Journal of "Regeneration, Reconstruction & Restoration" (Triple R)

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Introduction: Cell delivery in treatment of bone defects has been introduced to promote tissue healing in the recent years. However, no general consensus has been reached regarding the outcome of regenerative medicine for this purpose. The aim of this study was to review our 10 years of experience in application of mesenchymal stem cells (MSCs) in craniofacial bone defects. Applied Methodology: Iliac bone marrow, dental pulp and buccal fat pad were selected to harvest MSCs. Flow cytometric analysis, RT-PCR and differentiation staining including Alizarin red, Oil Red O and Toluidine blue were used to identify MSCs. Four groups of bone substitutes were used for cell delivery: synthetic scaffold [beta-tricalcium phosphate (B-TCP) and hydroxyapatite/tricalcium phosphate (HA/TCP)], xenograft [natural bovine bone mineral (NBBM)], allograft [freeze-dried bone (FDBA), demineralized freeze dried bone] and composite [polycaprolactone/TCP (PCL-TCP), demineralized freeze-dried bone/calcium sulfate]. Rat and rabbit calvaria, dog mandible, rabbit tibia sinus and alveolar cleft defects in human were used as the study models. Histomorphometric and radiomorphological analysis were used to determine new bone formation. Outcomes: Cell-treated groups showed greater new bone formation than cell-free group in all studies. Synthetic scaffolds showed better cell attachment according to scanning electron microscopy (SEM) results. In rat calvarial model, B-TCP loaded with MSCs showed better results than scaffolds carrying platelet rich plasma (PRP). NBBM showed less promising results both in dog mandible and ectopic bone formation in the masseter muscle. FDBA block fixed over a supracrestal defect in dog mandible showed 50% less new bone formation when compared with PCL-TCP as a carrier. Conclusion: More convergence studies with similar protocols of cell cultivation, culture, seeding and delivery should be done in the field of regenerative medicine for better generalizability of results for clinical setting.

Keywords: Mesenchymal stem cells; Bone regeneration; Tissue engineering; Craniofacial bone

Bone reconstruction in the maxillofacial region is a challenging task due to the exclusive anatomical complexity of the tissue, aesthetic requirements and functional demands. The gold standard method for maxillofacial reconstruction is based on autogenous bone grafting, which is associated with certain drawbacks. In this review, we describe recent bone tissue engineering approaches in reconstructive surgery of the maxillofacial region. Proper cell sources, scaffolds, signaling molecules as well as recent bioreactor technology are discussed. 

Introduction: This study aimed to prospectively assess the effectiveness of the use of the bilateral buccal fat pad (BFP) for wide cleft palate reconstruction and its effect on transverse palatal growth and fistula formation. Methods and Materials: Buccal fat pad was utilized for treatment of wide palatal cleft patients managed by at Department of Oral and Maxillofacial Surgery of Ahvaz Jundishapur University of medical sciences. Also, an electronic search of articles was performed in Medline and PubMed database from January 1990 to May 2015 to review the literature and summarize the utilization of BFP graft in reconstruction of palatal defects. Results: Ten wide palatal cleft patients were enrolled in this study from 2009 to 2015. Age ranged from 1.5 to 18 years with a mean of 6 in all cases and 2.4 in growing patients. The exposed BFP fully epithelialized within 4 weeks. No palatal fistula type III or IV was observed in follow-up. Palatal transverse growth was not adversely affected in seven growing patients in the follow-up time. Conclusion: The results of this study may suggest application of pedicled BFPs to support and fill nasal layer, raw bone, dead space between oral and nasal layer and hypoplastic muscles to prevent fistula formation and severe scar contracture.

Introduction : Ankylosis of the temporomandibular joint (TMJ) is a disabling condition due to the fusion of joint to the base of skull and results in mouth opening limitation. Several surgical techniques have been described for treatment of this condition but no consensus has been reached. This study sought to assess the success of treatment with regard to long-term functional improvement and rate of complications in ankylosis patients during a 10-year period.

Materials and Methods: Patients who underwent unilateral or bilateral condylectomy without joint reconstruction during 2001-2011 in the Maxillofacial Surgery Department of Shariati Hospital were evaluated in this historical cohort study. The patients were recalled to ensure the accuracy of information in their medical records and were clinically examined. Improvement in their joint function and rate of complications were evaluated. Data were analyzed using Wilcoxon Signed rank test, multivariate tests, Mauchly's sphericity test and McNemar’s test.

Results: A total of 27 subjects (13 males and 14 females) with a mean age of 34.8 years and 6.1 years mean duration of follow-up were evaluated. The results of observation showed that trauma was the most common cause of ankylosis (63%). The most common type of ankyloses was fibrous (55.6%) and 55.6% of the patients had bilateral ankylosis. Maximum mouth opening (MMO), the amount of lateral movement and open bite significantly improved after the operation (P<0.001). Frontal, zygomatic and buccal nerves had been injured in 4, 4 and 3 patients, respectively during the operation.

