used as a reference in clinical practice.

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Heterogeneity of Wnt1-Cre-marked and Pax2-Cre-marked first branchial arch cranial neural crest cells in mice
Xu Jue, Liu Shuang, Fu Honggao, Shao Meiying, Chen Meiling, Huang Zhen
West China Journal of Stomatology    2024, 42 (4): 435-443.   DOI: 10.7518/hxkq.2024.2023374
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Objective This study aimed to explore the heterogeneity and gene ontology of Wnt1-Cre-marked and Pax2-Cre-marked first branchial arch cranial neural crest cells (CNCs) in mice. Methods The embryos of Wnt1-Cre;R26RmTmG and Pax2-Cre;R26RmTmG at embryonic day (E)8.0-E9.25 were collected for histological observation. We performed immunostaining to compare green fluorescent protein (GFP)-positive CNCs in Pax2-Cre;R26RAi9 and Wnt1-Cre;R26RAi9 mice at E15.5. Single-cell RNA sequencing (scRNA-seq) was used to analyze the first branchial arch GFP-positive CNCs from Wnt1-Cre;R26RmTmG and Pax2-cre;R26RmTmGmice at E10.5. Real time fluorescence quantitative polymerase chain reaction (q-PCR) was performed to validate the differential genes. Results Wnt1-Cre-marked and Pax2-Cre-marked CNCs migrated from the neural plateto first and second branchial arches and to the first branchial arch, respectively, at E8.0. Although Wnt1-Cre-marked and Pax2-Cre-marked CNCs were found mostly in cranial-facial tissues, the former had higher expression in palate and tongue. The results of scRNA-seq showed that Pax2-Cre-marked CNCs specifically contributed to osteoblast differentiation and ossification, while Wnt1-Cre-marked CNCs participated in limb development, cell migration, and ossification. The q-PCR data also confirmed the results of gene ontology analysis. Conclusion Pax2-Cre mice are perfect experimental animal models for research on first branchial arch CNCs and derivatives in osteoblast differentiation and ossification.

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Case of precise full-mouth occlusal reconstruction guided by digital occlusal function analysis
Guo Yanling, Li Jiaxin, Liu Xinran, Yue Yuan, Wei Na, Wang Min, Hao Liang
West China Journal of Stomatology    2024, 42 (3): 394-402.   DOI: 10.7518/hxkq.2024.2023448
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The clinical demand for occlusal reconstruction increases rapidly with increasing number of patients who have lost their normal occlusion because of tooth wear and dentition defects. Occlusal reconstruction is a special type of restoration defined as a comprehensive restoration of the function of the stomatognathic system by reestablishing a uniform and stable occlusal relationship between the upper and lower dentitions. Occlusal function analysis is an important part of occlusal reconstruction to achieve accurate restoration design and adjustment. Digital occlusal function analysis was conducted to monitor the movement of the mandible and obtain related data for the parameter design of occlusal reconstruction. Preoperative design, intraoperative adjustment, and postoperative verification were achieved, thereby improving the efficiency and accuracy of occlusal reconstruction.

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Role of fatty acid metabolism-related genes in periodontitis based on machine learning and bioinformatics analysis
Chen Yuxiang, Zhao Anna, Yang Haoran, Yang Xia, Cheng Tingting, Rao Xianqi, Li Ziliang
West China Journal of Stomatology    2024, 42 (6): 735-747.   DOI: 10.7518/hxkq.2024.2024214
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Objective This study aims to investigate the role of genes related to fatty acid metabolism in periodontitis through machine learning and bioinformatics methods. Methods Periodontitis datasets GSE10334 and GSE-16134 were downloaded from the GEO database, and the fatty acid metabolism-related gene sets were obtained from the GeneCards database. Differentially expressed fatty acid metabolism-related genes (DEFAMRGs) in periodontitis were screened using the “limma” R package. Functional enrichment and pathway analyses were conducted. Recursive Feature Elimination, Least Absolute Shrinkage and Selection Operator, and Boruta algorithm were used to determine hub DEFAMRGs and construct diagnostic models with internal and external validation. Subtypes of periodontitis related to hub DEFAMRGs were constructed using consistency clustering analysis. CIBERSORT was used to analyze immune cell infiltration in gingival tissues and explore the correlation between hub DEFAMRGs and immune cells. Results A total of 113 periodontitis DEFAMRGs were screened out as a result. The enrichment analysis results indicate that DEFAMRGs are mainly associated with immune inflammatory responses and immune cell chemotaxis.Finally, 8 hub DEFAMRGs (BTG2, CXCL12, FABP4, CLDN10, PPBP, RGS1, LGALSL, and RIF1) were identified and a diagnostic model (AUC=0.967) was constructed, based on which periodontitis was divided into two subtypes. In addition, there is a significant correlation between hub DEFAMRGs and different immune cell populations, with mast cells and dendritic cells showing higher correlation. Conclusion This study provides new insights and ideas for the occurrence and development mechanism of periodontitis and proposes a diagnostic model based on hub DEFAMRGs to provide new directions for diagnosis and treatment.

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Application of temporomandibular joint prosthesis in oral and maxillofacial surgery: strategic thinking and prospects
Bi Ruiye, Zhu Songsong
West China Journal of Stomatology    2024, 42 (5): 551-557.   DOI: 10.7518/hxkq.2024.2024187
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The temporomandibular joint (TMJ) is the critical functional unit in the human stomatognathic system. Damage of the TMJ causes orofacial dysfunction and secondary jaw deformities, leading to seriously decreased quality of life in patients. The TMJ prosthetic replacement is an important treatment method for severe joint destruction because of its remarkable advantages compared with other methods. In recent years, this technique has gradually attracted wide attention in China, but it has not been popularized on a large scale in our country because of several limitations. Thus, in this study, the clinical experience of patients with TMJ prosthetic replacement in clinical units was summarized, and the treatment principles, treatment processes, and technical advantages were systematically discussed, aiming to promote the popularization and application of TMJ prosthetic replacement in China.

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Potential correlation between chronic periodontitis and Parkinson’s disease
Yang Rongxia, Zong Yingrui, Zhang Chen
West China Journal of Stomatology    2024, 42 (4): 521-530.   DOI: 10.7518/hxkq.2024.2024010
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Objective This study aims to investigate possible hub genes, associated pathways, and transcription factors between chronic periodontitis (CP) and Parkinson’s disease (PD). Methods Gene expression profiles of CP (GSE16134, GSE23586, and GSE10334) and PD (GSE20141 and GSE49036) were downloaded from the gene expression omnibus (GEO) database for differential expression analysis and functional clustering analysis. The protein-protein interaction (PPI) network was constructed, and hub genes were screened by four topological analysis algorithms and modular segmentation. Functional clustering analysis was performed. The hub genes were validated by external datasets of CP and PD, and causal relation was further assessed by Mendelian randomization (MR). Results After merging the data, 1 211 differentially expressed genes (DEGs) were screened in the CP datasets; of which, 551 were upregulated and 660 were downregulated. A total of 2 407 DEGs were screened in the PD dataset, of which, 1 438 were upregulated and 969 were downregulated. The PPI network included 145 nodes and 126 edges. Four hub genes (FCGR3B, PRF1, IL18, and CD33) and three transcription factors (HSF1, HSF2, and HSF4) were finally screened. The relevant pathway was predominantly natural killer (NK) cell-mediated toxic effects. The MR results suggest a possible positive causal relationship between CP and the risk of developing PD. Conclusion This study indicated the probably shared pathophysiology and possible causal relationship between CP and PD and may offer novel concepts and therapeutic targets for future mechanistic investigations.

