Expression of the pleiotrophin-midkine axis in a sheep tooth socket model of bone healing.

OBJECTIVE AND BACKGROUND: Resorption of alveolar bone after tooth extraction is a common problem often requiring bone grafting. The success of the grafting procedures is dependent on multiple factors including the presence of growth factors. This is the first in vivo study to investigate the role of the pleiotrophin family of cytokines in alveolar bone regeneration. This research investigated the role of the pleiotrophin-midkine (PTN-MDK) axis during osteogenesis, with and without a grafting material, after tooth extraction in a sheep model. METHODS: Thirty Romney-cross ewes were anesthetized, and all premolar teeth on the right side were extracted. The sockets were randomized to controls sites with no treatment and test sites with Bio-Oss® graft material and Bio-Gide® membrane. Samples were harvested after sacrificing animals 4, 8, and 16 weeks post-grafting (n = 10 per time-point). Tissue for qRT2 -PCR gene analysis was recovered from the socket next to the first molar using a trephine (Ø = 2 mm). Each socket was fixed, decalcified, paraffin-embedded, and sectioned. Immunohistochemistry was conducted to localize both PTN and MDK along with their receptors, protein tyrosine phosphatase receptor type Z1 (PTPRZ1), ALK receptor tyrosine kinase (ALK), and notch receptor 2 (NOTCH2). RESULTS: Within the healing sockets, high expression of genes for PTN, MDK, NOTCH2, and ALK was found at all time-points and in both grafted and non-grafted sites, while PTPRZ1 was only expressed at low levels. The relative gene expression of the PTN family of cytokines was not statistically different at the three time-points between test and control groups (p > .05). Immunohistochemistry found PTN and MDK in association with new bone, NOTCH2 in the connective tissue, and PTPRZ1 and ALK in association with cuboidal osteoblasts involved in bone formation. CONCLUSIONS: The PTN-MDK axis was highly expressed in both non-grafted and grafted sockets during osteogenesis in a sheep model of alveolar bone regeneration with no evidence that grafting significantly affected expression. The activation of NOTCH2 and PTPRZ1 receptors may be important during bone regeneration in vivo. The discovery of the PTN-MDK axis as important during alveolar bone regeneration is novel and opens up new avenues of research into these stably expressed highly active cytokines. Growth factor supplementation with PTN and/or MDK during healing may be an approach for enhanced regeneration or to initiate healing where delayed.

Formulation of a Semisolid Emulsion Containing Leptospermum scoparium Essential Oil and Evaluation of In Vitro Antimicrobial and Antibiofilm Efficacy.

Manuka oil, an essential oil derived from the Leptospermum scoparium, has been traditionally used for wound care and as a topical antibacterial, antifungal, and anti-inflammatory. However, the essential oil is not well retained at mucosal sites, such as the oral cavity, where the benefits of the aforementioned properties could be utilized toward the treatment of persistent biofilms. Within this study, L. scoparium essential oil was incorporated into a semisolid emulsion for improved delivery. The safety profile of L. scoparium essential oil on human gingival fibroblasts was determined via cell viability, cytotoxicity, and caspase activation. The minimal bactericidal concentration of L. scoparium essential oil was determined, and the emulsion's antibiofilm effects visualized using confocal laser scanning microscopy. L. scoparium essential oil demonstrated a lower IC50 (0.02% at 48 h) when compared to the clinical control chlorhexidine (0.002% at 48 h) and displayed lower cumulative cytotoxicity. Higher concentrations of L. scoparium essential oil (≥ 0.1%) at 6 h resulted in higher caspase 3/7 activation, suggesting an apoptotic pathway of cell death. A minimal bactericidal concentration of 0.1% w/w was observed for 6 oral bacteria and 0.01% w/v for Porphyromonas gingivalis. Textural and rheometric analysis indicated increased stability of emulsion with a 1 : 3 ratio of L. scoparium essential oil: Oryza sativa carrier oil. The optimized 5% w/w L. scoparium essential oil emulsion showed increased bactericidal penetrative effects on Streptococci gordonii biofilms compared to oil alone and to chlorhexidine controls. This study has demonstrated the safety, formulation, and antimicrobial activity of L. scoparium essential oil emulsion for potential antibacterial applications at mucosal sites.

