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OBJECTIVE Oral function disorders occur often in older people with increasing age. Oral function disorders affect bodily function and self-esteem, which are related to quality of life (QOL). The aim of this study was to evaluate the effectiveness of an oral function intervention programme on the oral function of older Taiwanese people. MATERIALS AND METHODS A one-group pretest-post-test study design was used. A total of 529 older Taiwanese people (women, 68.2%; men, 31.8%; average age, 75.07 ± 5.95 years) participated in this study. The oral function intervention programme consisted of a brief oral health education programme and oral function exercises. The total test period was 8 months. The oral condition and function examination comprised two questionnaires (self-reported symptoms of oral function disturbance and the Geriatric/General Oral Health Assessment Index [GOHAI]) and three oral function assessments (Repetitive Saliva Swallowing Test [RSST], Oral Diadochokinesia Test [ODT] and Cheek Expanding Test [CET]). RESULTS After the oral function intervention, the self-reported symptoms on the oral function questionnaire and GOHAI showed significant improvement (P

Background Use of proximal tibia as a donor site has been applied in jawbone reconstruction since the 1990s. Catone and colleagues described a U-shaped incision made on the iliotibial tract during tibial cancellous bone procurement for maxillofacial reconstruction in 1992. We used a curvilinear incision on the iliotibial tract in lateral approach in our tibial cancellous bone harvesting procedure. Objectives The objectives of this retrospective study are to describe our modified lateral approach for procuring cancellous graft from the proximal tibia and to assess the bone volume, donor site morbidity, and associated complications. Material and Methods Eighty consecutive jawbone reconstructions utilizing autogenous tibial cancellous bone grafts in 78 patients from March 1998 through March 2008 were reviewed. The patient group consisted of 45 males and 33 females, ages 18 to 76 (average age 36.1 ± 12.3). Minimal postoperative follow-up period was 3 months. Unlike the traditional U-shaped trapdoor incision on the iliotibial tract, our curvilinear incision was made almost parallel to the fibers of that tract. Result Only mild complications were observed at donor sites, including temporary paresthesia, gait disturbance, and an unpleasant scar. The average procured graft volume was 17.8 mL. We also present the first case of reconstruction of mandibular continuity defects of up to 6 to 7 cm lengthwise by tibial cancellous bone grafting, which has not previously been reported in the English literature. Conclusion The modified incision on the iliotibial tract allowed access to obtain an equally good bone volume from the lateral aspect of the proximal tibia, and it rendered wound closure much easier than the procuring techniques described in the earlier literature.

When the chondrocytes are isolated from the native cartilage and proliferate in vitro, they soon lose their original ability to express glycosaminoglycan (GAG) and type II collagen, which is termed dedifferentiation, or decrease cell viability. We first examined in vitro cartilage regeneration of tissue-engineered pellets that consisted of human auricular chondrocytes and atelocollagen and that were incubated in vitro under stimulation with bone morphogenetic protein-2 (BMP-2), insulin, and T(3). We then examined the administration of those growth factors into the scaffold or in the medium and explored the possibility that the atelocollagen, the hydrogel scaffold of the chondrocytes, may function for drug delivery of the factors. BMP-2 in the atelocollagen with the supplement of insulin and T3 in the medium could not only produce a greater GAG matrix in a shorter period but also sustain cell viability with lower mortality. The insulin in the medium could be better administered only for 2 weeks, rather than 3 weeks, which would save time and cost, hence shortening the in vitro culture of chondrocytes. Our protocol of mixing BMP-2 into the atelocollagen with the supplement of insulin and T3 hormone might provide a new insight into the development of tissue engineering in chondrogenesis.

Systemic sclerosis (SSc) is a relatively rare condition characterized by the excessive production and deposition of collagen within tissue. This condition is thought to be immunologically mediated and, in addition to its notorious cutaneous manifestations, often involves multiple organs. A case is presented of systemic sclerosis associated with extensive tumoural calcinosis in the temporomandibular joint. There has been no evidence of recurrence or complications during approximately 2 years of follow up, but long-term follow up is essential.

