The US Army Dental and Trauma Research Detachment: now part of the army institute of surgical research.
Subject: Dental care (Utilization)
Dental care (Services)
Dental research
Authors: Mellus, Davin E.
Amaya, Jacqueline
Pub Date: 01/01/2011
Publication: Name: U.S. Army Medical Department Journal Publisher: U.S. Army Medical Department Center & School Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2011 U.S. Army Medical Department Center & School ISSN: 1524-0436
Issue: Date: Jan-March, 2011
Topic: Event Code: 220 Strategy & planning; 360 Services information
Product: Product Code: 8000280 Dental Research; 9105215 Military Health Services NAICS Code: 54171 Research and Development in the Physical, Engineering, and Life Sciences; 92312 Administration of Public Health Programs
Organization: Government Agency: United States. Army. Medical Department; United States. Army. Medical Department
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 253627602
Full Text: The US Army Dental and Trauma Research Detachment (DTRD) has relocated from the Naval Training Center, Great Lakes, Illinois, to Fort Sam Houston, Texas. This move, completed in August 2010, marks a new era in military dental research. Not only are the location and research buildings new, but the entire DTRD research program is new and redefined to reflect new opportunities to collaborate with scientists and clinicians collocated at the Department of Defense's largest medical research campus.

In accordance with 2005 Base Closure and Realignment Committee action, all combat casualty care military research units, less neuroprotection, are now collocated on the Battlefield Health and Trauma Research Institute (BHT) on the campus of Brooke Army Medical Center in San Antonio. The BHT includes the Army Institute of Surgical Research (ISR), the Naval Medical Research Unit, San Antonio, and the US Air Force Dental Evaluation and Consultation Service. The DTRD, once a detachment of Walter Reid Army Institute of Research, is now aligned under the ISR, the surgical research unit of Army Medical Research and Material Command (MRMC).

The DTRD, a detachment of Dental Corps officers assigned to MRMC, provides militarily-relevant research and solutions to diseases and injuries to the teeth and craniomaxillofacial region. It is comprised of approximately 40 personnel, including officers, enlisted specialists, and civilians. Professional specialties include oral and maxillofacial surgeons, periodontists, dental public health, comprehensive dentists, prosthodontists, microbiologists, physiologists, cell biologists, chemists, and microscopists. Assigned enlisted personnel reflect diverse military occupational skills, including dental, operating room, animal care, and laboratory technicians.

The collocation of combat casualty care research units at the Battlefield Health and Trauma Research Institute creates a robust environment for researchers and clinicians to collaborate, developing better ways to treat battle injuries and diseases of service members.

MISSION AND VISION

In addition to a renewed research program, DTRD redefined its mission to provide militarily-relevant research and solutions for the prevention, treatment, and rehabilitation of craniofacial trauma and infectious dental diseases. DTRD's mission is the provision of world-class solutions in prevention, treatment, and rehabilitation of Warfighters with craniofacial trauma and infectious dental disease, and contributing expertise across the spectrum of combat casualty care. To meet those goals, DTRD research focuses on 3 areas: biofilm-induced dental disease (and wound impairment), craniomaxillofacial regenerative medicine, and mitigation of facial burns and scars.

DTRD's research mission receives strong support and collaboration from the ISR Extremity/Regenerative Medicine and Burn researchers, as well as newly collocated combat casualty care research units of the Navy and Air Force. To forge strong research relationships, DTRD's Research Steering Committee includes DTRD leadership, members of the ISR's extremity research team, and members of both Navy and Air Force dental research teams. Leaders from academia and the biomedical research industry also hold positions on the committee.

The BHT consists of 2 state-of-the-science research buildings, including a newly completed 150,000 sq ft building. DTRD, along with the dental research elements of the Navy and Air Force, occupies the first floor of this new building, designated BHT-2. The BHT also houses a 50,000 sq ft vivarium allowing scientists to perform critical experiments in order to translate research into improvements in combat casualty care.

