01 September 2020, Volume 47 Issue 5 Previous Issue   
Expert Forum
Surgery first approach: one of the hotspots in orthognathic surgery and common problems
Tao Wang
Int J Stomatol. 2020, 47 (5):  497-505.  DOI: 10.7518/gjkq.2020090
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After more than a century, orthopedic surgery has developed into a mature branch of oral and maxillofacial surgery and has been widely conducted locally and internationally. Tens of thousands of patients worldwide have achieved satisfactory results in the function and appearance of maxillofacial region. This study aims to clarify some common misunderstandings and experiences by analyzing the current situation of surgery first approach model in orthognathic surgery and other related subjects.

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Oral Microecology
Research progress on the microecology of dental plaque in caries
Yang Zhilei,Liu Baoying
Int J Stomatol. 2020, 47 (5):  506-514.  DOI: 10.7518/gjkq.2020032
Abstract ( 39 )   HTML ( 6 )   PDF(pc) (9481KB) ( 85 )   Save

The ‘ecological plaque theory’ leads a new direction for deep understanding on the aetiology of dental caries. This theory supports that caries is mediated by microecological imbalance in dental plaque biofilm, which shifts towards acid-producing and acid-resistant environment due to various factors. The emergence of high-throughput microbial detection technology based on the 16S ribosomal RNA (rRNA) gene made it possible to comprehensively study dental plaque microecology in caries. The main difference in microflora between health and dental caries does not depend on the composition, including core microflora, but that acid-producing and acid-resistant bacteria were selected during the process of dental caries. Different individuals may have different compositions of microflora in dental caries. Dental caries is accompanied by a series of changes in the ecological structure and function in dental plaques. Such changes include decreased microbial diversity, increased homogeneity, enhanced synergy among species and changed metabolism. In this paper, current status and frontiers on research of plaque microecology in dental caries will be reviewed.

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Progress on the application of probiotics in the management of periodontal diseases
Jia Leming,Jia Xiaoyue,Yang Ran,Zhou Xuedong,Xu Xin
Int J Stomatol. 2020, 47 (5):  515-521.  DOI: 10.7518/gjkq.2020080
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Periodontal diseases, which can seriously damage the structures that surround the teeth, including gums, perio-dontal ligament, and alveolar bone, are the major causes of tooth loss among adults. Approximately 80%-90% of adults in China are suffering from different degrees of periodontal diseases. The etiology of periodontal diseases is complicated, but periodontal micro dysbiosis and abnormal host immune response are recognized as the important causes of these diseases. The basic treatment of these diseases includes the mechanical removal of calculus and plaque and systemic and topical medications. Several drugs that modulate periodontal microbial ecology and immune abnormality have emerged because of the re-colonization of oral pathogens and the incidence of antibacterial resistance. Probiotics have been used to address intestinal microbial dysbiosis, and their application in the treatment of oral infectious diseases has also been suggested. This article reviewed the progress on the research and application of probiotics in the treatment of periodontal diseases to provide a new paradigm for the ecological management of these diseases.

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Bacterial diversity of oral flora in patients with diabetes
Yi Zumu,Wang Xinyu,Wu Yingying
Int J Stomatol. 2020, 47 (5):  522-529.  DOI: 10.7518/gjkq.2020095
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The ecological imbalance of oral flora is closely related to oral and systemic diseases. Studies have found a close two-way relationship between periodontal disease and diabetes. The starting factor of periodontal disease is bacteria. Diabetes is one of the main risk factors for periodontal disease. Whether diabetes affects the development of periodontal disease by affecting the structure of human oral flora remains controversial. Most researchers believe that bacteria may be the key link in the interaction between diabetes and periodontal disease. The change in oral bacterial diversity in patients with diabetes may play a key role. Some believe that the oral bacterial diversity of patients with and without diabetes does not differ. This article reviews the different perspectives of the effects of diabetes on the structure of oral flora in recent years and describes possible mechanisms. The changes in glucose levels in saliva and gingival crevicular fluid, inflammation, and inflammatory factors in patients with diabetes are the main reasons for the influence of diabetes on oral bacterial diversity.

