Group 5 ITI Consensus Report: Digital technologies.

OBJECTIVES: Working Group 5 was assigned the task to review the current knowledge in the area of digital technologies. Focused questions on accuracy of linear measurements when using CBCT, digital vs. conventional implant planning, using digital vs. conventional impressions and assessing the accuracy of static computer-aided implant surgery (s-CAIS) and patient-related outcome measurements when using s-CAIS were addressed. MATERIALS AND METHODS: The literature was systematically searched, and in total, 232 articles were selected and critically reviewed following PRISMA guidelines. Four systematic reviews were produced in the four subject areas and amply discussed in the group. After emendation, they were presented to the plenary where after further modification, they were accepted. RESULTS: Static computer-aided surgery (s-CAIS), in terms of pain & discomfort, economics and intraoperative complications, is beneficial compared with conventional implant surgery. When using s-CAIS in partially edentulous cases, a higher level of accuracy can be achieved when compared to fully edentulous cases. When using an intraoral scanner in edentulous cases, the results are dependent on the protocol that has been followed. The accuracy of measurements on CBCT scans is software dependent. CONCLUSIONS: Because the precision intraoral scans and of measurements on CBCT scans and is not high enough to allow for the required accuracy, s-CAIS should be considered as an additional tool for comprehensive diagnosis, treatment planning, and surgical procedures. Flapless s-CAIS can lead to implant placement outside of the zone of keratinized mucosa and thus must be executed with utmost care.

Effects of static magnetic fields on bone regeneration of implants in the rabbit: micro-CT, histologic, microarray, and real-time PCR analyses.

OBJECTIVES: The aim of this study was to investigate the effects of static magnetic fields (SMFs) on bone regeneration around titanium implants by µCT, histologic analysis, microarrays, and quantitative real-time PCR (qRT-PCR). MATERIALS AND METHODS: Neodymium magnets provided the source of SMFs, the specimens were grade 5 titanium implants, and the animals were twenty-seven adult male New Zealand white rabbits. These implants were divided into six groups according to the presence of a magnet and predetermined healing period (1, 4, and 8 weeks). Each group comprised six specimens for µCT (n = 6) and histologic examination, and three specimens (n = 3) for microarrays and qRT-PCR, yielding a total of 54 specimens. RESULTS: The µCT data showed that SMFs increased bone volume fraction (bone volume/total volume, BV/TV), trabecular number (Tb.N), and trabecular thickness (Tb.Th). Histologic observation indicated that SMFs promoted new bone formation and direct bony contact with implants. Microarray analysis identified 293 genes upregulated (>twofold) in response to SMFs. The upregulated genes included extracellular matrix (ECM)-related genes (COL10A1, COL9A1, and COL12A1) and growth factor (GF)-related genes (CTGF and PDGFD), and the upregulation was confirmed by qRT-PCR. Gene Ontology (GO) and pathway analysis revealed the involvement of the mitogen-activated protein kinase (MAPK), Wnt, and PPAR-gamma signaling pathways in implant healing. CONCLUSIONS: µCT, histology, microarrays, and real-time PCR indicate that SMFs could be an effective approach to improving bone regeneration around dental implants.

Mouthguards and their use in sports: Report of the 1st International Sports Dentistry Workshop, 2016.

There appears to be much confusion or misinformation worldwide regarding mouthguards and their use in sports. In an effort to clarify where the international dental community stands on mouthguards and mouthguard research, the workshop looked at some important questions. The goal was to one day formulate consensus statements related to these questions, which will be based on current scientific evidence-based research, to motivate the international community of the importance of dentally fitted laminated mouthguards and the wearing of them by athletes of all sports. There are only five sports in the United States that require the use of mouthguards. If, through workshops such as this, the importance of wearing dentally fitted laminated mouthguards can be demonstrated, then more sports may require their athletes to wear them.

Effects of moderate intensity static magnetic fields on human bone marrow-derived mesenchymal stem cells.

