中华口腔医学杂志最新文献

Non-syndromic cleft lip with or without cleft palate (NSCL/P) is one of the most common congenital craniofacial malformations, characterized by significant genetic heterogeneity and polygenic features. Historically, genetic studies of NSCL/P have primarily focused on coding region variants. However, only approximately 2% of the human genome consists of coding sequences, with the majority of variants located in non-coding regions. Recent large-scale genome-wide association studies have indicated that risk loci associated with NSCL/P are predominantly enriched in regulatory elements within non-coding regions of the genome. These non-coding variants, while not directly altering protein structures, can influence gene expression patterns in specific tissues or developmental spatiotemporal contexts by affecting the function of regulatory elements, thereby contributing to disease phenotypes. With the continuous advancement of functional genomics and bioinformatics methodologies, the identification, functional annotation, and mechanistic analysis of regulatory variants in non-coding regions have become critical directions in NSCL/P genetic research. This review systematically summarizes the research progress in identification methods, functional annotation strategies, and functional validation techniques for non-coding variants in NSCL/P patients. It elaborates on the significant role of non-coding regulatory elements in the pathogenesis of NSCL/P, aiming to provide new perspectives for understanding the functional significance of non-coding regions in NSCL/P and other complex diseases.

Objective: To evaluate the therapeutic efficacy of syndrome differentiation-based treatment in acupuncture for patients with primary trigeminal neuralgia (PTN). Methods: A total of 104 patients diagnosed with PTN at School of Stomatology, The Fourth Military Medical University from January 1, 2022, to August 31, 2023, were prospectively enrolled. Using a dynamic randomization method via a central randomization system, they were randomly assigned to the control group (n=52) and the experimental group (n=52). The control group received acupuncture treatment with acupoint selection based on the affected pain branches, while the experimental group received additional acupoint selection based on syndrome differentiation in addition to the branch-based selection. A comparative analysis was conducted between the two groups regarding changes in pain intensity, pain attack frequency, short-term clinical efficacy, as well as adverse reactions and emergencies during the treatment period. Results: 104 patients were enrolled in the clinical study, including 52 patients in the control group and 52 patients in the experimental group. During the treatment, the degree and frequency of pain attack in the experimental group were relieved with great intensity and fast speed. The pain changes of patients with branch Ⅱ and Ⅲ after treatment were relatively large and the effect was obvious. The short-term treatment effective rate [94.2%(49/52),96.2%(50/52)] in the experimental group was higher than that in the control group [88.5%(46/52),88.5%(46/52)] with statistical difference(P=0.026,P=0.034). The short-term curative effect of branch Ⅲ in the experimental group was better and more stable than that of other branches(P=0.013). In addition, the adverse drug reactions of both groups decreased after acupuncture treatment, but there were still more emergencies during treatment. Conclusions: According to the treatment of pain branches and syndrome differentiation, selecting the local acupoints of head and face and the distal acupoints of hands and feet can improve the effect of acupuncture on primary trigeminal neuralgia.

Objective: To provide guidance for rational clinical medication, reduce the incidence of adverse drug reactions (ADR) to articaine and epinephrine injection, and to investigate the causes and patterns of ADR associated with local anesthetics used in dentistry, thereby offering a reference for clinical practice. Methods: A retrospective analysis was conducted on 101 patients who received treatment with articaine and epinephrine injection (identified by its generic name) at the Department of Pharmacy, Yantai Stomatological Hospital Affiliated to Binzhou Medical College between January 2022 and March 2025. Statistical analysis was performed on the occurrence of new ADR. New ADR were defined as those not listed in the drug's prescribing information, or those where the nature, severity, outcome, or frequency of the reaction differed from or was more severe than described in the information. Data analyzed included patient gender, age (range: 4 to 72 years), body weight (20 to 88 kg), time of ADR onset, and symptoms. Results: Among the 101 reported new ADR, two were serious. One case involved ulceration and necrosis at the injection site, which resolved after 35 days of medical treatment. The other was an allergic reaction manifested as blurred vision and cardiac discomfort, requiring emergency intervention. The remaining 99 cases were new non-serious ADR. Among these, ulceration at the injection site was the most common, accounting for 81.82% (81/99). Local skin reactions at the injection site, such as discoloration, swelling, and pain, comprised approximately 13.13% (13/99). Cardiovascular and central nervous system reactions, including chest tightness, vomiting, palpitations, limb weakness, and dizziness, accounted for 4.04% (4/99). Single cases of skin blistering, pain with cold clammy skin at the injection site, and lip swelling were also reported. Conclusions: The spectrum of new ADR associated with articaine and epinephrine injection is primarily characterized by ulceration at the injection site. Other commonly observed reactions include pain, rash, and pruritus at the injection site, as well as palpitations, cold sweats, dizziness, nausea, and hypotension.

