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Table of Content
01 December 2024, Volume 42 Issue 6
  • 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.

    Special Review
    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.

    Hierarchical evolution of bone biomimicry and osteo-coagulo-immunomodulation induced by the size of biological hydroxyapatite
    Xu Jieyun, Zhao Yuan, Liu Haozhou, Yin Jingyuan, Chen Zetao
    West China Journal of Stomatology. 2024, 42(6):  706-715.  doi:10.7518/hxkq.2024.2024315
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    Biological hydroxyapatite (BHA) is widely used in the treatment of clinical bone defects due to its good biocompatibility and osteoconductivity. The clinical application of mateiral size is based on the principle of bone defect area adaptation, which contributes to diversity of BHA sizes. However, different sizes correspond to different hierarchical levels of bone biomimicry. As the size changes, the bone biomimicry hierarchy evolves accordingly and influences the process of bone repair and regeneration through osteo-coagulo-immunomodulation, leading to unstable bone graft outcomes. Therefore, this paper reviews the size effect of clinical BHA, analyzes the multilevel structure of natural bone, proposes the evolution of bone biomimetic hierarchy triggered by the size of BHA, and further analyzes the size-media-ted osteo-coagulo-immunomodulation. Based on the hierarchical levels of bone and its osteo-coagulo-immunomodulation effect, we provide a new understanding of the biological principle of the size effect of biomaterials and a theoretical basis for the basic research and clinical application of different size BHA materials.

    Basic Research
    Differences in near-infrared fluorescence imaging and histological analysis of cheek mucosa in golden hamsters with different pathological states
    Xie Diya, Shan Danni, Zhang Lei, Chen Sheng, Na Yingyu, Wang Zhiyong
    West China Journal of Stomatology. 2024, 42(6):  716-722.  doi:10.7518/hxkq.2024.2024150
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    Objective To explore and analyze the feasibility of using indocyanine green (ICG) near-infrared fluorescence (NIF) imaging technology for the early diagnosis of oral potential malignant disorders and oral squamous cell carcinoma. Methods 7,12-Dimethylbenz[a]anthracene in acetone solution was used to induce various pathological models of buccal mucosal lesions (mild/moderate dysplasia, severe dysplasia, squamous cell carcinoma) in golden hamster. ICG-NIF was conducted for the quantitative analysis of the fluorescence signal of lesion tissue, and evaluation of the diagnostic and discriminative capabilities of the ICG-NIF technology for mucosal lesions in various pathological states. Immunohistochemical staining was perform to examine the microvessel density (MVD) and microlymphatic vessel density (MLVD) of mucosa in various pathological states and explore the histological reasons underlying the differences in fluorescence signals. Results The results of ICG-NIF fluorescence quantitative analysis reveal the higher fluorescence intensity of mucosal lesions in the experimental group compared with that of the normal mucosa on the control side, with statistical differences (P<0.05). Moreover, the more severe the malignancy of mucosal lesions in the experimental group, the higher the fluorescence intensity. According to histopathological analysis, the malignant progression of mucosal lesions in golden hamsters was accompanied with an increase in MVD (P<0.05) and a decrease in MLVD (P<0.05). Conclusion The abnormal proliferation of mucosal lesions in golden hamsters exhibits a difference in ICG-NIF fluorescence signal compared with normal mucosal tissue. Fluorescence quantitative analysis methods can provide assistance in differentiation and show potential for clinical applications.

    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.

    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.

    Clinical Research
    Effect of symmetrical bone repair of nasal alar base on nasal deformity after unilateral cleft lip surgery
    Jian Jiaqi, Jing Bingshuai, Yang Chao, Shi Bing, Li Chenghao
    West China Journal of Stomatology. 2024, 42(6):  748-754.  doi:10.7518/hxkq.2024.2024074
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    Objective This study aimed to compare the impacts of undertaking symmetrical bone repair of the nasal alar base combined with nasolabial deformity repair versus nasolabial deformity repair alone on the improvement in nasal deformity of patients with unilateral cleft lip and alveolar cleft. Methods Fifty patients presenting with unilateral cleft lip and alveolar cleft were evaluated. Among them, 20 underwent nasolabial deformity repair solely (non-bone grafting group), whereas 30 patients received bone repair in conjunction with nasolabial deformity repair (bone-repair group). Preoperative measurements and one-year follow-up results were assessed through photographic anthropometric analysis. According to the Farkas anthropometric standard, the nasal anatomic landmarks were located, and 10 nostril indicators were measured. The operative effects of two groups were compared. Results In contrast to the non-bone-grafting group, the nasal deformity of patients in the bone-repair group demonstrated significant improvement one year post-operation. The symmetry parameters of the nasal columella more closely approximated 1, the columella deviation angle more closely approached 90°, and the sub-alare inclination angle and the inclination angle of the nasal alar were smaller (P<0.05). Conclusion The accomplishment of symmetrical bone repair of the nasal alar base is conducive to enhancing nasal deformity after cleft-lip surgery in patients with unilateral cleft lip and alveolar cleft. This strategy has a positive influence on nasal symmetry, the morphology of the nasal alar, and nasal base deformity.

