01 May 2023, Volume 50 Issue 3 Previous Issue   
Expert Forum
Biologic bases of nature tooth-related maxillary sinus floor elevation
Huang Dingming, Zhang Lan, Man Yi
Int J Stomatol. 2023, 50 (3):  251-262.  DOI: 10.7518/gjkq.2023048
Abstract ( 183 )   HTML ( 172 )   PDF(pc) (4497KB) ( 259 )   Save

When missing maxillary posterior teeth require implantation, adopting maxillary sinus floor elevation routinely provides bone augmentation to meet the initial stability of the implant due to insufficient bone volume. It is very difficult to eliminate the infection completely from the complex root canal system of maxillary posterior teeth by root canal treatment, which results in the chronic apical periodontitis after treatment. The close anatomy relationship among the maxillary posterior teeth, maxillary bone and sinus, termed as maxillary tooth-alveolar-process-sinus complex, makes it easy for the infection to spread into the maxillary sinus. When endodontic microsurgery is needed, the surgical access is often established through maxillary sinus floor elevation, which is named as tooth-related maxillary sinus floor elevation. It is necessary to put forward the tooth-related maxillary sinus floor elevation as it is different biologic basis from the traditional dental implantation-related maxillary sinus floor elevation in anatomy, etiology and pathology.

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Guideline interpret
Interpretation of the 2022 classification of head and neck tumors by the World Health Organization: odontogenic and maxillofacial bone tumors
Zhang Chaoying,Li Yining,Gong Jiaxing,Wang Huiming
Int J Stomatol. 2023, 50 (3):  263-271.  DOI: 10.7518/gjkq.2023024
Abstract ( 93 )   HTML ( 160 )   PDF(pc) (843KB) ( 91 )   Save

The classification of head and neck tumors published by the World Health Organization is an autho-ritative reference for oral and maxillofacial surgeons and oral pathologists. With the rapid development of molecular biology and the corresponding advancements in diagnosis and treatment technologies in recent years, new changes have emerged in the significant odontogenic and maxillofacial bone tumors of the 5th edition published in 2022. This article mainly illustrates three aspects of new tumor classification, new disease types, and new genetic and molecular changes in the latest edition compared with the 2017 4th edition for assisting in clinical diagnosis and treatment.

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Cleft Lip and Palate
Construction of a multi-dimensional intervention system for emergence agitation in pediatric patients with cleft lip and/or palate
Wan Xueli,Shi Yongle,Zhang Xiufen,Wang Huan,Tian Li
Int J Stomatol. 2023, 50 (3):  272-278.  DOI: 10.7518/gjkq.2023054
Abstract ( 35 )   HTML ( 160 )   PDF(pc) (870KB) ( 19 )   Save

Objective We constructed and applied a multi-dimensional intervention system under general anesthesia to reduce the incidence of emergence agitation (EA) in pediatric patients with cleft lip and/or palate. Methods Expert consultation was used to construct the intervention system. We conveniently selected 119 pediatric patients with cleft lip and/or palate from the Department of Oral and Maxillofacial Surgery, a university-affiliated tertiary hospital in Sichuan province, from November 2021 to June 2022. The patients were divided into an experimental group of 59 cases and a control group of 60 cases. The intervention system was applied to patients in the experimental group, while routine intervention was administered to patients in the control group. The effect of the intervention was assessed using the Pediatric A-nesthesia Emergence Delirium (PAED) scale and the Face, Legs, Activity, Crying, Consolability (FLACC) scale. Results The multi-dimensional intervention system for EA included 3 primary indicators, 6 secondary indicators, and 14 tertiary indicators. Patients in PACU and those leaving from post anesthesia care unit (PACU) in the experimental group had a lower incidence of EA than the control group (P<0.05), while no statistically significant differences in the incidence of postoperative vital signs, FLACC score, and complications were found between the two groups (P>0.05). Conclusion The proposed multi-dimensional intervention system can reduce the incidence of EA in pediatric patients with cleft lip and/or palate but has no definite improvement for the incidence of pain and postoperative complications.