Ultrastructure and properties of primary carious molars treated using the Hall Technique.

BACKGROUND: The Hall Technique (HT) is a method of restoring decayed primary teeth using stainless steel crowns (SSCs) without tooth preparation, caries removal, or local anaesthetic. AIM: To investigate the ultrastructural, biomechanical, and chemical characteristics of teeth managed with the Hall Technique in comparison with conventional SSC (controls). DESIGN: Twelve HT-treated primary molars and four controls were analysed. Teeth were dehydrated in ethanol, embedded in methylmethacrylate, mesio-distally sectioned, X-rayed, mounted, and polished. Biomechanical, ultrastructural, and chemical characterisation was performed for carious lesion and sound areas of each specimen. RESULTS: Pre-treatment and post-treatment X-rays showed evidence of little to no caries progression over time. In carious lesions, mean hardness and elastic modulus values were lower in HT-treated teeth than in controls. In both controls and HT-treated teeth, carious lesions had the lowest %wt of Ca and P of all tissues sampled. CONCLUSIONS: Although the retained carious tissue was biomechanically more compromised in HT-treated teeth, the Ca and P values were higher than reported elsewhere for carious lesions in primary molars, suggesting remineralisation may have occurred in caries in HT-treated teeth. Future investigations will help elucidate the processes involved with carious lesion arrest under SSC.

A qualitative analysis on participants' perspectives on oral implants.

BACKGROUND: Quantitative research methods provide clinicians with information about the effectiveness of interventions and determined causal-effect relationships, whereas qualitative research investigates other aspects of clinical implant practice, particularly the participants' perspectives and expectations. The aim of the qualitative study was to understand the experience of participants with immediate single molar implants. METHODS: In-depth, audiorecorded, semistructured interviews were conducted with 15 participants who had participated in a controlled clinical trial of immediate molar implants. Participants were aged 36-77 years. Nine participants received single implants in mandibular molar fresh extraction sockets while the remaining participants had their implants in healed sites. The interviews that assessed participants' perspectives of the pre-operative, operative, and postoperative phases of therapy were transcribed verbatim and analysed using inductive and content analysis. RESULTS: Participants took part in the clinical trial mainly because it offered oral implant therapy at a reduced cost. The affordability of implant treatment was the main factor in determining restorative options. Minimal differences were found between male and female participants of different age groups in terms of their perceptions of function and aesthetics. However, single molar implants did not have an impact on aesthetics and self-esteem. Participants' expectations regarding the longevity of oral implants were not realistic and their knowledge about future maintenance needs was not adequate. CONCLUSIONS: Using face-to-face verbal conversation more frequently may improve communication between clinicians and participants and minimize misunderstanding about the procedures of different treatment modalities. Special emphasis should be placed on understanding the importance of maintenance by spending more time with the participants to identify any future barriers to maintaining good outcomes of oral implants.

The effect of hydrothermal spark discharge anodization in the early integration of implants in sheep sinuses.