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Application of digital impression and model in removable partial dentures for Kennedy classⅠandⅡdentition defects
Huang Jianbo, Mei Ziyu, Huang Gang, Guo Yalin, Meng Xiangfeng
West China Journal of Stomatology    2024, 42 (4): 481-485.   DOI: 10.7518/hxkq.2024.2024103
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Objective This study aimed to evaluate the application of digital impression and resin model technology in removable partial dentures (RPD) for Kennedy classⅠandⅡdentition defects. Methods Patients with Kennedy classⅠorⅡdental defect were selected and grouped in accordance with the following denture production processes: digital impression/resin model/cast cobalt-chromium alloy framework group (group A), digital impression/resin model/laser printed titanium framework group (group B), alginate impression/plaster model/cast cobalt-chromium alloy framework group (group C), and alginate impression/plaster model/laser printed titanium framework group (group D), with 40 cases in each group. The final RPD was examined in place in the mouth, and the evaluation indicators included the retention force of clamp ring, the tightness of connector and base, and the accuracy of occlusion. The evaluation scores of each index were used for analysis on the Kruskal-Wallis rank-sum test. Results No statistically significant difference in the score of each index was found among the four groups in RPD. Conclusion The cast cobalt-chromium alloy and laser-printed titanium framework RPD using digital impression and resin model can meet the clinical restoration requirements of patients with Kennedy classⅠandⅡdentition defects.

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Design strategy of hydrogel wound dressings based on oral special environment
Xu Rui, Pan Zhao, Zou Duohong
West China Journal of Stomatology    2024, 42 (6): 689-698.   DOI: 10.7518/hxkq.2024.2024262
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Oral wounds caused by injuries, surgeries, diseases, and chemical irritations bring pain to the patient and increase the risk of infection. Effective wound protection and repair are crucial for improving patients’ quality of life and maintaining oral health. Wound dressings provide ideal healing conditions by isolating the wound from the oral environment. However, in the highly moist, microbiologically rich environment of the oral cavity, maintaining the stability of wound dressings remains a considerable challenge. Hydrogels show promising prospects for oral applications and are gradually becoming a research hotspot for addressing the challenges of oral wound protection and repair due to their excellent biocompatibility and versatile performance. In this paper, the current design strategies of hydrogel wound dressings that overcome the unique oral environment, achieve sustained adhesion and fulfill their functions are reviewed to provide new insights for the design of ideal oral wound barrier materials.

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Mechanism of mangiferin in the treatment of oral submucous fibrosis based on Gene Expression Omnibus database chip mining combined with network pharmacology and molecular docking
Song Ziyi, Yang Chao, Zhang Yunlong, Zhang Zhujiang, Ren Tianjiao, Zhang Xinyue, Li Xue
West China Journal of Stomatology    2024, 42 (4): 444-451.   DOI: 10.7518/hxkq.2024.2024050
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Objective This study aims to investigate the primary target and potential mechanism of mangiferin (MF) in treating oral submucous fibrosis (OSF) through Gene Expression Omnibus (GEO) database chip mining, network pharmacology, and molecular docking techniques. Methods Potential therapeutic targets for OSF were identified using GEO chip data. The potential targets of MF were predicted, and disease-related targets for OSF were collected from databases. A Venn diagram was created using the EVenn platform to identify overlapping targets. The protein-protein interaction (PPI) network was constructed using the STRING database. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed using the DAVID platform. Cytoscape 3.10.1 software was used to visualize a drug-target-pathway-disease network, while AutoDocktools 1.5.6 software was employed for molecular docking analysis. Results A total of 356 potential targets for MF and 360 disease-related targets for OSF were obtained from multiple databases. The top 15 key target proteins in the PPI network were selected as significant candidates. GO function and KEGG pathway enrichment analyses revealed that MF treatment primarily involved advanced glycation end products-receptor (AGE-RAGE), epidermal growth factor receptor (EGFR), and other signaling pathways associated with OSF pathogenesis. Molecular docking analysis demonstrated that MF exhibited a strong binding activity toward AKT serine kinase 1 (AKT1), tumor necrosis factor (TNF), and other core targets. Conclusion These findings suggest that MF may exert its therapeutic effects on OSF through a multitarget approach involving various signaling pathways.

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Advantages of remimazolam for sedation in impacted tooth extraction
Ba Kai, Ni Duan, Du Ruobing, Wei Xueqin
West China Journal of Stomatology    2024, 42 (4): 476-480.   DOI: 10.7518/hxkq.2024.2023450
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Objective This study aims to compare the sedative effects of remimazolam and midazolam during impacted tooth extraction to provide a comfortable sedation treatment for patients with dental anxiety. Methods A prospective randomized controlled trial was conducted, in which 60 patients undergoing intravenous sedation for mandibular impacted third molar extraction were evenly divided into either the remimazolam or midazolam group. Prior to receiving a nerve blocker, the patients were sedated with remimazolam or midazolam. Various parameters were recorded and analyzed, including onset time, awakening time, recovery time, modified dental anxiety scale (MDAS) scores before and after surgery, patient-doctor satisfaction levels, postoperative side effects within 24 hours, heart rate (HR), and mean arterial pressure (MAP) at different time points. Results Compared with the midazolam group, patients in the remimazolam group demonstrated significantly shorter onset, awakening, and recovery times as well as lower postoperative MDAS scores and higher levels of patient-doctor satisfaction. Fewer postoperative side effects were reported in the remimazolam group, although the differences were not statistically significant. Conclusion The use of remimazolam demonstrates faster onset and recovery, superior efficacy in reducing dental anxiety, and enhanced satisfaction among patients and doctors, thereby presenting distinct advantages for sedation treatment for patients with dental anxiety.

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Reflections on the current state of early orthodontic treatment
Li Huang
West China Journal of Stomatology    2025, 43 (2): 151-157.   DOI: 10.7518/hxkq.2025.2024323
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Early orthodontic treatment has been a hot spot and focus of development in recent years in the field of orthodontics, pediatric dentistry, and general practice dentistry. However, there are still some misconceptions, such as excessive or premature intervention, strict control of indications, exaggeration of the role of early orthodontic treatment. This article starts from the analysis of the current status of early orthodontic treatment in China and combines the latest literature and reviews at home and abroad to analyze the nine issues that dentists and the public are concerned about one by one, including whether early orthodontic treatment is a new concept, whether it is necessary, the timing of early orthodontic treatment, the indications for early orthodontic treatment, whether it can provide a non-tooth extraction or non-surgical opportunity, whether it can completely change the facial profile such as retrognathia and growth pattern of the mandible, whether it can treat habitual mouth breathing or adenoid face or obstructive sleep apnea, the role of myofunctional therapy with prefabricated appliances in early orthodontic treatment, whether transparent aligners are superior to traditional aligners in early orthodontic treatment, with the aim of promoting the standardization of early orthodontic treatment. Early orthodontic treatment must choose the right indications, master the basic principles and techniques of orthodontics, and choose the most suitable treatment method and timing for the child.

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Standardized treatment of oral cancer under the guidance of clinical practice guidelines of National Comprehensive Cancer Network
Qiu Siqi, Li Yuehan, Liu Fayu
West China Journal of Stomatology    2024, 42 (5): 566-571.   DOI: 10.7518/hxkq.2024.2024168
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Oral cancer represents a serious public health problem affecting oral and system health with a high global incidence. Treatment strategies for oral cancer vary in different disciplines and are likely to be limited to certain doctor’s personal experience. While clinical practice guidelines are considered to enable doctors to determine the most appropriate and consistent treatment strategy according to the patient’s situation. National Comprehensive Cancer Network (NCCN) clinical practice guidelines have become the most prevalent in global clinical oncology practice. This article mainly focuses on cases to discuss the normalized treatment strategy for oral cancer in different stages based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers, Version 3, 2024.

