AO CMF Start-up Grants
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AO CMF Start-up Funded Research Projects
The abstracts of the latest funded projects under the start-up grant
Project title: Creation and validation of a 3D cephalometric software based on Delaire’s analysis
There is a large number of cephalometric analyzes, based on the analysis of facial points or based on radiology analyzes. Nowadays new technologies allow us to catch and analyze patients’ faces (thanks to 3D photography) and to get simple access to head CT-scans. Under those circumstances, our cephalometric analyzes should evolve in order to adapt to these features.
There has already been attempts to create 3D cephalometric analyzes based on CT-scans, but none of them were based on a dedicated software. Therefore results were impossible to reproduce. We propose to create a 3D cephalometric analysis free software for research based on CT-scans DICOM files, easy to use and available for everyone.
Our first step after the creation of the software is to plan a comparative study between “classic” radiography analysis and 3D analysis, on a cohort of 100 to 150 patients with a point to point comparison, to show that the 3D analysis is theoriticaly at least as good as the classical radiographic one.
The advantages of this new technology would be a greater precision in cephalometric outline, and so in the analysis of the patient facial lines. By analyzing a 3D volume we also intend to answer some multi-dimensional questions about the chin position, mandibular asymmetry and other complex facial skull movements.
Project title: Fully MRI based 3D virtual planning of CMF tumour resection and free flap reconstructionThe aim of the proposed clinical study is to change the conventional CT-based 3D virtual planning workflow for CMF tumors by developing a method for MRI-based tumor resection as well as free flap reconstructive planning. In addition the MRI-based workflow is complemented with the quantification of vascular flow in both donor and recipient site, as well as the 3D visualization of perforators. Project description: Multiple types of MRI sequences will be studied for visualizing bone and vascularization. Several MRI- sequences are known to be suitable for segmenting bone for 3D planning, these will be explored within this project. Also MR-Angiogram with flow measurements will be selected for visualizing arteries and to quantify the arterial flow, thereby determining suitability for transplantation. A workflow for MRI-based 3D surgical planning with bone cutting guides will be developed using a four-step approach. Key MRI parameters are defined (phase 1), followed by an application of selected bone and Phase Contrast-MRI sequences on healthy volunteers (phase 2).The most suitable (bone and Phase Contrast) MRI sequences will be chosen for phase 3. These protocols are validated by applying them on patients (n=10) and comparison to corresponding patients CT data, which is the gold standard. The mean deviation values between the MRI- and the CT-based models are determined by 3D comparison analysis as a primary outcome measure.Already for validation of Black Bone sequences approval has been obtained from the local medicalethical board (file number M16.198347).Phase 4 entails examination of the clinical value during surgery and in pre-op clinical decision making,using bone cutting guides (for mandible/maxilla and fibula) designed from MRI-based models, inpatients with oral cancer who will undergo surgical treatment with free flap reconstruction. Secondary outcome measures are 1) the deviation of the actual bone cutting planes in the CMF region as well asat the bone-free flap, compared to the 3D planning and 2) the fit of the guides to the bone surface. The final result of this project is aimed to be a complete MRI based 3D virtual planning workflow including resection of the tumor and free flap reconstruction planning.
Project title: CTRead - A revolutionary approach to training residents in CT Facial Bones interpretationFacial trauma is a common occurrence worldwide which can lead to a plethora of functional, cosmetic, and emotional sequelae. Proper diagnosis of the direction, extent, and displacement of facial fractures by oral surgeons using the gold standard high-resolution CT scanning is imperative to improve patient outcomes and avoid unnecessary complications. Despite the importance of accurate diagnosis, oral surgery residents often receive a variable level of CT interpretation training from a senior resident or staff in an unstructured manner. To address this inconsistency in training, this project aims to create a standardized, scalable training module called CTRead for new residents in oral and maxillofacial surgery everywhere so that they can become competent and confident when interpreting scans and presenting them to their senior residents and staff. CTRead will be a web based training module which will take a student, resident, or even staff member through the reading of a CT Facial Bones scan one step at a time. Users will be shown normal CT scans, taught how to interpret anatomy, and then taught how to identify common fractures in facial trauma patients. To test the effectiveness of CTRead, participants’ confidence level and actual interpretation skill will be assessed via a mandatory short but comprehensive survey and marked CT interpretation quiz at the beginning and end of the training module. This will allow us to gather key information users’ confidence in interpreting CT scans, and their ability to accurately diagnose traumatic fractures as they progress through the module. It is hoped that completion of CTRead will lead to a significant increase in both confidence level and actual interpretation skill level of oral surgery residents when it comes to reading CT Facial Bones scans for trauma patients.
Project title: Antibacterial nano-biomaterials for the purposes of cranio- maxillofacial surgeryInfections associated with implantable devices, also known as biomaterial associated infections (BAIs) pose a real problem in contemporary regenerative medicine and traumatology. In the head and neck area extraoral BAIs manifest as “pin sites infections” (PSI), while intraoral are known as peri-implant mucositis and/or peri-implantitis, which affects the underlying alveolar bone. Despite efforts in bioengineering to improve the biocompatibility of the metallic biomaterials, which constitute a major part of the reconstructive surgery, the problem of bacterial settlement and infection development still poses a serious threat for the treatment outcome. Along with nanotechnology evolution, antibacterial approaches with the use of different nanoparticles (NPs) were taken into concern. However, studies showed that such devices exhibited some limitations, mostly due to a restricted effective release rate, an initial burst release, cytotoxicity and unknown interactions of NPs with the host’s biomolecules. The aim of this study is twofold. First is to evaluate antibacterial activity of nano-sized zinc compounds against the bacteria responsible for infections around the biomaterials in the head and neck area. Second is to evaluate the stability of the nano-colloidal suspensions in the human and artificial saliva, and physico-chemical properties of the nano-particle-protein-sugar complexes, known as protein-coronas (PCs), in such environments which determine the activity of the NPs in the living organisms.
Project title: Investigating effects of BMPER on osteogenic and chondrogenic differentiationBone morphogenetic proteins (BMPs) 2 and 7 have been approved for clinical use, yet complications limit their application. In addition, the supraphysiological doses applied would indicate that their use has not yet been optimized. BMP binding endothelial regulator (BMPER) also known as Crossveinless 2 was first identified as critical mediator in vein development (Conley, Silburn et al. 2000). Today it is known that BMPER is a BMP modulator, similar to Chordin, Noggin or Gremlin and interacts with BMP 2, 4, 6, 7, 9 and 10. In humans, the syndrome Diaphanospondylodysostosis (DSD) is caused by a lack / mutation of the BMPER protein. Characteristics are absent or severely delayed ossiﬁcation of vertebral bodies and other bone defects, a short broad thorax, a short neck and respiratory insufﬁciency. The severe bone phenotype suggests that BMPER plays a major role in osteogenesis, yet it has been largely overlooked. No studies have been performed to assess whether BMPER as BMP modulator might be as osteoinductive as BMPs themselves nor whether BMPER is able to potentiate the osteoinductive effects of BMPs. The aim of our study is therefore to identify the osteogenic and chondogenic potential effects of BMPER and to establish whether BMPER is promising as a new factor for promoting bone and/ or cartilage regeneration. As a first step the effects of BMPER on MSCs (Mesenchymal stem cells) will be investigated in vitro.