    Assessment of the efficacy and analysis of prognostic factors of flap division for postoperative airway obstruction following posterior pharyngeal flap
    Li Yanan, Shi Bing, Li Jingtao
    West China Journal of Stomatology. 2024, 42(6):  755-763.  doi:10.7518/hxkq.2024.2024218
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    Objective Flap division is the primary method for treating postoperative airway obstruction following pharyngeal flap surgery. However, a discussion on the treatment effectiveness and prognosis of this surgery is lacking. Therefore, this study aims to explore the effectiveness of flap division in improving airway obstruction and hyponasality after pharyngoplasty and to analyze the risk factors for postoperative complications. Methods A retrospective review was conducted on the data of all patients who underwent flap division following pharyngeal flap for airway obstruction at our institution. Pre- and post-operative assessments of ventilation, speech, and related factors were performed using the nasal obstruction symptom evaluation scale, speech evaluation scale, nasopharyngeal fiberscope, and lateral cephalometric radiographs. A nasopharyngeal fiberscope was utilized to observe the airway port of the patients, velopharyngeal closure, and the mobility of the lateral pharyngeal walls. Lateral cephalometric radiographs were employed to evaluate the patient’s maxillomandibular relationship and adenoid dimensions. A logistic regression model incorporating univariate analysis and multivariate analyses was established to identify the prognostic factors influencing the occurrence of persistent postoperative airway obstruction and hypernasality. Results Among the 63 patients, 56 patients (88.9%) experienced a reduction in the severity of airway obstruction postoperatively but 20 patients (31.7%) still presented with moderate-to-severe airway obstruction. Age at surgery (P=0.023) and adenoid hypertrophy (P=0.003) were significantly associated with persistent postoperative airway obstruction. All 39 individuals exhibiting preoperative hyponasality demonstrated effective resolution after flap division, and 11 patients (17.5%) experienced mild hypernasality postoperatively. Unilateral port obstruction (P=0.004) and BMI (P=0.027) were identified as potential independent factors influencing the development of postoperative hypernasality. Conclusion Flap division is an effective measure for improving postoperative airway obstruction and hyponasality following pharyngeal flap, although some patients may continue to experience persistent airway obstruction and develop hypernasality after division. Age at surgery and adenoid hypertrophy are prognostic factors for persistent airway obstruction following flap division. Unilateral/bilateral nasal airway obstruction and BMI are related factors for post-operative hypernasality.

    Immediate implantation of simple taper retentive implants in chronic apical infected teeth in the posterior region: a 5-year clinical observation
    Zhang Xu, Wei Shibo, Yu Fei, Wu Hao, Cao Liangwei, Cao Ning, Wei Hongwu, Guo Shuigen
    West China Journal of Stomatology. 2024, 42(6):  764-772.  doi:10.7518/hxkq.2024.2024166
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    Objective This study aims to evaluate the mid- and long-term clinical efficacies of simple taper retentive implants for immediate placement in chronic apical infected teeth in the posterior region. Methods A total of 36 patients with 41 simple taper retentive implants were included in the study conducted. These patients underwent immediate implant treatment for teeth with chronic apical infection in the posterior region. The soft and hard tissues surrounding the implants were assessed and documented over a period of 5 years following the completion of crown restoration. Results During the 5 years follow-up period, one implant failed with mobility, and the implant survival rate was 97.6%. The mean marginal bone resorption was (-0.74±1.03) mm from the immediate post-implant placement to the immediate post-crown restoration, and the difference in marginal bone heights between the two time points was statistically significant (P<0.05). The mean marginal bone resorption was (-0.21±0.70) mm from the immediate post-crown restoration to the 5-year post-crown restoration, and the difference in marginal bone height between the two time points was not statistically significant (P>0.05). No significant difference (P>0.05) was observed in bone resorption between mesial and distal, maxillary and mandibular, different tooth positions, and different implant lengths. The soft tissue surrounding the implants remained healthy at the 5 years follow-up period, one implant exhibited peri-implantitis, and no mechanical complications were observed. The overall satisfaction of patients was good. Conclusion Immediate placement of simple taper retentive implants after thorough debridement of chronic infected alveolar socket in the posterior region can achieve good mid- and long-term clinical outcomes after 5 years of loading. The soft and hard tissues were maintained in a steady state, which expanded the indications for immediate implantation.

