Diabetes mellitus is a chronic metabolic disease characterized by hyperglycemia. Apical inflammation is an infectious disease characterized by the destruction of periodontal tissue. It is the result of complex interaction between microbiota, microbial virulence factors, and host immune response in the root canal system. Diabetes mellitus and apical inflammation are two biologically related diseases. The bidirectional relationship between diabetes and apical inflammation has been the focus of in-depth research. This article reviews the relationship between effects of root canal treatment, blood glucose level, and inflammatory response of diabetes mellitus and apical inflammation in recent years. A thorough understanding of the relationship between diabetes and apical inflammation is of great significance to elucidate the bidirectional mechanism, and will have a positive impact on better and more accurate treatment of diabetes patients with apical inflammation.

Periodontitis is a common oral disease affecting the health and quality of life. Achieving satisfactory regeneration of periodontal tissue structure and function to preserve more teeth is the goal of treatment. Exosomes are nano vesicles containing a variety of biologically active substances, which can participate in intercellular information exchange and material transfer upon cellular uptake. The unique tissue specificity of dental stem cells makes the exosomes derived from them one of the hot spots in periodontal tissue regeneration. This paper reviews the latest progress of exosomes derived from dental stem cells in periodontal tissue regeneration, with a view to provide new ideas for periodontitis-related research.

Patients with missing teeth in the maxillary posterior area usually have lowered height of alveolar bone due to pathological absorption atrophy, aging, maxillary sinus gasification, and other reasons. When implantation is performed for these patients, due to insufficient bone mass, it is difficult to design and implement the implant repair scheme. In order to solve this problem, many scholars proposed oblique implantation to meet the needs of patients with insufficient bone mass. The article elaborates the oblique implantation from the aspects of application type, advantages, biomechanics, etc.

Objective: To construct a co-culture system of human gingival fibroblasts (HGFs) and human umbilical vein endothelial cells (HUVECs) to promote vascularization of HUVECs. Methods: HGFs and HUVECs were cultured to 3 to 5 passages for experiments. The HUVECs was labeled with a red fluorescent protein by lentiviral transfection. A two-dimensional co-culture system of HGFs and HUVECs was constructed. HGFs and HUVECs were co-cultured at different ratios (4∶1, 1∶1, and 1∶4), and the formation of vascular network was observed under fluorescence microscope. 5% methacrylylated gelatin (GelMA) 30 hydrogel was prepared to construct a three-dimensional co-culture system of HGFs & HUVECs, and the formation of vascular network was observed under laser confocal microscope and quantitative analyzed. HUVECs were separated from three-dimensional co-culture system to assess the proliferation, migration, tube formation, and expression levels of relevant angiogenesis genes after single-culture and co-culture for a certain period. Results: In two-dimensional co-culture, vascular network formation was best when HGFs and HUVECs were cocultured in a ratio of 1∶1. In three-dimensional co-culture, HGFs can promote HUVECs angiogenesis. The co-culture of HGFs & HUVECs had better effects on proliferation, migration, and tube formation compared to the three-dimensional culture of HUVECs alone, and the expression levels of relevant angiogenesis genes were significantly higher. Conclusion: Co-culture of HGFs and HUVECs can guide and promote HUVECs migration and sprouting.

Objective: To determine the optimal osteogenic induction system in vitro for MC3T3-E1 osteoblasts. Methods: Different osteogenic induction systems were constructed, which were dexamethasone 0.1 μmol/L, ascorbic acid 50 μg/mL, and β-sodium glycerophosphate 10 mmol/L in group A; dexamethasone 0.01 μmol/L, ascorbic acid 50 μg/mL, and β-sodium glycerophosphate 10 mmol/L in group B; dexamethasone 1 μmol/L, ascorbic acid 50 μg/mL, and β-sodium glycerophosphate 10 mmol/L in group C; ascorbic acid 50 μg/mL and β-sodium glycerophosphate 10 mmol/L in Group D; and ascorbic acid 100 μg/mL and β-sodium glycerophosphate 5 mmol/L in Group E. MC3T3-E1 cells were induced in vitro for 7 days and 14 days. The effects of alkaline phosphatase staining and alizarin red staining on osteogenic differentiation of MC3T3-E1 were analyzed. The expression levels of osteogenic differentiation related genes (ALP, Runx-2, COL-1, OCN, OPN) were detected by RT-qPCR. Results: There was a significant difference in the optimal quantification of alizarin among groups B, D, and E (P<0.05). The PCR results at 7 days after induction showed that the gene expression levels of ALP, Runx-2, and COL-1 in group C were the highest (P<0.05). PCR results at 14 days after induction showed that the expression of OCN in Group D was the highest (P<0.05). Conclusion: The concentrations of dexamethasone and ascorbic acid have an effect on the osteogenic differentiation of MC3T3-E1 cells. Group C was better for early osteogenesis and Group D was better for late osteogenesis. However, in comprehensive consideration, Group B is recommended for late osteogenesis.