OBJECTIVES: Spark discharge anodic oxidation forms a porous oxide film on titanium implant surfaces, which may increase surface roughness and enhance early osseointegration. This study aimed to clinically and histomorphometric compare commercially-available sandblasted (RBM) implants, treated with hydrothermal anodization and placed into an animal maxillary sinus model. MATERIALS AND METHODS: Thirty 3.75 mm × 8.5 mm threaded titanium implants were placed into the maxillary sinuses of 10 sheep via an external approach, with three test groups and 10 implants per group: right side, Control = CP-titanium with RBM surface, Test group 1 = CP-titanium with RBM + anodized surface; left side, Test group 2 = Ti-6Al-7Nb with RBM + anodized surface. Schneiderian membranes were elevated but not bone grafted. Resonant frequency analysis (RFA) was measured at surgery. Animals were sacrificed after 1 month unloaded healing. Resin-embedded undemineralized ground-sections were digitised, and mean bone-implant contact (% BIC) was measured bilaterally for the best-three consecutive threads. RESULTS: Seven of 30 implants showed signs of failure. RFA was low at placement but did not differ between the groups (group mean ISQ values ranged from 23 to 35; χ(2)  = 0.37). RFA was not repeated at sacrifice due to implant instability. Histomorphometric analysis showed % BIC was highest for control (34.8 ± 15.7), followed by Test 1 (29.6 ± 18.1) and Test 2 implants (23.3 ± 22.7), but this difference was not statistically significant (χ(2)  = 0.3). DISCUSSION AND CONCLUSIONS: Early integration of RBM implants placed into thin maxillary sinus walls was not enhanced by hydrothermal anodization of implant surfaces. This may be related to the initial low stability of the implants and the relatively short healing period. However, non-anodized RBM surfaces showed promising results, with % BIC values comparable to the best estimates of other studies using sinus grafting. Whether the modification of the implant surfaces through anodization with simultaneous sinus grafting would promote enhanced early osseointegration, is a subject of future research.

Implant-based three-dimensional superimposition of the growing mandible in a rabbit model.

BACKGROUND: The reliable assessment of craniofacial morphological changes during growth requires invariant regions for image registration. As these regions have not yet been identified in three dimensions, intra-osseous implants are required as fiducial markers for the reliable assessment of three-dimensional (3D) mandibular growth changes. The objective of this study was to develop an animal model for the assessment of the 3D morphological changes of the mandible during growth, using implants as fiducial markers. MATERIALS AND METHODS: Titanium implants were placed in the body of the mandible of six New Zealand White rabbits. Cone beam computed tomography (CBCT) scans were taken 1-week following implant placement and after an additional 8-weeks of growth. Segmentations of CBCT images were exported into custom-made scripts, implant centroids were identified, implant stability during growth calculated, and the segmented mandibles were registered on the implant centroids. RESULTS: The buccal cortical bone of the body of the mandible was stable during growth and suitable for fiducial marker placement. Bilateral implants resulted in more accurate rigid registration of the growing rabbit mandible than only unilateral implants. 3D mandibular growth changes were visualised by means of semi-transparencies. CONCLUSIONS: This animal model appears to be feasible for the assessment of the 3D morphological changes occurring during mandibular growth. To the best of our knowledge this is the first time that the implant superimposition method has been combined with 3D imaging to accurately reveal mandibular growth changes.

Reporting numeric values of complete crowns. Part 1: Clinical preparation parameters.

STATEMENT OF PROBLEM: An implemented objective measuring system for measuring clinical tooth preparations does not exist. PURPOSE: The purpose of this study was to compare clinically achieved tooth preparations for ceramic crowns by general dentists with the recommended values in the literature with an objective measuring method. MATERIAL AND METHODS: Two hundred thirty-six stone dies prepared for anterior and posterior complete ceramic crown restorations (IPS e.max Press; Ivoclar Vivadent) were collected from dental laboratories. The dies were scanned and analyzed using the coordinate geometry method. Cross-sectioned images were captured, and the average total occlusal convergence angle, margin width, and abutment height for each preparation was measured and presented with associated 95% confidence intervals. RESULTS: The average total occlusal convergence angles for each tooth type was above the recommended values reported in the literature. The average margin widths (0.40 to 0.83 mm) were below the minimum recommended values (1 to 1.5 mm). The tallest preparations were maxillary canines (5.25 mm), while the shortest preparations were mandibular molars (1.87 mm). CONCLUSIONS: Complete crown preparations produced in general practice do not achieve the recommended values found in the literature. However, these recommended values are not based on clinical trials, and the effects of observed shortfalls on the clinical longevity of these restorations are not predictable.

Reporting numeric values of complete crowns. Part 2: Retention and resistance theories.