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Original Articles
Influence of c57 mouse periodontitis model on cognitive ability
Tong Yuxin,Xiao Xinli,An Ying,Zhang Jiayu,Shi Xuyan,Wang Xu,Chen Yue
Int J Stomatol. 2020, 47 (5):  530-537.  DOI: 10.7518/gjkq.2020024
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Objective This work aimed to establish a lipopolysaccharide (LPS)-induced animal model of periodontitis and observe the influence of LPS injection on the behaviour of c57 mice. Methods Twenty female c57 mice were ran-domly divided into two groups: blank control and experimental periodontitis groups. Mice in the experimental group were injected with Escherichia coli LPS by a microsyringe. Morris water maze (MWM) test was performed to assess the learning and memory ability of mice after 39 days. The expression levels of the proinflammatory cytokine interleukin (IL)-1β in mouse hippocampus tissues and serum were determined by enzyme-linked immunosorbent assay. Nissl body and neuron status in the CA3 area of the brain hippocampus were observed by Nissl staining, and alveolar bone resorption was evaluated by haematoxylin and eosin staining. Results In MWM positioning navigation experiment, the latency and thigmotaxis of both groups decreased gradually. The latency and thigmotaxis of the experimental group in the MWM experiment increased significantly compared with the control group (P<0.000 1). The number of neurons in the CA3 area of the experimental group mice increased significantly compared with the control group (P=0.001). The serum IL-1β content was higher in the experimental group than in the blank control group (P=0.007). Conclusion Long-term injection of low-dose LPS can induce bone loss and may cause cognitive impairment to c57 mice.

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Preliminary study on osteoprotegerin/receptor activator of nuclear factor-κB ligand expression in mandible and femur on site selectivity of bone metastasis of lung cancer cells
Fu Shijin,Zeng Kan,Li Xin,Yang Jing,Wang Chenglin,Ye Ling
Int J Stomatol. 2020, 47 (5):  538-546.  DOI: 10.7518/gjkq.2020086
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Objective To explore the involvement of osteoprotegerin (OPG)/receptor activator of nuclear factor-κB ligand (RANKL) ratio in mandible and femur on the site selectivity of bone metastasis of lung cancer cells. Methods Mouse Lewis lung cancer cells were used to construct mouse models of systemic/local lung cancer bone metastasis. Hematoxylin-eosin staining and micro-computed tomography (MicroCT) analysis were used to determine the selectivity of tumor metastasis amongst different bone tissues. Immunohistochemical staining of cathepsin K (CTSK) was performed to detect osteoclast activation in bone tissues. RNA sequencing (RNA-seq) and real time-quantitative polymerase chain reaction (RT-qPCR) were conducted to measure OPG mRNA/RANKL mRNA in bone.Results Using the mouse model of systemic lung-cancer cell bone metastasis, we established that the bone metastasis was less likely to occur in the mandible than the femur. Under physiological conditions, taking the mandible and femur as representative bone tissues with low/high incidence of lung cancer-cell metastasis, we found that the mandible exhibited a significantly fewer osteoclast number and higher OPG mRNA/RANKL mRNA ratio than the femur (P<0.01). Further investigations suggested that lung cancer cell-induced bone destruction mainly distributed in areas concentrated with CTSK-positive osteoclasts, with a significantly greater osteoclast number (P<0.01) and lower OPG mRNA/RANKL mRNA ratio in the metastasized bone tissue compared with the non-metastasized bone tissue (P<0.000 1). Conclusion Differences in osteoclast activation and OPG mRNA/RANKL mRNA ratio levels exist in bone tissues with low/high incidence of lung cancer-cell bone metastasis, suggesting that OPG/RANKL may affect osteoclast activation, and is therefore involved in the site selectivity of lung cancer-cell bone metastasis.