This study aimed to explore effects of static magnetic fields (SMFs) of moderate intensity (3-50 mT) as biophysical stimulators of proliferation and osteoblastic differentiation of human bone marrow-derived mesenchymal stem cells (MSCs). MSCs were exposed to SMFs of three intensities: 3, 15, and 50 mT. Proliferation was assessed by cell counting and bromodeoxyuridine incorporation, and differentiation by measuring alkaline phosphatase (ALP) activity, calcium content, mineralized nodule formation, and transcripts of osteogenic markers. Moderate intensity SMFs increased cell proliferation, ALP activity, calcium release, and mineralized nodule formation in a dose- and time-dependent manner, which peaked at 15 mT. In the same manner, they upregulated expression of osteogenic marker genes such as ALP, bone sialoprotein 2 (BSP2), collagen1a1 (COL1a1), osteocalcin (OCN), osteonectin (ON), osteopontin (OPN), osterix (OSX), and runt-related transcription factor 2 (RUNX2) with peak at 15 mT after 14 or 21 days of exposure. Results demonstrate that moderate intensity SMFs promote proliferation and osteoblastic differentiation of MSCs. This effect could help to improve MSC responses during osseointegration between a dental implant and surrounding bone.

Reliability of a chairside CAD-CAM surgical guide for dental implant surgery on the anterior maxilla: An in vitro study.

PURPOSE: This study evaluated the reliability of the chair-side CAD-CAM surgical guide (CSG) in the anterior maxilla by comparing its accuracy with the laboratory 3D-printed surgical guide (3DSG) and manual surgical guide (MSG) concerning different levels of dentists' surgical experience. MATERIALS AND METHODS: Ten surgical guides of each type (MSG, 3DSG, and CSG) were fabricated on a control study model with missing right and left central incisors. Sixty implants were placed in 30 study models by two dentists (one inexperienced and one experienced) using three different types of surgical guides. Horizontal deviations at shoulder and at apex, vertical, and angular deviations were measured after superimposing the planned and placed implant positions in the software. Kruskal-Wallis and Mann-Whitney U tests were used to compare the accuracy of three types of surgical guides in each dentist group and the accuracy of each surgical guide between two dentists (α = .05). RESULTS: There were no significant differences in any deviations between CSG and 3DSG, apart from angular deviation, for both dentists' groups. Moreover, both CSG and 3DSG showed no significant differences in accuracy between the two dentists (P > .05). In contrast, MSG demonstrated significant differences from CSG and 3DSG and a significant difference in accuracy between the two dentists (P < .05). CONCLUSION: CSG provides superior accuracy to MSG in implant placement in the maxillary anterior region and is comparable to 3DSG at different levels of surgical experience, while offering the benefits of shorter manufacturing time and reduced patient visits.

Differences in implant stability associated with various methods of preparation of the implant bed: an in vitro study.

STATEMENT OF PROBLEM: It is difficult to achieve the primary stability necessary for immediate loading in the posterior maxilla because of thin cortical bone, low density trabecular bone, and inadequate bone height due to the presence of the maxillary sinus. PURPOSE: The purpose of this study was to examine the primary stability of dental implants placed by using different methods of preparation for in vitro monocortical and bicortical models of the posterior maxilla. MATERIAL AND METHODS: Sixty screw-shaped implants (4.0 × 10 mm) were inserted into solid rigid polyurethane blocks. The implants were divided into 6 groups (n=10) to test 2 variables: 1) location (monocortical or bicortical block) and 2) preparation method (standard preparation, underpreparation, or the osteotome technique). The insertion and removal torques were measured and resonance frequency analysis (RFA) was performed to determine the primary stability of each implant. Insertion and removal torque data were analyzed by 2-way ANOVA, followed by the post hoc Tukey HSD multiple comparison test. RFA data were analyzed by 2-way and 1-way ANOVAs and the Tukey HSD multiple comparison test (α=.05). The Pearson correlation analysis was also performed to examine correlations among the values. RESULTS: The preparation method had a significant effect on insertion torque, RFA value, and removal torque; however location had a significant effect only on the removal torque (P<.001). There was a significant interaction between location and preparation method for RFA values (P=.045) and a significant difference in standard preparation method according to the location (P=.039); however, there was no significant difference in underpreparation (P=1.00) and osteotome technique (P=1.00). Statistically significant correlations were found between insertion torque and RFA values (r=0.529, P< .001), insertion torque and removal torque values (r=0.517, P< .001), and removal torque and RFA values (r=0.481, P<.001). CONCLUSIONS: Underpreparation and bicortical fixation significantly increased implant stability and the osteotome technique decreased implant stability in synthetic bone models that mimicked the posterior maxillary region. The primary stability values had statistically significant correlations to each other.