Conclusion: Condylectomy without reconstruction significantly improves the TMJ function in patients with TMJ ankylosis with regard to MMO, the amount of lateral movement, maintenance of occlusion and the skeletal form.

Introduction: It is suggested that arch bars act as plaque-retentive ligatures and therefore exert effects on periodontal tissues health. The aim of the present study was to assess pocket probing depth prior to placing arch bars and following their removal.

Materials and Methods: Pocket probing depths were studied in the subjects who had arch bars for one month due to condylar fracture. Pocket depths were measured before placing arch bars, one month and 12 months after removing them. The mean of pocket depth was measured for each tooth. Periodontal probing depth was measured in six sites of each tooth .The mean pocket depth was calculated by the division of the sum of the pocket depths by the number of teeth for anterior and the posterior teeth in all subjects.

Results: Eleven males and nine females were included in this study. No significant pocket depth differences was detected among the anterior and posterior of the mandible and maxilla before and after placing the arch bars. Results demonstrated a significant pocket depth increase in the anterior and posterior of both jaws one month following removal of the arch bars .The pocket depths were decreased following 12 months which were indicative of relative improvement at the sites.

Conclusion: Arch bars can affect periodontium and pocket depths increased one month after releasing the arch bars. However, a significant improvement was detected following 12 months that suggested a partial reversible change in the pocket depths.

Lateral osteotomy is a necessity in several rhinoplasty cases. However, it can be challenging for inexperienced surgeons to perform external osteotomy due to difficulties such as lack of control, inconsistent results and technical complications. The present article presents a simplified approach for external lateral nasal osteotomy by using a customized lateral nasal osteotomy guide fabricated with three-dimensional printer. This technique may assist novice surgeons to perform external lateral nasal osteotomy more safely and with reduced operation time and consistent outcomes.

Statement of Problem: Radiographs are commonly used to detect misfit of implant components, but various factors including implant connection and component opacity could affect this decision.

Purpose: The purpose of this study was to evaluate the diagnostic capability of senior students and experienced dentists on the adaptation of implant and impression coping in different vertical and horizontal angled radiographs.

Materials and Methods: The implant and the impression coping were attached to each other; once without any gap and once with a gap of 0.5 mm. Totally, 40 digital X-rays were taken with vertical inclinations of 0, 5, 10, 15, 20, 25, 30 degrees in positive and negative directions, and the rest were horizontally inclined with the same values. Forty senior students and twenty experienced dentists observed the radiographs. Their diagnoses were compared with the real status of components.

Results: No significant difference was observed between the performance of students and experts (P=0.74). Statistical T-test analysis revealed that the directions (inclinations toward the implants or the impression copings) does not result in any significant difference in diagnoses of students (P=0.29) and dentists (P= 0.15). Nevertheless, general linear model showed the radiograph angulations had a significant impact on the diagnoses of students (P=0.003) and dentists (P<.001). Youden factor revealed that there was not a consistent trend regarding sensitivity and specificity of vertically angled radiographs; however, sensitivity and in particular, specificity decreased as a result of horizontal angle inclination.

Conclusion: Increasing vertical angulations of the radiographs for diagnosing the adaptation of implant components is likely to reduce diagnostic capability of clinicians, even experienced ones. Specificity is more affected than sensitivity in both horizontally and vertically angled radiographs.  

Introduction: Annually ~2 million permanent teeth are lost in public dental clinics in Iran. Many of these losses are caused by difficulties in
provision of timely root canal treatment (RCT) or their low quality. The present guideline aimed to find and recommend the best treatment
options for management of vital permanent teeth with carious exposure.

Materials and Methods: The guideline domain was examined and
treatment options were determined as scenarios comprised of indications and possible interventions. Two main indications including
carious pulp exposure with or without irreversible pulpitis in open-apex and in closed-apex permanent teeth were included. Nine treatment
options were found for each indication based on the available literature. Exhaustive search was performed to find the current evidence and the
retrieved studies were critically reviewed. Treatment options and their supporting evidence were extracted. Search for the side effects and
benefits of each treatment option was also performed. The expenses regarding each treatment were then determined and treatment options with
Level of Evidence (LOE) I and II evidence were presented to an expert panel for each indication. Each clinical scenario was examined and rated
by each member considering six aspects: effectiveness of the intervention, costs, side effects, side benefits, applicability of the scenario and
generalizability of the treatment. The best scenarios were chosen based on the expert panel ratings and the recommendations were extracted.

Results: Based on the present guideline, full pulpotomy with calcium enriched mixture (CEM) cement is recommended in vital permanent teeth
with open- or closed-apex, with or without irreversible pulpitis, following carious pulp exposure (Grade A recommendation).

Conclusion: Adherence to the present guideline may help preserve pulp vitality and decrease the risk of loss of vital permanent teeth with carious
pulp exposure.