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Background Autologous grafting, despite some disadvantages, is still considered the gold standard for reconstruction of maxillofacial bone defects. The aim of this study was to evaluate bone regeneration using bone marrow-derived mesenchymal stromal cells (MSCs) in a clinical trial, a less invasive approach than autologous bone grafting. This comprehensive clinical trial included subjects with severe mandibular ridge resorption. Methods The study included 11 subjects aged 52–79 years with severe mandibular ridge resorption. Bone marrow cells were aspirated from the posterior iliac crest and plastic adherent cells were expanded in culture medium containing human platelet lysate. The MSCs and biphasic calcium phosphate granules as scaffolds were inserted subperiosteally onto the resorbed alveolar ridge. After 4–6 months of healing, new bone formation was assessed clinically and radiographically, as were safety and feasibility. Bone at the implant site was biopsied for micro-computed topography and histological analyses and dental implants were placed in the newly regenerated bone. Functional outcomes and patient satisfaction were assessed after 12 months. Results The bone marrow cells, expanded in vitro and inserted into the defect together with biphasic calcium phosphate granules, induced significant new bone formation. The regenerated bone volume was adequate for dental implant installation. Healing was uneventful, without adverse events. The patients were satisfied with the esthetic and functional outcomes. No side effects were observed. Conclusions The results of this comprehensive clinical trial in human subjects confirm that MSCs can successfully induce significant formation of new bone, with no untoward sequelae. Hence, this novel augmentation procedure warrants further investigation and may form the basis of a valid treatment protocol, challenging the current gold standard. Trial registration EudraCT, 2012-003139-50. Registered on 21 August 2013. ClinicalTrials.gov, NCT 02751125 . Registered on 26 April 2016.

Temporomandibular disorders (TMDs) are characterized by pain and dysfunction in the masticatory apparatus and the temporomandibular joint (TMJ). Previous trauma, stress symptoms, psychosocial impairment, and catastrophizing have been related to TMD. To assess if the hypothalamic-pituitary-adrenal (HPA) axis is upregulated in TMD patients, we performed a cross-sectional study with saliva from 44 TMD patients and 44 healthy sex- and age-matched controls for cortisol (F) and cortisone (E) with liquid chromatography-tandem mass spectrometry. Furthermore, we calculated the F/E ratio for the evaluation of 11β-hydroxysteroid dehydrogenase activity. We also assessed anxiety/depression and pain catastrophizing scores from a questionnaire that participants completed prior to the examination. We found that F (P=0.01), E (P=0.04), the F/E ratio (P=0.002), and the sum of glucocorticoids (E + E) in saliva (P=0.02) were significantly higher in the TMD group. Anxiety/depression and catastrophizing scores were also significantly higher in the TMD group (P<0.0001). Our findings indicate that patients with TMDs may have an upregulated HPA axis with higher F secretion from the adrenal cortex. Anxiety/depression and pain catastrophizing scores were significantly higher in the TMD group, and psychological factors may contribute to chronic upregulation of the HPA axis.

The heavy dependence on online education during the COVID-19 pandemic has long-term consequences for teaching and learning. The problem statement of the present study is to identify, from a student-centered perspective, solutions for a teaching approach in the virtual environment to increase student involvement and stimulate active relevant learning. The research objectives are to describe the team dynamics in Project-Based Virtual Learning (PBVL) and to identify the advantages and disadvantages of learning in PBVL, from the students’ perspective. At three separate intervals, 102 undergraduate students enrolled in three different courses wrote down reflections of their experience with PBVL in an online self-administrated reflective journal. Following a data-driven systematic qualitative content analysis of the students’ learning journals, four main themes emerged regarding the learning experience in virtual teams: collaboration, communication, trust, and learning. Based on the results, a three-stage framework for PBVL team dynamics was proposed: Teambuilding–Teamwork–Team performance (TTT) framework. The results show that PBVL favors the development of professional, learning, and personal skills through collaboration.