Correlation between surface hydrophilicity and osteoblastic differentiation on microgrooved titanium substrata.

Surface microgrooves and acid etching on titanium (Ti) have been proposed to enhance various cell behaviors. In this study, surface hydrophilicity, protein adsorption, and alkaline phosphatase activity of osteoblasts were analyzed and compared between microgrooved Ti, Ti with microgrooves and further acid etching, smooth Ti, and acid-etched smooth Ti. Correlations between the results of each experiment were analyzed using Pearson's correlation analysis, and the influential factor on alkaline phosphatase activity was determined using multiple stepwise regression analysis. Among groups, the Ti substrata with microgrooves and subsequent acid etching showed significantly greater surface hydrophilicity and alkaline phosphatase activity compared with smooth Ti, whereas the Ti substrata with only microgrooves showed the greatest protein adsorption. Multiple stepwise regression analysis determined the surface hydrophilicity of Ti as the influential factor on alkaline phosphatase activity. This study indicates that surface microgrooves and acid etching on Ti substrata enhance surface hydrophilicity, leading to increased alkaline phosphatase activity.

Histomorphometric analysis and removal torque of small diameter implants with alternative surface treatments and different designs.

This study was designed to investigate the histomorphometric and biomechanical comparison of small-diameter implants with different designs. These implants can be placed surgically in narrow bone spaces, such as the lower incisor region, that have low occlusal loading. Specimens of screw-shaped pin implants were designed for the study. These specimen implants were divided into 6 groups: group 1, machined implants; group 2, resorbable blast media (RBM)-treated implants; group 3, machined implants with a long vertical groove; group 4, RBM-treated implants with a long vertical groove; group 5, RBM-treated implants with a vertical groove on the upper thread; and group 6, RBM-treated implants with a vertical groove on the lower trunk. The specimen implants were placed surgically on the medial side of the rabbit tibia. Animals were sacrificed 2, 4, and 8 weeks after surgery. The removal torque was measured and tissues were prepared for histologic and histomorphometric analysis. The bone-to-implant contact and the percentage of the bone area inside the threads were measured. RBM-treated implants with vertical groove groups showed significantly higher values of removal torque, bone-implant contact, and bone area rate than the ones of machined surface groups.

Oral Soft Tissue Regeneration Using Nano Controlled System Inducing Sequential Release of Trichloroacetic Acid and Epidermal Growth Factor.

BACKGROUND: The effect of nano controlled sequential release of trichloroacetic acid (TCA) and epidermal growth factor (EGF) on the oral soft tissue regeneration was determined. METHODS: Hydrophobically modified glycol chitosan (HGC) nano controlled system was developed for the sequential release of TCA and EGF, and the release pattern was identified. The HGC-based nano controlled release system was injected into the critical-sized defects created in beagles' palatal soft tissues. The palatal impression and its scanned body was obtained on various time points post-injection, and the volumetric amount of soft tissue regeneration was compared among the three groups: CON (natural regeneration control group), EXP1 (TCA-loaded nano controlled release system group), EXP2 (TCA and EGF individually loaded nano controlled release system). DNA microarray analysis was performed and various soft tissue regeneration parameters in histopathological specimens were measured. RESULTS: TCA release was highest at Day 1 whereas EGF release was highest at Day 2 and remained high until Day 3. In the volumetric measurements of impression body scans, no significant difference in soft tissue regeneration between the three groups was shown in two-way ANOVA. However, in the one-way ANOVA at Day 14, EXP2 showed a significant increase in soft tissue regeneration compared to CON. High correlation was determined between the histopathological results of each group. DNA microarray showed up-regulation of various genes and related cell signaling pathways in EXP2 compared to CON. CONCLUSION: HGC-based nano controlled release system for sequential release of TCA and EGF can promote regeneration of oral soft tissue defects.

Influence of microgroove dimension on cell behavior of human gingival fibroblasts cultured on titanium substrata.

