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20 May 2015, Volume 13 Issue 3 Previous Issue    Next Issue

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Basic Research Articles

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The function and mechanism of integrin signal pathway in the stretched rat BMSCs JIANG Xi-liang, ZHU Xiao-wen, HU Jing, SONG Jian, YE Bing 2015, 13 (3):  193-199.  Abstract ( 449 )   HTML ( 0 )   PDF (1583KB) ( 583 )   PURPOSE: To detect the role and mechanism of integrin signal pathway acting on distraction osteogenesis（DO）. METHODS: A distraction model was established on the basis of an uniaxial static stretching device, and siRNA technology was used to silence the focal adhesion kinase (FAK) of bone marrow derived mesenchymal stem cells (BMCs), an important signal transduction molecule in integrin signaling pathway. After distraction, at 0, 6, 12 and 24 h, RNA and protein of important signal transduction molecules such as FAK, ILK and integrinβ1,were detected by RT-PCR and Western blot. And the cell proliferation,expression of the osteogenic genes Cbfa 1/Runx 2 and ALP were detected. SPSS 20.0 software package was used for one way analysis of variance. RESULTS: The expression of FAK specific siRNA lentiviral expression vector-bone differentiation factors Runx-2, ALP decreased compared to control group. And the expression of important signal molecules integrinβ1 and ILK in integrin pathway decreased dramatically. CONCLUSION: BMSCs bone differentiation is inhibited after FAK gene silence and the integrin signal pathway takes part in the conversion of cellar mechanical signals to biological chemical signals. References | Related Articles | Metrics

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Age-related changes of mandibular condylar cartilage: A histomorphometric study in rabbit temporomandibular joint HUANG Lin-jian, CAI Xie-yi, LI Hui, SHENG Xia-han, YANG Chi 2015, 13 (3):  200-204.  Abstract ( 500 )   HTML ( 0 )   PDF (1172KB) ( 439 )   PURPOSE: To study the age-related changes of the condylar cartilage in rabbit temporomandibular joint. METHODS: Three New Zealand rabbit were obtained at the ages of 1, 4, 12 and 32 weeks, respectively. Each specimen was subjected to histolgical assessment about each layer of fibrocartilage thickness. One-way ANOVA as performed using SPSS19.0 software package. RESULTS: The decrease of the total cartilage thickness (P=0.008), the mature layer (P=0.008) and the hypertrophic layer (P=0.007) occurred from 1 to 4 weeks, and there were no significant changes within 4-32 weeks. The changes of fibrous layer and proliferative layer thickness were not significant between 1-4 weeks, 4-12 weeks, 12-32 weeks. However, the thickness of fibrous layer was significantly greater at 32-week than at 1-week (P=0.024). CONCLUSIONS: The thickness of condylar cartilage, mature layer and hypertrophic layer decreased remarkably during 1-4 week. This period is the most important stage for mandibular in growth and development. The adulthood mandibular condyle might have a stronger adaptive capacity to alteration of pressure microenvironment in temporomandibular joint. References | Related Articles | Metrics

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In vitro study of the radiosensitivity of bone marrow stem cells isolated from Sprague-Dawley rats LIU Zhong-long, DAI Tian-guo, FU Shui-ting, HU Hai-sheng, HE Yue 2015, 13 (3):  205-210.  Abstract ( 312 )   HTML ( 0 )   PDF (1080KB) ( 265 )   PURPOSE: To investigate the radiosensitivity of bone marrow stem cells (BMSCs) isolated from mice in vitro. METHODS: BMSCs was isolated from Sprague-Dawley rats and subsequently cultured in vitro. Third passage of BMSCs was exposed under ionizing radiation with various doses (0,4,8,10 Gy). Cell proliferation was detected using CCK-8 method and flow cytometry was applied to identify the cell apoptosis. Real-time PCR was used to measure the gene expression of Cyclin-D1 and Casepase-3 at 24 hour and 7 day. The difference between various treatment groups was analyzed with SPSS 20.0 software package. RESULTS: BMSCs were successfully isolated and cultured in vitro. Cell growth curve analysis indicated that BMSCs with 10 Gy treatment showed faster growth compared with the control group. Meanwhile, group with 10 Gy irradiation showed higher proportion of died cells and apoptotic cells than those treated with other doses. Significant up-regulation of Cyclin-D1 was found in group with 10 Gy irradiation at 24 hour (P<0.01) and 7 day (P<0.001).Up-regulation of Casepase-3 was only found at 24 hour (P<0.01). CONCLUSIONS: BMSCs of SD rats showed radioresistance following ionizing radiation in vitro. References | Related Articles | Metrics

