Sharon Aronovich

Optimized Cell Survival and Seeding Efficiency for Craniofacial Tissue Engineering Using Clinical Stem Cell Therapy

Traumatic injuries involving the face are very common, yet the clinical management of the resulting craniofacial deficiencies is challenging. These injuries are commonly associated with missing teeth, for which replacement is compromised due to inadequate jawbone support. Using cell therapy, we report the upper jaw reconstruction of a patient who lost teeth and 75% of the supporting jawbone following injury. A mixed population of bone marrow‐derived autologous stem and progenitor cells was seeded onto β‐tricalcium phosphate (β‐TCP), which served as a scaffold to deliver cells directly to the defect. Conditions (temperature, incubation time) to achieve the highest cell survival and seeding efficiency were optimized. Four months after cell therapy, cone beam computed tomography and a bone biopsy were performed, and oral implants were placed to support an engineered dental prosthesis. Cell seeding efficiency (>81%) of the β‐TCP and survival during the seeding process (94%) were highest when cells were incubated with β‐TCP for 30 minutes, regardless of incubation temperature; however, at 1 hour, cell survival was highest when incubated at 4°C. Clinical, radiographic, and histological analyses confirmed that by 4 months, the cell therapy regenerated 80% of the original jawbone deficiency with vascularized, mineralized bone sufficient to stably place oral implants. Functional and aesthetic rehabilitation of the patient was successfully completed with installation of a dental prosthesis 6 months following implant placement. This proof‐of‐concept clinical report used an evidence‐based approach for the cell transplantation protocol used and is the first to describe a cell therapy for craniofacial trauma reconstruction.

A Case of Imperforate Wharton Duct

Congenital oral masses are rare entities. The establishment of formal fetal diagnostic teams has led to an increased antenatal detection of such lesions. The congenital ranula is a distinct entity from the more familiar variant presenting later in life. The congenital variant may result from an anomaly of the Wharton duct with subsequent dilation of the duct. The variant presenting later in life is the more familiar mucous extravasation phenomenon in the floor of the mouth. Management of the congenital ranula is distinct from its noncongenital counterpart and more conservative and is discussed in the present report.

Foregut duplication cyst of the floor of mouth in a neonate: case report

Congenital oral masses may interfere with vital functions such as respiration and deglutition in neonates. We report a congenital heterotopic oral gastrointestinal cyst that caused failure to thrive. A working knowledge of the differential diagnosis and pathophysiology of this can guide the clinician in its evaluation and management.

Trauma to the Pediatric Temporomandibular Joint

Management of pediatric condylar fractures presents a unique challenge because the developing mandible provides limited available bone for fixation and primary teeth preclude the use of typical closed reduction techniques. The available literature is reviewed with regard to closed and open treatment approaches.

Temporomandibular Joint Discectomy With Abdominal Fat Graft Versus Temporalis Myofascial Flap: A Comparative Study

PURPOSE Open temporomandibular joint (TMJ) arthroplasty with discectomy has been described as a primary surgical treatment and as a secondary treatment when minimally invasive procedures have failed. The aim of the present study was to compare TMJ discectomy with a fat graft versus TMJ discectomy with a temporalis graft using the pain score and maximal interincisal opening (MIO). PATIENTS AND METHODS We performed a retrospective study of patients who had undergone TMJ arthroplasty and discectomy with an abdominal fat graft or an interpositional temporalis flap at the University of Michigan from 1999 to 2014. The predictor variable was the type of surgical intervention. The main outcome variables were the pain score and MIO. Additional outcome variables were diet, medication use, the presence of myofascial pain, and occlusal outcomes. The statistical analysis included the mean ± standard deviation, a 1-way analysis of variance for continuous data, and Pearsons χ2 test for categorical variables. RESULTS The study cohort included 50 patients, of whom 30 had undergone discectomy with a fat graft and 20 had undergone discectomy with a temporalis myofascial graft. The mean pain scores were decreased by 78.3% in the myofascial flap group and 52.8% in the fat graft group. Changes in MIO showed a statistically significant increase in the fat graft group but only approached statistical significance in the myofascial flap group. CONCLUSIONS The patients who had undergone TMJ arthroplasty and discectomy with a temporalis myofascial flap showed significantly greater improvement in pain scores and marginal improvement in the MIO compared with patients who had received an abdominal fat graft.