STATEMENT OF PROBLEM: Determining the retention and resistance of a tooth preparation for a complete crown has only existed in theory, and these theories have never been measured on tooth preparations performed in vivo. PURPOSE: The purpose of this study was to measure the theoretical retention and resistance of clinically produced complete crown preparations by using an objective measuring method. MATERIAL AND METHODS: Stone dies from 236 complete crown preparations were collected from dental laboratories. The dies were scanned and analyzed with the coordinate geometry method. Cross-sectional images were captured, and the surface area was measured with a cone frustum and right truncated pyramid formula. Two different theories of resistance form, the "on" or "off" theory (limiting taper) and the linear model (resistance length), were calculated for premolar and molar preparations. RESULTS: The mean surface areas ranged from 33.97 mm(2) to 105.44 mm(2) for the cone frustum formula and 41.75 mm(2) to 117.50 mm(2) for the right truncated pyramid formula. The facial side of maxillary premolars exhibited the highest percentage of resistance form with the limiting taper, at 58%, and the mesial side of the mandibular molars exhibited the lowest percentage of resistance form, at 6%. CONCLUSIONS: The objective method used in this study provides a way for retention and resistance theories to be tested and for further clinical implications to be investigated.

Clinical tooth preparations and associated measuring methods: a systematic review.

STATEMENT OF PROBLEM: The geometries of tooth preparations are important features that aid in the retention and resistance of cemented complete crowns. The clinically relevant values and the methods used to measure these are not clear. PURPOSE: The purpose of this systematic review was to retrieve, organize, and critically appraise studies measuring clinical tooth preparation parameters, specifically the methodology used to measure the preparation geometry. MATERIAL AND METHODS: A database search was performed in Scopus, PubMed, and ScienceDirect with an additional hand search on December 5, 2013. The articles were screened for inclusion and exclusion criteria and information regarding the total occlusal convergence (TOC) angle, margin design, and associated measuring methods were extracted. The values and associated measuring methods were tabulated. RESULTS: A total of 1006 publications were initially retrieved. After removing duplicates and filtering by using exclusion and inclusion criteria, 983 articles were excluded. Twenty-three articles reported clinical tooth preparation values. Twenty articles reported the TOC, 4 articles reported margin designs, 4 articles reported margin angles, and 3 articles reported the abutment height of preparations. A variety of methods were used to measure these parameters. CONCLUSIONS: TOC values seem to be the most important preparation parameter. Recommended TOC values have increased over the past 4 decades from an unachievable 2- to 5-degree taper to a more realistic 10 to 22 degrees. Recommended values are more likely to be achieved under experimental conditions if crown preparations are performed outside of the mouth. We recommend that a standardized measurement method based on the cross sections of crown preparations and standardized reporting be developed for future studies analyzing preparation geometry.

Could the median-palate accommodate wide-bodied implants in order to support maxillary over-dentures? A radiomorphometric study of human cadavers.

INTRODUCTION: Atrophy of the alveolar bone is an irreversible multifactorial phenomenon, the rate of which varies between individuals and between the jaws. This atrophy of the alveolar ridges presents severe limitations for the oral rehabilitation of the edentulous patients and poses a clinical challenge to the prosthodontists and implant surgeons. The present research aimed to investigate whether the median-palate of elderly edentulous subjects is anatomically suitable for implant placement. MATERIALS AND METHODS: A total of 32 samples were harvested from the maxillae of 16 human cadavers. One dentate male subject was included for contrast. Bone quality and quantity were analysed at two regions: the median-palate and the edentulous maxillary alveolar ridge. Samples were scanned through micro-CT, and the region of analysis (ROA) identified and dissected. Bone volume to tissue volume ratio (%BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp) and trabecular bone pattern factor (Tb.Pf) were evaluated for the two regions using Skyscan CTAn(®). RESULTS: The results of bone volume fraction obtained from CTAn(®) of the median-palatal region show higher values than the respective premolar sites in 12 of 15 (80%) edentulous samples. However, this difference was statistically non-significant (P = 0.06). Similarly, the trabecular number for 10 of 15 samples (66.6%) from the median-palate shows greater values than the respective premolar site (P = 0.07). Trabecular thickness of 10 of 15 (66.6%) premolar samples is larger than in the median-palatal region. However, these differences were also statistically non-significant (P = 0.25). Statistically significant difference (P = 0.04) was found between the Tb.Sp values of the two regions. CONCLUSION: The results indicate that the anterior median-palate is structurally better than their respective maxillary premolar region in elderly edentulous persons, and an implant can be placed to anchor an overdenture. The best site for a wide-body implant was established to be 6-8 mm posterior to the incisive foramen in elderly edentulous patients.