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Characterizing the nasal growth among patients with cleft lip and palate
Chen Zhuo,Shi Bing,Li Jingtao.
Int J Stomatol. 2023, 50 (3):  279-286.  DOI: 10.7518/gjkq.2023055
Abstract ( 45 )   HTML ( 13 )   PDF(pc) (1154KB) ( 16 )   Save

Congenital cleft lip and palate is often associated with nasal deformity, impairing facial aesthetics and life quality. Thorough understanding of the dynamic changes of nasal morphology during growth is prerequisite for improving clinical management. This review pooled nasal growth data from current literature and systemically introduced the nasal growth pattern among normal and cleft population and iatrogenic influence exerted by sequence treatment, providing refe-rence to further researches and clinical decision-making concerning surgical techniques and timing.

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Review of the precise diagnosis and genetic etiology of Pierre Robin sequence
Xia Weiyao,Luo Yankun,Jia Zhonglin
Int J Stomatol. 2023, 50 (3):  287-292.  DOI: 10.7518/gjkq.2023032
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Pierre Robin sequence is a congenital craniofacial anomaly with strong genetic heterogeneity. It mainly mani-fests as micrognathia, retrognathia and cleft palate. Its major pathogenic genes include SRY-box transcription factor 9 (SOX9), potassium inwardly rectifying channel subfamily J member 2 (KCNJ2), distal-less homeobox 5/6 (DLX5/6), leukocyte antigen related receptor protein tyrosine phosphatases (LAR RPTPs), and bone morphogenetic protein 2 (BMP2). Prenatal imaging focuses on micrognathia. However, the position and shape of the tongue in utero may also contribute to the diagnosis of this anomaly. This paper mainly reviews the clinical manifestations, genetic etiology and diagnosis of this sequence sign to clarify its etiology and pathogenesis, guide its prenatal imaging, and provide support for its precise diagnosis of this disease.

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Original Articles
Soft tissue changes of the maxillary region in patients after anterior maxillary osteotomy setback and Le Fortosteotomy advancement
Li Peiran,Bi Ruiye,Wang Min,Wang Ruiyu,Liu Yao,Jiang Nan,Cao Pinyin,Zhu Songsong.
Int J Stomatol. 2023, 50 (3):  293-301.  DOI: 10.7518/gjkq.2023028
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Objective This work aimed to analyze nasolabial soft tissue changes in patients with maxillary advancement and setback via different maxillary orthognathic procedures. Methods A retrospective, observational, and analytical study was carried out for a period of 4 years involving 37 patients. A total of 18 patients diagnosed with maxillary retrusion were treated by Le Fort Ⅰ osteotomy advancement (LFIA), and 19 patients diagnosed with maxillary protrusion were treated by anterior maxillary osteotomy setback (AMOS). Similarity and distinction of soft tissue changes in these two groups (AMOS and LFIA) were investigated and compared. Spiral computed tomography was conducted immediately before surgery and 6-12 months after surgery. The hard and soft tissue landmarks were measured in a 3D coordinate system after CT reconstruction. The differences between pre- and postoperative images were recorded as surgical changes. The appropriate statistical test was carried using GraphPad Prism, and the level of significance was α=0.05. Results Both LFIA and AMOS brought greater soft tissue changes in the lip region compared with those in the nose and cheek regions. In the anteroposterior direction, the hard/soft tissue change ratio after LFIA (0.628) was higher than that after AMOS (0.465). Cheek and nose tips protruded after both surgical processes. Ck advancement was significantly correlated with soft tissue thickness change in the AMOS group. In the vertical direction, Prn presented uplift movement that was correlated with the maxilla advancement distance in the LFIA group, whereas Ls showed downward movement that was correlated with the maxilla setback distance in the AMOS group. Postoperative alar width increased in both groups. Interestingly, the degree of alar widening was negatively correlated with the maxilla setback distance in the AMOS group. Conclusion Postoperative nasolabial soft tissue changes in both LFIA and AMOS patients could be predicted through the direction and amount of maxilla movement to a large extent, especially in the lip region. Further investigations to illustrate the precise correlations between soft tissue changes and maxillary movement in the future could be beneficial for the prediction of postoperative appearance.