OBJECTIVE: The purpose of this study was to determine the dimension of surface microgrooves on titanium (Ti) substrata that shows the greatest positive influence on characterizing specific cell behavior of cultured human gingival fibroblasts. MATERIAL AND METHODS: Commercially pure Ti disks with surface microgrooves of monotonous 3.5 mm in depth and respective 15, 30, and 60 microm in width were fabricated using photolithography and used as the culture substrata in the three experimental groups in this study (TiD15, TiD30, and TiD60 groups), whereas the smooth Ti disk was used as the control substrata (smooth Ti group). Human gingival fibroblasts were cultured on the four groups of Ti substrata on successive timelines. Cell behaviors, such as adhesion, morphology,viability and proliferation, and gene expression were analyzed and compared between all groups using crystal violet stain, scanning electron microscopy (SEM), XTT assay, and reverse transcriptase-polymerase chain reaction, respectively. RESULTS: SEM demonstrated that cells were able to readily descend into the microgrooves of TiD30 at the early phase of culture. Cells on the ridge edges or in groove corners were spindle shaped with abundant filopodia formation toward the acid-etched surface inside the microgrooves, thus mimicked the cell shape in three-dimensional (3D) nanoenvironment. TiD15 significantly increased the cell viability and proliferation compared with the smooth Ti substrata after 72 h of culture. Up-regulation of fibronectin(FN) and alpha5 integrin genes was noted in cells cultured on TiD15 and TiD30. Gene expression pattern specific to the cells in 3D-matrix culture, such as down-regulation of alpha-smooth muscle actin gene along with up-regulation of FN and p21 genes, was pronounced in cells cultured on TiD30. CONCLUSION: This study indicates that surface microgrooves of both 15 and 30 microm in widt hand a monotonous 3.5 microm in depth on Ti substrata increase various cell behaviors of cultured human gingival fibroblasts.

Influence of etched microgrooves of uniform dimension on in vitro responses of human gingival fibroblasts.

OBJECTIVE: The purpose of this study was to investigate the influence of titanium (Ti) substrata with etched surface microgrooves on in vitro responses of human gingival fibroblasts. MATERIAL AND METHODS: Commercially pure Ti discs with surface microgrooves 15, 30, and 60 microm in width were fabricated using photolithography. Microgrooves 15 microm in widths were designed to be 3.5 microm in depth, whereas microgrooves 30 and 60 microm in width varied between 5 and 10 microm in depth. The entire surface of the microgrooved Ti substrata was further acid etched and used as the five experimental groups in this study (E15/3.5, E30/5, E30/10, E60/5, and E60/10), whereas the smooth and acid-etched Ti discs were both used as the control (NE0 and E0). Human gingival fibroblasts were cultured on all groups of substrata on successive timelines. Fibroblast adhesion and morphology was analyzed using confocal laser scanning microscopy (CLSM). Cell adhesion and proliferation were analyzed and compared using crystal violet staining and sulforhodamine B protein staining assays, respectively. RESULTS: In CLSM, the cells in E30/10 and E60/10 were observed to be able to readily descend into and form focal adhesions inside the microgrooves, whereas the cells in E15/3.5 were mostly found on the ridge tops. Cell adhesion was significantly increased in E60/10 compared with that in NE0 or E0 at 4-h incubation. Cell proliferation was significantly increased in E60/10 and E15/3.5 compared with NE0 or E0 after 72 and 96 h of culture. CONCLUSION: This study indicates that Ti substrata with etched microgrooves 60 microm in width and 10 microm in depth significantly enhance human gingival fibroblast adhesion and proliferation.

Surface microgrooves and acid etching on titanium substrata alter various cell behaviors of cultured human gingival fibroblasts.

OBJECTIVE: This study aimed to investigate the influence of surface microgrooves and acid etching on titanium substrata on cell proliferation and gene expression of cultured human gingival fibroblasts. MATERIAL AND METHODS: Ti substrata with various dimensions of microgrooves and further acid etching comprised four experimental groups (E15/3.5, E30/5, E60/10, and E90/15), whereas smooth and acid etched Ti discs were both used as control (NE0 and E0). The chemical composition of the control and experimental cp Ti substrata was analyzed by X-ray photoelectron spectroscopy (XPS). Cell proliferation, gene expression, and protein expression of cultured human gingival fibroblasts were analyzed between all groups using bromodeoxyuridine (BrdU) assay, reverse-transcriptase polymerase chain reaction (RT-PCR), and Western blotting, respectively. RESULTS: The XPS results showed that the Ti substrata used in this study showed no significant differences in the expression of surface chemical composition. BrdU assay showed that cell proliferation was significantly increased in E60/10 compared with that in any other group. In RT-PCR, E60/10 was noted to increase the expression of various genes involved in cell-matrix adhesion and adhesion-dependent cell cycle progression. In Western blotting, increased expression of fibronectin and Rho A was noted in E60/10 compared with that in NE0 or E15/3.5. CONCLUSION: This study indicates that surface microgrooves 60 mum in width and 10 mum in depth, and further acid etching on Ti substrata trigger the proliferation and alter the expression of both genes and proteins in cultured human gingival fibroblasts.