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Application value of generative artificial intelligence in the field of stomatology
Ye Yuanlong, Zeng Wei, Chen Jinlong, Liu Lei
West China Journal of Stomatology    2024, 42 (6): 810-815.   DOI: 10.7518/hxkq.2024.2024144
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Objective This study aims to compare and analyze three types of generative artificial intelligence (GAI) and explore their application value and existing problems in the field of stomatology in the Chinese context. Methods A total of 36 questions were designed, covering all the professional areas of stomatology. The questions encompassed various aspects including medical records, professional knowledge, and translation and editing. These questions were submitted to ChatGPT4-turbo, Gemini (2024.2) and ERNIE Bot 4.0. After obtaining the answers, a blinded evaluation was conducted by three experienced oral medicine physicians using a four-point Likert scale. The value of GAI in various application scenarios was evaluated. Results Gemini scored 45, ERNIE Bot scored 38, and ChatGPT scored 33 for clinical documentation and image production. For research assistance, Gemini achieved 45, ERNIE Bot had 39, and ChatGPT scored 35. Teaching assistance capabilities were rated at 54 for ERNIE Bot, 50 for Gemini, and 48 for ChatGPT. In patient consultation and guidance, Gemini scored 78, ERNIE Bot scored 59, and ChatGPT scored 48. Overall, the total scores were 218, 190, and 164 for Gemini, ERNIE Bot, and ChatGPT, respectively. Among GAI applications, the top scoring categories were article translation and polishing (26), patient-doctor communication documentation (23), and popular science content creation (23). The lowest scoring categories were literature search and reporting (13) and image generation (12). Conclusion In the Chinese context, the application value of GAI is the highest for Gemini, followed by ERNIE Bot and ChatGPT. GAI shows significant value in translation, patient-doctor communication, and popular science writing. However, its value in literature search, reporting, and image generation remains limited.

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Research progress in problem-solving nickel-titanium rotary instrument in endodontics
Cui Chen, Quan Jingjing, Wei Xi
West China Journal of Stomatology    2024, 42 (6): 699-705.   DOI: 10.7518/hxkq.2024.2024225
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Root canal therapy is the primary treatment method for pulpal and periapical diseases. Various advanced endodontic instruments for mechanical preparation have been marketed. The emergence of nickel-titanium rotary instruments has greatly improved the efficiency of root canal preparation. New demands have been put forward for nickel-titanium rotary instruments as a result of the deepening of clinicians’ awareness of root canal anatomy system as well as the purpose and prognosis of root canal treatment. These clinical-oriented demands accelerate instrument reform and innovation. This work presents new marketed nickel-titanium systems and discusses the advantages and limitations of these systems and how they perform in terms of the efficiency and outcome of root canal preparation.

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Practice and challenge of age-friendly functional restoration of stomatognathic system based on the strategy of functional tooth loss
Cheng Yiting, Man Yi, Liu Yang, Cai He, Cheng Ran, Cheng Li, Wu Fanglong, Wu Hongkun, Yu Fanyuan, Liao Xueyang, Sun Yimin, Wang Jing, Yang Xue, Zhu Jinyi, Cheng Xingqun, Yi Zumu, Ye Ling, Hu Tao
West China Journal of Stomatology    2025, 43 (1): 15-27.   DOI: 10.7518/hxkq.2025.2024188
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Geriatric oral health care encounters significant challenges with the increase in the proportion of older individuals. Age-related changes in the dentition, muscles, and joints result in a decline in objective masticatory function, subjective restoration requirements, and acceptability among the elderly population, with individual variations influenced by systemic health. Considering functional requirements, the adaptability of stomatognathic and systemic health conditions, health economics and other factors, the authors believe that it should not be limited to the conventional “one-to-one” strategy for replacing missing teeth in geriatric prosthodontics. There is an urgent need for a precise and adaptable restoration strategy that is more suitable for older individuals. The proposal of a new concept of functional tooth loss updates the minimal restoration standards for elderly patients and establishes the theory of age-friendly functional restoration. Based on the restoration strategy of functional tooth loss, this paper proposes a new concept termed “age-friendly functional restoration of the stomatognathic system”, which integrates treatment considerations including endodontics, periodontology, mucosa, muscles, temporomandibular joint, and systemic health. Efforts should be made in four areas as follows. Firstly, the “assessment of accessible function” should be enhanced by considering the interrelationship between stomatognathic and systemic health. Secondly, the “evaluation of appropriate function” is supposed to be optimised in view of subjective needs and objective evaluation of the stomatognathic system. Moreover, the “formulation of treatment plans” needs to be accomplished with the aid of assistive technologies, such as artificial intelligence, to accurately exert appropriate functional restoration. Lastly, the “management and maintenance of health” is likely to be strengthened through follow-ups, propaganda and education, and preventive healthcare, so as to improve quality of life and ultimately achieve healthy ageing among older individuals.

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Burkitt lymphoma manifested by initial oral and maxillofacial lesions: a case report in a child patient and review of related articles
Wu Hong, Zhao Wenhui, Yang Xiaoqian, Li Xiuli, Zhang Yanrong, Song Aimei
West China Journal of Stomatology    2024, 42 (5): 675-682.   DOI: 10.7518/hxkq.2024.2023432
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Burkitt lymphoma is a highly aggressive B-cell lymphoma and the fastest proliferating human malignant tumor. If the disease is found in the early stage, the patient could have a high possibility to be cured successfully, whereas the prognosis is poor in the late stage. Burkitt lymphoma can occur in children and adults, and it is categorized as local (Africa), sporadic, and immunodeficiency associated type. Sporadic Burkitt lymphoma mainly affects children and adolescents, and the most common initial sites are abdominal organs and lymph nodes. Sporadic Burkitt lymphoma manifested by initial oral and maxillofacial lesions is relatively rare. Here, a case of pediatric sporadic Burkitt lymphoma, with oral and maxillofacial lesions as the first symptoms, was reported. The patient was treated in the Department of Periodontology, Shandong University School and Hospital of Stomatology. After timely checkup was provided, the patient was transferred to another hospital and had good results. In this article, an incidence of Burkitt lymphoma, with oral and maxillofacial lesions as the first symptom, was reviewed to provide reference for oral clinicians to achieve early diagnosis and treatment of patients with Burkitt lymphoma with oral diseases and improve the success rate of treatment.

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Current status and influencing factors of fear of surgery in patients with oral and maxillofacial tumors
Zhang Yu, Kuang Lixia, Bi Xiaoqin, Zhan Xueli, Zhang Tianyu
West China Journal of Stomatology    2024, 42 (4): 494-501.   DOI: 10.7518/hxkq.2024.2024039
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Objective This study aimed to investigate the incidence and severity of surgical fear in patients with oral and maxillofacial tumors. Methods The survey participants were composed of patients with oral and maxillofacial tumors, who were scheduled to undergo surgery. A general information questionnaire, the Surgical Fear Questionnaire (SFQ), the Patient Health Questionnaire (PHQ)-9, and the Generalized Anxiety Disorder (GAD)-7 score were used for the investigation. Results A total of 203 patients were investigated. Among them, 85.22% had fear of surgery. The median score of SFQ was 20, and the quartile was (6, 36). The patients were categorized into none, mild, moderate, and severe groups according fear level. Gender, diabetes, obvious discomfort before surgery, PHQ-9, and GAD-7 scores were the variables with statistical difference in each fear level. Multifactor analysis showed that women were more likely to have moderate and severe fear than men (OR=2.19, P=0.03; OR=2.72, P=0.01), patients with obvious preoperative discomfort symptoms were more inclined to have no fear (OR=4.73, P=0.02), and patients with diabetes were more likely to have severe fear (OR=3.33, P=0.02). The incidence rates of depression and anxiety were 31.03% and 24.63%, respectively. The incidence of anxiety and depression in patients with severe fear was 40.00%. Surgical fear was moderately positively correlated with anxiety (r=0.491, P<0.001) and depression (r=0.514, P<0.001). Conclusion The fear of surgery in patients with oral and maxillofacial tumors is common and distributed in all levels. Medical staff can screen and assess patients with moderate and severe fear of surgery in accordance with the influencing factors and implement targeted interventions to reduce fear of surgery, anxiety, and depression on the basis of the source of fear.

