Trabecular Bone Component Assessment under Orthodontic Loads and Movements during Periodontal Breakdown-A Finite Elements Analysis.

This numerical analysis, by employing Tresca and Von Mises failure criteria, assessed the biomechanical behavior of a trabecular bone component subjected to 0.6, 1.2, and 2.4 N orthodontic forces under five movements (intrusion, extrusion, tipping, rotation, and translation) and during a gradual horizontal periodontal breakdown (0-8 mm). Additionally, they assessed the changes produced by bone loss, and the ischemic and resorptive risks. The analysis employed eighty-one models of nine patients in 405 simulations. Both failure criteria showed similar qualitative results, with Tresca being quantitatively higher by 1.09-1.21. No qualitative differences were seen between the three orthodontic loads. Quantitatively, a doubling (1.2 N) and quadrupling (2.4 N) were visible when compared to 0.6 N. Rotation and translation followed by tipping are the most stressful, especially for a reduced periodontium, prone to higher ischemic and resorptive risks. In an intact periodontium, 1.2 N can be safely applied but only in a reduced periodontium for extrusion and intrusion. More than 0.6 N is prone to increasing ischemic and resorptive risks for the other three movements. In an intact periodontium, stress spreads in the entire trabecular structure. In a reduced periodontium, stress concentrates (after a 4 mm loss-marker for the stress change distribution) and increases around the cervical third of the remaining alveolar socket.

Case Report of a 4-Year-Old Girl with Stage IV Grade C Localized Periodontitis (Pre-Puberal Localized Aggressive Periodontitis) Affected by Misrecognition and Late Diagnosis.

BACKGROUND AND OBJECTIVES: Stage IV grade C localized periodontitis (pre-puberal localized aggressive periodontitis/LPP) is a rare form of inflammatory periodontal disease occurring in clinically healthy individuals (no/small calculus/dental plaque traces), due a hyper-aggressive auto-immune response to high amounts of bacteria present in the oral cavity. CASE PRESENTATION: This case report describes a 4-year-old Caucasian girl with localized gingival inflammation and advanced bone loss around the temporary lower left canine. The first diagnostic assumption was hypophosphatasia, and the patient was sent for further genetic and metabolic investigations (which turned out to be negative). The LPP diagnosis was made during the family's summer holidays due to her parents' concerns about persistent gingival inflammation and tooth mobility. RESULTS: The diagnosis of LPP was supported by clinical oral examination results, earlier X-rays, earlier blood tests, and a periodontal bacterial test. The treatment was limited to avoid spreading inflammation to other teeth (via topical antibiotic treatment) due to our limited time frame, while the main problem of excessive amounts of periodontal bacteria in the oral cavity was not addressed. The tooth was eventually lost. CONCLUSIONS: The ability to early recognize radiological and clinical LPP signs correlated with understanding of its pathological auto-immune mechanism is extremely important for expanding treatment options, since bone preservation and reducing amounts of bacteria are strictly correlated with therapeutic speed.

Effects of Increasing the Orthodontic Forces over Cortical and Trabecular Bone during Periodontal Breakdown-A Finite Elements Analysis.

Background and Objectives: Herein we used numerical analysis to study different biomechanical behaviors of mandibular bone subjected to 0.6 N, 1.2 N, and 2.4 N orthodontic loads during 0-8 mm periodontal breakdown using the Tresca failure criterion. Additionally, correlations with earlier FEA reports found potential ischemic and resorptive risks. Materials and Methods: Eighty-one models (nine patients) and 243 simulations (intrusion, extrusion, rotation, tipping, and translation) were analyzed. Results: Intrusion and extrusion displayed after 4 mm bone loss showed extended stress display in the apical and middle third alveolar sockets, showing higher ischemic and resorptive risks for 0.6 N. Rotation, translation, and tipping displayed the highest stress amounts, and cervical-third stress with higher ischemic and resorptive risks after 4 mm loss for 0.6 N. Conclusions: Quantitatively, rotation, translation, and tipping are the most stressful movements. All three applied forces produced similar stress-display areas for all movements and bone levels. The stress doubled for 1.2 N and quadrupled for 2.4 N when compared with 0.6 N. The differences between the three loads consisted of the stress amounts displayed in color-coded areas, while their location and extension remained constant. Since the MHP was exceeded, a reduction in the applied force to under 0.6 N (after 4 mm of bone loss) is recommended for reducing ischemic and resorptive risks. The stress-display pattern correlated with horizontal periodontal-breakdown simulations.

