Masayoshi Kawakami

Comparison of the effects of hydrostatic compressive force on glycosaminoglycan synthesis and proliferation in rabbit chondrocytes from mandibular condylar cartilage, nasal septum, and spheno-occipital synchondrosis in vitro

We have developed a simple in vitro model whereby precise quantities of compressive force can be applied to cultured chondrocytes from craniofacial cartilage: mandibular condylar cartilage (MCC), nasal septal cartilage (NSC), and spheno-occipital synchondrosis (SOS). Using this model, we found that hydrostatic compressive force stimulated glycosaminoglycan (GAG) synthesis, a cartilage phenotype, in MCC and SOS chondrocytes and DNA synthesis in MCC, NSC, and SOS chondrocytes. These stimulations were dependent on force magnitude and duration, reaching maximal GAG synthesis at 27 hours and maximal DNA synthesis at 20 hours after application of force. The maximal increase of GAG synthesis induced by compressive force was about 60% at 100 gm/cm2 for 5 minutes in nonstimulated MCC chondrocytes and 40% at 50 gm/cm2 for 1 minute in nonstimulated SOS chondrocytes. The maximal increase in DNA synthesis, produced by a compressive force of 50 gm/cm2 for 1 minute, was 50% in NSC chondrocytes, 50% in SOS chondrocytes, and 30% in MCC chondrocytes. There was no stimulation of GAG synthesis in NSC chondrocytes. These observations suggest that extrinsic force regulates craniofacial growth by controlling the differentiation and proliferation of chondrocytes in the craniofacial skeleton and that the difference in their responses to compressive force may reflect differences in the characteristics of these cells and their physiologic function in vivo.

Local injection of 1,25-dihydroxyvitamin D3 enhanced bone formation for tooth stabilization after experimental tooth movement in rats.

The present investigation evaluated the effect of 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) on alveolar bone formation during tooth movement in rats. Orthodontic elastics were inserted between the maxillary first and second molars on bilateral sides in male rats. 1,25(OH)2D3 was injected locally, at the concentration of 10−10 M, once every 3 days in the submucosal palatal area of the root bifurcation of the molar on the right side. Histomorphometric analysis revealed that tooth movement without application of 1,25(OH)2D3 decreased the mineral appositional rate (MAR) on the compression area at 7 days. Repeated injections of 1,25(OH)2D3 in the orthodontically treated animals distinctly stimulated alveolar bone formation on the mesial side at 14 days. There was a significant increase in MAR associated with elevated osteoblast surface (Ob.S/BS) value on the tension surface. These findings suggest that local application of 1,25(OH)2D3 enhances the reestablishment of supporting tissue, especially alveolar bone of teeth, after orthodontic treatment.

Screw-type Implants Used as Anchorage for Lingual Orthodontic Mechanics: A Case of Bimaxillary Protrusion with Second Premolar Extraction

We present a case of bialveolar protrusion treated with second premolar extraction. The patient did not agree to placement of a visible labial appliance or to the use of a headgear. Therefore, a lingual orthodontic appliance was used, and titanium screws were placed into the buccal alveolar bone for orthodontic absolute anchorage and support of en masse retraction of the anterior teeth. Cephalometric superimposition and panoramic radiographs showed little anchorage loss and good occlusion at the end of treatment. Our results suggest that lingual treatment combined with a screw-type implant anchorage provides reliable and comfortable results for those seeking invisible treatment.