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Protective effect of carvacrol hydrogel on the alveolar bone in rats with periodontitis
Zhou Lulu, Teng Nian, Gao Tiantian, Wang Hongbin, Gao Xiang
West China Journal of Stomatology    2024, 42 (5): 593-608.   DOI: 10.7518/hxkq.2024.2024037
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Objective This study aimed to investigate the protective effect and mechanism of carvacrol hydrogel on the alveolar bone in rats with periodontitis. Methods A thermosensitive hydrogel supported by carvacrol was prepared using poloxamer and hydroxypropyl methyl cellulose as matrix. SD rats were randomly divided into blank group, periodontitis group, blank hydrogel group, and low-, medium-, and high-dose hydrogel groups. The periodontitis symptoms and the CT structure of the alveolar bone were observed. The changes in liver, spleen, kidney, and periodontal tissues were observed. The related indexes of bone metabolism in serum were detected. The expression of osteoprotegerin (OPG) and nuclear transcription factor-κB (NF-κB) pathway proteins was determined by Western blot. The levels of inflammatory factors were assessed by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Results Carvacrol hydrogel had good slow release, biocompatibility, and cell adhesion. The periodontitis of rats in the carvacrol hydrogel group was significantly alleviated, the expression of OPG protein in gingival tissue was significantly increased (P<0.01), and the levels of receptor activator of NF-κB ligand (RANKL), receptor activator of NF-κB (RANK), NF-κB protein, and inflammatory factors were significantly decreased (P<0.01). Conclusion Carvacrol hydrogel can regulate the OPG and NF-κB pathways, reduce alveolar bone absorption, and improve periodontal inflammation.

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Non-surgical treatment of maxillary lateral incisor double dens invaginatus type Ⅲ with apical periodontitis
Chen Hong, Zhang Ronghua, Zhao Yuan
West China Journal of Stomatology    2024, 42 (3): 409-414.   DOI: 10.7518/hxkq.2024.2023291
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Dental invagination is an abnormality of the crown or root development induced during tooth germ development when the enamel-forming apparatus or epithelial root sheath overpopulates and folds into the papilla. In severe cases, the invaginated channels are connected to the pulp and periodontal tissues, often causing endodontic and periapical diseases. The complex anatomical pattern of this disease adds difficulty in its preoperative diagnosis and clinical operation. In this paper, we report a case of non-surgical treatment assisted by cone beam CT and microscopy for maxillary lateral incisor double dens invaginatus type Ⅲ (Ⅲa and Ⅲb) with apical periapical infection. After 1-year follow-up, the affected tooth was asymptomatic and the periapical lesion was significantly reduced.

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The role of uncoupling protein 2 in experimental periodontitis-associated renal injury in rats
Li Qiong, Ma Haonan, Shang Yaqi, Xin Xirui, Liu Xinchan, Wu Zhou, Yu Weixian
West China Journal of Stomatology    2024, 42 (4): 502-511.   DOI: 10.7518/hxkq.2024.2023378
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Objective This study aims to explore changes in uncoupling protein 2 (UCP2) in experimental periodontitis-associated renal injury induced by ligation and investigate the effect of UCP2 on renal injury induced by periodontitis. Methods Twelve Wistar male rats were randomly divided into two groups: control and periodontitis groups. A periodontal model was built by ligating the maxillary first molars area with 0.2 mm orthodontic ligature wire. After 8 weeks, the intraoral condition of the rats was observed and periodontal clinical indices such as gingival bleeding index (BI), periodontal probing depth (PD), and tooth mobility (TM) were detected. The maxillary bone was scanned by Micro CT to observe the alveolar bone resorption. The tissue mineral density (TMD), bone mineral density (BMD), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular bone separation (Tb.Sp) were recorded, and the distance from the enamel bone boundary to the alveolar crest (CEJ-ABC) of the maxillary first molar was measured. The oxidative stress indexes such as malondialdehyde, glutathione (GSH), and superoxide dismutase (SOD) were detected using frozen rat kidney tissue. The gene expression of UCP2, nuclear factor erythroid 2-related factor 2 (Nrf2), and peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) was observed by quantitative real-time polymerase chain reaction (qRT-PCR) test. The gingival tissue of the rats was used for immunohistochemical staining to observe the expression of the UCP2 protein. The fixed rat kidney tissue was used for hematoxylin-eosin (HE), periodic acid-schiff (PAS), MitoSOX Red, JC-1, and immunohistochemical staining to observe the renal histopathology, the level of reactive oxygen species (ROS), the level of mitochondrial membrane potential, and the expression of UCP2, Nrf2, and PGC-1α protein. Rat serum was collected to detect renal function indices, namely, blood urea nitrogen (BUN), creatinine (Cre), and albumin (Alb). Results Compared with the control group, the periodontitis group showed red, swollen, and soft gingival tissue, with gingival probing bleeding, periodontal PD increased, tooth loosening, alveolar bone resorption, decreased TMD, BMD, BV/TV, and Tb.Th indices, and increased Tb.Sp index, CEJ-ABC, and gingival UCP2 protein expression. Compared with the control group, the levels of MDA and ROS in the kidney tissue of periodontitis rats and the gene and protein expression of UCP2 increased, and the levels of MMP, GSH, and SOD and the gene and protein expression of Nrf2 and PGC-1α decreased. Renal functional indices, namely, BUN, Cre, and Alb, were not significantly different between the two groups. Conclusion UCP2 may play a role in renal injury induced by periodontitis through oxidative stress.

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Removal of fiber post under the guidance of digital guide plate and one-piece glass fiber posts-and-cores repair: a clinical report
Xu Yuchen, Yin Lu
West China Journal of Stomatology    2024, 42 (4): 538-542.   DOI: 10.7518/hxkq.2024.2023344
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This study explores the potential application of computer aided design (CAD)/computer aided manufac-turing (CAM) for one-piece glass fiber posts and cores in restoring tooth defects post-removal of a broken fiber post using a digital guide plate. This paper reports a fractured left upper incisor fiber post removed using a customized needle and digital guide plate. Following root canal retreatment, CAD/CAM integrated fiber post-core and zirconia full crown restoration were completed. The occlusion testing was conducted using the T-Scan Ⅲ system. This study offers insights for managing secondary repair after fiber post fractures.