    Clinical study of the effect of the metal precrown restoration in the first deciduous molar on the composite resin filling in the second deciduous molar
    Wang Chunxian, Zhang Yu
    West China Journal of Stomatology. 2024, 42(6):  773-777.  doi:10.7518/hxkq.2024.2024189
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    Objective The effect of metal precrown restoration of distal proximal maxillofacial caries in the first deciduous molar on the composite resin filling of mesio-adjacent maxillofacial caries in the second deciduous molar was investigated. Methods A total of 80 children aged 4-8 who visited our clinic were selected, and 120 teeth were examined. Two consecutive deciduous molars in one jaw were considered a single case when the distal proximal maxillary surface of the first deciduous molar and the mesial proximal maxillary surface of the second deciduous molar simultaneously had caries. The teeth were randomly divided into two groups: group A (68 cases), in which the first and second molars were repaired with composite resin, and group B (52 cases), in which the first deciduous molar was repaired with metal precrown after composite resin filling and the second deciduous molar was filled with composite resin. The two groups were compared in terms of the success rate of composite resin filling in the second deciduous molar. Results At 3 months, no significant difference (P>0.05) was found between groups A (92.65%) and B (96.15%). At 6 months, no significant difference (P>0.05) was observed between groups A (89.71%) and B (94.23%). At 12 months, statistically significant difference (P<0.05) was found between groups A (73.53%) and B (88.46%); At 24 months, statistically significant difference (P<0.05) was found between groups A (66.18%) and B (86.54%). Conclusion Compared with composite resin filling of the first deciduous molar, the metal precrown restoration of the first deciduous molar can improve the success rate of composite resin filling of the second deciduous molar.

    Construction and verification of prediction model for postoperative hypokalemia in patients with oral cancer
    Wang Guangman, Bi Xiaoqin, Tang Xiaoxue
    West China Journal of Stomatology. 2024, 42(6):  778-786.  doi:10.7518/hxkq.2024.2024130
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    Objective This study aimed to explore the risk factors of postoperative hypokalemia in patients with oral cancer and to provide a basis for preventing and controlling postoperative hypokalemia. Methods We included 366 patients undergoing oral cancer surgery in the Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University from January 2022 to August 2022. Univariate and multivariate analyses were used to determine the risk factors of postoperative hypokalemia. The receiver operation characteristic (ROC) curve was used to quantify the effectiveness of the factors. A nomogram of the risk factors for postoperative hypokalemia in oral cancer patients was developed and validated. Results A total of 224 patients (61.20%) had postoperative hypokalemia, the lowest serum potassium level (3.50±0.35) mmol/L on the 4th day after surgery, and the highest incidence of hypokalemia (54.68%). Variables with P<0.05 in the univariate analysis were quantified by ROC curve followed by multivariate logistic regression analysis. Results showed an independent correlation with postoperative hypokalemia as follows: preoperative serum potassium<3.87 mmol/L (P=0.008), preoperative serum calcium<2.31 mmol/L (P=0.033), preoperative PNI<49.16 (P=0.032), postoperative drainage volume>264.25 mL (P=0.002). The above variables were constructed into a postoperative hypokalemia risk nomogram and verified, and a good degree of fit was found. Conclusion The independent risk factors for postoperative hypokalemia in patients with oral cancer were as follows: preoperative serum potassium<3.87 mmol/L, preoperative serum calcium<2.31 mmol/L, preoperative PNI<49.16, and postoperative drainage volume>264.25 mL. Clinical attention should be paid to managing the above high-risk patients. Preventive potassium supplementation should be performed as soon as possible to reduce hypokalemia occurrence.

