Effect of prosthetic restoration on masticatory function in patients with shortened dental arches: a multicentre study.

The aim of this multicentre study was to investigate the effect of prosthetic restoration for missing posterior teeth on mastication in patients with shortened dental arches (SDAs). Partially dentate patients who had an intact teeth in anterior region and missed distal molar(s) (2-12 missing occlusal units) classified as Kennedy Class I or Class II were recruited from seven university-based dental hospitals in Japan. Of the 125 subjects who underwent baseline (pre-treatment) and follow-up/post-treatment evaluation, 53 chose no replacement of missing teeth and 72 chose treatment with removable partial dentures (n = 53) or implant-supported fixed partial dentures (n = 19). Objective masticatory performance (MP) was evaluated using a gummy jelly test. Perception of chewing ability (CA) was rated using a food intake questionnaire. In the no-treatment group, mean MP and CA scores at baseline were similar to those at follow-up evaluation (P > 0·05). In the treatment group, mean MP after treatment was significantly greater than the pre-treatment mean MP (P < 0·05). However, the mean perceived CA in the treatment groups was similar at pre- and post-treatment (P > 0·05). In a subgroup analysis of subjects in the treatment group, subjects with lower pre-treatment CA showed a significant CA increase after treatment (P = 0·004), but those with higher pre-treatment CA showed a significant decrease in CA (P = 0·001). These results suggest that prosthetic restoration for SDAs may benefit objective masticatory performance in patients needing replacement of missing posterior teeth, but the benefit in subjective chewing ability seems to be limited in subjects with perceived impairment in chewing ability before treatment.

Effect of prosthetic restoration on oral health-related quality of life in patients with shortened dental arches: a multicentre study.

The aim of this multicentre prospective study was to investigate the effect of prosthetic restoration for missing posterior teeth in patients with shortened dental arches (SDAs). SDA patients with 2-12 missing occlusal units (a pair of occluding premolars corresponds to one unit, and a pair of occluding molars corresponds to two units) were consecutively recruited from seven university-based dental hospitals in Japan. Patients chose no replacement of missing teeth or prosthetic treatment with removable partial dentures (RPDs) or implant-supported fixed partial dentures (IFPDs). Oral health-related quality of life (OHRQoL) was measured using the oral health impact profile (Japanese version - OHIP-J) at baseline and follow-up/post-treatment evaluation. Of the 169 subjects who completed baseline evaluation, 125 subjects (mean age; 63.0 years) received follow-up/post-treatment evaluation. No-treatment was chosen by 42% (53/125) of the subjects, and 58% (72/125) chose treatment with a RPD (n = 53) or an IFPD (n = 19). In the no-treatment (NT) group, the mean OHIP summary score at baseline was similar to that at follow-up evaluation (P = 0.69). In the treatment (TRT) group, the mean OHIP summary score decreased significantly after the RPD treatment (P = 0.002), and it tended to decrease, though not statistically significant (P = 0.18), after the IFPD treatment. The restoration of one occlusal unit was associated with a 1.2-point decrease in OHIP summary score (P = 0.034). These results suggest that the replacement of missing posterior teeth with RPDs or IFPDs improved OHRQoL. Prosthetic restoration for SDAs may benefit OHRQoL in patients needing replacement of missing posterior teeth.

Manometric evaluation of oral function with a hand-held balloon probe.

Tongue pressure measured with a disposable hand-held balloon probe has been used for assessing tongue function; however, no diagnostic standard for assessing other oral functions exists currently. In this study, to develop a method for multifactorial manometric evaluation of oral functions, 20 men and 20 women (21-32 years of age) were instructed to apply 7-s maximal voluntary muscular effort on a hand-held balloon probe placed against the anterior and lateral parts of the palate, buccal surface of the molars on the habitual chewing side and labial surface of the anterior teeth for measuring anterior and posterior tongue, cheek and lip pressures (LPs), respectively. Intra-session reproducibility was determined by three repeated measurements, and associations between the obtained and the conventional data on oral diadochokinesis were tested. The men exhibited higher values of all the pressure types. Further, both genders showed a positive correlation between anterior and posterior tongue pressures (PTPs) (P < 0·05), but only the women exhibited positive correlations between anterior tongue and cheek pressures, cheek and PTPs, anterior tongue and LPs, and cheek and LPs (P < 0·05). No statistically significant correlation was found between the pressures and the number of syllabic articulations, except between LP and the number of /pa/ articulations in the women (r = 0·524, P < 0·05). In conclusion, the balloon probe method enables objective manometric evaluation of oral functions and could be an effective tool for clinical epidemiological studies and evidence-based decision-making in nursing care.