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Expression of BDNF/TrkB in the progress of epithelial-mesenchymal transition in salivary adenoid cystic carcinoma HU Zhi-qiang, YANG Xin-jie, WANG Wei-xi, JIA Sen, WU Bao-lei, LEI De-lin 2015, 13 (3):  211-215.  Abstract ( 516 )   HTML ( 0 )   PDF (791KB) ( 277 )   PURPOSE: To investigate the expression of BDNF,TrkB and E-cadherin in salivary adenoid cystic carcinoma (SACC) and study their role in metastasis and nerve invasion. METHODS: The high and low metastatic SACC cell lines (SACC-LM, SACC-83) were analyzed by real-time PCR and Western blot to determine the expression of BDNF, TrkB and E-cadherin. To observe the BDNF/TrkB pathway in the metastasis process of SACC, the SACC-83 cells were treated by exogenous BDNF and/or TrkB inhibitor k252a, respectively. Meanwhile, the epithelial mesenchymal transition (EMT) of SACC-83 cells were evaluated by real-time PCR, Western blot, morphology observation, cell migration and invasion analysis. SPSS 17.0 software package was employed to analyze the data statistically. RESULTS: The expression of BDNF and TrkB in SACC-LM cells were higher than SACC-83 cells whereas the E-cadherin was down regulated. Exogenous BDNF could activate TrkB, inhibit E-cadherin and promote N-cadherin expression in SACC-83 cells. The morphology of SACC-83 cells stimulated by BDNF was also elongated and migration and invasion capabilities were improved. When TrkB was inhibited by k252a, the BDNF effects were inhibited including the suppressing of SACC-83 morphology alteration, migration and invasion capabilities. CONCLUSIONS: BDNF/TrkB pathway can promote the migration and invasion capabilities of SACC cells by mediating its EMT progression. References | Related Articles | Metrics

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The effect of reaction force on stress and displacement of the temporomandibular joint with anterior traction of the chin WANG Jin, YANG Chun 2015, 13 (3):  216-219.  Abstract ( 430 )   HTML ( 1 )   PDF (835KB) ( 353 )   PURPOSE: A three dimensional finite element model is established for analysis of the influence of reaction force on stress and displacement of the temporomandibular joint (TMJ) with anterior traction of the chin. METHODS: A healthy adult male was chosen for the study. Spiral CT data of the original images was collected, 3-D finite element model was established by using Mimics, MSC, Magics, Marc image processing software. 5 N force was applied to the chin, and the direction of force was change. Stress and displacement changes of TMJ and jaw bone were measured and analyzed. RESULTS: Three dimensional finite element model including the maxilla, mandible, TMJ, skull was established, which had 28760 nodes and 110790 units. The maxilla had 20487 nodes and 76982 units, while the mandible had 8273 nodes and 33080 units. When 5N force was loaded on the chin at 37° with the occlusal plane, the equivalent Mises stress value of 20487 maxillary nodes was 0.143N, 0.111N for 8273 mandibular nodes, 0.829N for 14305 condylar head nodes. When the applied load was 5N, the displacement of TMJ from the chin to the condylar position gradually declined, the displacement direction and the applied load direction were consistent. The chin displacement was the biggest, approximately 0.015 mm; while the condylar displacement was minimal, about 0.006 mm. CONCLUSIONS: A three dimensional finite element model of the craniofacial bone was successfully established, with a high degree of similarity and biological entities, which can be used for the study of reaction with anterior traction, and simulation of the distribution of traction force in TMJ. References | Related Articles | Metrics