Objective: To investigate the effects of ipriflavone (IP) on proliferation and mineralization of human dental pulp stem cells (hDPSCs). Methods: The hDPSCs were cultured in complete culture medium containing IP (10^-9-10^-5 mol/L) and identified. The cell activity at different time points (1, 2, 3 d) was detected by CCK-8. After induced for 7 days with mineralization liquid containing IP (10^-8-10^-5 mol/L), the alkaline phosphatase (ALP) activity, ALP staining, alizarin red staining, and RT-qPCR were used to detect the osteogenic differentiation of hDPSCs. Results: CCK-8 detection showed that 10^-9-10^-5 mol/L IP could promote the proliferation of hDPSCs,and 10^-6 mol/L IP had the best results (P<0.05). In 10^-6 mol/L IP group, the ALP staining was deepened, the activity was increased (P<0.05), and the mineralization nodules were increased. RT-qPCR showed that the contents of Runt-related transcription factor, ALP, and osteocalcin in the 10^-6 mol/L IP group were significantly up-regulated (P<0.05). Conclusion: 10^-6 mol/L IP can promote the proliferation and mineralization of hDPSCs.

Objective: To investigate the molecular mechanism of 30 kPa hydrostatic pressure regulating the proliferation and apoptosis of condylar chondrocytes. Methods: Rat condylar chondrocytes were cultured in vitro. Cells divided into four groups: normal pressure group, 30 kPa pressure group, KN93 control group, and 30 kPa pressure+KN93 group. EdU labeling method was used to measure cell proliferation. Flow cytometry was used to detect the proportion of cell apoptosis. Fluorescence probe method was used to detect intracellular Ca²⁺ levels. Western blot was used to detect the expression of CaMK Ⅱ, p-c-Jun, c-Jun, p-ERK1/2, ERK1/2, p-p38, and p38 proteins in cells. Results: Compared with the normal pressure group, the cell proliferation rate in the 30 kPa pressure group decreased, the cell apoptosis rate increased significantly, the intracellular Ca²⁺ levels increased significantly, the expression of CaMK Ⅱ protein was upregulated, and the ratios of (p-c-Jun)/(c-Jun), (p-ERK1/2)/(ERK1/2), and (p-p38)/(p38) were all increased (P<0.01). Compared with the 30 kPa pressure group, the cell proliferation rate in the 30 kPa pressure+KN93 group was increased, the cell apoptosis rate decreased, the intracellular Ca²⁺ level decreases, the expression of CaMK Ⅱ protein was downregulated, and the ratios of (p-c-Jun)/(c-Jun), (p-ERK1/2)/(ERK1/2), and (p-p38)/(p38) were all reduced (P<0.01). Conclusion: The sustained effect of 30 kPa hydrostatic pressure can inhibit condylar chondrocytes proliferation, promote cell apoptosis, and increase intracellular Ca²⁺ levels. The mechanism of action may be that Ca²⁺ activates the MAPK signaling pathway through CaMK Ⅱ.

Objective: To investigate the application of buccal fat pad (BFP) combined with adjacent soft tissue flap in management of large oro-antral communication (OAC) in the elderly. Methods: Eight patients with intraoperative large OAC (maximum diameter greater than 4 cm) admitted to the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Medical School, Nanjing University from January 2020 to December 2022 were collected, and the age of the patients ranged from 62 to 84 years old. The application of BFP combined with a buccal advancement flap or a palatal mucosal flap to cover the defect was retrospectively analyzed, and the efficacy was prospectively evaluated during postoperative follow-up. Results: All cases were successfully repaired, and no flap necrosis, perforation, infection, or maxillary sinusitis was found. The maxillofacial region was basically symmetrical during the 3-month follow-up. After mouth opening training, the mouth opening returned to normal. Conclusion: BFP combined with adjacent soft tissue flap is a convenient and reliable method to repair large OAC in the elderly, and is worthy of clinical promotion.