Association between soluble MICA levels and disease stage IV oral squamous cell carcinoma in Japanese patients

The soluble form of major histocompatibility complex class I-related chain A (MICA) is released from the surface of tumor cells of epithelial origin. Although MICA expressed on the cell surface stimulates the immunoreceptor natural killer (NK) group 2, member D (NKG2D), the secreted form downregulates NKG2D activity, thus allowing the tumor to escape immunosurveillance by NKG2D-expressing cells. In this study, we examined the association between serum levels of soluble MICA and the severity of disease in patients with oral squamous cell carcinoma (OSCC). We used enzyme-linked immunoabsorbent assay to measure serum levels of soluble MICA in OSCC patients and normal control individuals. Among patients categorized according to most disease parameters tested (tumor size, location, grade of differentiation, regional lymph node status, disease stage), soluble MICA levels in sera did not statistically differ from those in normal control individuals. Patients with stage IV disease and/or regional lymph node metastasis did, however, exhibit significantly higher serum levels of soluble MICA than control individuals (95% confidence interval (CI), 0.65-2.45, p = 0.021, and 95% CI, 0.62-4.42, p = 0.031, respectively). Overall survival rates were significantly higher for OSCC patients with low soluble MICA levels (<50 pg/ml) than for those with high soluble MICA levels (>50 pg/ml) (95% CI, 0.43-2.75, p = 0.03). Serum levels of soluble MICA may be useful in the diagnosis of advanced stage OSCC and as an indicator of regional lymph node metastasis.

Relationship between soluble MICA and the MICA A5.1 homozygous genotype in patients with oral squamous cell carcinoma.

NK and cytotoxic T cells play an important role in the elimination of virus-infected and tumor cells through NKG2D activating receptors, which can promote the lysis of target cells by binding to the major histocompatibility complex class I-related chain A (MICA) proteins. Polymorphisms in MICA may influence its binding to the NKG2D. The soluble form of MICA is released from the surface of tumor cells of epithelial origin. Whereas MICA expressed on the cell surface stimulates the immunoreceptor natural killer group 2, member D (NKG2D), the secreted form down-regulates NKG2D activity, thus allowing the tumor to escape immunosurveillance by NKG2D-expressing cells. In this study, we examined the association between MICA gene microsatellite polymorphisms and serum levels of soluble MICA in patients with oral squamous cell carcinoma (OSCC). We found that patients with OSCC were more likely to have the A5.1 allele when compared to healthy subjects and also more likely to be homozygous for this allele (p=0.041). Patients with the homozygous A5.1 genotype had higher levels of soluble MICA (p=0.031) and a lower survival rate (p=0.026).

Panoramic findings for predicting eruption of mandibular premolars associated with dentigerous cyst after marsupialization.

PURPOSE The purpose of this study was to investigate the eruption of mandibular premolar teeth associated with dentigerous cysts. PATIENTS AND METHODS A total of 60 cyst-associated teeth in the mandibular premolars were examined retrospectively by using normalized panoramic radiographs. The subjects were divided into 2 groups: the erupted group, in which the teeth had erupted spontaneously after marsupialization, and the nonerupted group. Patient age, as well as impacted premolar angulation to the adjacent teeth axes, the cusp depth, space/tooth size, eruption period and cyst size, as measured on initial images, were used as parameters. RESULTS Using a logistic model of our data, we found that patient age less than 10 years, cusp depth less than 5.1 mm, angulations less than 25 degrees, and space/tooth size greater than 1.0 enhanced the success of eruption. CONCLUSION Our findings present predictors of successful eruption of impacted mandibular premolars associated with dentigerous cysts after marsupialization.

Biomechanical Analysis of Miniplate Osteosynthesis for Fractures of the Atrophic Mandible

PURPOSE The purpose of this study was to investigate the biomechanical behavior of miniplate osteosynthesis for fracture of the edentulous mandible with various degrees of atrophy by finite element (FE) analysis. MATERIALS AND METHODS Three-dimensional FE models simulating various atrophic or nonatrophic edentulous mandibles were constructed. The models were divided into 3 groups based on the height: 20 mm, 15 mm, and 10 mm. A model 30-mm high was defined as a nonatrophic mandible. Fracture in the premolar region was simulated. Single or double miniplate osteosynthesis was assumed to fix the fracture. In each case, models of fractures with and without bone contact between bone fragments were prepared. A bite force of 62.8 N was applied in the FE models as a point load on the anterior point. RESULTS There were no noticeable differences in compressive stress level in the bone around screws among the single miniplate models or double miniplate models with bone contact. Single miniplate models without bone contact showed markedly greater compressive stress than that of models with bone contact. The use of double miniplates showed a great influence on von Mises stress reduction in the miniplates. Without bone contact, greater interfragmentary displacements occurred; however, interfragmentary displacements were within the limit of not causing a malunion of the fractured bone in all models. CONCLUSION Double miniplate fixation may be a reliable method for treating fracture of the atrophic mandible from a biomechanical viewpoint.