Factors related to prosthetic restoration in patients with shortened dental arches: a multicentre study.

The aim of this study was to identify the factors related to prosthetic restoration in patients with shortened dental arches (SDA). SDA patients with 2-12 missing occlusal units were consecutively enrolled from seven university-based dental hospitals in Japan. Of the 145 subjects (mean age; 63·4 years), 41% chose no treatment and 59% sought to replace their edentulous spaces with removable partial dentures or implant-supported fixed partial dentures. Restoration decisions were related to tooth loss patterns. Only 3% of subjects missing just second molar(s) sought to receive prosthetic treatment, while the percentage increased to 58% in subjects who were missing first and second molars and 93% in subjects missing premolar(s). Logistic regression analyses found that young age, increased number of missing occlusal units, asymmetric arch and presence of chewing complaint were significant predictors for prosthetic restoration (P<0·05). Increased number of missing occlusal units and asymmetric arch were significant predictors for the presence of chewing complaint (P<0·05). These results suggest that perceived impairment of chewing ability owing to missing occlusal units is a critical factor for prosthetic restoration in SDA patients.

Enhanced initial bone regeneration with inorganic polyphosphate-adsorbed hydroxyapatite.

Inorganic polyphosphate (poly(P)) can promote binding between fibroblast growth factors and their receptors and enhance osteoblastic cell differentiation and calcification. This study evaluated the possibilities for poly(P) adsorbed onto interconnected porous calcium hydroxyapatite (IP-CHA) as a new bone regeneration material. Prepared 1%, 5%, 25% and 50% poly(P)/IP-CHA composites showed the elution peak of poly(P) between 15 and 20 min, respectively, with the highest value from 50% poly(P)/IP-CHA in vitro. Histologically, at 1 week of placement into the femur of rabbits, granulation tissue had penetrated into the pores in all composites and IP-CHA as a control. In contrast, at 2 weeks of placement, newly formed lamellar bone was found in all groups, although a higher amount of bone regeneration was obviously formed in the 25% and 50% poly(P)/IP-CHA with a significantly higher value of bone regeneration ratio of 50% poly(P)/IP-CHA. These results indicate that 25% and 50% poly(P)/IP-CHA composites may enhance initial bone regeneration.

Dynamic viscoelastic properties of vinyl polysiloxane denture soft lining materials.

The aim of this study was to investigate the dynamic viscoelastic properties of seven commercially available vinyl polysiloxane denture soft lining materials. Five rectangular specimens (2 x 10 x 30 mm) were prepared from each material. The complex modulus E* (MPa) and loss tangent (tan delta) of each specimen were determined with a non-resonance forced vibration method using an automatic dynamic viscoelastometer at 1 Hz after 1 day of dry storage, and after 1, 30, 60, 90 and 180 days of wet storage at 37 degrees C. All data were analysed using one-way anova and Bonferroni/Dunn's test for multiple comparisons with a significance level of P < 0.01. All materials varied widely in terms of viscoelasticities and showed both an increase in E* and a decrease in tan delta at 1 Hz after the 1-day wet storage. After 60 days of wet storage, both E* and tan delta did not change significantly. The stiffer materials (>30% filler content) with high E* values (>2.00 MPa) showed elastic behaviour with tan delta values of around 0.03. The softer materials (6% filler content) with high tan delta values (initial value > 0.10) showed viscous behaviour and were easily affected by water absorption after the 1-day wet storage. It can be concluded that for the proper selection of vinyl polysiloxane denture soft lining materials, it is very important to evaluate the viscoelastic properties after 60 days of wet storage.

Effect of combined application of bFGF and inorganic polyphosphate on bioactivities of osteoblasts and initial bone regeneration.