Stem cell therapy for reconstruction of alveolar cleft and trauma defects in adults: A randomized controlled, clinical trial

BACKGROUND Stem cell therapy with bone marrow-derived mesenchymal stem cells is a promising tissue engineering strategy to promote regeneration of craniofacial bone. PURPOSE To determine whether cell therapy with ex vivo expanded stem cell populations would be safe and efficacious in the regeneration of large alveolar defects in patients with a history of cleft palate or craniofacial trauma. MATERIALS AND METHODS Eighteen patients (10 patients with traumatic injury and 8 patients with cleft palate) presenting with missing teeth associated with horizontal alveolar bone deficiencies were included in this randomized controlled clinical trial. Patients were randomized to receive either conventional autogenous block grafts or stem cell therapy. After a healing period of 4 months the treated sites were re-entered and the bone width re-assessed prior to implant placement. Implant stability was evaluated through torque testing of the implant upon insertion and at 6 months postloading. RESULTS The mean gain in bone width was 1.5 ± 1.5 mm in the stem cell therapy group and 3.3 ± 1.4 mm in the control group. Overall, bone gain was higher in trauma patients as compared to patients with cleft palate, for both the control and the stem cell therapy groups. Most postoperative complications were wound dehiscences and incision line openings. Implants were placed successfully in 5 out of 10 patients in the stem cell therapy group and in all 8 patients in the control group. One implant from the control/cleft palate group failed before loading, while the rest of the implants were loaded successfully and remained stable at 6 months. The patients who did not receive implants were re-treated with autogenous block bone graft. CONCLUSION The ability of stem cells to treat large alveolar defects is safe, yet, their ability to completely reconstitute large alveolar defects is limited. This approach requires further optimization to meet the outcomes seen using current methods to treat large defects, particularly those resultant of cleft palate.

Endodontists' Intravenous Sedation–related Attitudes and Professional Behavior: A National Survey

Introduction Research shows that a high percentage of endodontic patients are interested in receiving intravenous (IV) sedation. The objectives of this study were to assess endodontists’ IV sedation–related education, attitudes, and professional behavior and to explore whether providing versus not offering IV sedation procedures was associated with IV‐related education and attitudes and whether background characteristics and education were related with IV sedation attitudes and behavior. Methods Data were collected with an anonymous Web‐based survey from 616 members of the American Association of Endodontists (response rate = 29%). Results Only 10% of respondents agreed/strongly agreed that they had adequate training in IV sedation. However, 48% agreed/strongly agreed that there was a need for IV sedation in their practice. Although 69% did not offer IV sedation, 26% had another professional provide it, and 4% provided it themselves. These 3 groups of providers differed in the mean quality of their IV sedation–related education (scale from 1–5 with 5 = best education: 1.50 vs 1.62/2.37, P < .001) and the positivity of their attitudes toward IV sedation (2.90 vs 3.50/4.21, P < .001). Although the quality of IV sedation education was not correlated with the graduation year, the more recently respondents had graduated, the more positive they were toward providing education about IV sedation (r = .16, P < .001). Conclusions Most endodontists did not evaluate their IV sedation–related graduate education positively. However, nearly half acknowledged the need for IV sedation in endodontics. The more recently they graduated, the more they agreed that IV sedation–related graduate education was needed but also that staff training and maintenance of equipment would be a problem.

Do signs of an effusion of the temporomandibular joint on magnetic resonance imaging correlate with signs and symptoms of temporomandibular joint disease

Effusions are common among patients with disorders of the temporomandibular joint (TMJ), but publications are limited and results inconsistent about the correlation between them and important clinical variables, in particular severity of pain and degenerative disease. We organised a retrospective study of patients who presented for the evaluation and management of arthralgia of the TMJ and myofascial pain at the University of Michigan between 2011 and 2014. Inclusion criteria were: patients who had pain that was primarily arthrogenous, and coexisting myogenous pain, who had had initial non-surgical treatment, and arthroscopy of the TMJ with or without intramuscular injection of onabotulinumtoxinA (Botox,® Allegan, Weston, Fl, USA). The primary outcome variables were pain at rest as measured by visual analogue score (VAS) and the presence of degenerative disease of the joint. The secondary outcome variables included the position of the disc and whether it was perforated, signs of synovitis, maximal interincisal opening (MIO), and duration of symptoms. We studied 47 patients (94 TMJ) who met the inclusion criteria. We found no significant differences in pain at rest before or after arthroscopy, between patients with and without effusions, or in maximal MIO or duration of symptoms between the two groups. There was, however, a significant relation between effusions and degenerative joint disease. Effusions were also associated with a lower probability of the disc being in a normal position and a higher probability of anterior disc displacement without reduction.

Friedman tongue position and cone beam computed tomography in patients with obstructive sleep apnea

Evaluate the correlation between Friedman Tongue Position (FTP) and airway cephalometrics in patients with obstructive sleep apnea (OSA).

Bioengineered tissue TMJ TJR

One of the major obstacles that have plagued the reconstruction of the temporomandibular joint (TMJ) has been the adverse reactions seen with the use of alloplastic, non-biologic materials. These inert and passive materials, by themselves, do not respond to normal biochemical or biomechanical signals, which are present in situ within the TMJ. The patient, because of the biologic inertness of these materials, must adapt to the material or mechanical device that has been used. This may result in related complications or compromised functional outcome [1]. The main advantage of a tissue engineered TMJ, in contrast, will allow the patient to biologically remodel, overtime, the implanted prosthesis to their own anatomy during functional movements of the jaw per Wolff’s Law, i.e. form and function are related, thus minimizing compromise of function.