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Brass wire ligation for treatment of the ectopic eruption of the mandibular second molar: a case report
Lihua Lü, Chen Wenjin, Wei Rixia, Huang Hua
West China Journal of Stomatology    2024, 42 (4): 531-537.   DOI: 10.7518/hxkq.2024.2023418
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Ectopic eruption of the second permanent molar is a tooth replacement disorder during adolescence. If not treated in time, it can cause hard tissue of the adjacent first molar resorption, early tooth loss, decreased chewing efficiency, and other serious malocclusions. Timely detection and treatment of ectopic eruption of the second permanent molar are of great significance in preventing malocclusions in adolescents and establishing normal occlusion relationships. However, current case reports on the ectopic eruption of the mandibular second molar are relatively rare and are mostly concentrated on surgical and orthodontic treatments, and long-term follow-up is lacking. This paper reports a case in which brass wire ligation was used to treat ectopic eruption of the mandibular second permanent molar, allowing the permanent teeth to erupt smoothly and establish a normal occlusion. The patient was observed for five years after the operation. The occlusion was stable, and the tooth root development, pulp vitality, and periodontal conditions were normal. This paper provides a clinical approach that is short in treatment duration, simple, and minimally invasive for young mandibular second permanent molars with moderate mesial inclination and partial eruption. This method is of importance in helping children establish physiological occlusion.

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Temporal and spatial expression analysis of periostin in mice periodontitis model
Li Yue, Xu Chunmei, Xie Xudong, Shi Peilei, Wang Jun, Ding Yi
West China Journal of Stomatology    2024, 42 (3): 286-295.   DOI: 10.7518/hxkq.2024.2023336
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Objective This study aimed to investigate the temporal and spatial changes in the expression of periostin during periodontal inflammation in mice. Methods A periodontitis model was constructed using silk thread ligation. Mice were randomly divided into five groups including control group, 4-day ligation group, 7-day ligation group, 14-day ligation group, and self-healing group (thread removal for 14 days after 14-day ligation). Micro-CT and histological staining were performed to characterize the dynamic changes in the mouse periodontal tissue in each group. RNAscope and immunohistochemical staining were used to analyze the pattern of changes in periostin at various stages of periodontitis. The cell experiment was divided into three groups: control group, lipopolysaccharide (LPS) stimulation group (treated with LPS for 12 h), and LPS stimulation removal group (treated with LPS for 3 h followed by incubation with medium for 9 h). Quantitative real-time polymerase chain reaction (qRT-PCR) was used to detect the expression of periostin, transforming growth factor-β1 (TGF-β1), and matrix metalloproteinase 2 (MMP2). Results Significant alveolar bone resorption was observed 7 days after ligation. With increasing duration of ligation, the damage to the mouse periodontal tissue was aggravated, which manifested as increased osteoclasts, widening of the periodontal membrane space, and decreased alveolar bone height. Some degree of periodontal tissue repair was observed in the self-healing group. Periostin expression decreased at 4 and 7 days compared with the control group and increased at 14 days compared with 4 and 7 days. A significant recovery was found in the self-healing group. The qRT-PCR results showed that the expression of periostin and TGF-β1 in the LPS stimulation group decreased compared with that in the control group but significantly recovered in the LPS removal group. Conclusion Periostin expression in the PDL of mice showed a downward and upward trend with inflammation progression. The significant recovery of periostin expression after removing inflammatory stimuli may be related to TGF-β1, which is crucial to maintain the integrity of the PDL.

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Geometric position relationship between gingival, preparation, restoration margins and the cementation (adhesive) layer in the marginal area: new classification and scheme for margin position
Yu Haiyang, Luo Tian
West China Journal of Stomatology    2025, 43 (2): 163-174.   DOI: 10.7518/hxkq.2025.2024379
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The current low quality of fixed restoration margins is highly correlated with the high incidence of margin-related complications. It is also related to the unclear spatiotemporal geometric position relationship among the consensus definitions of the gingival margin (G), preparation margin (P), and restoration margin (R). This paper discusses the existing problem of the existing term “gingival margin” as a surface anatomical landmark; proposes the term “free gingival margin line” that conforms to geometry and measurement and has importance as a surface anatomical landmark; and clarifies the participants that exist in the marginal area. These participants include the P, R, and G; cementation (adhesive) layer; and gingival sulcus. Moreover, this paper discusses the various iatrogenic damages induced by entering the gingival sulcus via the P, R, and cementing (adhesive) layer. Through the discussion of the design deficiencies of the subgingival and biologically oriented preparation technique, the physiological and clinical importance of the concept of gingival sulcus/gingival sulcus fluid + supercrestal tissue attachment (biological width) = first periodontal protective barrier was analyzed. The value of preserving the physiological role of the gingival sulcus is emphasized. Furthermore, the newly defined RPG distance represents the distance between the successive P or R line and free G line and can be measured in the clinical procedure of tooth preparation. The optimal solution is 0-200 µm, that is, RPG200: the P and R are located on the free G line and the distance between these margins is less than 200 µm. This distance not only has the aesthetic effect of invisibility to the naked eye, it also has a minimal effect on the G and gingival sulcus and is convenient for doctors and patients to clean. Furthermore, in accordance with the positional relationship between the three margins and cementation (adhesive) layer, a new classification of marginal positions is proposed. This classification overcomes the problems of incomplete inclusion objects and uncontrolled risk factors in the previous classification. It also has the advantages of strong practicability, good efficiency of main control geometric quantity, and clear risk control points. The new design scheme and classification of the margi-nal position of RPG200 proposed in this paper provide a new understanding for margin design and complication prevention in the future.

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Craniofacial features and incisor position design of esthetics population after orthodontic treatment
Cheng Junxin, Zhu Yujie, Li Yuelin, Zheng Yingcheng, Wang Jun
West China Journal of Stomatology    2024, 42 (5): 609-623.   DOI: 10.7518/hxkq.2024.2023443
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Objective This study aims to provide craniofacial features and incisor position prediction models among esthetics population after orthodontic treatment. Methods A total of 338 patients with esthetic profiles were selected from 1 055 post-orthodontic adults based on inclusion and exclusion criteria and scored by five dental students. Mean values of cephalometric measurement were demonstrated with gender and sagittal skeletal pattern (ANB) differences assessed by generalized estimating equation. Correlations among age, skeletal, and soft tissue variables in different genders were determined. Multivariate analysis was used to assess the influence of skeletal and soft tissue variables on orthodontic incisor position. Results Within the esthetic cohort after orthodontic treatment, gender differences existed in cranial and mandibular length, mandibular rotation, protrusion of pogonion, inclination of maxillary incisors, upper lip thickness, lower 1/3 face height, and nose protrusion. However, in class Ⅰ malocclusion, the development of the chin showed no significance, whereas the protrusion of the lower lip significantly differed between genders, with less protrusion in males. In males, the protrusion of lip and chin varied among groups, with thinner basic upper lip thickness of class Ⅱ than class Ⅰ and greater lower lip height of class Ⅲ than class Ⅰ. In females, the protrusion and height of the upper lip and chin varied in groups, with thicker basic upper lip thickness of class Ⅲ than class Ⅰ. Upper lip thickness, female basic upper lip thickness, and female lower lip height were correlated with age. The protrusion of the upper lip was mainly correlated with posterior cranial base, mandibular body length, ANB in male and SNA, ANB, sagittal maxillary length, mandibular rotation, and protrusion of pogonion in female. The protrusion of the lower lip in males was mainly correlated with ramus height, mandibular rotation, protrusion of pogonion in male and ANB, mandibular rotation, and protrusion of pogonion in females. After employing skeletal variables to fit dental parameters, optimal results were achieved in male IMPA (adjusted R2=0.712) and female G Vert-U1 (adjusted R2=0.795). After employing skeletal and soft tissue variables simultaneously, optimal results were achieved in male and female G Vert-U1, which was mainly influenced by the protrusion of the chin and nasal base in males (adjusted R2=0.836) and the protrusion of the nasal base as well as ANB in females (adjusted R2=0.842). Conclusion This study demonstrated the craniofacial features of esthetics population after orthodontic treatment and revealed the correlation of gender, age, skeleton, and soft tissues to provide reliable prediction models for aesthetic orthodontic incisor position.