Maxillary Expansion and Protraction in Correction of Midface Retrusion in a Complete Unilateral Cleft Lip and Palate Patient

A 7-year-old girl with a cleft lip and palate had a midface retrusion due to growth inhibition of the maxillary complex. She presented for correction of a severe total crossbite with a Class III skeletal pattern. Initially, maxillary expansion was provided to widen the maxilla and then maxillary protraction headgear was worn to improve the sagittal skeletal relation. Fixed orthodontic appliances were placed to align the dentition and Class III elastics were used to establish intercuspation and stability. The maxillary expansion and protraction usually provide effective improvement in skeletal Class III patients with repaired cleft lip and palate patients. The success of the orthopedic procedure essentially depends on the individual growth of the maxilla and the mandible. This case report shows the significant growth of the mandible after maxillary expansion and protraction in late adolescence.

Biomechanical Analysis of the Strength of the Mandible After Marginal Resection

PURPOSE This study investigated the biomechanical behavior of the mandible after marginal resection by tensile test in a human cadaveric mandible and finite element (FE) analysis. MATERIALS AND METHODS Human cadaveric mandibular models after marginal resection were prepared with residual heights of 5, 10, and 15 mm. The strength in each of these mandibular models was examined by tensile testing. In addition, FE models of the mandible after marginal resection were prepared with residual heights of 5, 7.5, 10, 12.5, and 15 mm. Distribution and magnitude of von Mises stress were analyzed by applying bite forces of 151 N as a point load on the incisal region and 355.2 and 478.1 N on the premolar and molar regions on the nonresected and resected sides, respectively. At the molar region of the resected side, bite forces of 368.5 N and 286.9 N (80% and 60%, respectively, of 478.1 N) were also applied. RESULTS On tensile testing, all cadaveric mandibular models were broken at the posterior resection corner. The tensile force was significantly larger in the model with a residual height of 15 mm compared with that of those with a 5- or 10-mm residual height. On FE analysis, von Mises stress was concentrated at the resection corner. The region of maximal von Mises stress concentration in FE models was consistent with that showing destruction on tensile testing. The relationship between the residual height and von Mises stress in the resection area was linear in models of the incisal, premolar, and molar loading on the nonresected side and quadratic in models of the premolar and molar loading on the resected side. The maximal von Mises stress in the resection area was highest during molar loading on the resected side under the present loading condition and exceeded the threshold for the development of pathologic fracture in the model with a residual height of around 10 mm or less. However, the maximal von Mises stress decreased in parallel with the reduction of bite force in the molar region of the resected side. CONCLUSIONS The residual height and bite force are critical factors for the prevention of pathologic fracture of the mandible after marginal resection. Currently, a residual height of more than 10 mm and reduction of bite force are recommended to reduce the risk of fracture.

Surgical Orthodontic Correction of Acromegaly with Mandibular Prognathism

A male (30 years five months) who complained of mandibular prominence and masticatory dysfunction was diagnosed as a mandibular prognathic with acromegaly after cephalometric and endocrine examinations. The level of growth hormone (GH) subsequent to a transsphenoidal hypophysectomy had been controlled by medicines for about five years. Surgical orthodontic correction improved his occlusion and profile, but magnetic resonance imaging detected a recurrent adenoma in the cranial base during the retention period. The recurrence resulted in slight prognathic changes of the patient with a high level of GH. This is a case report of the treatment of an acromegalic patient discussing growth considerations that could influence the orthodontic treatment plan and long-term stability.