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Evaluation of maxillary sinusitis with cone beam computed tomography
Yang Yunan,Liu Peng,Wang Hu,You Meng
Int J Stomatol. 2023, 50 (3):  302-307.  DOI: 10.7518/gjkq.2023027
Abstract ( 63 )   HTML ( 15 )   PDF(pc) (1294KB) ( 47 )   Save

Objective The present study aimed to analyze the influence of odontogenic factors on maxillary sinus mucosal thickening using cone beam computed tomography (CBCT). Simultaneously, this study evaluated the effect of dental treatment on maxillary sinus mucosal thickening through the follow-up. Methods This study retrospectively reviewed patients with mucosal thickness thickened more than 2 mm in the maxillary sinus selected by CBCT in West China Hospital of Stomatology, Sichuan University from August 2017 to December 2017. Herein, the relationship between the floor of the maxillary sinus and the affected teeth was evaluated while the affected teeth and relevant dental treatment were recorded, and the changes in maxillary sinus mucosal thickening were observed. Results A very weak negative correlation was found between the mucosal thickness and the distance from the inflammation to the sinus floor (P<0.05, r=-0.154), whereas the distance from the root apex to the sinus floor had no direct correlation with the mucosal thickness (P>0.05). In the treatment group, the change of mucosal thickness in the sinus floor destruction group was larger than that in the continuous sinus floor group. In addition, the change in mucosal thickness was weakly negatively correlated with the distance from the root apex to the sinus floor (P<0.01, r=-0.382), meanwhile the change in mucosal thickness was moderately negatively correlated with the distance from inflammation to sinus floor (P<0.001, r=-0.524). Conclusion The severity of maxillary sinusitis may be more dependent on the distance of the periapical inflammatory margin from the sinus floor rather than the simple apical position. On the contrary, the closer the inflammation is to the maxillary sinus, the larger destruction of the maxillary sinus floor. Furthermore, the greater the influence of odontogenic factors on maxillary sinusitis, the better the effect of the oral treatment.

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Investigation on the degree of psychological distress and its influencing factors in patients with oral lichen planus
He Jing,Hu Mingjia,Xiao Ning,Li Jia,Sun Wanxin,Ling Lü,Liu Fan
Int J Stomatol. 2023, 50 (3):  308-313.  DOI: 10.7518/gjkq.2023042
Abstract ( 26 )   HTML ( 13 )   PDF(pc) (816KB) ( 18 )   Save

Objective This study aims to investigate the degrees of psychological distress in patients with oral lichen planus (OLP) and analyze the influencing factors. Methods We conducted a cross-sectional survey of 236 OLP patients who met the inclusion criteria using a general information questionnaire, distress thermometer (DT) and generalized an-xiety disorder-7 (GAD-7). We used SPSS 26.0 for statistical analysis of the survey results. Results The psychological pain score of all patients was 3.17±2.64, including 97 patients (41.1%) with significant psychological pain (≥ 4 points) and 90 patients (38.1%) with mild psychological pain (1-3 points). The main causes of psychological distress were oral pain (47.5%), worry (41.5%), and sleep disturbance (39.4%). Multiple regression analysis showed that disease type (erosion, non-erosion), anxiety, age, lack of time and energy to do housework, sleep disturbance, diarrhea, edema, and dry nose/congestion were independent factors for psychological distress. Conclusion Patients with OLP generally suffered from var-ying degrees of psychological distress, and those with erosion, anxiety, and/or sleep disturbance had a higher degree of psychological pain. Medical staff should strengthen the evaluation of psychological pain in patients with OLP and identify those with significant psychological distress in a timely manner to carry out reasonable and effective intervention.

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Research progress on mechanism and treatment of sex-determining region Y box 9 in oral squamous cell carcinoma
Sheng Nanning,Wang Jue,Nan Xinrong
Int J Stomatol. 2023, 50 (3):  314-320.  DOI: 10.7518/gjkq.2023043
Abstract ( 44 )   HTML ( 14 )   PDF(pc) (826KB) ( 21 )   Save

Oral squamous cell carcinoma is the most common malignancy of the head and neck. It has poor prognosis and survival rate that has not improved for many years. Sex-determining region Y box 9 (SOX9) is expressed in malignant tumors of various systems throughout the body. In recent years, SOX9 has become a hotspot in research on tumor surface markers and tumor-targeted therapy. In oral squamous cell carcinoma, SOX9 exhibits complex and diverse effects and may lead to poor prognosis by inducing the development of stem cell features, such as chemotherapy resistance. Understanding the specific role and mechanism of SOX9 in the occurrence, development, and prognosis of OSCC is important to improve the prognosis and survival of oral squamous cell carcinoma. In this paper, the role and mechanism of SOX9 in the early diagnosis, prevention, occurrence, development, and treatment prognosis of oral squamous cell carcinoma are discussed.