Basic fibroblast growth factor (bFGF) and inorganic polyphosphate (poly(P)) have been recognized as therapeutic agents that enhance bone regeneration. It has also been shown that poly(P) may enhance the mitogenic activity of bFGF. The purpose of this study is to evaluate the combined effect of bFGF and poly(P) on bioactivities of osteoblasts and initial bone regeneration in vitro and in vivo. MC3T3-E1 cells were treated with bFGF, poly(P) or bFGF+poly(P), then subjected to cell proliferation assay, alkaline phosphatase (ALP) activity measurement, quantitative real-time reverse transcription-polymerase chain reaction and Alizarin S Red staining. In an in vivo study, bFGF-, poly(P)- and bFGF+poly(P)-modified interconnected porous hydroxyapatite (IPHA) complexes were fabricated, and placed into the femurs of rabbits to evaluate new bone formation histologically and histomorphometrically. The highest enhancement of cell proliferation were observed in those treated with bFGF+poly(P) on days 5 and 7. Cells treated with bFGF+poly(P) also exhibited increased ALP activity on days 5 and 10, up-regulated mRNA levels of osteocalcin and osteopontin, and enhanced calcification when compared to the non-treated cells. In vivo, the highest bone formation ratio was observed in bFGF+poly(P)-modified IPHA complexes. This study indicated that co-application of bFGF and poly(P) may provide enhanced bone formation by modulating cell proliferation and the mineralization process. It is anticipated that a combined application of bFGF and poly(P) can provide a novel method for bone regeneration in clinical use.

Effects of tooth loss and denture wear on tongue-tip motion in elderly dentulous and edentulous people.

The purpose of this study was to clarify quantitatively the differences in tongue-tip motion among the dentulous elderly people and also among the elderly edentulous, both with and without their dentures and, to identify the influence of tooth loss and denture wear on tongue-tip motion. Fourteen young dentulous people, 12 elderly dentulous people and 13 elderly edentulous people participated in this study. Subjects were asked to swallow a 10 mL barium sulfate solution three times. The elderly edentulous people were asked to swallow the solution while wearing dentures and with dentures removed. Functional swallowing was recorded on cine-film with a digital subtraction angiography system. Lateral cinefluorography images were obtained from seated subjects. Using a cine-projector, the movements of the tongue surface were traced as dots and lines frame by frame on a single tracing sheet within a definite period of time from the beginning of the oral phase to the end of the pharyngeal phase. With counting the number of 'trajectories' of tongue-tip motion, tongue movements were classified as 'stable' and 'hyperactive' types. The results was that significantly more 'hyperactive' type subjects were found among the elderly edentulous who were not wearing dentures (12 of 13) compared with the dentulous young (1 of 14), the elderly dentulous (1 of 13) or the elderly edentulous wearing dentures (1 of 13) (P < 0.001). The tongue-tip motion for the 'hyperactive' type was very complex and the tongue-tip anchoring against the palate was always instable.

Patterns of missing occlusal units and oral health-related quality of life in SDA patients.

The aim of this study was to explore the relationship between patterns of missing occlusal units (OUs) and oral health-related quality of life (OHRQoL) in subjects with the shortened dental arches (SDAs). Subjects with SDAs were recruited consecutively for 1 month from six university-based prosthodontic clinics. In total, 115 SDA subjects participated (mean age, 58.5 +/- 10.0 years; 71% female). The location and number of missing teeth were examined and the number of missing OUs was calculated. To evaluate OHRQoL, the Japanese version of the Oral Health Impact Profile (OHIP-J) was administered and the summary score of OHIP-J was calculated. The SDA subjects were categorized depending upon the anterior-posterior lengths of the missing or remaining OUs. Regression analyses were performed to investigate the OHIP-J differences between groups of subjects with various anterior-posterior SDA lengths. The analyses revealed that subjects who only lost the second molar contact exhibited significantly better OHRQoL than those who lost more teeth [coefficient: 11.1, 95% confidence interval (CI): 2.8-19.2, P = 0.02]. Furthermore a statistically significant group difference was observed between the groups with and without the first molar occlusal contact (coefficient: 12.8, 95% CI: 1.4 to 24.1, P = 0.03). In conclusion, although our results are of exploratory nature and need validation, patterns of missing OUs are likely to be related to the OHRQoL impairment in SDA subjects with the presence of first molar contact having a particularly important role.