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Efficacy evaluation of zirconia crown on primary molars with caries defects
Deng Shuman, Niu Shanshan, Gao Qi, Zhang Li, Chen Zhixiao, Liu Meng
West China Journal of Stomatology    2024, 42 (5): 652-659.   DOI: 10.7518/hxkq.2024.2024122
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Objective This study aimed to estimate the therapeutic effects of preformed metal crown (PMC) and prefabricated zirconia crowns (ZC) on decayed primary morals in children, as well as to analyze the possible influencing factors. Methods A retrospective cohort study was performed on the data of 192 patients (aged 3 to 8) in the Stomatological Department of Shenzhen Children’s Hospital from October 2021 to December 2021. The decayed mandibular first molars were selected and restored by vital-pulp therapy followed by PMC and ZC, including 96 cases (96 caries) in the PMC group and 96 cases (96 caries) in the ZC group. Oral clinical examination was performed at 3 months, 1 year, and 2 years after treatment, overwiewing the clinical therapeutic effects and periodontal status of PMC and ZC groups, as well as recording the crown integrity, gingival index (GI), probing bleeding index (BI), plaque index (PLI) and various prosthetic indices. Results No significance differences existed in the periodontal status of PMC and ZC groups at 3 months, 1 year, and 2 years after treatment (P>0.05). However, the GI, BI, and PLI in the PMC group were higher than those in the ZC group at 3 months, 1 year, and 2 years after treatment, and the difference was dramatically significant (P<0.05). No significances difference existed in various prosthetic indices (P>0.05), as well as in the GI, BI, and PLI, between the two groups (P>0.05). No significant differences existed in various prosthetic indices between genders after PMC restoration (P>0.05). The scores of girls in various prosthetic indices after ZC restoration were higher than those of boys (P<0.05). Pearson correlation analysis indicated an inverse correlation between age in the PMC group and the GI, BI, PLI, and FDI indices (P<0.01), rather than in the ZC group (P>0.05). Conclusion PMC and ZC can be applied to restore deciduous molar caries. The periodontal status of deciduous teeth in ZC group was superior to that in the PMC group. The periodontal status of deciduous teeth in PMC group may be stable with increased age.

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Effects of collagen modification on the osteogenic performance of different surface-modified titanium samples in vitro
Dong Danni, Huang Yanling, Lai Yingzhen, Yin Ge
West China Journal of Stomatology    2024, 42 (4): 452-461.   DOI: 10.7518/hxkq.2024.2023451
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Objective The aim of this study was to evaluate the effects of collagen modification on the osteogenic performance of different surface-modified titanium, including alkaline etching, alkaline etching followed by silanization, and alkaline etching followed by dopamine modification. The proliferation, adhesion, and osteogenic differentiation abilities of MC3T3-E1 cells on the surfaces with collagen modification were analyzed and compared. Methods Collagen was immobilized on the surfaces of pure titanium (Ti-C), alkaline-etched titanium (Ti-Na-C), alkaline-etched and silanized titanium (Ti-A-C), and alkaline-etched and dopamine-modified titanium (Ti-D-C), with pure titanium (Ti) as the control group. The surface morphology was observed by scanning electron microscopy (SEM), and the surface elemental composition was analyzed by X-ray photoelectron spectroscopy (XPS). Contact angle measurements were conducted to evaluate the hydrophilicity of the surfaces. MC3T3-E1 cells were cultured on the surfaces, and their proliferation, adhesion, and osteogenic differentiation abilities were assessed using CCK-8 assay, laser scanning confocal microscope, alkaline phosphatase (ALP) staining, Alizarin red staining and quantitative analysis, as well as real-time quantitative polymerase chain reaction (RT-qPCR) to evaluate the mRNA expression levels of osteogenic-related genes, including ALP, typeⅠcollagen (COL-1), osteocalcin (OCN), osteopontin (OPN). Results SEM and XPS results confirmed the successful immobilization of collagen on the titanium surfaces, with the Ti-Na-C group exhibiting a higher amount of collagen modification. Contact angle measurements showed improved hydrophilicity of the surfaces after collagen modification. CCK-8 results indicated good compatibility of the materials with MC3T3-E1, with enhanced cell proliferation on the collagen-modified surfaces. Cell fluorescence staining revealed better cell spreading on the collagen-modified surfaces, and ALP and Alizarin red staining results suggested that the Ti-Na-C group exhibited the best osteogenic performance, with significantly higher absorbance values in the Alizarin red quantification analysis. RT-qPCR analysis showed that the Ti-Na-C group had the highest expression of the osteogenic-related gene OPN. Conclusion Among the different collagen modification approaches employed in this study, collagen modification on alkaline-etched titanium surfaces showed the most conducive effects on MC3T3-E1 cell adhesion, spreading, proliferation, and osteogenic differentiation. This approach can be considered as the optimal collagen modification strategy for enhancing osteogenesis on titanium surfaces.

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Integration of autonomous maximal smile 3D image with digital 3D dental model and investigation of its accuracy
Tang Zhenxing, Qian Yuran, Ren Ruiting, Song Wanzhong, Li Yu
West China Journal of Stomatology    2024, 42 (3): 334-339.   DOI: 10.7518/hxkq.2024.2023407
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Objective This study aims to establish an approach to integrate autonomous maximal smile (AMS) 3D facial image with digital 3D dental models to demonstrate the digital orthodontic set-up in the 3D facial context. Methods Using Geomagic Studio software, the AMS 3D facial image and pre-treatment dental model were manually and globally registered. Subsequently, the pre-treatment dental model was substituted with the predicted post-treatment dental model. The intraoral region of the AMS 3D facial image was removed, achieving a conjunctive display of the AMS 3D facial image and the post-treatment dental set-up. The distances between four groups of corresponding landmark pairs on the AMS 3D facial image and the pre-treatment dental set-up were calculated, and the accuracy of the registration operation was evaluated by paired t-test. Results The novel approach effectively facilitated the integration of AMS 3D facial images with the pre-treatment and predicted post-treatment 3D dental models. The average distances between the pairs of points were (1.19±0.55) mm and (1.55±0.59) mm for the two registrations, respectively. Notably, no statistically significant difference was observed between the two measurements (P>0.05), indicating a high agreement (intraclass correlation coefficient=0.914). Conclusion This study established an approach to integrate AMS 3D facial images with digital 3D dental models. Through this approach, the digital orthodontic set-up design can be displayed in the context of a 3D facial image, which may help to improve the quality of outcome set-up in digital orthodontics, such as clear aligner therapy.

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Application of bone perforation in the surgery of medication-related osteonecrosis of the jaw in stage Ⅱ
Gao Na, Tian Mei, Sun Yawei, Wang Danni, Sun Guowen
West China Journal of Stomatology    2024, 42 (5): 629-635.   DOI: 10.7518/hxkq.2024.2024133
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Objective This study aimed to explore the effect of surgery combined with bone perforation for treating stage Ⅱ medication-related osteonecrosis of the jaw (MRONJ). Methods A total of 21 patients with stage Ⅱ mandibular MRONJ who underwent surgical treatment from June 2020 to June 2023 were included in this study. Retrospective analysis was conducted on their clinical data, including gender, age, primary disease, drug name and administration method, pre-surgery drug cessation, and prognosis. The cohort comprised 14 males and 7 females, with an average age at onset of 68.33±10.74 years. According to the guidelines of the American Association of Oral and Maxillofacial Surgeons, the included patients had stage Ⅱ mandibular MRONJ. The treatment approach consisted of partial mandibulectomy combined with bone perforation techniques, ensuring tension-free suturing of soft tissues. Follow-up was performed regularly, and the curative effect was evaluated. The SF-12 health survey was used to assess the quality of life for all patients before and after surgery. Results A total of 21 patients were followed up for 8-38 months after surgery, and the mucosal healing of 17 patients was good (80.95%). The postoperative quality of life score (83.62±5.90) was significantly higher than that before operation (63.67±4.70, P<0.05). Conclusion Surgery combined with bone perforation technique is an effective treatment method with high success rate in refractory stage Ⅱ MRONT patients.