Clinical Articles

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A preliminary study on application of CT angiography in accurate mapping of the free medial sural artery perforator FANG Zao, JIN Shu-fang, TIAN Zhuo-wei, ZHANG Chen-ping, HE Yue 2015, 13 (3):  220-225.  Abstract ( 429 )   HTML ( 1 )   PDF (1238KB) ( 378 )   PURPOSE: To evaluate the application of CT angiography (CTA) in mapping the medial sural artery perforating branches, and explore the anatomy of the flap. METHODS: Preoperative CTA was performed in mapping the medial sural artery perforating branches in 9 Chinese adult patients with squamous cell carcinoma of the tongue. The perforator flap for tongue reconstruction based on preoperative CTA mapping was operated on the 9 patients, the number and location of perforators, the length of pedicle, thickness of the flap were measured. The discrepancies between perforator mapped by preoperative CTA and by intraoperative exploration were compared using SPSS 20.0 software package for paired t test. RESULTS: The pedicle length was long, the diameter of the vascular pedicle matched the recipient vessel in the neck, with minor donor site complications. The length of pedicle, thickness of the flap and location of the medial sural artery perforators were not significantly different between CTA mapping and interoperative measurement, including the preoperative CTA mapping was precise. CONCLUSIONS: CTA can be used to map the perforators preoperatively and precisely, which is beneficial for surgeons to harvest the flap and reduce surgical risks. References | Related Articles | Metrics

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The influence of unilateral disc displacement without reduction of temporomandibular joint on condylar height in juvenile ZHUO Zi-ang, XIE Qian-yang, YANG Chi, CAI Xie-yi 2015, 13 (3):  226-231.  Abstract ( 781 )   HTML ( 10 )   PDF (1068KB) ( 506 )   PURPOSE：To evaluate the influence of unilateral temporomandibular joint anterior disc displacement without reduction on condylar height in juvenile patients during its natural course with quantitative measurement based on MRI. METHODS: The study collected 124 juvenile patients diagnosed with unilateral disc displacement without reduction and followed-up with MRI from January 2010 to June 2013,including 101 females and 23 males, with the mean age of 16.4 years and mean follow-up interval of 13.6 months. The disc length, displacement distance and condylar height were measured quantitatively on MRI. The difference was statistically analyzed with SAS 9.13 software package. RESULTS: The results showed that the mean displacement distance increased from 5.44 mm to 6.83 mm (P<0.05); The mean disc length of the affected sides reduced from 9.06 mm to 8.12 mm (P<0.05); The mean condylar height of the healthy sides increased from 26.07 mm to 26.82 mm (P<0.05); The mean condylar height of the affected sides reduced from 24.22 mm to 23.81 mm (P<0.05); The difference of condylar height between healthy and affected sides increased from 1.85 mm to 3.00 mm (P<0.05). CONCLUSIONS: During the natural course of temporomandibular joint unilateral disc displacement without reduction in juvenile, the organic disease tended to progress, which might finally contribute to maxillofacial abnormalities. References | Related Articles | Metrics

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Minimally invasive selective neck dissection: a prospective study of endoscopically assisted dissection via a small submandibular approach in cT1-2N0 oral squamous cell carcinoma FAN Song, YANG Zhao-hui, YE Jian-tao, CHEN Wei-liang, WANG You-yuan, ZHANG Da-ming, LIN Zhao-yu, ZHOU Bin, LIANG Qi-xiang, HUANG Xiao-ming, LI Jin-song 2015, 13 (3):  232-239.  Abstract ( 513 )   HTML ( 2 )   PDF (3205KB) ( 598 )   PURPOSE: Selective neck dissection(SND) in clinical N0 (cN0) cases of oral squamous cell carcinoma has been performed by surgeons using a retroauricular or modified facelift approach with robotic or endoscopic assistance. However, these procedures provide cosmetic satisfaction at the cost of possible maximal invasiveness. In this prospective study, we introduced and evaluated the feasibility as well as surgical invasiveness and cosmetic outcome of endoscopically assisted SND via a small submandibular approach. METHODS: Fifty-four patients with cT1-2N0 oral squamous cell carcinoma(OSCC) were randomly divided into 2 groups of endoscopically assisted SND and conventional SND. Perioperative and postoperative outcomes of the patients were evaluated, including the length of the incision, operating time for neck dissection, estimated blood loss during the operation, amount and duration of drainage, total hospitalization period, total number of lymph nodes retrieved, satisfaction scores based on the cosmetic results, perioperative local complications, shoulder syndrome and follow-up information. RESULTS: The mean operation time in the endoscopically assisted group (124.04±13.47 min) was longer than that in the conventional group(73.47±15.36 min). However, the mean length of the incision was （4.23±0.56） cm in the endoscopically assisted SND group, and the amount and duration of drainage, total hospital stay, postoperative shoulder pain score and cosmetic outcomes were superior in the endoscopically assisted SND group. Additionally, the retrieved lymph nodes and complications were comparable. CONCLUSIONS: Endoscopically assisted SND via a small submandibular approach had a longer operation time than the conventional approach. However, endoscopically assisted SND was feasible and reliable which provided minimal invasiveness and satisfactory appearance. References | Related Articles | Metrics