Chemical Regeneration of Wound Defects: Relevance to the Canine Palatal Mucosa and Cell Cycle Up-Regulation in Human Gingival Fibroblasts.

Background: Trichloroacetic acid (TCA) is an agent widely applied in dermatology for skin regeneration. To test whether TCA can offer an advantage for the regeneration of oral soft tissue defects, the cellular events following TCA application were explored in vitro and its influence on the oral soft tissue wound healing was evaluated in a canine palate model. Methods: The cytotoxicity and growth factor gene expression in human gingival fibroblasts were tested in vitro following the application of TCA at four concentrations (0.005%, 0.05%, 0.5% and 1%) with different time intervals (0, 3, 9 and 21 h). One concentration of TCA was selected to screen the genes differentially expressed using DNA microarray and the associated pathways were explored. TCA was injected in open wound defects of the palatal mucosa from beagle dogs (n = 3) to monitor their healing and regeneration up to day 16-post-administration. Results: While the 0.5-1% concentration induced the cytoxicity, a significantly higher expression of growth factor genes was observed after 3 and 9 h following the 0.5% TCA application in comparison to other groups. DNA microarray analysis in 0.5% TCA group showed 417 genes with a significant 1.5-fold differential expression, involving pathways of cell cycle, FoxO signaling, p53 signaling, ubiquitin mediated proteolysis and cAMP signaling. In vivo results showed a faster reepithelialization of TCA-treated wounds as compared to spontaneous healing. Conclusion: TCA promoted the healing and regeneration of oral soft tissue wound defects by up-regulating the cell cycle progression, cell growth, and cell viability, particularly at a concentration of 0.5%.

Clinical outcome of immediately and early loaded implants with laser treated surface: a 3-year retrospective study.

PURPOSE: The marginal bone loss of implants with laser treated surface was investigated after six weeks of loading after implant installation to the mandible molar area. MATERIALS AND METHODS: A total of 23 implants were placed in the edentulous molar area of the mandible: 13 implants were immediately loaded and 10 implants were early loaded. The implants used were made of titanium grade 23, screw shaped, 4.2 mm in diameter, and 10 mm in length. Patients were evaluated with resonance frequency analysis at implant fixture installation and 1, 2 (final prosthesis installation), 3, 5, 8, and 14 months later. X-rays were taken at 2 months after fixture installation and 1, 2, 3 years after to measure the marginal bone loss. RESULTS: The mean ISQ value measured at the implant installation was over 70 at all-time points. The average of marginal bone loss was average 0.33 mm. CONCLUSION: Immediate implant loading for laser treated implants would be possible.

The Effect of Fibronectin-Immobilized Microgrooved Titanium Substrata on Cell Proliferation and Expression of Genes and Proteins in Human Gingival Fibroblasts.

BACKGROUND: We aimed to determine the effect of fibronectin (FN)-immobilized microgrooved titanium (Ti) on human gingival fibroblast proliferation, gene expression and protein expression. METHODS: Photolithography was used to fabricate the microgrooved Ti, and amine funtionalization (silanization) was used for FN immobilization on titanium surfaces. Cell proliferation, gene expression and protein expression were analyzed, followed by multiple regression analysis for determining the influential factors on cell proliferation. RESULTS: FN-immobilized microgrooved Ti significantly enhanced the fibroblast proliferation in various timelines of culture, among which a burst of fivefold increase is induced at 96 h of culture compared to that on the control smooth Ti. We suggest a presence of the synergistic promotion effect of microgrooves and FN immobilization on fibroblast proliferation. Through a series of analyses on the expression of various genes and proteins involved in cell adhesion and proliferation, cyclin-dependent kinase 6, cyclin D1, integrin α5, oncogene c-Src, osteonectin, paxillin and talin-2 were determined as influential factors on promoting fibroblast proliferation induced by FN-immobilized microgrooved Ti. CONCLUSION: FN-immobilized microgrooved Ti can act as an effective surface for enhancing fibroblast proliferation, and can be used for promoting soft tissue response on the connective tissue attachment zone of biomaterial surfaces.