Orthodontic Internal Resorption Assessment in Periodontal Breakdown-A Finite Elements Analysis (Part II).

This finite elements analysis (FEA) assessed the accuracy of maximum shear stress criteria (Tresca) in the study of orthodontic internal surface resorption and the absorption-dissipation ability of dental tissues. The present study was conducted over eighty-one models totaling 324 simulations with various bone loss levels (0-8 mm), where 0.6 N and 1.2 N were applied in the intrusion, extrusion, rotation, tipping, and translation movements. Tresca criteria displayed localized high-stress areas prone to resorption for all situations, better visible in the dentine component. The internal resorptive risks are less than external ones, seeming to increase with the progression of the periodontal breakdown, especially after 4 mm. The internal and external surface high-stress areas are strictly correlated. The qualitative stress display for both forces was almost similar. The rotation and tipping displayed the highest resorptive risks for the pulp chamber, decreasing with bone loss. The resorptive risks seem to increase along with the progression of periodontal breakdown if the same applied force is kept. The dentine resemblance to ductile based on its high absorption-dissipation ability seems correct. Tresca seems to supply a better predictability of the prone-to-resorption areas than the other failure criteria.

Cortical and Trabecular Bone Stress Assessment during Periodontal Breakdown-A Comparative Finite Element Analysis of Multiple Failure Criteria.

Background and Objectives: This numerical analysis investigated the biomechanical behavior of the mandibular bone as a structure subjected to 0.5 N of orthodontic force during periodontal breakdown. Additionally, the suitability of the five most used failure criteria (Von Mises (VM), Tresca (T), maximum principal (S1), minimum principal (S3), and hydrostatic pressure (HP)) for the study of bone was assessed, and a single criterion was identified for the study of teeth and the surrounding periodontium (by performing correlations with other FEA studies). Materials and Methods: The finite element analysis (FEA) employed 405 simulations over eighty-one mandibular models with variable levels of bone loss (0-8 mm) and five orthodontic movements (intrusion, extrusion, tipping, rotation, and translation). For the numerical analysis of bone, the ductile failure criteria are suitable (T and VM are adequate for the study of bone), with Tresca being more suited. S1, S3, and HP criteria, due to their distinctive design dedicated to brittle materials and liquids/gas, only occasionally correctly described the bone stress distribution. Results: Only T and VM displayed a coherent and correlated gradual stress increase pattern for all five movements and levels of the periodontal breakdown. The quantitative values provided by T and VM were the highest (for each movement and level of bone loss) among all five criteria. The MHP (maximum physiological hydrostatic pressure) was exceeded in all simulations since the mandibular bone is anatomically less vascularized, and the ischemic risks are reduced. Only T and VM displayed a correlated (both qualitative and quantitative) stress increase for all five movements. Both T and VM displayed rotation and translation, closely followed by tipping, as stressful movements, while intrusion and extrusion were less stressful for the mandibular bone. Conclusions: Based on correlations with earlier numerical studies on the same models and boundary conditions, T seems better suited as a single unitary failure criterion for the study of teeth and the surrounding periodontium.

Assessment of the Orthodontic External Resorption in Periodontal Breakdown-A Finite Elements Analysis (Part I).

This Finite Elements Analysis (FEA) assessed the accuracy of Tresca failure criteria (maximum shear stress) for the study of external root resorption. Additionally, the tooth absorption-dissipation ability was assessed. Overall, 81 models of the second mandibular premolar, out of a total of 324 simulations, were involved. Five orthodontic movements (intrusion, extrusion, rotation, translation, and tipping) were simulated under 0.6 N and 1.2 N in a horizontal progressive periodontal breakdown simulation of 0-8 mm. In all simulations, Tresca criteria accurately displayed the localized areas of maximum stress prone to external resorption risks, seeming to be adequate for the study of the resorptive process. The localized areas were better displayed in the radicular dentine-cementum component than in the entire tooth structure. The rotation and translation seem prone to a higher risk of external root resorption after 4 mm of loss. The resorptive risks seem to increase along with the progression of periodontal breakdown if the same amount of applied force is guarded. The localized resorption-prone areas follow the progression of bone loss. The two light forces displayed similar extensions of maximum stress areas. The stress displayed in the coronal dentine decreases along with the progression of bone loss. The absorption-dissipation ability of the tooth is about 87.99-97.99% of the stress.