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Effect of silencing Ras homolog family member C on proliferation, invasion, and migration of salivary adenoid cystic carcinoma
Yu Wenyuan, Zhao Peng, Shao Yu, Xu Yong, Xu Jin, Xie Lei, Yu Chenghao, He Qiuping, Chen Zhenggang
West China Journal of Stomatology    2024, 42 (6): 723-734.   DOI: 10.7518/hxkq.2024.2024092
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Objective This study aimed to investigate the effects of silencing Ras homolog family member C (RhoC) on the proliferation, apoptosis, invasion, migration, and epithelial-mesenchymal transition (EMT) of salivary adenoid cystic carcinoma (SACC) and its molecular mechanisms. Methods A total of 27 SACC lesions and normal salivary gland tissues that were surgically resected at Qingdao Municipal Hospital from January 1, 2019 to March 1, 2024 were selected, and the expression levels of RhoC were detected by Western blot and immunohistochemistry. Three small interfering RNA (siRNAs) were designed to target the RhoC gene sequence, transfected into SACC-LM and SACC-83 cell lines, and evaluated for transfection efficiency. The protein expression levels of RhoC, Rho-associated protein kinase-1 (ROCK1), p38 mitogen-activated protein kinase (p38MAPK), phosphorylated-p38MAPK (p-p38MAPK), twist family bHLH transcription factor 1 (TWIST1), E-cadherin, N-cadherin, and Vimentin were compared using Western blot. CCK-8 assay, flow cytometry, transwell invasion assay, and wound healing assay were conducted to assess the differences in cell proliferation, apoptosis, invasion, and migration abilities among the groups. Bioinformatics methods were also used to predict possible upstream micro RNAs (miRNAs) of RhoC and their expression levels in SACC. Moreover, dual-luciferase reporter gene experiments were performed to verify the binding sites of miR-138-5p and RhoC. Results RhoC was highly expressed in SACC (P<0.05). After silencing RhoC, the test group showed a significant decrease in the expression level of ROCK1, p-p38MAPK, TWIST1, N-cadherin, and Vimentin, as well as a significant increase in the expression level of E-cadherin (P<0.05). No significant difference in the expression level of p38MAPK was observed (P>0.05). The cell proliferation, invasion, and migration ability decreased in the test group, whereas the apoptosis rates significantly increased (P<0.05). miR-138-5p was lowly expressed in SACC, and miR-138-5p mimic can significantly downregulated the luciferase activity of 293T cells after transfection with a RhoC wild-type plasmid (P<0.05). Conclusion RhoC is highly expressed in SACC, and RhoC silencing may target the downstream ROCK1/p38MAPK/TWIST1 signaling pathway, thereby inhibiting the proliferation, invasion, migration, and EMT of SACC while promoting its apoptosis. On the contrary, miR-138-5p is lowly expressed in SACC and is a potential upstream gene of RhoC, and there may be binding sites between the two genes.

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Comparison of upper airway volume and hyoid position after camouflage orthodontic or orthodontic-orthognathic treatment in patients with skeletal class Ⅲ malocclusion with normal-angle vertical pattern
ChingCho Hsu, Liu Haojie, Lin Chengzhao, Liu Zhenhao, Zhai Ye, Guo Shuyu, Xu Rongyao
West China Journal of Stomatology    2025, 43 (1): 53-62.   DOI: 10.7518/hxkq.2025.2024184
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Objective This study aims to compare the effects of two orthodontic treatment modalities for skeletal class Ⅲ malocclusion on specific changes in airway volume, morphology, palatal angle, mandibular rotation, and bone displacement. Results provide scientific evidence for the selection of orthodontic treatment plans and reduce the risk of developing obstructive sleep apnea hypopnea syndrome (OSAHS). Methods Thirty-six patients diagnosed with skeletal class Ⅲ malocclusion at the Department of Orthodontics, the Affiliated Stomatological Hospital of Nanjing Medical University from September 2018 to December 2023 were divided into two groups: orthodontic-orthognathic treatment group (18 patients) and camouflage orthodontic treatment group (18 patients). Changes in airway volume, cross-sectional area, palatal angle, mandibular, and tongue positions were observed through pre- and post-operative cone beam computed tomography and 3D cephalometric measurements. Results In the camouflage orthodontic treatment group, nasopharyngeal volume and oropharyngeal volume statistically increased after treatment (P<0.05). In the orthodontic-orthognathic treatment group, changes in nasopharyngeal volume, nasopharyngeal airway, distance from posterior tongue to pharyngeal wall, palatal angle, mandibular rotation, and hyoid bone displacement were statistically significant after surgery (P<0.05). In the comparison between the two groups after treatment, changes in the distance from posterior tongue to pharyngeal wall, palatal angle, and distance from hyoid bone to sella turcica point were statistically significant (P<0.05). Conclusion Patients in the orthodontic-orthognathic treatment group showed significantly greater changes in oropharyngeal cross-sectional area, palate angle, and tongue position compared with patients in the camouflage orthodontic treatment group. As individuals susceptible to OSAHS often exhibit mandibular retrusion and decreased minimum airway cross-sectional area, special attention should be paid to airway morphology changes when adopting orthodontic-orthognathic treatment to avoid adverse consequences.

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Role of connexin 43 in a rat model of periodontitis-induced renal injury
Xin Yu, Fu Ruobing, Xin Xirui, Shang Yaqi, Liu Xinchan, Yu Weixian
West China Journal of Stomatology    2024, 42 (3): 296-303.   DOI: 10.7518/hxkq.2024.2023352
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Objective This study aims to investigate the role of gap junction mediated by connexin 43 (Cx43) in renal injury induced by periodontitis in rats. Methods Twelve SPF-grade Wistar male rats were divided into a control group and a periodontitis group by using a completely random number table method, with six rats in each group. The control group rats were not treated, while the periodontitis group rats were subjected to wire ligation of the neck of their bilateral maxillary first molars to construct a periodontitis model. After 8 weeks of modeling, the rats were examined for clinical indicators of the periodontium. micro-CT scanning of the maxilla reconstructed its 3D structure and analyzed the absorption of alveolar bone. Histopathological changes in periodontal and renal tissues were detected. MitoSOX red reagent was used to determine reactive oxygen species (ROS) content in renal tissues. A biochemical reagent kit was used to detect serum oxidative stress biomarkers. Real-time fluorescent quantitative-polymerase chain reaction (qRT-PCR) was employed to determine Cx43, nuclear factor kappa-B (NF-κB) , interleukin (IL)-1β, IL-6, BCL2-Associated X (Bax), B-lymphomatoma-2 gene (Bcl-2), and Caspase-3 mRNA were determined. Western blot analysis was used to detect Cx43, NF-κB, IL-1β, Bax, Bcl-2 and Caspase-3 protein. Results micro-CT 3D reconstruction showed significant bone resorption of the first molar alveolar bone in the periodontitis group rats and decreased height of the alveolar ridge. The distance from the enamel cementum boundary to the top of the alveolar ridge in the periodontitis group was significantly higher than that inthe control group. The histopathological results showed a large number of inflammatory cells that infiltrated the periodontal tissue of the periodontitis group, and the alveolar bone was significantly absorbed. Rats in the periodontitis group also exhibited mild thickening of the glomerular basement membrane, dilation of the Bowman’s capsule, and destruction of the brush-like edge of the renal tubules in the renal tissue. The MitoSOX red staining results showed a significant increase in ROS content in the renal tissue of the periodontitis group. The biochemical test results showed that the levels of superoxide dismutase and glutathione in the serum of rats with periodontitis decreased, while that of malondialdehyde increased. The results of qRT-PCR and Western blot showed that the expression levels of Cx43, IL-1β, IL-6, Bax, Caspase-3 mRNA and Cx43, IL-1β, NF-κB, Bax, Caspase-3 proteins in the periodontitis group significantly increased compared with those in the control group, while the expression levels of Bcl-2 mRNA and protein decreased. Conclusion Periodontitis may activate NF-κB signaling molecules by upregulating the expression of Cx43 in rat kidney tissues, leading to increased levels of inflammation and apoptosis and ultimately inducing kidney injury.