    Application of digital model of mixed reality dynamic tracking technique in oral and maxillofacial surgery: a basic research
    Zhao Shuangyuan, Li Chengyan, Zhang Zhuang
    West China Journal of Stomatology. 2024, 42(6):  787-794.  doi:10.7518/hxkq.2024.2024101
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    Objective This paper aims to explore the application value of mixed reality in oral and maxillofacial surgery and to conduct dynamic tracking using an in vitro model. Methods By collecting preoperative enhanced CT data of patients, rebuilding 3D digital model, combined with 3D printing technology, dynamic tracking of lesions was realized in the in vitro model, and the efficiency of different registration methods was compared. Results The 3D visualized head and neck model was obtained by combining multiple anatomical models, and dynamic tracking was completed in vitro. The average tracking time of the facial mark recognition method was T45°=3.67 frames, T90°=10.67 frames, and T total=12 seconds 28 frames (30 frames per second). The average tracking time of QR code recognition method was T45°=1.67 frames, T90°=2.33 frames, and T total=11 seconds 13 frames (30 frames per second). Conclusion The combination of MR technology and 3D printing technology can realize the dynamic tracking of lesions in vitro, which lays a foundation for the clinical application of MR technology to implement precise, personalized surgical programs.

    Prospective study on the localization of anterolateral thigh perforator vessel based on mixed reality and artificial algorithm
    Liu Yixiu, Tang Xi, Wu Jian, Zhou Lian, Wu Shuangjiang, Qu Yang, Wu Xiaoyue
    West China Journal of Stomatology. 2024, 42(6):  795-803.  doi:10.7518/hxkq.2024.2024129
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    Objective This paper aims to construct a system integrating mixed reality technology with artificial algorithm and to evaluate its effectiveness in vascular localization during anterolateral thigh perforator flap surgery to provide new insights for clinical practice. Methods Twenty patients undergoing anterolateral thigh perforator flap repair were selected. After attaching positioning devices on the lower limb, CT angiography (CTA) scans were performed. The 2D data obtained were converted into a 3D model of the positioning device and vessels. Mixed reality technology was utilized to achieve 3D visualization of perforator vessels. An artificial algorithm was developed in HoloLens 2 to match the positioning device automatically with its 3D model intraoperatively to overlap the perforator vessels with their 3D models. The number of perforator vessels identified within the flap harvesting area and the actual number detected during surgery were recorded to calculate the accuracy rate of vessel identification based on CTA data reconstruction. The distance between the perforator vessel exit points located by the system and the actual exit points was measured, and the error values were calculated. The surgical time required for the system to harvest the anterolateral thigh perforator flap was documented and compared with the surgical time required by conventional methods. The clinical applicability of the system was discussed. Results The CTA data reconstruction identified 30 perforator vessels, while the actual number found during surgery was 32, resulting in an identification accuracy rate of 93.75%. The average distance between the perforator vessel exit points located by the system and the actual exit points was (1.65±0.52) mm. The average surgical time for flap harvesting with the assistance of the system was (43.45±4.6) min compared with (57.6±7.9) min required by conventional methods. All perforator flaps survived the procedure. One case of flap infection occurred seven days postoperatively, and one case of partial flap necrosis was treated with symptomatic therapy, resulting in delayed healing. Conclusion The system constructed in this paper can achieve 3D visualization of perforator vessels through mixed reality technology and improve the accuracy of perforator vessel localization using artificial algorithms, hence demonstrating potential application in anterolateral thigh perforator flap harvesting surgeries.

    Application of intraoral scanning registration implant robot in dental implant surgery
    Jin Nenghao, Qiao Bo, Zhu Liang, Meng Fanhao, Lin Quanquan, Li Liangbo, Xing Lejun, Zhao Rui, Zhang Haizhong
    West China Journal of Stomatology. 2024, 42(6):  804-809.  doi:10.7518/hxkq.2024.2024213
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    Objective This paper aims to investigate the application of intraoral scanning and cone beam computed tomography (CBCT) registration implant robot in dental implant surgery. Methods The data of 40 cases with dental defect of robot-assisted implantation from November 2023 to May 2024 were retrospectively analyzed. Before the operation, the intraoral scan data and CBCT data of the positioning markers were automatically fused with the initial CBCT images, and the registration error was calculated. The average registration error of positioning markers was determined during the operation, and the implantation accuracy was analyzed after the operation. Results The intraoral scan data and CBCT data of 40 patients with dental defect wearing positioning markers were successfully registered with the initial CBCT image, and the registration errors were (0.157±0.026) mm and (0.154±0.033) mm, respectively. Statistical analysis showed no statistical significance between them. The registration errors of the marker was (0.037 3±0.003 6) mm. A total of 55 implants were performed, and the total deviations of the implant point and the apical point were (0.78±0.41) and (0.89±0.28) mm, respectively. The transverse deviations of the implant point and the apical point were (0.44±0.36) and (0.58±0.25) mm, respectively. The depth deviations of the implant point and the apical point were (0.51±0.32) and (0.54±0.36) mm, respectively. The deviation of the implant angle was 1.24°±0.67°. Conclusion The fusion technology based on intraoral scanning and CBCT registration can meet the accuracy requirements of preoperative registration of oral implant robots. The technology increases the choice of registration methods before robot-assisted dental implant surgery and reduces the multiple radiation exposuresof the patient.