Finite Elements Analysis of Tooth-A Comparative Analysis of Multiple Failure Criteria.

Herein Finite elements analysis (FEA) study assesses the adequacy and accuracy of five failure criteria (Von Mises (VM), Tresca, maximum principal (S1), minimum principal (S3), and Hydrostatic pressure) for the study of tooth as a structure (made of enamel, dentin, and cement), along with its stress absorption-dissipation ability. Eighty-one 3D models of the second lower premolar (with intact and 1-8 mm reduced periodontium) were subjected to five orthodontic forces (intrusion, extrusion, tipping, rotation, and translation) of 0.5 N (approx. 50 gf) (in a total of 405 FEA simulations). Only the Tresca and VM criteria showed biomechanically correct stress display during the 0-8 mm periodontal breakdown simulation, while the other three showed various unusual biomechanical stress display. All five failure criteria displayed comparable quantitative stress results (with Tresca and VM producing the highest of all), showing the rotational and translational movements to produce the highest amount of stress, while intrusion and extrusion, the lowest. The tooth structure absorbed and dissipated most of the stress produced by the orthodontic loads (from a total of 0.5 N/50 gf only 0.125 N/12.5 gf reached PDL and 0.01 N/1 gf the pulp and NVB). The Tresca criterion seems to be more accurate than Von Mises for the study of tooth as structure.

Recent Trends in Hydroxyapatite Supplementation for Osteoregenerative Purposes.

Bone regeneration has gained attention in the biomedical field, which has led to the development of materials and synthesis methods meant to improve osseointegration and cellular bone activity. The properties of hydroxyapatite, a type of calcium phosphate, have been researched to determine its advantages for bone tissue engineering, particularly its biocompatibility and ability to interact with bone cells. Recently, the advantages of utilizing nanomolecules of hydroxyapatite, combined with various substances, in order to enhance and combine their characteristics, have been reported in the literature. This review will outline the cellular and molecular roles of hydroxypatite, its interactions with bone cells, and its nano-combinations with various ions and natural products and their effects on bone growth, development, and bone repair.

Assessment of the Maximum Amount of Orthodontic Force for PDL in Intact and Reduced Periodontium (Part I).

This study examines 0.6 N and 1.2 N as the maximum orthodontic force for periodontal ligament (PDL) at multiple levels of periodontal breakdown, and the relationships with the ischemic, necrotic, and resorptive risks. Additionally, this study evaluates if Tresca failure criteria is more adequate for the PDL study. Eighty-one 3D models (from nine patients; nine models/patients) with the 2nd lower premolar and different degrees of bone loss (0-8 mm) where subjected to intrusion, extrusion, rotation, translation, and tipping movements. Tresca shear stress was assessed individually for each movement and bone loss level. Rotation and translation produced the highest PDL stresses, while intrusion and extrusion determined the lowest. Apical and middle third PDL stresses were lower than the cervical stress. In intact periodontium, the amount of shear stress produced by the two investigated forces was lower than the 16 KPa of the maximum physiological hydrostatic pressure (MHP). In reduced periodontium (1-8 mm tissue loss), the apical amount of PDL shear stress was lower than MHP for both applied forces, while cervically for rotation, translation and tipping movements exceeded 16 KPa. Additionally, 1.2 N could be used in intact periodontium (i.e., without risks) and for the reduced periodontium only in the apical and middle third of PDL up to 8 mm of bone loss. However, for avoiding any resorptive risks, in the cervical third of PDL, the rotation, translation, and tipping movements require less than 0.2-0.4 N of force after 4 mm of loss. Tresca seems to be more adequate for the study of PDL than other criteria.

Assessment of the Maximum Amount of Orthodontic Force for Dental Pulp and Apical Neuro-Vascular Bundle in Intact and Reduced Periodontium on Bicuspids (Part II).