The prognostic accuracy of resonance frequency analysis in predicting failure risk of immediately restored implants.

OBJECTIVES: It is of imperative clinical significance to define a safe threshold for planned immediate implant restoration. The aim of this report was to evaluate the prognostic accuracy of resonance frequency analysis (RFA) measurements recorded at two different times (implant placement and 8-week post-implant placement) and to determine the optimal threshold value for predicting failure risk of immediately restored/loaded implants. MATERIAL AND METHODS: Twenty-eight 8- or 9-mm-diameter implants were placed in either a fresh molar extraction socket or a healed site. An electronic RFA device was used to record the implant stability quotients (ISQs) at implant placement surgery, 8 weeks and 1 year. Receiver operating characteristic (ROC) analysis was used to identify the optimal cut-off level. Sensitivity and specificity were also determined at the selected cut-off value. RESULTS: The area under the ROC curve for RFA at 8 weeks was 0.93 with a significant P-value (P = 0.001). The optimum cut-off value for detecting implant stability was 60.5 ISQ measured at 8 weeks, with sensitivity and specificity of 95.2% and 71.4%, respectively. CONCLUSIONS: The implant stability measurements after 8 weeks showed a better accuracy in predicting implants that were at risk of failure than those taken at the time of implant placement.

"I lost my first tooth here": Syrian former refugees' experiences of oral healthcare in Dunedin, New Zealand.

AIM: Oral health conditions are highly prevalent among former refugees; however, little is known about their experiences of accessing dental care. We aimed to explore Syrian former refugees' experiences of oral healthcare in New Zealand. METHOD: Thirty-nine Syrian former refugees resettled in Dunedin, New Zealand participated in nine focus group discussions. The interviews were audio-recorded, transcribed verbatim and thematically analysed. RESULTS: Almost all participants reported motivation to care for their teeth but multiple factors facilitated or hindered their ability to address their oral health needs, including financial factors, communication issues and dental care provider cultural safety. Most participants arrived with high expectations of New Zealand's health system. CONCLUSION: Oral healthcare providers and policymakers need to expect and accept their patients' past experiences and emotions, and consider their cultures, languages and backgrounds.

Quantity and Size of Titanium Particles Released from Different Mechanical Decontamination Procedures on Titanium Discs: An In Vitro Study.

Complications such as peri-implantitis could ultimately affect the survival of a dental implant. The prevention and treatment of peri-implant diseases require managing bacterial biofilm and controlling environmental risks, including the presence of pro-inflammatory titanium (Ti) particles in the peri-implant niche. Objectives included the evaluation of the size and quantity of Ti particles released from moderately roughened Ti surfaces during common mechanical surface decontamination methods. One hundred and forty moderately roughened Ti discs were divided into seven groups (n = 20 per group); six groups received mechanical decontamination procedures (ultrasonic scaling (US) with a metal tip and poly-ether-ketone (PEEK) under low and medium power settings, air-polishing with erythritol powder, and Ti brush), and the control group underwent air-water spray using a dental triplex. The rinsing solution was collected for Ti mass analysis using inductively coupled plasma mass spectrometry (ICPMS), as well as for Ti particle size and count analysis under scanning electron microscopy (SEM) with energy-dispersive spectroscopy (EDS). US metal tip instrumentation generated 34.00 ± 12.54 µg and 34.44 ± 6.08 µg of Ti under low and medium power settings, respectively. This amount of Ti generation was significantly higher than other instrumentation methods. The mean Ti particle size of the US groups ranged from 0.89 ± 0.27 µm to 1.25 ± 0.24 µm. No statistically significant difference was found in the particle size among US groups and Ti brush group (1.05 ± 0.11 µm), except for US with the PEEK tip, where a significantly smaller mean particle diameter was found at the low power setting (0.89 ± 0.27 µm). Mechanical instrumentation can produce Ti particulates and modify the implant surfaces. US using a metal tip generated the highest amount of Ti with smaller Ti size particles compared to all other commonly used mechanical surface instrumentations. The EDS analysis confirmed Ti in PEEK US tips. It can be suggested that deterioration from the PEEK US tip and Ti brush, as observed under SEM, is an additional source of Ti release during Ti surface decontamination.