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The role of surgery in the treatment of hemangioma and vascular malformation in head and neck region XUE Lei, WANG Xu-kai, XI Shan-long, SUN Hua-liang, XU Da-peng, GONG He, CHENG Chen 2015, 13 (3):  240-244.  Abstract ( 419 )   HTML ( 0 )   PDF (1130KB) ( 317 )   PURPOSE: To summarize and analyze the effect of surgery in the treatment of hemangioma and vascular malformation in head and neck region. METHODS: From February 2009 to February 2013, for 38 cases with hemangiomas which poorly responded to conservative treatment or affected cosmetics and function, surgical resection was performed. For 155 cases with vascular malformations, including 126 cases of venous malformation, 17 cases of arteriovenous malformation, and 12 cases of venular malformation, pingyangmycin injection or electrochemical therapy in combination with high concentration of pingyangmycin or cerclage method combined with high concentration of pingyangmycin and embolism method or surgical resection were applied accordingly. RESULTS: All patients were followed up for 0.5-4 years after treatment. The clinical cure rate of hemangioma, venous malformation, arteriovenous malformation and venular malformation was 94.7%, 81.0%, 70.6% and 91.7%, respectively. There were fewer complications, and cosmetics and function improved remarkably. CONCLUSIONS: Surgery still plays an important role in the treatment of hemangioma and vascular malformation, with the advantages of short treatment time and higher curative effect. References | Related Articles | Metrics

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Selection of segmental cutting methods for extracting impacted mandibular third molars ZHUANG Hao, SHEN Hai-ping, WANG Hui-juan 2015, 13 (3):  245-248.  Abstract ( 475 )   HTML ( 4 )   PDF (513KB) ( 268 )   PURPOSE：Use of segmental cutting methods with high speed turbine for extraction of mesially impacted mandibular third molars. METHODS: Six hundred and seventy-five mesially impacted mandibular third molars in 481 persons were extracted with high speed turbine. Three hundred and twenty-seven teeth were extracted by two-segment method; three hundred and forty-eight teeth were extracted by three-segment method. RESULTS: Impacted mandibular third molar were extracted entirely; the operation time was 5-20 minutes(average 16 minutes); temporary lower lip numbness occurred in 3 teeth of 3 cases; postoperative infecting occurred in 15 teeth of 15 cases. CONCLUSIONS: Two-segment method can be applied for mesially impacted mandibular third molars, while three-segment method can be applied for mesially and horizontally impacted mandibular molars. References | Related Articles | Metrics

Clinical Reports

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Comprehensive treatment of 48 patients with severe oral and maxillofacial multi-space infections FAN Yu-li, CAO Zheng, WU Xin, WANG Qiao 2015, 13 (3):  249-252.  Abstract ( 441 )   HTML ( 2 )   PDF (571KB) ( 465 )   PURPOSE: To analyze the features and results of multidisciplinary treatment of oral and maxillofacial multi-space infections. METHODS: Forty-eight cases of maxillofacial multi-space infections were treated by multidisciplinary approach including oral and maxillofacial surgery, emergency and other departments of our hospital. The clinical data, laboratory data, diagnosis and treatment were analyzed. RESULTS: Among 48 cases, fifty-five were cured after cooperative treatment while 3 died, the mortality rate was 6.25%. CONCLUSIONS: For severe maxillofacial multi-space infections, better clinical outcome may be achieved by multidisciplinary collaboration treatment with multiple departments. References | Related Articles | Metrics