Temporomandibular disorders (TMDs) are characterized by moderate to severe pain in the masticatory muscles and/or the temporomandibular joint (TMJ). The present study is a part of a multidisciplinary project, initiated by the Norwegian Ministry of Health. The main purpose of this study is to compare a cohort of TMD patients to healthy individuals regarding experimental pain, the degree of disability caused by living with pain and psychometric variables, and to investigate which of these variables is the best predictor for TMD patients. We hypothesised that TMD patients have more disability when living with pain and lower pain thresholds than healthy controls, and those psychometric variables are stronger predictors than pain thresholds provoked by experimental pain. Sixty TMD patients were matched by sex and age to sixty healthy individuals without TMD symptoms or other musculoskeletal symptoms in the head and neck region. All subjects completed a questionnaire that included psychometric characteristics, that is, a one- and two-item version of the Pain Catastrophizing Scale, the Hospital Anxiety and Depression Scale (HADS), and the Roland Morris Scale (RMS), which measures disability when living with pain. They also underwent a clinical examination including the measurement of pain thresholds with electrical and pressure stimuli. The TMD patients had lower pain thresholds for experimental electrical and pressure stimuli compared with the controls (P < 0.05 and <0.001, respectively). They also scored higher than healthy individuals with disability living with pain (P<0.001), anxiety (P<0.001), depression (P<0.001), and catastrophizing (P<0.001). The results for anxiety, depression, and catastrophizing have been published earlier, and the reused data in this study are compared with RMS and pain thresholds. The conditional logistic regression model identified catastrophizing (OR = 2.42, CI 1.22–4.79) as a significant predictor of TMD patients. The results support this hypothesis and indicate that TMD patients have lower pain thresholds and more disability when living with pain compared to healthy individuals, where the strongest prediction for TMD was catastrophizing. Awareness of psychometric disabilities in TMD patients is of importance when considering the choice of treatment.

Temporomandibular disorder (TMD) is characterized by pain and dysfunction in the temporomandibular join (TMJ) and the masticatory apparatus. Associations with autoimmune diseases, inflammatory conditions, and nutrition deficiencies have been reported in previous studies of TMD patients. To evaluate essential proteins, hormones, electrolytes, and vitamins in serum from TMD patients, a standard blood sample analysis was performed in 60 TMD patients and 60 healthy controls matched for age and gender, retrieving 19 different analyses. We found that TMD patients had significantly higher values of hemoglobin (p=0.036), cobalamin (p=0.023), albumin (p=0.005), parathyroid hormone (PTH) (p=0.038), and vitamin D (p=0.005), and significantly lower values of creatinine (p=0.006) and potassium (p=0.011), compared to controls. In the TMD group, most of the determinants had a wider range, and several subjects, compared to the control group, had values outside the normal reference area. However, most of the TMD patients and controls had values within normal biological range. Our findings could not associate any severe systemic disease, malnutrition, or systemic inflammation with the TMD. Results from our study suggest that serum analyses should neither be used as a biomarker of TMD nor a diagnostic tool for an individual subject with TMD.

This study explores the impact of a transnational team-based virtual learning experience on students’ self-perceived learning outcomes. The purpose of this research is to identify students’ self-perceived learning outcomes in virtual classrooms and describe the attributes of team members considered valuable for achieving team goals and learning success. Students who participated in a team-based international joint course across three editions from 2020 to 2022 completed reflective learning journals, which served as data collection research instruments. The researchers utilized a mixed-methods approach, combining quantitative and qualitative methods, along with thematic content analysis, to examine 327 validated source documents. The results revealed that students highly valued the transnational team-based learning activities during the virtual course. Participants highly valued the transnational nature of the course, as it facilitated effective collaboration within international teams and developed cross-cultural understanding skills. The virtual learning environment played a crucial role in enabling cultural exchange and understanding, fostering active participation, and encouraging reflective practice for groups of students from different countries and universities. Additionally, the study emphasized the development of digital skills as students engaged in transnational collaborative online learning using advanced technologies for communication and teamwork across distances. The digital learning environment positively influenced students’ motivation, sense of belonging, and camaraderie. The research identified 16 self- and hetero-identified attributes of team members, deemed valuable by participating students for achieving teamwork goals and learning outcomes. Attributes such as effective communication, collaboration, goal-oriented attitudes, and organizational skills were among the most highly regarded. These findings underscore the importance of transnational team-based virtual learning experiences in preparing students for global labor market demands. The study highlights the significance of fostering collaboration, cultural understanding, and digital literacy skills in educational settings.

To investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD) three years after a Norwegian interdisciplinary evaluation program with attention to patient satisfaction, function, pain, and psychosocial variables. The study population consisted of 60 long-term refractory TMD patients who were investigated by a Norwegian interdisciplinary team. A questionnaire that covered medical history, function, pain, lifestyle factors, TMD-status and follow-up from their general medical practitioner (GMP) was sent to the patients three years after the evaluation. Questionnaires that assessed function (Mandibular Functional Index Questionnaire [MFIQ] and Roland Morrison Scale [RMS]), pain intensity (General Pain Intensity questionnaire [GPI]) and psychosocial factors (Hospital Anxiety and Depression scale [HADS]); a 2-item version of the Coping Strategies Questionnaire [CSQ]) were included in the package. Thirty-nine out of 60 TMD patients completed the questionnaires. Improvements in TMD symptoms were reported in 10 patients (26%), were unchanged in 16 patients (41%) and worsened in 13 patients (33%). Only 8 patients (21%) were satisfied with the follow-up of the suggested treatments from their GMP. Significant improvements of symptoms were noted in MFIQ (jaw function), GPI (including pain intensity at maximum and suffering from pain), and CSQ (pain related catastrophizing), in all 39 TMD patients as one group. However, a subgroup analysis showed that the significant improvements were mostly within patients who reported improvement of TMD symptoms. A high pain intensity at baseline was a significant risk factor .79, 95% CI: 1.34, 24.96) for patients who reported worsening of TMD symptoms at follow-up. High pain intensity at baseline was a significant risk factor for poorer recovery three years after an interdisciplinary evaluation. Our data support the notion that improved coping with TMD pain includes both decreased pain intensity, CSQ and MFIQ scores.