Monolithic Zirconia Single Crowns Supported by Narrow or Standard Diameter Titanium-zirconium Implants in Posterior Sites: One-year Results of a Randomized Controlled Trial.

The replacement of missing teeth with implant-supported prostheses has become a standard treatment option with reliable long-term outcomes in various clinical indications.1-6 The implant-supported single crowns, in particular, presented the most favorable outcome with a survival rate of 89.5% to 96% over a 10-year period.5,6 A notable prosthetic maintenance requirement, however, was reported irrespective of the prosthetic material used for the crown construction.1,7 Metal-ceramic restorations have been considered the gold standard when replacing single or multiple missing teeth with implant-supported fixed dental prostheses.8 A systematic review of 4363 metal-ceramic implant-supported single crowns in the anterior and posterior region reported an impressive survival rate of 98.3% over five years.9 Yet, the biologic and prosthetic complications associated with these restorations were substantial with a rate of 13.5%. In the posterior region, a recent systematic review of short-term randomized controlled trials10 reported a survival rate of 99.1% for metal-ceramic implant-supported single crowns. The reported prosthetic complications, mainly ceramic chipping, were also notable with an incidence rate of 7.6%.mIn recent years, the introduction of high-strength all-ceramic materials as well as digitaldesign and manufacturing processes, has allowed faster fabrication of more esthetic and cost effective restorations.11 Zirconia-based fixed dental prostheses on teeth and implants are now increasingly used and show 5-year cumulative survival rates of 89.4 to 100%.12 These restorations are typically made up of a zirconia framework that is veneered with a layer of glass ceramic to impart translucency for enhanced esthetics.13 However, chipping of the ceramic layer has been a lingering issue, shifting the attention toward the use of full anatomic monolithic zirconia restorations.14,15 Replacement of missing teeth with dental implants in posterior ridges with limited bone width can be surgically challenging and the notion of narrow diameter implants has been suggested.16,17 These implants were thought to offer potential advantages in terms of costeffectiveness and surgical morbidity.18,19 The literature, however, remains controversial on treatment outcomes with narrow diameter implants, particularly in posterior sites.19-21 When single tooth replacement with monolithic zirconia implant-supported single crowns in posterior sites are considered, only short to medium-term outcomes are available.22-26 The survival rates and clinical performances reported in these studies were variable. Crown survival rates between 84% and 100% were demonstrated over an observation time of one to three years, while the prosthetic complications were between 0% to 14%. In three studies,22,23,25 standard diameter titanium implants were used in premolar and molar sites to support the single crowns. The remaining two studies by Mühlemann et al. (2020) and Zumstein et al. (2023) reported the one-year and three-year outcomes, respectively, of the same cohort. In these studies, narrow titanium-zirconium (TiZr) implants of 3.3 mm diameter were exclusively utilized in molar sites. The implant and crown survival rates reported at one and three years were 97.4% and 84%, respectively. The lower survival rate observed in the report of Zumstein et al. (2023) resulted from fracture of five implants and the subsequent loss of their respective crowns. Aside from these two reports, no other information on the outcomes of monolithic zirconia single crowns supported by narrow diameter TiZr implants in posterior sites are available. The validity of this treatment, therefore, needs further investigation with well-designed clinical trials. Hence, a randomized controlled trial was undertaken to assess various implant, prosthetic, and patient-reported outcomes of monolithic zirconia single crowns supported by either narrow or standard diameter titanium-zirconium (TiZr) implants in posterior sites. The present report focuses on the one-year prosthetic results.