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Digital technology-assisted extraction of impacted maxillary third molar located between the furcation of maxillary second molar by root dislocation: a case report
He Lanxi, Jurat·Omar , Zhou Zihang, Yu Jian, Wang Zhaoling, Chen Hongyu
West China Journal of Stomatology    2024, 42 (3): 403-408.   DOI: 10.7518/hxkq.2024.2023362
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Most of the maxillary impacted third molars are located in the maxillary tuberosity, where the vision and operation space are limited. This paper reports a case of surgical extraction of the left maxillary horizontal superhigh impacted third molar, which is located between the roots of the adjacent teeth and is closely related to the maxillary sinus. The digital simulation technology was used to reconstruct a three-dimensional visual image of the patient’s maxilla, related teeth, and other adjacent anatomical structures to assist in finding the optimal surgical method accurately. Root dislocation before the crown not only protects the roots of the adjacent tooth, but also reduces the risk of maxillary sinus lining damage or perforation during operative procedures, improves the efficiency of the operation, and reduces surgical trauma, which conforms to the concept of minimally invasive surgery and provides a new idea and experience for the clinical extraction of such maxillary impacted third molars.

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Reamer-scraping and implant-pushing technique for transcrestal sinus floor elevation
Peng Peizhao, Wang Lan, Xu Mingzhang, Zheng Ziyang, Zhao Renshengjie, Xiao Keming, Zhou Yang, Yu Ke
West China Journal of Stomatology    2024, 42 (5): 683-688.   DOI: 10.7518/hxkq.2024.2024076
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Transcrestal maxillary sinus floor elevation is an effective method to solve the problem of insufficient bone height in the posterior maxillary region. However, current methods, such as osteotome sinus floor elevation, cushioned grind-out technique, Smart Drill technique, etc., require specialized surgical tool boxes. In this article, we introduce a new method of transcrestal maxillary sinus elevation that uses built-in reamers of various implant systems to scrap residual bone at the sinus floor and uses the implant to push the sinus membrane during implant placement. This technique is easy to operate and time saving and has a low rate of sinus membrane perforation. After a one-year follow-up observation of 146 people and 175 implants, the endo-sinus bone gains were 5.00 (4.70, 5.30) mm and 2.10 (1.40, 2.70) mm in the group of 3 mm≤residual bone height (RBH)<5 mm and the group of 5 mm≤RBH<8 mm, respectively, which can meet the clinical requirements of implant stability. This technique is suitable in generalizing dental implantation.

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Dynamic and static nasolabial muscle anatomy of unilateral cleft lip adult patients based on magnetic resonance imaging data
Wang Kangzhe, Li Yuming, Xia Chunchao, Shi Bing, Li Chenghao
West China Journal of Stomatology    2024, 42 (5): 636-643.   DOI: 10.7518/hxkq.2024.2024063
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Objective This study aims to obtain a three-dimensional reconstruction model based on magnetic resonance imaging (MRI) data of patients with different degrees of unilateral cleft lip and analyze the anatomy and changes in multiple groups of nasolabial muscles under dynamic and static conditions. Methods One normal person and four adult patients with unilateral cleft lip were included, and MRI was performed under static (upper and lower lips closed naturally) and dynamic (pout and grin) conditions. 3D Slicer software was used to reconstruct the model and draw the anatomic morphology of nasolabial muscles. The distance between the junction (where the muscle merges into the orbicularis oris) of the levator muscle, zygomaticminor muscle, and zygomatic major muscle to the median sagittal plane, the starting point to the junction point, the dynamic and static junction points, and the angle between the connection of dynamic and static junctions and the horizontal plane were measured under three kinds of movements, and the ratio was calculated. Results In all patients, under dynamic and static conditions, the distance from the muscle junction to the median sagittal plane, their ratios of the cleft side to the non-cleft side were all greater than 1. While the ratios of the distance from the starting point of the muscle to the junction point were less than 1. At static conditions, the two ratios of the same muscle increased gradiently with the severity of the cleft, and the ratio of the zygomatic minor muscle was prominent in the same patient. The ratio of the cleft side to the non-cleft side was greater than 1, and the value for comparison was the angle of the line from the static to the dynamic junction and the horizontal plane. Conclusion The symmetry of the insertion site of the orbicularis oris and the linear distance of both sides of the muscle are related to muscle and cleft types. The angle of muscle contraction on the cleft side is greater than that on the non-cleft side.

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Concentrated growth factor and collagen as barrier materials in alveolar ridge preservation for posterior teeth: a prospective cohort study with one-year follow-up
Zhu Zhanfeng, Yang Tingting, Chen Qinyi, Qiu Weien, Li Yongshan, Lin Yilan, Ban Yu
West China Journal of Stomatology    2024, 42 (3): 346-352.   DOI: 10.7518/hxkq.2024.2023458
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Objective This study aims to evaluate the efficacy of concentrated growth factor (CGF) membrane and collagen as barrier materials in sealing the alveolar socket in alveolar ridge preservation (ARP) in the posterior region during a one-year follow-up. Methods A total of 24 patients who underwent ARP in the posterior region were selected for inclusion and randomly assigned to the CGF group (12 cases) and Collagen group (12 cases). The patients in both groups underwent extraction of posterior teeth. The extraction sockets were filled with a bone substitute to the level of the pre-extraction buccal and lingual or palatal alveolar bone plates. The wounds in the CGF group were closed with a fabricated CGF overlaying the upper edge of the bone substitute material, whereas those in the Collagen group were closed with Bio-Oss Collagen. The implants were placed after 6 months. The evaluation was based on implant retention, re-grafting rate, and vertical and horizontal alveolar ridge bone volume changes measured by cone beam computed tomography (CBCT). Data were statistically analyzed using SPSS 28.0 software. Results No patient withdrew throughout the follow-up period. No implant failure and no severe peri-implant or mucosal soft tissue complications were observed. Six months after the operation, the degree of vertical alveolar ridge height resorption in the CGF group was lower than that in the Collagen group (P<0.05). There were no statistically difference between the groups at 1 year after the operation (P>0.05). The amount of bone reduction in horizontal alveolar ridge width showed no difference between the groups at 6 months and 1 year after surgery (P>0.05). Conclusion CGF membrane and Bio-Oss Collagen as barrier materials for posterior ARP inhibited reduction in alveolar ridge bone mass.

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