BIOFILM RESEARCH

No scientific advancements in work by DTRD at the Great Lakes location were lost in the transition to San Antonio. For example, following relocation, the research in the treatment and prevention of biofilm dental disease, a disease which accounts for 20% of sick call cases in the combat zone, achieved approval by MRMC's Decision Gate Board to receive $3.8 million for the manufacture of antiplaque chewing gum, a drug delivery device, in preparation for Food and Drug Administration clinical trials.

BONE REGENERATION

According to the Joint Theater Trauma Registry (JTTR) data, 26% of battle injuries are to the maxillofacial region, which often includes jaw fractures. (1) Resultant bone and dentoalveolar defects common after severe and comminuted fractures are difficult to reconstruct without lengthy, invasive multi-staged procedures involving bone graft harvests. Before dental implants can return the jaws to full function, reconstruction must precisely position the implant supporting bone to the opposing dental arch, a requirement seldom achieved without surgical revisions. Aggravating reconstruction of major defects is a frequent complication and wound healing problems are accepted as unavoidable consequences of jaw reconstruction using conventional techniques and biomaterials. The DTRD, in collaboration with ISR's extremity research group, directly addresses the shortfalls of conventional techniques and biomaterials in reconstructing bone defects.

Using a novel flowable biomaterial, DTRD now performs research on critical size defects in animals to tune the biomaterial's characteristics for optimal bone regeneration. The flowable nature of the biomaterial promises to allow the surgeon to reconstruct bone defects through minimally invasive surgical procedures, manipulating the biomaterial as it sets into the proper shape and orientation to the opposing dental arch. Continued success of this bone regeneration research elevates the standard of care in jaw reconstruction by achieving better clinical results through fewer and less invasive surgeries.

FACIAL BURNS AND SCARS

Another major thrust of DTRD research is to mitigate the consequences of severe facial burns and scars. According to JTTR data, facial burns occur in 77% of all burned service members who are evacuated from the combat theater. (2) Severe facial burns and scars often lead to contractures and hypertrophic scars which are especially problematic to the eyelids, nostrils, and mouth. The effect to the injured service member is lifelong microstomia, lip incompetence, ectropion, and facial disfigurement, conditions all important to the dental profession.

Improvement over conventional care of facial burns and scars includes strategies to modulate inflammation and comprehensively reconstruct the wound through advanced regenerative medicine and tissue engineering technologies. To deploy these technologies, DTRD is collaborating with bioengineers at University of Texas, Arlington, to develop an in situ bioreactor in the form of a custom, multifunctional polymer-based mask. The basic concept of this "biomask" is to optimize the burn wound bed, modulate excessive inflammation, and tissue-engineer all layers of the skin sequentially under a protective mask that enhances tissue engraftment. Development will take many years, but, if successful, the biomask will represent a paradigm shift in facial burn management.

Over the short time since DTRD arrived in San Antonio, the collocation of combat casualty care research has already proved to be a successful strategy. Located on the campus of a major medical center, DTRD's research and development of devices, therapeutic agents, and techniques to treat and rehabilitate craniomaxillofacial trauma and prevent infectious dental disease has been given a new focus. DTRD's new home fosters continuous, direct, and personal contacts with BHT researchers, enriching the process of exchanging ideas and technologies. The net result is acceleration of new biomedical technologies to return the Wounded Warrior to full function and a normal life.

References

(1.) Lew TA, Walker JA, Wenke JC, Blackbourne LH, Hale RG. Characterization of craniomaxillofacial battle injuries sustained by United States service members in the current conflicts of Iraq and Afghanistan. J Oral Maxillofac Surg. 2010;68(1):3-7.

(2.) Kauvar DS, Wolf SE, Wade CE, Cancio LC, Renz EM, Holcomb JB. Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom. Burns. 2006;32(7):853-857.

MAJ Davin E. Mellus, DC, USA

Jacqueline Amaya

MAJ Mellus is Chief, Oral and Maxillofacial Surgery, Cranio-Maxillo-Facial Surgery Section, US Army Dental and Trauma Research Detachment, US Army Institute of Surgical Research, Fort Sam Houston, Texas.

Ms Amaya is the Administrative Officer, US Army Dental and Trauma Research Detachment, US Army Institute of Surgical Research, Fort Sam Houston, Texas.
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