Immediate single implant restorations in mandibular molar extraction sockets: a controlled clinical trial.

BACKGROUND: In the replacement of missing teeth, a paradigm shift is currently observed with immediate implant placement and/or restoration, particularly in the aesthetic zone. In molar sites, however, anatomical, occlusal and biomechanical considerations remain deterrent factors influencing the outcome of this treatment paradigm. The aim of this report was to evaluate immediate placement and immediate restoration of strongly tapered wide-diameter implant in fresh mandibular molar extraction sockets. METHODS: Twenty-four 8- or 9-mm diameter implants were placed in either a fresh molar extraction socket or a healed site. All the implants received provisional crowns within 48 h. The provisional crowns were replaced with full ceramic crowns after 8 weeks of implant placement. RESULTS: The overall implant success rate after 1 year of service for the 24 implants in two treatment groups was 75%. Success rates were 83.3% and 66.7% for the delayed and immediate placement groups respectively, with no significant difference observed between the two groups (P = 0.35). Implant stability measurements identified the immediately placed implants to be more stable immediately after surgery than delayed placed implants. In contrast, the delayed placed implants were more stable after 8 week healing time. CONCLUSIONS: The rehabilitation of single missing mandibular molars by immediately placed and restored wide-diameter implants was associated with a relatively high failure rate.

Trabecular bone microarchitecture in the median palate and maxillary premolar alveolar sites of edentulous elderly cadavers.

PURPOSE: The median palate has been proposed as an alternative site for implant placement supporting maxillary overdentures. The aim of our research was to compare the histologic bone microarchitecture of the median palatal and the maxillary premolar alveolar ridge in edentulous elderly human cadavers. MATERIALS AND METHODS: The bone quality and quantity were analyzed at two regions of analysis (ROA) in 16 maxilla of human cadavers: the median palate (ROA I) and edentulous maxillary alveolar premolar ridge (ROA II). Histomorphometry of the scanned images was performed using image analysis software (National Institutes of Health ImageJ). The bone volume/tissue volume ratio, trabecular thickness, trabecular separation, and trabecular number were evaluated for the two regions. RESULTS: The bone volume fraction of the median-palatal region (ROA I) was greater than at the respective premolar sites (ROA II) in 10 of 15 samples (66.6%), with mean values ranging from 19.3-61.3%. However, the results were not statistically significant (P = .151). Similarly, the trabecular number of ROA II showed greater values than that for ROA II (mean TbN for ROA I, 1.03 mm(-1) and for ROA II, 0.96 mm(-1)). However, these differences were not statistically significant (P = .454). CONCLUSIONS: These results have indicated that the anterior median palate is structurally similar to the corresponding maxillary premolar region in elderly edentulous persons. Therefore, it can be used as an implant site to anchor a maxillary overdenture in patients with atrophic maxillary ridges.

Bone remodelling marker expression in grafted and ungrafted sheep tooth extraction sockets: A comparative randomised study.

OBJECTIVE: To compare key markers of bone remodelling in a sheep tooth extraction model for sockets left to heal naturally or grafted with the bovine-derived xenograft Bio-Oss® covered with a collagen Bio-Gide® membrane. DESIGN: Right side premolar teeth were removed from thirty Romney-cross ewes. Standardised sockets in each sheep were randomly allocated treatments, a grafted test and an empty control. At 4-, 8- and 16-weeks sheep were euthanized and tissue collected (N = 10/group). RANK, RANKL and OPG immunohistochemical analysis was performed (n = 3). RANK, RANKL, OPG, COL1A1, TIMP3, SP7 and MSX2 mRNA expression levels were determined using RT2-qPCR assays (n = 3). RESULTS: Histologically, more new woven bone was observed in the test group at all time points. Strong RANK and RANKL expression was found in both groups; at all time points with stronger RANK staining in the test group at 8 and 16 weeks. Strong OPG staining was localized to both osteoblasts and connective tissues. RANK receptor mRNA was expressed at a lower level in the test group (-4.26-fold; p = 0.02) at 4 weeks and SP7 at 16 weeks (-2.89-fold; p = 0.04). COL1A1 and TIMP3 mRNA expression increased significantly over time in the control group (p = 0.045, F = 5.4 and p = 0.003, F = 42.2 respectively). CONCLUSION: Socket healing over time was comparable. The sheep tooth extraction model was found to be suitable for the evaluation of changes in the alveolar bone at the molecular level.