Analysis of crown size and morphology, and gingival shape in the maxillary anterior dentition in Korean young adults.

PURPOSE: The aim of this investigation was to analyze the dimensions of clinical crowns and to classify the crown and the gingival type in the anterior teeth in Korean young adults. MATERIALS AND METHODS: Casts were obtained from 50 subjects ranging in age from 24 to 32. Measurements of length and width were made on the casts using a pair of digital calipers on the entire dentition. Crown thickness and papilla height were also measured and MDW/CL (mesiodistal width to clinical length) and CW/CL (cervical width to clinical length) ratios of the maxillary anterior teeth were calculated. The K-clustering method was used for CW/CL to classify the anterior tooth shape into three groups (tapered, ovoid, and square), and one-way analysis of variance and Duncan's post-hoc comparison were used to evaluate statistical significance between the groups. Pearson's correlation analysis was performed between tooth shape and papillary height (PH) to demonstrate the correlation between tooth shape and gingival morphological characteristics. RESULTS: The average length of the maxillary central incisors was 9.89 mm; the mesio-distal width was 8.54 mm; and the ratio of width/length was 0.86 in Korean young adults. The average bucco-palatal thickness of the central incisor was 3.14 mm at the incisal 1/3 aspect. Ovoid type was the most common tooth shape (48%), followed by square type (29%) and taper type (23%) in the central incisors of Korean young adults. Tooth shape and gingival type were correlated with each other. CONCLUSION: New reference data were established for tooth size in Korean young adults and the data show several patterns of tooth shape and gingival type. Clinicians should diagnose and treat based on these characteristics for better results in the Korean population.

Analysis of dimensions and shapes of maxillary and mandibular dental arch in Korean young adults.

PURPOSE: The aim of this study was to investigate dental arch dimensions and to classify arch shape in Korean young adults. MATERIALS AND METHODS: The sample included 50 Koreans with age ranging from 24 to 32 years. Maxillary and mandibular casts were fabricated using irreversible hydrocolloid and type III dental stones. Incisor-canine distance, incisor-1st molar distance, incisor-2nd molar distance, intercanine distance, inter-1st molar distance, and inter-2nd molar distance in both the maxillary and mandibular arch were measured using a three-dimensional measuring device. The dental arch was classified into three groups using five ratios from the measured values by the K-means clustering method. The data were analyzed with one-way analysis of variance. RESULTS: Arch lengths (IM2D, incisal-2nd molar distance) were 44.13 mm in the maxilla and 40.40 mm in the mandible. Arch widths (M2W, inter 2nd molar width) were 64.12 mm in the maxilla and 56.37 mm in the mandible. Distribution of the dental arch form was mostly ovoid shape (maxilla 52% and mandible 56%), followed by the V-shape and the U-shape. The arch width for the U-shape was broader than for the other forms. CONCLUSION: This study establishes new reference data for dental arch dimensions for young Korean adults. The most common arch form is the ovoid type in the maxilla and mandible of Koreans. Clinicians should be aware of these references and classify arch type before and during their dental treatment for effective and harmonized results in Koreans.

Reliability of a CAD/CAM Surgical Guide for Implant Placement: An In Vitro Comparison of Surgeons' Experience Levels and Implant Sites.

PURPOSE: This in vitro study evaluated the reliability of a surgical guide with regard to different levels of operator surgical experience and implant site. MATERIALS AND METHODS: A stereolithographic surgical guide for epoxy resin mandibles with three edentulous molar sites was produced using a computer-aided design/computer-assisted manufacture (CAD/CAM) system. Two surgeons with and two surgeons without implant surgery experience placed implants in a model either using or not using the CAD/CAM surgical guide. Four groups were created: inexperienced surgeon without the guide (group 1); experienced surgeon without the guide (group 2); inexperienced surgeon with the guide (group 3); and experienced surgeon with the guide (group 4). Planned implants and placed implants were superimposed using digital software, and deviation parameters were calculated. RESULTS: There were no significant differences in any of the deviation parameters between the groups when using the surgical guide. With respect to the implant sites, there were no significant differences among the groups in any parameter. CONCLUSION: Use of the CAD/CAM surgical guide reduced discrepancies among operators performing implant surgery regardless of their level of experience. Whether or not the guide was used, differences in the anterior-posterior implant site in the molar area did not affect the accuracy of implant placement.

