Purpose The surgical condylar displacement often resulted in relapse and serious symptoms of temporomandibular joint disorders (TMD) after orthognathic surgery. To minimize the displacement, numerous techniques have been proposed. To verify their accuracy in positioning and effectiveness in preventing post‐operative TMD and relapse, we reviewed the literature related to intraoperative condylar positioning techniques on the mandible in this study. Methods The literature on condylar positioning techniques was reviewed with two charts, including the non‐computer‐assisted and the computer‐assisted positioning methods. The pre‐ and post‐operative alterations of condyles, the post‐operative temporomandibular joint (TMJ) function and surgical relapse were analysed regarding the techniques. The clinical usage and characteristics were reviewed as well. Results A total of 22 articles, including 907 patients, have been reported since 2001. Nearly all methods reach a considerable positioning accuracy within the range of 1‐2 mm and 1‐2° from the pre‐operative position. We ranked the accuracy of the methods from high to low: CAD/CAM CPDs > CAD/CAM titanium plate positioning > manual positioning > computer‐assisted navigation systems > imaging positioning systems. Most skeletal class II and class III patients achieved great occlusion and had no TMJ dysfunction or relapse after condylar positioning. Conclusions Both the non‐computer‐assisted and computer‐assisted condylar positioning techniques reach considerable accuracy in locating the pre‐operative condyle position and preventing TMJ dysfunction and surgical relapse. Different levels of surgeons and cases can benefit from multiple suggested positioning methods. Further research with large samples and long‐term follow‐up is worth looking forward to upgrading the current methods, improving the clinical utility and developing new positioning techniques.
One of the main goals of bone tissue engineering is the development of scaffolds that mimic both functional and structural properties of native bone itself. This study describes the preliminary work carried out to assess the viability of using three dimensional printing (3DP) technology for the fabrication of porous titanium scaffolds with lowered modulus and improved biocompatibility. 3DP enables the manufacturing of three dimensional (3D) objects with a defined structure directly from a Computer Aided Design (CAD). The overall porosity of the 3D structures is contributed by the presence of both pores-by-process (PBP) and pores-by-design (PBD). This study mainly focuses on the PBP, which are formed during the sintering step as the result of the removal of the binding agent polyvinyl alcohol (PVA). Sintering temperatures of 1250oC, 1350oC and 1370oC were used during the fabrication process. Our results showed that by varying the binder percentage and the sintering temperature, pores with diameters in the range of approximately 17-24 μm could be reproducibly achieved. Other physical properties such as surface roughness, porosity and average pore size were also measured for all sample groups. Results from subsequent cell culture studies using adipose tissue-derived mesenchymal stem cells (ASCs) showed improved attachment, viability and proliferation for the 3DP titanium samples as compared to the two-dimensional (2D) dense titanium samples. Hence, based on our current preliminary studies, 3DP technology can potentially be used to fabricate customized, patient-specific metallic bone implants with lowered modulus. This can effectively help in prevention of stress-shielding, and enhancement of implant fixationin vivo. It is envisioned that an optimized combination of binder percentage and sintering temperature can result in the fabrication of scaffolds with the desired porosity and mechanical properties to fit the intended clinical application.
Background: Adequate peri-implant bone mass and bone quality are essential factors to ensure the initial stability of the implant and success of implant operation. In clinical settings, the lack of bone mass often restricts the implant operation. In this study, we fabricated a smart porous scaffold with a shape memory function and investigated whether it could promote peri-implant osteogenesis under the periosteum. Methods: A porous shape memory polymer (SMP) scaffold was fabricated and its shape memory function, mechanical properties, and degradation rate were tested in vitro. Moreover, the scaffold was implanted in the mandible of rabbits to evaluate its efficacy to promote peri-implant osteogenesis in the periosteum and enhance the initial stability of the implant. Histological, micro-CT, and biomechanical analyses were carried out for further verification. Results: The SMP scaffold has a good shape memory function and biocompatibility in vitro. In vivo experiments demonstrated that the SMP scaffold could recover to its original shape after implantation to create a small gap in the periosteum. After 12 weeks, the scaffold was gradually replaced by a newly formed bone, and the stability of the implant increased when it implanted with the scaffold. Conclusion: The present study indicates that the SMP scaffolds have a good shape memory function and could enhance peri-implant bone formation under the periosteum. The SMP scaffold provides a clinical potential candidate for bone tissue engineering under the periosteum.
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