Effect of saliva on an antimicrobial tissue conditioner containing silver-zeolite.

The purpose of this study was to evaluate the influence of human saliva on the antimicrobial effect of a tissue conditioner containing an antibiotic agent, silver-zeolite. Samples of each tissue conditioner with or without silver-zeolite were prepared and a plastic disk was used as a control. Candida albicans and nosocomial respiratory infection-causing bacteria, Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa and the Streptococcus milleri group (S. constellatus and S. intermedius), were selected as test microorganisms. Antimicrobial effects of samples after water or saliva immersion for 28 days were evaluated by counting the number of viable cells [colony forming unit (CFU)] in each microbial suspension (100 microL). All data were statistically analysed by one-way anova and Bonferroni's test (P < 0.05). The antimicrobial effects of samples with silver-zeolite immersed in saliva against C. albicans, S. aureus and MRSA were observed while CFU of P. aeruginosa indicated no significant difference from that of the control. As for the S. milleri group, its CFU after saliva immersion showed the significantly smaller value than that of the control. It is concluded that the antimicrobial effects of samples containing silver-zeolite against all tested microbes except for P. aeruginosa and the S. milleri group are not influenced by saliva immersion for 28 days.

Action of FGMgCO3Ap-collagen composite in promoting bone formation.

To improve the biological properties of materials as bone substitutes, functionally graded CO3 apatite crystals containing magnesium, FGMgCO3Ap, were synthesized to be mixed with atelocollagen and made into a composite pellet. A radio-labeled cell adhesion experiment showed that the degree of adherence of mouse MC3T3E1 osteoblast-like cells to the FGMgCO3Ap-collagen composite was better than to CO3Ap-collagen and much better than to the Ti plate. When the composites were implanted beneath the periosteum cranii of rats, the FGMgCO3Ap-collagen composite was metabolized faster than the CO3Ap-collagen composite and better formation of new bone and osteoblast arrangement at the interface between the composite and the periosteum cranii was observed. When the composites were implanted into the femur of rabbits, clear bone formation with a higher degree of bone density was observed for the FGMgCO3Ap-collagen composite. These results suggest that the Mg2+ ions taken into the apatite crystals may contribute to the acceleration of osteoblast adhesion to apatites and promote bone formation, cross-talking with osteoblasts at the molecular level.

Handy measurement for tongue motion and coordination with laryngeal elevation at swallowing.

At the oral stage of swallowing, the tongue plays a major role and proper tongue performance is necessary to form the bolus and transfer it to the pharynx. For the present study we built a prototype device for safe and handy objective estimation of tongue motion and coordination with laryngeal elevation at swallowing. The device records tongue pressure by means of two strain gauge pressure transducers aligned 20 mm apart on a brass strap placed along the palatal midline. Laryngeal vibration is recorded with piezo-electric acceleration transducers. Time differences between pressure onset at the anterior and posterior transducers and the first spike from laryngeal vibration are measured. Ten healthy subjects were asked five times to swallow 5 mL of water. Pressure onset at the anterior transducer preceded posterior pressure by 294 +/- 164 ms. Given the distance between the transducers, the tongue contracted (squeezed) at a speed of 93 +/- 60 mm s(-1). Laryngeal vibration occurred 671 +/- 175 ms after the onset of anterior pressure. There was considerable variation in these parameters between subjects. Though the data is limited, the device successfully and easily revealed certain aspects of tongue motion and coordination with laryngeal elevation.

Acid pretreatment of titanium implants.