Influence of the connection design and titanium grades of the implant complex on resistance under static loading.

PURPOSE: The purpose of this study was to evaluate the resistance to deformation under static overloading by measuring yield and fracture strength, and to analyze the failure characteristics of implant assemblies made of different titanium grades and connections. MATERIALS AND METHODS: Six groups of implant assemblies were fabricated according to ISO 14801 (n=10). These consisted of the combinations of 3 platform connections (external, internal, and morse tapered) and 2 materials (titanium grade 2 and titanium grade 4). Yield strength and fracture strength were evaluated with a computer-controlled Universal Testing Machine, and failed implant assemblies were classified and analyzed by optical microscopy. The data were analyzed using the One-way analysis of variance (ANOVA) and Student's t-test with the level of significance at P=.05. RESULTS: The group IT4S had the significantly highest values and group IT2 the lowest, for both yield strength and fracture strength. Groups IT4N and ET4 had similar yield and fracture strengths despite having different connection designs. Group MT2 and group IT2 had significant differences in yield and fracture strength although they were made by the same material as titanium grade 2. The implant system of the similar fixture-abutment interfaces and the same materials showed the similar characteristics of deformation. CONCLUSION: A longer internal connection and titanium grade 4 of the implant system is advantageous for static overloading condition. However, it is not only the connection design that affects the stability. The strength of the titanium grade as material is also important since it affects the implant stability. When using the implant system made of titanium grade 2, a larger diameter fixture should be selected in order to provide enough strength to withstand overloading.

Co-Cr dental alloys induces cytotoxicity and inflammatory responses via activation of Nrf2/antioxidant signaling pathways in human gingival fibroblasts and osteoblasts.

OBJECTIVE: Although cobalt-chromium (Co-Cr) dental alloys are routinely used in prosthodontics, the biocompatibility of Co-Cr alloys is controversial. The aims of the present study were to investigate the effects of Co-Cr alloys on human gingival fibroblasts (HGF) and osteoblasts in an in vitro model as well as their potential molecular mechanisms, focusing on NF-E2-related factor 2 (Nrf2) pathways. METHODS: Cells were directly seeded on prepared Co-Cr alloy discs (15.0mm diameter, 1.0mm thickness) or indirectly treated with Co-Cr alloy located at the bottom of an insert well and incubated for 3 days. Cytotoxicity and reactive oxygen species (ROS) production was evaluated by MTS assay and flow cytometry, respectively. Protein and mRNA levels were determined by Western blotting and RT-PCR analysis, respectively. RESULTS: Cell viability and flow cytometric assay demonstrated that the Co-Cr alloy was cytotoxic to HGFs and osteoblasts, and significantly increased ROS production. In addition, the Co-Cr alloys upregulated pro-inflamamtory cytokines (TNF-α, IL-1ß, IL-6, and IL-8) and increased levels of various inflammatory mediators (iNOS derived nitrite oxide, and COX-2-derived PGE2) in both cells. A mechanistic study showed that Co-Cr alloys activates the NRF2 pathway and up-regulate antioxidant enzymes including heme oxygenase-1 (HO-1). Co-Cr alloys activated JAK2/STAT3, p38/ERK/JNK MAPKs and NF-κB signaling pathways. Furthermore, antioxidants (resveratrol and NAC) and HO-1 inhibitor (SnPP) significantly inhibited the production of ROS and inflammatory mediators, as well as the activation of NF-κB signaling in Co-Cr alloy stimulated HGFs and osteoblasts. SIGNIFICANCE: This study is the first to show that Co-Cr alloys exert cytotoxic and inflammatory effects via activation of Nrf2/ARE signaling and up-regulation of downstream HO-1, which could represent candidate targets for the regulation of inflammatory responses to Co-Cr alloys.