Purpose: To investigate the outcome of patients with long-term refractory temporomandibular disorders (TMD) three years after a Norwegian interdisciplinary evaluation program with attention to patient satisfaction, function, pain, and psychosocial variables. Patients and Methods: The study population consisted of 60 long-term refractory TMD patients who were investigated by a Norwegian interdisciplinary team. A questionnaire that covered medical history, function, pain, lifestyle factors, TMD-status and follow-up from their general medical practitioner (GMP) was sent to the patients three years after the evaluation. Questionnaires that assessed function (Mandibular Functional Index Questionnaire [MFIQ] and Roland Morrison Scale [RMS]), pain intensity (General Pain Intensity questionnaire [GPI]) and psychosocial factors (Hospital Anxiety and Depression scale [HADS]); a 2-item version of the Coping Strategies Questionnaire [CSQ]) were included in the package. Results: Thirty-nine out of 60 TMD patients completed the questionnaires. Improvements in TMD symptoms were reported in 10 patients (26%), were unchanged in 16 patients (41%) and worsened in 13 patients (33%). Only 8 patients (21%) were satisfied with the follow-up of the suggested treatments from their GMP. Significant improvements of symptoms were noted in MFIQ (jaw function), GPI (including pain intensity at maximum and suffering from pain), and CSQ (pain related catastrophizing), in all 39 TMD patients as one group. However, a subgroup analysis showed that the significant improvements were mostly within patients who reported improvement of TMD symptoms. A high pain intensity at baseline was a significant risk factor (OR = 5.79, 95% CI: 1.34, 24.96) for patients who reported worsening of TMD symptoms at follow-up. Conclusion: High pain intensity at baseline was a significant risk factor for poorer recovery three years after an interdisciplinary evaluation. Our data support the notion that improved coping with TMD pain includes both decreased pain intensity, CSQ and MFIQ scores. Keywords: catastrophizing, interdisciplinary, orofacial pain, refractory pain, stress, evaluation

What do people make of places? In the present article, I pursue this question from the perspective of a peculiar polysemy in the definition of places found among the inhabitants of the small Romanian industrial town of Copşa Mică. Copşa Mică suffers conditions so extreme that, analytically speaking, the town can be described as a zone - that is, as a limited area in which the conditions are such that normal limitations do not apply; thus, zone refers to a line that in a way effaces all lines, a boundary that negates all pronounced boundaries. What do we find instead? The local construction of safe ground reaches deeply into various cultural spheres, particularly into a moral order, by which the questions of where to stay and who is where are replaced to a certain extent by who is places - who is entitled to make them count as so different that it makes a difference? As a result, the local surroundings place themselves, so to speak, as contradictions brought to light in polysemous definitions such as: wherever it is safe, it is also exceptionally unsafe.

This research was conducted as a collaborative project between the West University of Timișoara (Romania) and the Norwegian University of Science and Technology (Norway) to develop a transnational learning activity. The students learned in virtual collaborative study groups; developed project-based teams; shared experiences, skills, and professional competencies; and collaborated directly with their teachers, the researchers, and the labor force. Three virtual learning groups of undergraduate students (N = 131), presenting comparable course descriptors and disciplinary group compositions, participated in the study. This study aimed to determine the effects of disciplinary composition on virtual learning group process dynamics from the students’ perspectives. This study applied a quasi-experimental between-subjects study design: quantitative methods were used to validate a research instrument and to determine statistical differences in the group process dynamic between the three groups; a qualitative method was applied to identify an in-depth understanding of the students’ perception about the group learning experience. By analyzing the group dynamics in the three settings—mono-disciplinary, cross-disciplinary, and cross-cultural—the research results show the advantages of each virtual learning composition in the group dynamic and learning outcomes in terms of group skill acquisitions. The conclusions can help teachers design virtual team compositions, a crucial stage in ensuring the achievement of desired learning outcomes.