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Meta-analysis and GRADE evaluation of the intervention effects of using amifostine before radiotherapy on xerostomia in patients with head and neck cancer
Wei Binbin,Hu Huiwei,Liu Yujuan,Sun Zhe,Yi Yuli
Int J Stomatol. 2020, 47 (5):  547-556.  DOI: 10.7518/gjkq.2020084
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Objective To evaluate the intervention effect of using amifostine before radiotherapy on xerostomia and other side effects in patients with head and neck cancer. Methods First, related studies were collected from different databases, such as China National Knowledge Infrastructure (CNKI), WanFang Data Knowledge Service Platform, China Biology Medicine disc (CBMdisc), VIP Database for Chinese Technical Periodicals (VIP), PubMed, Cochrane Library, EMbase, and Medline, from the date of their establishment to July 2019. Second, the collected studies were screened and evaluated based on inclusion and exclusion criteria. Third, meta-analysis was performed using RevMan5.3 software. Lastly, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) evidence quality grading system was used to evaluate the evidence quality of the outcome indexes. Results A total of 948 patients were enrolled in nine randomized control trials (RCTs). The results of the meta-analysis showed that compared with the control group, amifostine reduced acute xerostomia above grade 2 [risk ratio (RR)=0.62, 95% CI (0.44, 0.87), P=0.005], six months after the end of radiotherapy [RR=0.58, 95% CI (0.37, 0.91), P=0.02]. No significant difference was observed in the glandular function index after the radiotherapy, advanced xerostomia 12 months after radiotherapy, acute mucositis, disease control, and overall survival (P>0.05). Amifostine caused various side effects, including nausea and vomiting, hypotension, and allergic reactions, and the difference was statistically significant (P<0.05). The results of the GRADE evidence quality evaluation indicated that 1) the five outcome indexes of acute xerostomia above grade 2, nausea and vomiting, allergic reaction, disease control, and overall survival were moderate-level evidences; 2) the outcome indexes of advanced xerostomia above grade 2, acute mucositis, and hypotension were low-level evidences; and 3) the glandular function index was an extremely low-level evidence. Conclusion Using amifostine before radiotherapy can reduce moderate to severe acute xerostomia within six months after the completion of radiotherapy, as well as the occurrence of acute mucositis. However, no positive effect was observed in the glands function after radiotherapy, xerostomia 12 months after the completion of radiotherapy, acute mucositis, and tumor therapeutic effect. Moreover, the side effects of using amifostine were remarkable. Comprehensive research with large samples should be conducted to verify this conclusion.

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Reliability and validity evaluation of the Chinese version of the oral potentially malignant disorder questionnaire
Peng Shuyuan,Xiang Xuerong,Chen Fangchun,Sun Yan,Yin Feng,Li Min
Int J Stomatol. 2020, 47 (5):  557-562.  DOI: 10.7518/gjkq.2020100
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Objective This study aimed to evaluate the reliability and validity of the Chinese version of the oral potentially malignant disorders questionnaire (OPMDQ). Methods Initial translation, back-translation, quality evaluation, cultural adjustments, and pre-evaluation of the OPMDQ were performed to develop a Chinese version. This questionnaire was distributed to 370 subjects [210 patients with oral potentially malignant disorders (OPMD) and 160 healthy subjects] to evaluate its reliability and validity. After the subjects accomplished the questionnaires, the collected data were analyzed to evaluate the reliability and validity of the scale. Results Exactly 339 efficient scales were collected, with completion rate of 91.6%. The α value of the total Cronbach coefficient in the scale was 0.876, and the total score of the interclass correlation coefficient of the test-retest was 0.84. Following exploratory factor analysis, four factors were extracted and showed an accumulating contribution rate of up to 67.89%, suggesting that the scale had the expected joint and logical relationships ranging from 0.469 to 0.854. For the discri-minant validity of the scale, the difference between the scale scores of patients with OPMD and those of healthy subjects were statistically significant (P<0.001), suggesting that the scale had good discriminant validity. Conclusion The Chinese version of the OPMDQ displayed good reliability and validity, as indicated by strict performance tests. This questionnaire can be applied to evaluate the quality of patients with oral potentially malignant disorders in China.