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New advances in oral diseases based on salivary metabolomics
Yang Qianjuan,Song Zhixin,Fang Shishu,Gu Zexu,Jin Zuolin,Liu Qian
Int J Stomatol. 2023, 50 (3):  321-328.  DOI: 10.7518/gjkq.2023044
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Salivary metabolomics is a newly developing subject that investigates the changes of metabolites in orga-nisms qualitatively and quantitatively in order to study the disease and health of organisms with saliva as the research object. Studies in the field of stomatology found some connection issues between saliva metabolites and diverse oral disea-ses. This article reviews the recent progress in oral-disease-related research that uses salivary metabolomics as a research method, including oral squamous cell carcinoma, oral mucosa precancerous lesion (oral lichen planus and oral leukoplakia), recurrent Aphthous ulcer, primary Sjogren syndrome, early childhood caries, periodontitis, chronic periapical inflammation, and root resorption after orthodontics. By summarizing the relevant differential metabolites and signaling pathways selected by saliva metabolomics, oral disease prediction models can be built through these differential metabolites to carry out early screening, prognosis judgment, and the study of the pathogenesis of oral diseases. Saliva metabolomics is expected to provide a non-invasive method for the diagnosis of oral diseases, which has important clinical significance.

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Research progress on the role of interleukin-6-hepcidin signal axis in regulating the pathogenesis of periodontitis-associated anemia
Sun Jia,Han Ye,Hou Jianxia
Int J Stomatol. 2023, 50 (3):  329-334.  DOI: 10.7518/gjkq.2023030
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Periodontitis is a chronic inflammatory disease initiated by bacterial infection. The pathogenic micro-organisms and their toxic products activate the host defense system and evoke immune-inflammatory responses, which affect systemic health. Periodontitis is a risk factor for many systemic diseases. Anemia of inflammation (AI), the second most prevalent type of anemia, occurs in chronic or acute infections and manifests as infection, inflammation, or tumor. These diseases activate the host defense system, resulting in systemic iron disorder and iron-restricted hemoglobin production disorders. A close association exists between AI and periodontitis, but the potential mechanism remains unclear. The interleukin-6-hepcidin signal axis is suggested to play a central role. This paper discusses the recent findings of the asso-ciation between AI and periodontitis to provide theoretical basis and clinical guidance for the prevention, diagnosis, and treatment of periodontitis-associated AI.

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Research progress on dual-energy CT in the evaluation of cervical lymph node disease
Yan Zening,Sun Rui,Li Fei,Zhang Jiansen
Int J Stomatol. 2023, 50 (3):  335-340.  DOI: 10.7518/gjkq.2023059
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Early detection and qualitative diagnosis of head and neck lymphadenopathy is very important, which is helpful for timely clinical intervention and treatment plan formulation, delaying or stopping disease progression. At pre-sent, multiple sets of dual-energy CT images, such as virtual non-contrast image, iodine map, virtual monoenergetic ima-ges, spectral Hounsfield unit attenuation curves and blended images have been gradually used to evaluate the head and neck lymph node lesions, providing many quantitative indicators for the qualitative, staging and pathological classification of lymph node lesions. This article reviews the research progress of multi-group post-processing images and related parameters of dual-energy CT in the evaluation of cervical lymph node diseases.