    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.

    Digital technology-assisted minimally invasive removal of odontoma with high impacted maxillary canine by double-fenestration technique: a case report
    Zhou Jing, Wang Luning, Yu Jian, Wang Zhaoling, Chen Hongyu
    West China Journal of Stomatology. 2024, 42(6):  816-821.  doi:10.7518/hxkq.2024.2024222
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    Odontoma is a hamartoma or developmental malformation of dental tissues and often causes delayed or impacted permanent teeth. This paper reports a case of surgical removal of an odontoma that is closely attached to the labial bone plait and examines the extraction of accompanying high-impacted maxillary canine beside the nose and maxillary sinus. Digital technology was used in reconstructing a part of a patient's maxilla, odontoma, related teeth, and other adjacent anatomical structures, accurately determine the lesion boundary, and design an optimal surgical plan. The minimally invasive extraction of lesions and embedded teeth with a double-fenestration technique through the upper and lower paths not only preserved the continuity of the labial alveolar bone plate in the operative area and prevented postoperative bone collapse but also reduced the risk of maxillary sinus mucosal injury and perforation, improved surgical efficiency, and reduced the surgical trauma. These features were in line with the concept of minimally invasive alveolar surgery.

    GLI1-altered mesenchymal tumor of tongue: a case report and literature review
    Xie Na, Huang Yousheng, Wu Wenting, Weng Yang
    West China Journal of Stomatology. 2024, 42(6):  822-827.  doi:10.7518/hxkq.2024.2024098
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    GLI1-altered mesenchymal tumors are a relatively rare type of mesenchymal tumor that is common in the head and neck. It is a newly added tumor type in the World Health Organization Tumor Classification of Head and Neck (5th edition). This article reports a case ofGLI1-alteredmesenchymal tumor occurring at the left tongue and reviews the relevant literature to summarize the pathological morphological characteristics, immunophenotype, molecular changes, clinical manifestations, and prognosis of the disease.

    Malignant hyperthermia during orthognathic surgery: a case report
    Li Yue, Lin Jie, Luo Wei, Luo Kai, Luo Lin
    West China Journal of Stomatology. 2024, 42(6):  828-831.  doi:10.7518/hxkq.2024.2024200
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    Malignant hyperthermia is a rare life-threatening hyperthermic reaction that occurs during general anesthesia and is difficult to diagnose preoperatively. In most reported cases, final diagnoses of malignant hyperthermia were eventually confirmed by genetic testing after the episodes of hyperthermia. Dantrolene is the only specific medicine with improved treatment outcomes for malignant hyperthermia. In this work, we reported a case of malignant hyperthermia that occurred during orthognathic surgery. Malignant hyperthermia was successfully reversed because of the prompt recognition and specific treatment of dantrolene, and only slight increases in myoglobin and creatine kinase were observed postoperatively.

    A case of hypophosphatemia rickets with unidentified apical periodontitis as the initial symptom of diagnosis
    Shi Yuan, Su Jimei, Lü Lihua, Wu Dingwen
    West China Journal of Stomatology. 2024, 42(6):  832-838.  doi:10.7518/hxkq.2024.2024175
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    Hypophosphatemia rickets is a rare disease that is divided into two categories, namely, hereditary and acquirability. Its clinical manifestations include growth disorders, limb deformities and dysfunction, poor mineralization of the teeth, and growth retardation in children as well as hyperparathyroidism, osteoarthritis, osteomalacia, and pseudofracture in adults. Oral manifestations include non-carious teeth with recurrent apical periodontitis, periapical abscess and even cellulitis, periodontitis, and early tooth loss. X-linked hypophosphatemia rickets (XLHR) accounts for approximately 80% of all hypophosphatemia rickets. We report a 3-year-old child with XLHR whose first diagnosis was apical periodontitis of multiple non-carious and non-traumatic teeth. Through medical history, clinical examination, laboratory examination, radiographic findings, genotype testing, and literature analysis, we analyze the pathogenesis, clinical manifestations, radiographic features, diagnosis and differential diagnosis, treatment, and follow-up. This work provides reference for clinical diagnosis and treatment and reduces missed diagnosis and misdiagnosis by dentists.