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Case Report
Root canal retreatment with subcutaneous emphysema: a case report
Tan Kaixuan,Li Fan,Zhang Lijuan,Li Shanshan,Lu Jie,Zhang Ying,Yang Fang
Int J Stomatol. 2020, 47 (5):  563-566.  DOI: 10.7518/gjkq.2020099
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Subcutaneous emphysema is a rare complication after dental treatment and is characterized by the swelling of soft tissues caused by air passing through the skin and submucosa. Air can enter the buccal space and temporal space through connective tissues in the face and neck and even spread to the thorax and mediastinum; thus, this condition is life-threatening. This article reports a case of subcutaneous emphysema during root canal retreatment of right maxillary central incisor, analyzes the causes, and discusses its diagnosis and treatment measures.

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Internal structural changes of the temporomandibular joint associated with mandibular lateral displacement
Yin Xiaoli,Liu Yang,Wang Jun
Int J Stomatol. 2020, 47 (5):  567-573.  DOI: 10.7518/gjkq.2020083
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Mandibular lateral displacement is a common craniomaxillofacial deformity in clinical practice, which manifests as various forms of mandibular deviation. In addition to changes in appearance, this deformity is often associated with changes in the internal structure of the temporomandibular joint (i.e., condyle and temporomandibular joint disc) and functions of the oral and maxillofacial systems, which increase the difficulty of conducting clinically comprehensive diagnosis and treatment of mandibular lateral displacement. To resolve such difficulty, the forms of mandibular deviation and the changes in the internal structure of the temporomandibular joint must be analyzed and clarified. However, the existing research on this topic is not sufficient. Therefore, this study reviews the possible relationship between the changes in the internal structure of the temporomandibular joint and the mandibular deviation in patients with mandibular lateral displacement to provide reference to clinicians.

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Research progress on denture tissue conditioner
Zhang Tingting,Hu Changhong,Peng Yan
Int J Stomatol. 2020, 47 (5):  574-580.  DOI: 10.7518/gjkq.2020085
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Tissue conditioners, which are short-term soft liners with viscoelasticity and fluidity, are formed from a mixture of a polymer powder and a liquid plasticizer and applied to the tissue surface of the denture base. Tissue conditioners have soft viscoelasticity when placed in the mouth, thereby entering the clinical plasticity period, and harden with the leaching of the plasticizer, thereby entering the clinical invariable period. In accordance with its operability, tissue conditioners are used clinically to adjust deformed and inflamed mucosal tissues, make dynamic functional impressions, temporarily line dentures, and maintain the suitability of dentures. This article reviews the recent advances in the composition and gelation process, improvement by adding antifungal agents, physical properties, clinical applications, and use of tissue conditioners.

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Early biological management of early childhood caries
Deng Xiaoyu,Zhang Yunhan,Zou Jing
Int J Stomatol. 2020, 47 (5):  581-588.  DOI: 10.7518/gjkq.2020082
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Caries is the most common infectious bacterial disease in children. Severe early childhood caries often causes decreased masticatory efficacy, pain, and pulpitis and apical periodontitis, which seriously affect the oral, physical and mental health of children. In this study, we conducted risk assessment and preventive work on the basis of the occurrence and development of caries. When caries occurs, biological treatment is applied by cutting off the source of nutrition of the cariogenic bacteria and preventing remineralization. Pediatric dentists must implement the early management of early childhood caries, maintain the integrity and physiological functions of the primary dentition, and promote the healthy development of children’s mind and body.

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Advances in the decontamination of plaque on implant surface in vitro
Tong Zian,Si Misi
Int J Stomatol. 2020, 47 (5):  589-594.  DOI: 10.7518/gjkq.2020098
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Peri-implantitis is a plaque-associated pathological condition that occurs in the tissues around dental implants. This condition is characterized by inflammation in the peri-implant mucosa and the subsequent progressive loss of supporting bone; thus, this disease leads to the failure of dental implants. Surface decontamination is a critical process in the treatment of this disease. Current debridement methods include physical and chemical decontamination methods, such as manual scraping, ultrasonic scaling, atmospheric pressure plasma, laser, air polishing, normal saline, hydrogen peroxide, chlorhexidine, citric acid, and photodynamic therapies. Physical methods focus on removing foreign bodies, whereas chemical methods are used to kill microorganisms. These decontamination methods are often combined in practical clinical practice to maximize their efficacy. This review summarizes the current in vitro studies on the decontamination of plaque on implant surface.