This study aimed to correct complicated alveolar defects with autogenous iliac bone blocks, thereby facilitating subsequent dental implant-supported restorations. Using a retrospective study design, 27 consecutive patients (age, 19- 63 years) who underwent iliac “J-bone block” procedures from 2006 through 2010 were enrolled. All the reconstruction materials were harvested from the superior and medial aspects of the anterior iliac crest. Each iliac bone block was tailored to passively fit the contour of the alveolar defect and secured in position by titanium mini-screws to achieve significant bone volume expansion in both the transverse and vertical dimensions. Pre and post-operative computed tomography imaging studies with a radiographic guide in position were conducted to evaluate the changes in shape and volume of the recipient sites. All iliac bone grafts healed uneventfully with minimal volume shrinkage and unremarkable donor site morbidity. A total of 73 dental implants in 21 patients appeared clinically healthy. Iliac cortico-cancellous bone blocks were easily manipulated by hand instruments and transformed into a J-bone block, which lead to high-quality bone augmentation and allowed ideal implant positioning with proper axial alignment. We suggest that iliac J-bone block be used in the near future to improve the success rate of complicated implant restorations.

The reconstruction of the soft palate following resection of a tumour remains a challenge to this day. We recently reconstructed the soft palate by a procedure using the palatal mucoperiosteal flap, with blood supply from the greater palatine vessels. This operative procedure is simple, easy to perform and minimally invasive, and has been used on 2 patients with satisfactory results and good postoperative function.

Background Betel quid chewing is associated with the periodontal status; however, results of epidemiological studies are inconsistent. To the best of our knowledge, no study has reported radiographic alveolar bone loss (RABL) associated with betel quid chewing. Methods This survey was conducted in an aboriginal community in Taiwan because almost all betel quid chewers were city-dwelling cigarette smokers. In total, 114 subjects, aged 30–60 years, were included. Full-mouth intraoral RABL was retrospectively measured and adjusted for age, gender, and plaque index (PI). Multiple regression analysis was used to assess the relationship between RABL and potential risk factors. Results Age-, gender-, and PI-adjusted mean RABL was significantly higher in chewers with or without cigarette smoking than in controls. Multiple regression analysis showed that the RABL for consumption of 100,000 pieces betel quid for the chewer group was 0.40 mm. Full-mouth plotted curves for adjusted mean RABL in the maxilla were similar between the chewer and control groups, suggesting that chemical effects were not the main factors affecting the association between betel quid chewing and the periodontal status. Conclusion Betel quid chewing significantly increases RABL. The main contributory factors are age and oral hygiene; however, the major mechanism underlying this process may not be a chemical mechanism. Regular dental visits, maintenance of good oral hygiene, and reduction in the consumption of betel quid, additives, and cigarettes are highly recommended to improve the periodontal status.

Objectives The aim of this study was to investigate the viability of artificial dermis as a substitute for split-thickness skin graft in the treatment of oral submucous fibrosis (OSF). Methods The study was conducted on 21 patients who had undergone surgical treatment of trismus caused by OSF. Artificial dermis grafts were used to repair the surgical defects after surgery on the fibrous bands. The changes in the interincisal distances (IDs) were analyzed in the preoperative, intraoperative, and postoperative stages. All the patients were followed up for at least 3 months. Results All the patients habitually chewed betel nuts. The overall success rate was 100% without any or only partial graft loss. There were no reports of immunologic reactions or significant complications. The mean preoperative, intraoperative, and final follow-up IDs were 15.5, 35, and 25 mm, respectively. Evaluation of the changes in the IDs revealed statistically significant differences between the values recorded at the different stages. Conclusions Artificial dermis may be an alternative to split-thickness skin grafts in patients with OSF with moderate trismus.

Betel quid (BQ) products, with or without tobacco, have been classified by the International Agency for Research on Cancer (IARC) as group I human carcinogens that are associated with an elevated risk of oral potentially malignant disorders (OPMDs) and cancers of the oral cavity and pharynx. There are estimated 600 million BQ users worldwide. In Taiwan alone there are 2 million habitual users (approximately 10% of the population). Oral and pharyngeal cancers result from interactions between genes and environmental factors (BQ exposure). Cytochrome p450 (CYP) families are implicated in the metabolic activation of BQ- and areca nut-specific nitrosamines. In this review, we summarize the current knowledge base regardingCYPgenetic variants and related oral disorders. In clinical applications, we focus on cancers of the oral cavity and pharynx and OPMDs associated withCYPgene polymorphisms, includingCYP1A1,CYP2A6,CYP2E1, andCYP26B1. Our discussion ofCYPpolymorphisms provides insight into the importance of screening tests in OPMDs patients for the prevention of oral and pharyngeal cancers. Future studies will establish a strong foundation for the development of chemoprevention strategies, polymorphism-based clinical diagnostic tools (e.g., specific single-nucleotide polymorphism (SNP) “barcodes”), and effective treatments for BQ-related oral disorders.