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Interventional treatment with stent graft implantation of pseudoaneurysm following blunt dissection of carotid body tumors ZHOU Bin, ZHUANG Xiu-mei, CHEN Wei-liang, WANG You-yuan, ZHANG Da-ming, FAN Song, HUANG Zhi-quan 2015, 13 (3):  253-257.  Abstract ( 418 )   HTML ( 1 )   PDF (1542KB) ( 561 )   PURPOSE: To evaluate the clinical effect of surgical treatment of carotid body tumor and interventional treatment with stent graft implantation of pseudoaneurysms following blunt dissection of the tumor treated. METHODS: Six cases were classified as Shamblin I, II and III in 1, 1, and 4 cases, respectively. The tumor sizes varied from a minimum of 2 cm×3 cm to a maximum of 5 cm× 6 cm (median: 3.7 cm×4.7 cm). Two of them underwent blunt dissection of carotid body tumor, two underwent blunt dissection and ligation of external carotid artery of carotid body tumor and 2 had common carotid artery-internal carotid artery artificial vascular reconstruction. RESULTS: No perioperative mortality and stroke occurred. The range of mean blood loss was 455 mL (range, 250-650 mL). Two patients had pseudoaneurysm or vocal cord paralysis postoperatively and both recovered with stent graft implantation and medical treatment respectively. The patients were followed up for 6-17 months, no recurrence was seen at the follow-up period. CONCLUSIONS: Surgical treatment of carotid body tumor is acceptably safe and effective according Shamblin classification; Pseudoaneurysms following blunt dissection of the tumor can occur and using a stent graft was feasible for treating the lesion. References | Related Articles | Metrics

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Endoscopy-assisted transoral resection of 6 large benign parapharyngeal space tumors ZHONG Jiang-long, ZHANG Da-ming, CHEN Wei-liang, WANG You-yuan, HUANG Zhi-quan 2015, 13 (3):  258-261.  Abstract ( 386 )   HTML ( 2 )   PDF (1294KB) ( 457 )   PURPOSE: Surgical resection is regarded as the principal treatment of parapharyngeal space tumors. Although several techniques to access the parapharyngeal space have been described, tumor surgery in this area still remains a great challenge. This study evaluated the outcomes of endoscopy-assisted resection of large benign parapharyngeal space tumors via an intraoral approach. METHODS: Six patients (4 males, 2 females) with primary benign parapharyngeal space tumors were treated with endoscopy-assisted resection via an intraoral approach. The patients had a mean age of 41.7 years. The lesions comprised parapharyngeal space pleomorphic adenoma (n=4), Warthin’s tumor (n=1), and schwannoma (n=1). Tumor sizes varied from a minimum of 4 cm×4 cm to a maximum of 7 cm×7 cm. RESULTS: All tumors were removed completely without rupture while avoiding damage to the facial nerve. No patient exhibited any permanent postoperative complications, facial nerve injury, salivary fistula, or limited mouth opening. The cosmetic and functional results were excellent. The patients were followed for 8 to 21 months (average, 14.7 months), and no recurrence was encountered. CONCLUSIONS: Endoscopy-assisted transoral resection of large benign parapharyngeal space tumors is a simple and safe technique that achieves excellent aesthetic and functional results. References | Related Articles | Metrics