The purpose of this study was to evaluate the effectiveness of several methods of cleaning titanium surfaces as pretreatment for surface modifications by analyzing the chemical interaction of three acids, such as Na(2)S(2)O(8),H(2)SO(4) and HCl, followed by rinsing with acetone or ultrapure water. Chemical evaluation, using X-ray photoelectron spectroscopy (XPS), and mechanical evaluation, using nanoindentation, were employed. XPS revealed that an untreated Ti surface consisted of carbon- and nitrogen-containing contaminant and titanium oxide layer on metallic titanium substrate. The method involving the combination of 10 N HCl and acetone was the most effective of all the methods investigated. Such a combination most effectively reduced values of contamination parameters C/Ti and N/Ti, as well as the intensity of the titanium oxide component in Ti 2p spectra. Chlorine was barely detected from the surface treated with HCl in any concentration. Sulfur from the residual S(2)O(8)(2-) or SO(4)(2-), however, was detected from the samples treated with either Na(2)S(2)O(8) or H(2)SO(4). The S/Ti values depended on concentration of the acidic solution. In addition, nanoindentation measurements revealed that Young's modulus of the surface treated with 0.1-10 N HCl was not significantly different from that of an untreated surface (p > 0.05). Consequently, the HCl/acetone treatment is proposed as an excellent decontamination method for the surface preparation process of Ti.

A mimic osseointegrated implant model for three-dimensional finite element analysis.

The purpose of this study was to develop a new three-dimensional (3D) mimic model of an osseointegrated implant for finite element analysis (FEA) and to evaluate stress distributions in comparison with a model commonly used in most studies as a control. Based on the 3D computer graphic data obtained by serial in vivo bucco-lingual peri-implant bone structure at 75 microm interval in monkey, a mimic FEA model with trabecular structure and a control model with uniform cancellous bone were constructed. A vertical load of 143 N was applied at the top of the implant and induced stress was evaluated at the peri-implant bone. In the mimic model, stress was distributed at both cortical and cancellous bones (1-5 MPa) in bucco-lingual central planes, but concentrated at the cortical crest (3-7 MPa) in the mesio-distal central plane. In contrast, the control model presented stress concentration at the cortical crest around the implant (5-14 MPa), with less stress (0-1 MPa) at the peri-implant cancellous bone in both planes. The findings, that stress distribution at the peri-implant bone were quite different between the mimic and control models, suggest the need to carefully interpret stress distribution in previous studies with models of uniform cancellous peri-implant bone.

Synthesis of functionally graded MgCO3 apatite accelerating osteoblast adhesion.

As a means of improving the biological properties of materials for use as bone substitutes, functionally graded carbonate apatite containing Mg, FGMgCO3Ap, was synthesized at 60 degrees C and pH 7.4 using a gradient magnesium supply system. X-ray diffraction analysis of FGMgCO3Ap showed a poorly crystallized apatitic pattern, similar to that of human bone. ESCA analysis clearly showed the negative gradient distribution in Mg1s intensity (atomic concentration) of magnesium from the crystal surface toward the inner core. When the FGMgCO3Ap crystals were mixed with collagen, the resulting FGMgCO3Ap-collagen composite, irradiated with UV light for 4 h, retained their features in the saline solution. After washing away the nonadhesive cells, a cell adhesion assay showed that the optical density of the FGMgCO3Ap-collagen composite was higher than that of the CO3Ap-collagen composite. SEM observation showed that the osteoblast-like cells adhered well to the surface of the FGMgCO3Ap-collagen composite. Staining with hematoxylin-eosin and alizarin red confirmed the existence of a great many more cells and a thicker extracellular matrix layer on the FGMgCO3Ap-collagen composite than on the CO3Ap-collagen composite. This result demonstrated the acceleration effect of magnesium ions on osteoblast adhesion on the FGMgCO3Ap-collagen composite.

Forskolin-induced clearance of the fluorescent dye sulforhodamine from rat parotid intralobular duct lumen: visualization of the secretory function under a confocal laser scanning microscope.