This study examines 0.6 N-4.8 N as the maximum orthodontic force to be applied to dental pulp and apical NVB on intact and 1-8 mm reduced periodontal-ligament (PDL), in connection with movement and ischemic, necrotic and resorptive risk. In addition, it examines whether the Tresca finite-element-analysis (FEA) criterion is more adequate for the examination of dental pulp and its apical NVB. Eighty-one (nine patients, with nine models for each patient) anatomically correct models of the periodontium, with the second lower-premolar reconstructed with its apical NVB and dental pulp were assembled, based on X-ray CBCT (cone-beam-computed-tomography) examinations and subjected to 0.6 N, 1.2 N, 2.4 N and 4.8 N of intrusion, extrusion, translation, rotation, and tipping. The Tresca failure criterion was applied, and the shear stress was assessed. Forces of 0.6 N, 1.2 N, and 2.4 N had negligible effects on apical NVB and dental pulp up to 8 mm of periodontal breakdown. A force of 4.8 N was safely applied to apical NVB on the intact periodontium only. Rotation and tipping seemed to be the most invasive movements for the apical NVB. For the dental pulp, only the translation and rotation movements seemed to display a particular risk of ischemia, necrosis, and internal orthodontic-resorption for both coronal (0-8 mm of loss) and radicular pulp (4-8 mm of loss), despite the amount of stress being lower than the MHP. The Tresca failure criterion seems more suitable than other criteria for apical NVB and dental pulp.

Assessment of the Best FEA Failure Criteria (Part II): Investigation of the Biomechanical Behavior of Dental Pulp and Apical-Neuro-Vascular Bundle in Intact and Reduced Periodontium.

The aim of this study was to biomechanically assess the behavior of apical neuro-vascular bundles (NVB) and dental pulp employing Tresca, Von Mises, Pressure, S1 and S3 failure criterions in a gradual periodontal breakdown under orthodontic movements. Additionally, it was to assess the accuracy of failure criteria, correlation with the maximum hydrostatic pressure (MHP), and the amount of force safe for reduced periodontium. Based on cone-beam computed tomography, 81 3D models of the second lower premolar were subjected to 0.5 N of intrusion, extrusion, rotation, tipping, and translation. A Finite Elements Analysis (FEA) was performed. In intact and reduced periodontium apical NVB, stress (predominant in all criteria) was significantly higher than dental pulp stress, but lower than MHP. VM and Tresca displayed identical results, with added pulpal stress in translation and rotation. S1, S3 and Pressure showed stress in the apical NVB area. 0.5 N seems safe up to 8 mm periodontal breakdown. A clear difference between failure criteria for dental pulp and apical NVB cannot be proved based only on the correlation quantitative results-MHP. Tresca and VM (adequate for ductile materials) showed equivalent results with the lowest amounts of stress. The employed failure criteria must be selected based on the type of material to be analyzed.

Assessment of the Best FEA Failure Criteria (Part I): Investigation of the Biomechanical Behavior of PDL in Intact and Reduced Periodontium.

The accuracy of five failure criterions employed in the study of periodontal ligaments (PDL) during periodontal breakdown under orthodontic movements was assessed. Based on cone-beam computed tomography (CBCT) examinations, nine 3D models of the second lower premolar with intact periodontium were created and individually subjected to various levels of horizontal bone loss. 0.5 N of intrusion, extrusion, rotation, tipping, and translation was applied. A finite Elements Analysis (FEA) was performed, and stresses were quantitatively and qualitatively analyzed. In intact periodontium, Tresca and Von Mises (VM) stresses were lower than maximum physiological hydrostatic pressure (MHP), while maximum principal stress S1, minimum principal stress S3, and pressure were higher. In reduced periodontium, Tresca and VM stresses were lower than MHP for intrusion, extrusion, and the apical third of the periodontal ligament for the other movements. 0.5 N of rotation, translation and tipping induced cervical third stress exceeding MHP. Only Tresca (quantitatively more accurate) and VM are adequate for the study of PDL (resemblance to ductile), being qualitatively similar. A 0.5 N force seems safe in the intact periodontium, and for intrusion and extrusion up to 8 mm bone loss. The amount of force should be reduced to 0.1-0.2 N for rotation, 0.15-0.3 N for translation and 0.2-0.4 N for tipping in 4-8 mm periodontal breakdown. S1, S3, and pressure criteria provided only qualitative results.

Psychometric Properties of Scared-C Scale in a Romanian Community Sample and Its Future Utility for Dental Practice.