Objective: To observe the application of sialoendoscopy and intraoral small incision in removing deep hilar submandibular calculi. Methods: Data from patients with deep hilar submandibular calculi who visited our hospital from January 2020 to December 2023 were retrospectively reviewed. Patients who underwent sialoendoscopy and intraoral small incision surgery for stone removal were included in the observation group (53 cases), while patients who underwent traditional intraoral incision for stone removal were included in the control group (55 cases). Success rate and incidence of complications were analyzed. The quality of life before and after operation in the observation group was evaluated. Results: In the observation group, 52 cases were successfully removed the calculi and the gland was preserved, with a surgical success rate of 98.1%. No postoperative complications such as lingual nerve injury were observed. One case in which the stone was not removed underwent submandibular gland resection during the surgery, however, temporary lingual nerve injury occurred postoperation, with a complication rate of 1.89%. After follow-up, the glands of 52 patients with stones removed restored function at varied degrees, and the postoperative quality of life was improved (P<0.05). There was no secondary surgical resection of submandibular glands up to present. However, in the control group, 35 cases were successfully removed the stone, with a success rate of 63.6%. Among them, 10 patients experienced temporary lingual nerve injury, and 1 patient developed sublingual gland cyst, with a complication rate of 20%. Conclusion: Sialoendoscopy and intraoral small incision surgery has a high success rate, minimal trauma, and fewer postoperative complications in the treatment of deep hilar submandibular calculi, which is beneficial for improving quality of life.

Objective: To research the sagittal and vertical changes of the maxilla after miniscrew-assisted rapid palatal expansion(MARPE)in adult patients. Methods: A retrospective study was performed on 45 adult patients who underwent miniscrew-assisted rapid palatal expansion, including 38 females and 7 males, with an average age of (21.7±3.4) years. By importing patients’ CBCT data before and immediately after the expansion into the Dolphin11.9 software and MIMICS21.0 software, after correcting the head position through Dolphin, the 3D reconstruction of the CBCT data is generated in MIMICS. The model was registered, and then the anterior nasal spines before and after the expansion of the palatal, the most anterior and inferior nasal bone end of the nasofrontal suture, the most anterior and inferior end of the nasal bone, the uppermost jaw end of the zygomaticomaxillary suture, the innermost frontal bone end of the zygomatic frontal suture, and the lowermost zygomatic bone end of the temporal zygomatic suture were fixed. The sagittal and vertical changes of above points before and after palatal expansion were measured and calculated. Results: After palatal expansion, in the sagittal and vertical direction, the anterior nasal spine was (0.52±0.58) mm forward and (0.49±0.93) mm downward on the left side, and (0.70±0.86) mm forward and (0.41±0.97) mm downward on the right side, both of which were statistically significant (P<0.05). The most anterior and inferior nasal bone end of the nasofrontal suture, the most anterior and inferior end of the nasal bone, the uppermost jaw end of the zygomaticomaxillary suture, the innermost frontal bone end of the zygomatic frontal suture, and the lowermost zygomatic bone end of the zygomatic temporal suture were generally backward 0.06 mm to 0.30 mm and upward 0.10 mm to 0.55 mm, most of which were statistically significant. Conclusion: When adult patients are treated with MARPE, the maxilla is moved forward and downward, and the adjacent structures above the maxilla are moved upward and backwards.

Objective: To evaluate the three-dimensional changes of soft and hard tissues in adult females after extraction orthodontic treatment. Methods: A total of 40 female cases were included, and the CBCT data before and after orthodontic treatment were quantitatively analyzed using Dolphin software. Results: There is statistically significant difference in the displacement of upper and lower lips, as well as the soft tissue around nasolabial folds along the sagittal direction. The changes of soft tissue around nasolabial folds showed a gradual increase (NFL3＞NLF2＞NFL1) and a gradual decrease from the inside to the outside (L2＞NLF2＞L1). There was a moderate positive correlation between incisor retraction and changes in lip tissue (r=0.52), as well as a moderate positive correlation between upper canine retraction and changes in soft tissue around nasolabial folds(r=0.63). Conclusion: The convex facial profile and lip morphology can be effectively improved after extraction orthodontic treatment in adult females. The retraction of incisors and canines can be used to predict changes of lips and soft tissue around nasolabial sulcus in the sagittal direction. Although the soft tissue around nasolabial folds showed negative changes, further research is needed to determine whether the folds in the nasolabial folds will deepen.