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Severe early childhood caries management based on chronic disease management
Gao Ruofan,Xia Bin.
Int J Stomatol. 2023, 50 (3):  341-346.  DOI: 10.7518/gjkq.2023057
Abstract ( 45 )   HTML ( 16 )   PDF(pc) (732KB) ( 16 )   Save

Severe early childhood caries (SECC) is the main disease threatening the oral health of our children. At pre-sent, the main strategy of caries treatment in China is caries removal and restoration. However, for patients with SECC, restoration therapy has limitations such as children difficult cooperating, high recurrence risks, and heavy economic and me-dical burden, etc. With the development of knowledge on the etiology and the disease process of dental caries, the caries management strategies based on the concept of chronic disease management is proposed by the academy to improve the treatment effect of dental caries through managing the caries risk factors and protective factors to improve the oral environment and shifting from removal of caries lesions to the management of the disease process of dental caries. In this paper, we review the concept of chronic disease management of caries and summarize the guidelines issued by foreign professional academic organizations to provide a reference for prevention and treatment of SECC in China.

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Clinical application and research progress on hyaluronic acid in the repair of papillary height loss
Wu Jiaxin,Cheng Xingqun,Wu Hongkun.
Int J Stomatol. 2023, 50 (3):  347-352.  DOI: 10.7518/gjkq.2023058
Abstract ( 86 )   HTML ( 16 )   PDF(pc) (846KB) ( 69 )   Save

Loss of gingival papillae height can cause a series of problems such as food impaction, plaque accumulation, root surface sensitivity and aesthetic effects. Hyaluronic acid, as a mature soft tissue filling agent, has achieved a certain effect in the minimally invasive treatment of gingival papillae defects. Based on the latest literature, the preparation and characteristics of hyaluronic acid were summarized, and the clinical application of hyaluronic acid in repairing papillary height loss was discussed, providing references for the subsequent study of repairing papillary height loss with hyaluronic acid.

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Research progress on functionally graded membranes for guided bone regeneration
Xu Yanxue,Fu Li.
Int J Stomatol. 2023, 50 (3):  353-358.  DOI: 10.7518/gjkq.2023026
Abstract ( 37 )   HTML ( 16 )   PDF(pc) (765KB) ( 18 )   Save

Guided bone regeneration (GBR) is a therapeutic modality to achieve bone tissue regeneration by using barrier membranes. As the key part of GBR, barrier membranes can seal the bone defect area, prevent non-osteogenic cell infiltration, and provide a benign environment for bone tissue regeneration. However, the effect of GBR membranes on the market is compromised by their limited bone regenerative potential and deficient antibacterial activity. To achieve the va-rious functional requirements of barrier membranes, many studies have proposed a novel membrane composed of multiple layers with different compositions and structures. This article reviews the research progress on functionally graded membranes and discussed its development directions to provide reference for further research on GBR membranes.

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Management and prevention strategies for complications of internal bleaching
Wang Lei,Ye Ling,Wang Chenglin.
Int J Stomatol. 2023, 50 (3):  359-365.  DOI: 10.7518/gjkq.2023050
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For changes in tooth shade caused by endogenous factors, internal tooth bleaching can achieve a basically non-destructive treatment effect, but it is still accompanied with several complications such as external cervical resorption, color relapse, affect bond strength to dentin, affect tooth structure and properties, and soft tissue injury, etc.. This article describes the possible mechanisms of various complications according to the problems that may occur after internal tooth bleaching, provides targeted treatment and prevention, and emphasizes the precautions to be taken during and after the treatment of internal tooth bleaching process, aiming to suggest details that clinicians need to pay attention to during the operation and follow-up after treatment in order to reduce the occurrence of complications and harm after internal tooth bleaching.

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Research progress on oral and maxillofacial sports protective equipment
Dai Qingyi,Hao Hao,Hua Chengge,Huang Bo,Yang Zheng
Int J Stomatol. 2023, 50 (3):  366-373.  DOI: 10.7518/gjkq.2023036
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Oral and maxillofacial trauma account for a high proportion of sports injuries. Children, adolescents, and the disabled are the high-risk groups for sports injuries. The incidence of sports injuries can be effectively reduced by wearing various protective equipment, but the civil awareness of sports dentistry protection is deficient. People should be aware of the high incidence and severity of sports oral and maxillofacial injuries, and the use of protective equipment needs to be popularized urgently. This review summarizes common sports dentistry protectors and their latest research progress and briefly introduces the prevention strategy used by the disabled.

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