Trismus is frequently a sequel of temporomandibular joint (TMJ) involvement in a zygomaticomaxillary complex (ZMC) fracture. Although trismus is commonly observed in patients with ZMC fracture, continuous follow-up examinations of their degree of mouth opening have rarely been documented. The aim of this retrospective study was to determine the incidence and clinical significance of ZMC fracture involving the glenoid fossa or articular eminence of the TMJ with an emphasis on trismus. The medical and computed tomography (CT) imaging data of 28 patients with ZMC fracture treated by oral and maxillofacial surgeons (OMFSs) (OMFS group) and 174 patients with ZMC fracture treated by surgeons other than OMFSs (non-OMFS group) between May 2002 and May 2006 were reviewed. Maximal interincisal opening (MIO) less than 35 mm or three-finger width was considered limited mouth opening and indicative of trismus. Preoperative CT imaging data indicated that about 64% (18/28) and 50% (87/174) of the patients in the OMFS and non-OMFS groups, respectively, had a ZMC fracture involving the TMJ. Among these OMFS patients, 17 (94.40%) patients had limited mouth opening (MIO range, 7–33 mm) preoperatively, which improved markedly postoperatively. Among the non-OMFS patients with such fractures, 42 (48.3%) patients had trismus preoperatively and two retained trismus postoperatively. Lack of proper preoperative CT images, inadequate postoperative follow-up protocol, and/or neglect by patients and medical staff could influence the outcomes of ZMC fracture involving the TMJ. We make recommendations for reducing the risk of complications subsequent to ZMC fracture involving the TMJ.

Three-dimensional culture of the tissue-engineered cartilage constructs may increase the matrix production, but central necrosis must occur if the construct becomes large. To increase the cell viability in the middle part of constructs and to enhance the in vivo cartilage regeneration, we attempted to administer the insulin into the scaffold. Insulin is known to strongly enhance the matrix production in the chondrocytes. The pellets of human auricular chondrocytes with atelocollagen hydrogel were 3D-cultured in the medium. The comparison among three groups (insulin mixed in the atelocollagen, insulin added to the medium, and control group, i.e.; insulin in neither atelocollagen nor medium) revealed that both insulin mixed in the atelocollagen and that in the medium could effectively promoted the cell viability and matrix synthesis of the chondrocytes. The daily assay also showed the gradual release of insulin from the atelocollagen hydrogel, suggesting that this material may work as a control release of insulin. We actually transplanted the poly-L-lactide porous scaffolds carrying the chondrocytes and the atelocollagen mixed with or without insulin, into the nude mice, showing that glycosaminoglycan accumulation was evident in the group with insulin although less without insulin. We thus showed the possibility to enhance the in vivo cartilage regeneration, when administered insulin into the atelocollagen hydrogel. © 2011 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 97A: 186―192, 2011.

Background and objectives:Recently tissue engineering has become available as a regenerative treatment for bone defects. Mesenchymal derived stem cells (MSCs) were applied with different kinds of bone substitute in bone defects. The purpose is to appraise the effectiveness of the MSCs with different kind of the bone substitutes in dentomaxillofacial regeneration in our previous 10 years experiences. Methods: Eight animal experiments and three human trials have been designed to investigate the use of MSCs in bone regeneration during last 10 years. Cells were extracted from bone marrow and cultured for 3 weeks. The stemness was examined with differential potential and flowcytometeric analysis. Biphasic HA/TCP, natural bovine bone mineral (NBBM), ‘beta’-TCP, demineralized Bone mineral (DBM), freeze-dried bone allograft block, nano HA silica gel and polycaprolactone–TCP (PCL–TCP) were used as a carrier for MSCs. In all experiments cells were mixed with scaffold 24–48 h before implantation in bony defects. Results: In all experiments scaffold seeded with MSCs showed higher amount of bone formation in comparison with scaffold alone groups. Dog circular defects and rabbit calvaria defects reached to 50% bone formation. MSCs showed more formation than PRP treated group in rat calvaria defects. HA/TCP could carry more cells and showed more bone formation than NBBM. Increasing the size of the defect in dog supracrestal critical sized defect accompanied with less amount of new bone formation (25%). PCL–TCP/MSCs blocks in supracrestal bone formation have more successful than FDBA block. In human trials MSCs in sinus environment showed more promising results than alveolar cleft defects. Conclusion: The mixture of MSCs with bone substitute may enhance bone regeneration. But in critical sized defects there is a long way to reach to autogenous bone grafting standards.