Objective: To investigate the optimal mechanical design for canines during anterior teeth intrusion with Clear Aligners. Methods: CBCT imaging data from an adult patient was selected and constructed physical models of the maxillary dental arch and invisible aligners through in vitro simulation. Nineteen sets of loads were designed based on different degrees of intrusion angles from 0 to 90 degrees. These mechanical distributions were loaded onto the models according to the maximum movement stride of the invisible aligners, and the differences in mechanical results were compared and analyzed. Results: The various parts of the canines showed different movement phenomena under different mechanical designs for the crown and root, and showed attenuation and incremental movement in different planes as the sagittal component force decreased and the vertical component force increased. Conclusion: The optimal mechanical distribution design for canines is in the range of 40 to 50 degrees for anterior teeth intrusion angle of clear aligners. However, additional design elements are required to control tooth axis and torque expression.

Objective: To quantitatively analyze the occlusal contact of single posterior implant prosthesis in the intercuspal position(ICP), and to explore its effect on vertical bone loss around the implant. Methods: Forty patients without a adverse repair phenomena such as early contact and bad habits such as bruxism were selected for conventional implant restoration of the first molar. The T-Scan occlusal analyzer was used to record the difference in occlusal contact between the implant prosthesis and the contralateral homonymous tooth.They were grouped according to occlusal delay time, percentage ratio of occlusal force, peak occlusal force, and occlusal contact area ratio. The effect of occlusion on vertical bone loss(VBL) around the implant was analyzed, and a multiple linear regression model was established. Results: There were significant differences in the average VBL between groups in the comparison of the occlusal delay time and the peak bite force (P<0.05). At the same time, the prediction equation was obtained: Y=1.060-0.734X1 + 0.248X2-0.589X3, where Y is average VBL, X1 is occlusal delay time, X2 is peak bite force, and X3 is occlusal contact area ratio. Conclusion: In addition to considering the appropriate occlusal design in the implant restoration, when adjusting the occlusal contact of implant restorations or during regular occlusal examinations,the application of T-Scan is recommended,to minimize the peak occlusal force (light occlusal contact) at ICP, and to delay the first occlusal contact time of the implant restorations as much as possible, which is extremely beneficial to maintain the stability of the peri-implant bone.

Objective: To determine whether advanced periodontal defect (APD) was the risk factor of guided bone regeneration (GBR) in implant surgery of mandibular first molar. Methods: One-hundred and seventy-six patients with 179 implants placed in naturally healed mandibular first molars sites were included. The time interval between tooth extraction and implant surgery was 3-12 months. Age, sex, the time interval, and APD (yes or no) of extracted teeth were recorded. The risk factors of GBR were assessed using Logistic regression. Results: Adjusting for age, sex , and the time interval, the risk of GBR for implant surgery was 4.738 times higher in mandibular first molars with APD than non-APD sites(95%CI:1.650-13.609, P<0.05). Conclusion: APD increases the risk of GBR in implant surgery of mandibular first molar.

The introduction of digital guide plates into apical microsurgery can accurately locate the lesion, minimize bone tissue removal, and avoid damage to adjacent teeth or tissues. This article reported a case of left mandibular first molar with chronic apical periodontitis treated with apical microsurgery assisted by digital guide plate.

For maxillary first molar, the incidence of C-shaped root canals was only 0.12%, and the incidence of enamel pearls was 2.68%. Therefore, the presence of both anatomical structures was rarer. Here we report a retreatment case of maxillary first molar with C-shaped palatal root canal (Vertucci Ⅷ, 3-3) and furcal enamel pearl. It is suggested that using dental operating microscope combined with CBCT can detect structural abnormalities and avoid missing the root canal.

Direct resection of large epulis can easily lead to problems such as increased gingival defect area and exposed root surface. The use of mucogingival aesthetic surgery is conducive to the recovery of soft tissue defects and appearance after epulis

Oral lichen planus (OLP) is a common chronic inflammatory oral mucosal disease with a risk of malignant transformation, which required active intervention and close follow-up and monitoring. Photodynamic therapy (PDT) has been widely used in the treatment of OLP due to its advantages of minimally invasive, effective, good selectivity, and repeatability. However, there are still limitations in the efficacy evaluation approaches of PDT for OLP. DNA quantitative analysis of exfoliated cells is a non-invasive auxiliary examination method, which can be used for the early screening and diagnosis of the malignancy of oral potentially malignant disorders and oral cancer. Here we reported a case of OLP with epithelial dysplasia using DNA content analysis of exfoliated cells to dynamically monitor the risk of malignancy and the effect of PDT. The aim of this report is to provide a reference for establishing the precise and minimally invasive diagnosis and treatment of OLP with epithelial dysplasia.