Cyclic AMP evokes fluid secretion with bicarbonate in exocrine ducts. Clearance of fluorescent dyes from rat parotid intralobular ducts by forskolin was visualized as a fluorescence change in the duct luminal space by optical sectioning under a confocal laser scanning microscope to clarify the secretory function in the ducts. When the isolated rat parotid intralobular duct segments were superfused with membrane-impermeable fluorescent dyes during the experimental period, fluorescent dyes were passively moved into the duct space. Forskolin and isobutylmethylxanthine decreased the fluorescence of anionic dye, sulforhodamine B, and neutral dye, dextran tetramethyl-rhodamine, in the duct space, suggesting that the forskolin-induced clearance of fluorescent dyes might be the result of fluid secretion in the ducts. Methazolamide inhibited a forskolin-induced sustained decrease in duct fluorescence and intracellular acidification. Low concentrations of external Cl?, DIDS, bumetanide and amiloride did not markedly inhibit a forskolin-induced decrease in duct fluorescence. These findings suggest that a major portion of the steady decrease in duct fluorescence by forskolin was related to intracellular HCO3? production, not the uptake mechanism of external Cl?. Glibenclamide, NPPB, DPC and DMA inhibited the forskolin-induced decrease. Forskolin evokes the clearance of fluorescent dyes from duct space possibly due to fluid secretion in rat parotid ducts, associated with secretion through CFTR and DPC-sensitive anion channels of carbonic anhydrase-dependent bicarbonate linked with the Na+/H+ exchange mechanism.

[Oral care reduces pneumonia of elderly patients in nursing homes, irrespective of dentate or edentate status].

Aspiration of oral secretions and their bacteria, especially gram-negative bacilli, is increasingly being recognized as an important factor in pneumonia. We investigated whether oral care reduces the frequency of pneumonia in the institutionalized elderly. Nurses or caregivers cleaned patients' teeth with toothbrushes after each meal, and scrubbed the oropharynx with an applicator with povidone iodine (1%) every day. Dentists or dental hygienists gave professional care once a week. During follow up, pneumonia decreased significantly in patients with oral care. Oral care was of benefit for both edentate as well as dentate subjects, although periodontal diseases might cause pneumonia. We suggest that oral care may be useful in preventing pneumonia in institutionalized elderly, irrespective of dentate or edentate status.

Another anti-allergic mechanism: antibody IgE deglycosylation induced by a substance extracted from human urine.

Enzymically-deglycosylated antibody IgE lost its allergic activity in mouse systemic anaphylaxis, though the IgE kept its antibody activity. IgE antibody obtained from mice treated with a substance extracted from human urine was deglycosylated. This IgE also lost the allergic activity on the systemic anaphylaxis but kept its antibody activity. These findings strongly suggest that glycosylation of IgE has a close relation to the binding of the Fc receptor and that humans have another antiallergic mechanism: in vivo IgE antibody deglycosylation induced by the substance.

Extremely high drug-reductase activity based on aldehyde oxidase in monkey liver.

Drug-reducing ability of monkey liver cytosol was examined in this study. Monkey liver cytosol exhibited significant reductase activities toward zonisamide, sulindac and imipramine N-oxide in the presence of 2-hydroxypyrimidine or benzaldehyde, an electron donor to aldehyde oxidase. These activities were abolished by inhibitors of aldehyde oxidase, such as menadione. These reductase activities in monkeys were extremely high compared to those in other animals. The zonisamide reductase activity of monkey liver cytosol was about 40-fold higher than that of the liver microsomes. It appears that the high levels of aldehyde oxidase exists in monkey liver, and zonisamide, sulindac and imipramine N-oxide are mainly reduced by this enzyme, not by cytochrome P450.

An in vitro wear study of posterior denture tooth materials on human enamel.

This in vitro study evaluated the wear effects of five posterior denture tooth materials on human enamel. The tooth specimen was cusp shaped and enamel specimen was formed as a 10 C 10 C 5 mm plate. All material-enamel combinations were tested using a machine designed to produce sliding contact 20 C 104 times at 60 cycles min-1 and a 4-mm sliding distance per stroke in the bucco-lingual direction under a load of 1 kg. Wear analysis was measured as the total height loss of each combination. In addition, the surface roughness (Ra) of each worn specimen was also evaluated. The least total height loss occurred with poly (methyl methacrylate) (PMMA) enamel pair, and the greatest did with porcelain (Po)-enamel pair. The lowest compound Ra value was measured in high-strength resin (HR)-enamel pair, and the highest in Po-enamel pair. These findings suggest that the best combination is PMMA-enamel, and the poorest combination is Po-enamel.