Dental high-speed handpiece and ultrasonic scaler aerosol generation levels and the effect of suction and air supply.

OBJECTIVE: Exposure to aerosol spray generated by high-speed handpieces (HSHs) and ultrasonic scalers poses a significant health risk to oral health practitioners from airborne pathogens. Aerosol generation varies with different HSH designs, but to date, no study has measured this. MATERIALS AND METHODS: We measured and compared aerosol generation by (1) dental HSHs with 3 different coolant port designs and (2) ultrasonic scalers with no suction, low-volume evacuation (LVE) or high-volume evacuation (HVE). Measurements used a particle counter placed near the operator's face in a single-chair, mechanically ventilated dental surgery. Volume concentrations of aerosol, totaled across a 0.3-25-µm size range, were compared for each test condition. RESULTS: HSH drilling and scaling produced significantly high aerosol levels (P < .001) with total volume concentrations 4.73×108µm3/m3 and 4.18×107µm3/m3, respectively. For scaling, mean volume of aerosol was highest with no suction followed by LVE and HVE (P < .001). We detected a negative correlation with both LVE and HVE, indicating that scaling with suction improved operator safety. For drilling, simulated cavity preparation with a 1-port HSH generated the most aerosol (P < .01), followed by a 4-port HSH. Independent of the number of cooling ports, lack of suction caused higher aerosol volume (1.98×107 µm3/m3) whereas HVE significantly reduced volume to -4.47×105 µm3/m3. CONCLUSIONS: High concentrations of dental aerosol found during HSH cavity preparation or ultrasonic scaling present a risk of infection, confirming the advice to use respiratory PPE. HVE and LVE both effectively reduced aerosol generation during scaling, whereas the new aerosol-reducing 'no air' function was highly effective and can be recommended for HSH drilling.

Evaluation of mandibular growth using cone-beam computed tomography in a rabbit model: a pilot study.

OBJECTIVES: The aim of this pilot study was to describe three-dimensional (3D) changes during mandibular growth in a rabbit model using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT scans were taken of three growing New Zealand white rabbits at baseline and then fortnightly for eight weeks. Metallic tantalum 1-mm spheres were implanted as bone reference markers. 3D images were constructed, and mandibular growth was described by six measurements. RESULTS: The animals coped well with the experimental procedures. The use of CBCT to evaluate 3D mandibular growth appeared feasible in this rabbit model. Consistent mandibular growth (of 0.6 to 5.7 mm) was observed in all rabbits. Distances between the bone markers changed slightly (0.0 to 1.6 mm). CONCLUSION: During the observation period, vertical ramus growth in the rabbit mandible was more prominent than either sagittal or transverse growth. The mandibular molar region seemed to be the most stable area for radiographic superimposition in the rabbit model. 3D evaluation of mandibular growth in a rabbit model using CBCT represents a promising approach for the preclinical evaluation of proposed treatment intervention studies.

Meeting the challenges and clinical requirements for dental regeneration; the New Zealand experience.

Disease and trauma leading to tooth loss and destruction of supporting bone is a significant oral handicap, which may be addressed through surgical therapies that aim to regenerate the lost tissue. Whilst complete regeneration of teeth is still aspirational, regeneration of supporting structures (dental pulp, cementum, periodontal ligament, bone) is becoming commonplace, both for teeth and for titanium dental implants that are used to replace teeth. Most grafting materials are essentially passive, however the next generation of oral regenerative devices will combine non-antibiotic antimicrobials and/or osteogenic or inductive factors and/or appropriate multipotential stem cells. The review gives an overview of the approaches taken, including fabrication of novel scaffolds, incorporation of growth factors and cell-based therapies, and discusses the preclinical animal models we employ in the development pathway.