Clinical Guideline

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Chinese expert consensus document on head and neck mucosal malignant melanoma WU Yun-teng, REN Guo-xin, SUN Mo-yi, KONG Yun-yi, WANG De-hui, BU Rong-fa, RAN Wei, TANG Zhan-gui, CHEN Hong, LIN Ming, WANG Li-zhen, GUO Wei 2015, 13 (3):  262-269.  Abstract ( 595 )   HTML ( 9 )   PDF (869KB) ( 591 )   The incidence of malignant melanoma (MM) in China is lower compared to the white people. The incidence of malignant melanoma in Shanghai is only 0.42 per million in 2009. However, because of the big population in China, the number of MM patients is huge. Cutaneous melanoma is commonly seen in China. Guidelines for the diagnosis and management of MM had been published in 2009 and 2011, mainly pertaining to cutaneous melanoma. Mucosal MM was seldom investigated, but it is different from cutaneous MM in the treatment or prognosis. Therefore, there is necessity to make an expert consensus on mucosal melanoma based on the Chinese data and experience. References | Related Articles | Metrics

Review Articles

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Research progress on lymphoepithelial carcinoma of salivary gland TAN Yi-ran, ZHONG Lai-ping 2015, 13 (3):  270-272.  Abstract ( 545 )   HTML ( 6 )   PDF (348KB) ( 655 )   Lymphoepithelial carcinoma of salivary gland is a rare primary carcinoma in salivary gland. It was first described by Hilderman in 1962. It had different designation in the literatures as lymphoepithelioma-like carcinoma, malignant lymphoepithelial lesion, undifferentiated carcinoma with lymphoid stroma, carcinoma in lymphoepithelial lesion. It was finally defined as lymphoepithelial carcinoma in histological classification of salivary gland tumors (version 3 of pathology and genetics of head and neck tumors in World Health Organization classification of tumors in 2005). There is still no standard treatment guideline for lymphoepithelial carcinoma of salivary gland, the paper briefly reviewed current progress on lymphoepithelial carcinoma of salivary gland on the aspects of carcinogenesis, clinical and pathological features, diagnosis, treatment and prognosis to improve the comprehensive understanding of this disease. References | Related Articles | Metrics

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Progress on reconstruction of total maxillary defects with vascularized osseous composite flap YU Miao, QIN Xing-jun, XU Li-qun 2015, 13 (3):  273-279.  Abstract ( 424 )   HTML ( 1 )   PDF (1344KB) ( 367 )   The importance of the central portion of the face, including the maxilla, cheek, palate, cannot be underestimated. This portion of the face provides much of the facial appearance,as well as supports the function of mastication, deglutition,speech and normal vision. So reconstruction of a mid-facial defect is one of the most complex and controversial tasks in head and neck reconstructive surgery, among which reconstruction of total maxillary defects with preservation of orbital contents (James Brown Class Ⅲb) is the most difficult. In the present article, we reviewed the goals of total maxillary reconstruction, the methods to reconstruct the total maxillary defects with vascularized osseous composite flaps and issues related to bone reconstruction. References | Related Articles | Metrics

Case Reports

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Intraneural brachial plexus epitheloid hemangioendothliomas: a case report and literatures review LUO Quan, FAN Song, CHEN Wei-xiong, CHEN Wei-liang, LI Jin-song 2015, 13 (3):  280-283.  Abstract ( 421 )   HTML ( 7 )   PDF (1110KB) ( 448 )   Epithelioid hemangioendothelioma is a rare vascular tumor that occurs in the liver, lungs, bones, head and neck and soft tissues mostly. Epitheloid hemangioendothliomas occurring in brachial plexus bundle membrane has not been reported in both the literatures. We reported here 1 case of epitheloid hemangioendothliomas occurring in brachial plexus bundle and reviewed the relevant literatures on clinical manifestation, imaging characteristics, pathology, treatment and prognosis. References | Related Articles | Metrics

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A case report of extraction of two difficult embedded supernumerary teeth HU Ying-kai, YANG Chi, XU Guang-zhou 2015, 13 (3):  284-288.  Abstract ( 569 )   HTML ( 0 )   PDF (1136KB) ( 365 )   In this article, we discussed a rare case with 2 supernumerary teeth impacted in the horizontal plate of palatine bone and premaxilla, with emphasis on the choice of surgical approach and design of osteotomy lines to preserve normal anatomical morphology of premaxilla and protect adjacent teeth when extracted them contemporaneously with the application of piezosurgery. We also evaluated the clinical effect through clinical and imaging examination. References | Related Articles | Metrics