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Factitious oral ulcer: causes, clinical characteristics, and treatment
Yue Jinhan,Wang Fei,Xin Chuan,Yin Fengying,Chen Qianming,Zeng Xin
Int J Stomatol. 2020, 47 (5):  595-600.  DOI: 10.7518/gjkq.2020096
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Factitious oral ulcer is a kind of traumatic oral ulcer that is caused by harmful habits or self-injurious behaviors. In this article, we reviewed and summarized the epidemiological characteristics, clinical manifestations, classification, and pathological characteristics of factitious oral ulcer. We mainly focused on the etiology, diagnosis, and treatment characteristics to emphasize the essential role of abnormal mental and psychological behaviors in the diagnosis, differential diagnosis, and treatment of the disease. Results of this study can help provide clear and standardized diagnosis and treatment ideas for clinicians.

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Literature review of death from serious complications associated with dental treatment
Tan Xing,Pan Jian
Int J Stomatol. 2020, 47 (5):  601-606.  DOI: 10.7518/gjkq.2020076
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] Death is a rare but the most significant adverse event of dental treatment. Death related to dental treatment continues to occur annually as a result of patients, providers, and procedural factors. This article reviews the causes of death, risk factors, prevention, emergency management, and bereavement support related to dental treatment to reduce the incidence of adverse reactions in patients and improve the level of oral diagnosis and treatment.

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Regulation of osteoimmunology by MicroRNA 155 and research progress of its possible mechanism in periodontitis
Sun Jianwei,Lei Lihong,Tan Jingyi,Chen Lili
Int J Stomatol. 2020, 47 (5):  607-615.  DOI: 10.7518/gjkq.2020022
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Periodontitis is a chronic infectious disease that is characterised by the inflammation of gingiva and the progressive destruction of alveolar bone. The interaction between plaque microbes and host defence affects the process of the disease. As a new interdisciplinary field, osteoimmunology mainly studies the molecular interaction mechanism between skeletal and immune systems, which are related to the occurrence of periodontitis. MicroRNA 155 (miR-155) is an endogenous noncoding single-stranded RNA in eukaryotic organisms. miR-155 combines with the 3’-untranslated region of target mRNA to negatively regulate the expression of mRNA. miR-155 can participate in multiple physiological and pathological processes, such as immunity, haematopoiesis and inflammation. A large number of studies have shown that the expression level of miR-155 can be altered during periodontitis development, but results reported in literature are inconsistent. miR-155 can also regulate the skeletal system through multiple pathways. This review elaborates the modulation of miR-155 in osteoimmunology and periodontitis. We aim to offer novel insights and strategies for clinical therapy of periodontitis.

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Advances in the mechanism and effect of nicotine on alveolar osteoclasts
Yang Peipei,Yang Yuchen,Zhang Qiang
Int J Stomatol. 2020, 47 (5):  616-620.  DOI: 10.7518/gjkq.2020052
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Smoking can promote periodontal disease. As one of the toxic chemicals in tobacco, nicotine is an important cause of periodontal diseases, including gingival bleeding, periodontal pocket formation, alveolar bone absorption and tooth loosening. Alveolar bone resorption results from the disrupted dynamic balance of bone tissue, which refers to the imbalance of bone resorption regulated by osteoblasts and osteoclasts. The special effect of nicotine on bone metabolism was clarified by studying the regulatory effect of nicotine on osteoclasts and inducing factors. The inducing effect of nicotine on the development of periodontal disease was further analysed. This article reviewed the research progress on the effect of nicotine on osteoclasts.

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