Hertwig's epithelial root sheath precisely regulates the morphology and structure of tooth roots. During root development, interference in the spatiotemporal development of the Hertwig's epithelial root sheath can lead to excessive or defective proliferation, subsequently causing morphological variations of root and pulp cavity. Taurodontism is a characteristic manifestation resulting from defective Hertwig's epithelial root sheath proliferation, presenting with abnormal root and pulp morphology. Currently, clinicians have an incomplete understanding and conceptual confusion regarding its pathogenesis, anatomical features, and clinical manifestations, which hinders accurate root canal therapy difficulty assessment and optimal treatment planning. This article, taking the role of the epithelial root sheath in root development as its starting point, systematically reviews the mechanisms of taurodontism formation, nomenclature, classification, and research progress. It further analyzes its clinical characteristics, and proposes strategies for root canal therapy. The aim is to enhance clinicians' comprehensive understandings of this root developmental anomaly, thereby improving the success rates of clinical treatments.

Nonsurgical endodontic retreatment refers to the non-surgical endodontic treatment that needs to be performed again on tooth that had undergone failure root canal treatment due to various reasons. For most post-endodontic diseases, nonsurgical retreatment is the best way to remove bacteria from root canal system. There are still multiple controversies in the case selection, treatment plan determination, and clinical operation details of nonsurgical endodontic retreatment, far from forming a scientific and systematic expert consensus at present. This consensus provides detailed guidance on the indications, contraindications, operation principles, efficacy evaluation and prognosis of nonsurgical endodontic retreatment, so as to improve the success rate and reduce complications. By establishing an individualized retreatment system for root canal therapy, it is possible to provide clinicians with more accurate and comprehensive treatment references, for better preserving the function of teeth that possess failed root canal therapy.

Objective: To explore the effects of pleiotropic regulator, catabolite control protein A (CcpA), on the biofilm formation of Streptococcus mutans (Sm). Methods: The CcpA knockout strain ΔccpA and complementation strain ΔccpA/pDL278-ccpA were constructed. The cell morphologies and growth curves of UA159 and ΔccpA cells were detected. The pH meter and acid tolerance assay were conducted to evaluate the effect of CcpA on the acid-producing and acid resistance capacity of Sm, respectively. Crystal violet assay (CVS), anthrone-sulfuric method, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) were conducted to evaluate the characteristics of Sm biofilms. Moreover, real-time fluorescence quantitative PCR (RT-qPCR) and electrophoretic mobility shift assay (EMSA) were employed to explore the molecular mechanism of CcpA in prompting the biofilm formation at transcriptional level. Results: Growth curve analysis indicated that ΔccpA demonstrated slightly reduced growth rate compared with UA159, while the final yield showed no significant difference. SEM observation showed ΔccpA bacteria formed loose biofilm architectures and exhibited a reduced capacity in synthesizing extracellular matrix, and these findings were further confirmed by CVS that ΔccpA (0.55±0.11) exhibited decreased biomass relative to UA159 (0.82±0.01) (P<0.01), while no significant difference between ΔccpA/pDL278-ccpA and UA159 (P>0.05). CLSM observation exhibited a reduced capacity to synthesize exopolysaccharides of ΔccpA strain, and these findings were further confirmed by data of anthrone-sulfuric method that ΔccpA exhibited decreased water-soluble glucans (0.10±0.01) and water-insoluble glucans (0.08±0.00) relative to UA159 (0.14±0.02, 0.20±0.03) (all P<0.01), while there was no significant difference between ΔccpA/pDL278-ccpA and UA159 (all P>0.05). RT-qPCR showed the expression levels of gtfB/C/D genes were markedly downregulated in ∆ccpA strain with different carbon resources (all P<0.05). Specifically, the promoter regions of gtfB and gtfC were directly regulated by CcpA. Conclusions: In summary, CcpA can trigger transcription of biofilm-formation genes via direct binding. Our study supports a role for CcpA as a crucial regulator that exploit the nuanced control of Sm biofilm formation.

Objective: To evaluate the irrigation performance of a modified flat-side open-ended needle (FS needle) in comparison with a traditional flat needle (F needle) and a side-vented needle (S needle), aiming to optimize clinical irrigation strategies. Methods: A 3% sodium hypochlorite solution was selected as the irrigant. Idealized root canal and three irrigation needle geometries were modeled using FreeCAD. Mesh generation and computational setup were performed using Fluent software to simulate the irrigation process with three needle types at working depths of 1, 3, and 5 mm (nine groups in total). Apical pressure, wall shear stress, and velocity data were extracted. Data were processed using Python, and flow field characteristics and irrigation efficacy were comparatively analyzed based on velocity and wall shear stress distributions, as well as four evaluation metrics: apical pressure, effective replacing depth, and effective shear stress depth and span. Results: The apical pressures of the FS needle were 14.22, 11.79, and 9.43 kPa at working depths of 1, 3, and 5 mm, respectively, which were lower than those of the F needle (35.09, 25.04, 17.78 kPa) and close to those of the S needle (9.49, 7.66, 5.92 kPa). The effective replacing depths of the FS needle were 1.25, 1.65, and 1.95 mm, slightly lower than those of the F needle (1.30 mm) but much higher than those of the S needle (0.15 mm) at 1 mm working depth, and comparable to the S needle (1.95 mm) at 5 mm working depth. The effective shear stress depths were 5.07, 3.36, and 1.56 mm, with spans of 3.18, 1.93, and 1.40 mm, respectively, slightly lower than those of the F needle in depth but close to or higher than the S needle in span. Conclusions: At working depths of 1-3 mm, the FS needle was associated with low apical pressure and superior fluid replacement capacity, indicating a favorable balance between pressure control and irrigation efficiency.