The psychological management of children and adolescents in need of pedodontics or orthodontic treatments continues to be an essential objective in dental activity because along with the accuracy of the techniques that are used, anxiety reduction, and knowledge of how to approach the patient are necessary for the treatment to be successful. Therefore, our study aimed to validate the Screen for Child Anxiety Related Emotional Disorders questionnaire, the child version of 41 items (SCARED-C) in the Romanian population for later use in pediatric dentistry. The instrument showed moderate to good internal consistency (α Cronbach from 0.63 to 0.91 for the total scale) and good test-retest reliability (0.70) on a subset of a sample comprising 85 children. A confirmatory factorial analysis (CFA) was conducted to test the factor structure of the Romanian version of the SCARED-C; the results showed that SCARED-C has good psychometric properties that can be used for screening anxiety in Romanian children and adolescents. The implications of using the SCARED-C in dental practice are discussed. Future studies need to be conducted to explore the convergent and discriminative validity of the instrument and its sensitivity to current DSM-V criteria. Application on a pediatric dental sample is also required.

Accuracy of Three-Dimensional (3D) Printed Dental Digital Models Generated with Three Types of Resin Polymers by Extra-Oral Optical Scanning.

Digital impression devices are used alternatively to conventional impression techniques and materials. The aim of this study was to evaluate the precision of extraoral digitalization of three types of photosensitive resin polymers used for 3D printing with the aid of a digital extraoral optical scanner. The alignment of the scans was performed by a standard best-fit alignment. Trueness and precision were used to evaluate the models. The trueness was evaluated by using bias as a measure and the standard deviation was used to evaluate the precision. After assessing the normality of the distributions, an independent Kruskal-Wallis test was used to compare the trueness and precision across the material groups. The Mann-Whitney test was used as a post-hoc test for significant differences. The result of the analysis showed significant differences (U = 66, z = -2.337, p = 0.019) in trueness of mesiodistal distances. Upon visual inspection of the models, defects were noticed on two out of nine of the models printed with a photosensitive polymer. The defects were presented as cavities caused by air bubbles and were also reflected in the scans. Mean precision did not vary too much between these three photosensitive polymer resins, therefore, the selection of 3D printing materials should be based on the trueness and the required precision of the clinical purpose of the model.

The effect of rotation upon dental structure components following orthodontic fix appliance.

BACKGROUND AND AIMS: The purpose of the study is to evaluate through a FEM (Finite Element Method) the effects of the rotation movement upon a complex structure (enamel- pulp -alveolar bone, PDL), for external load. METHOD: The progressive action of a fixed orthodontic device on three teeth: first molar, first and second premolar is modeled and simulated with the components placed on the buccal and palatal surfaces of the tooth. For the reproduction of a situation similar to the real one, the loading of the model was performed through a nodal force applied at a height of the crown, of various amplitudes, F = 1 N; 2, 3 and 4 N. The values of stress are: maximum stress of the whole structure and the shearing effect for the pulp. RESULTS: The characteristics of the material are Young's E modulus and Poisson's ratio of the components of the modeled structure. The most stressed elements of the structure are the pulp and the ligament, revealed by von Mises stress. The elements of the structure are mainly stressed in fiber compression in the direction of the moment's action given by the orthodontic forces and in fiber stretching in the opposite direction. Out of the orthodontic movements: translation, tipping, intrusion-extrusion, rotation is the most dangerous. CONCLUSIONS: The accumulated stress effect in the pulp becomes dangerous. The orthodontic movements given by dental force values higher than 1.5-2N are to be avoided.

Orthodontic tooth movement following analgesic treatment with Aspirin and Algocalmin. An experimental study.

The objective of this study was the tracing of the effect of Aspirin and Algocalmin, two of the most frequently used analgesics after the application of orthodontic appliances, on the dental displacements, starting from the hypothesis according to whom any substance that inhibits prostaglandins' production will have as result the inhibition of the osteoclasts' activity and of the orthodontic tooth movements implicit. Twenty-four male Wistar rats, separated into three groups were used. Group I (control) included eight rats in which the orthodontic device was applied, without a subsequent administration of any analgesic; Group II - eight rats in which after the device application Aspirin was administrated; and Group III - eight animals in which Algocalmin was administrated. A histological study was completed in order to establish the size of bone areola. Average mesial displacement of the first left inferior maxillary molar 28 days after applying the orthodontic device was of 3.61±0.29 mm for the control group. The average displacement in the group in which Aspirin was administrated was 0.03 mm. In the group treated with Algocalmin, the dental displacement was of 0.19±0.08 mm. Histological examination revealed the presence of large sizes bone areola in control group (244 µm), more reduced in the group treated with Aspirin (74 µm), and intermediate in that treated with Algocalmin (127 µm). Treatments with Aspirin and Algocalmin in experimental groups, immediately after the orthodontic device application, induced a decreased dental displacement rate.