25-Hydroxycholesterol induces odontoclastic differentiation through RANK-RANKL upregulation and NF-κB activation in odontoblast-like MDPC-23 cells: An in vitro study.

AIM: The physiological effects and cellular mechanism of 25-hydroxycholesterol (25-HC), which is an oxysterol synthesized from cholesterol by cholesterol-25-hydroxylase (CH25H) expressed under inflammatory conditions, are still largely unknown during odontoclastogenesis. This study aimed to evaluate 25-HC-induced odontoclastogenesis and its cellular mechanisms in odontoblast-like MDPC-23 cells. METHODOLOGY: To investigate 25-HC-induced odontoclastogenesis of MDPC-23 cells and its cellular mechanism, haemotoxylin and eosin staining, tartrate-resistant acid phosphatase (TRAP) staining, dentine resorption assay, zymography, reactive oxygen species (ROS) detection, immunocytochemistry, and nuclear translocation were performed. The experimental values are presented as mean ± standard deviation and were compared using analysis of variance, followed by post hoc multiple comparisons (Tukey's test) using SPSS software version 22 (IBM Corp.). A p-value <.05 was considered statistically significant. RESULTS: Lipopolysaccharide or receptor activator of nuclear factor-κB ligand (RANKL) induced the synthesis of 25-HC via the expression of CH25H in MDPC-23 cells (p < .01). Multinucleated giant cells with morphological characteristics and TRAP activity of the odontoclast were increased by 25-HC in MDPC-23 cells (p < .01). Moreover, 25-HC increased dentine resorption through the expression and activity of matrix metalloproteinases in MDPC-23 cells. It not only increased the expression of odontoclastogenic biomarkers but also translocated cytosolic nuclear factor-κB (NF-κB) to the nucleus in MDPC-23 cells. Additionally, 25-HC not only increased the production of ROS (p < .01), expression of inflammatory mediators (p < .01), pro-inflammatory cytokines, receptor activator of NF-κB (RANK), and RANKL but also suppressed the expression of osteoprotegerin (OPG) in MDPC-23 cells. In contrast, CDDO-Me, a chemical NF-κB inhibitor, decreased TRAP activity (p < .01) and downregulated the expression of the odontoclastogenic biomarkers, including RANK and RANKL, in MDPC-23 cells. CONCLUSION: 25-HC induced odontoclastogenesis by modulating the RANK-RANKL-OPG axis via NF-κB activation in MDPC-23 cells. Therefore, these findings provide that 25-HC derived from cholesterol metabolism may be involved in the pathophysiological etiological factors of internal tooth resorption.

Volumetric evaluation of effects of platelet-rich fibrin and concentrated growth factor on early bone healing after endodontic microsurgery: a randomized controlled trial.

BACKGROUND: This randomized controlled clinical trial compared the effects of platelet-rich fibrin (PRF) and concentrated growth factor (CGF) on early bone healing after endodontic microsurgery. METHODS: Eighteen patients with an isolated periapical lesion < 10 mm in the maxillary anterior region were randomly assigned to three groups: control, PRF, or CGF. Endodontic microsurgery was performed and PRF or CGF membranes were placed over the bone defects in the experimental groups. The volume of the bone defect at postoperative one week, three months, and six months was evaluated using cone-beam computed tomography and Mimics software. The results were statistically analyzed using the Kruskal-Wallis test and post-hoc Mann-Whitney U test with Bonferroni correction. RESULTS: At the three-month follow-up, the PRF and CGF groups showed significantly greater bone healing compared with the control group (p > 0.05). However, no significant difference was observed between the PRF and CGF groups. At the six-month follow-up, no significant differences were observed between the groups. CONCLUSIONS: These results suggested that PRF and CGF promote early bone healing after endodontic microsurgery.

Technical Note on Simplified Free Gingival Graft Using Tack Fixation (sFGG).

Free gingival graft (FGG) is the gold standard procedure for the reliable augmentation of lost keratinized mucosa (KM) around dental implants. This conventional surgical approach has its drawbacks, including limitations in manipulation, the requirement for suturing, postoperative discomfort, and pain. This case report aimed to evaluate the efficacy of a simplified free gingival graft (sFGG) in addressing the issue of inadequate keratinized mucosa around dental implants. Fixation tacks were used to perform the sFGG procedure. Initially, a partial-thickness flap was created and apically repositioned. The gingival graft was harvested from the palate with a narrow profile and securely affixed to the recipient site using 5 mm long fixation tacks. Significant gains in keratinized mucosa were achieved and successfully maintained within 1 year. Consequently, the sFGG technique emerges as a simple and reliable treatment approach for managing inadequate keratinized mucosa around dental implants.

Vertical bony step between proximal and distal segments after mandibular setback is related with relapse: A cone-beam computed tomographic study.

INTRODUCTION: Vertical bony step (VBS) occurs between proximal and distal segments of the mandible during mandibular setback surgery with bilateral sagittal split ramus osteotomy. The purpose of this study was to investigate whether VBS is correlated with the relapse of mandibular setback using 3-dimensional models constructed from cone-beam computed tomography. METHODS: The subjects consisted of 30 patients who underwent bilateral sagittal split ramus osteotomy for a mandibular setback. Double jaw surgery was performed in 18 patients, and isolated mandibular setback surgery was performed in 12 patients. Cone-beam computed tomography scans were taken at pretreatment (T0), postsurgery (T1), and posttreatment (T2). Treatment changes and the correlations between measurements were evaluated. RESULTS: The mean mandibular setback was -11.9 mm, and the mean VBS was -5.6 mm. Correlations with the relapse of mandibular setback were found in the amount of mandibular setback (T1 - T0), development of VBS (T1 - T0), posterior movement of the proximal segment (T1 - T0), counterclockwise rotation of symphysis (T2 - T1), and the resolution of VBS (T2 - T1). CONCLUSIONS: The development and resolution of VBS were correlated with the relapse of mandibular setback. Minimizing VBS is recommended to reduce the relapse of mandibular setback.

Comparative Study on Early Osseointegration of Implants According to Various Drilling Speeds in the Mandible of Dogs.

PURPOSE: This study evaluated the effect of drilling speed on early bone healing in the mandible of dogs. MATERIAL AND METHODS: Six dogs were selected, and mandibular premolars and molars were extracted. After 2 months, 3 hydroxyapatite-surfaced fixtures were implanted with drilling speeds of 50, 800, and 1200 rpm on the right side first and then on the left side after 2 weeks. Implant stability quotient (ISQ) was measured on insertion, after 2 and 4 weeks. RESULTS: Based on the ISQ measurement, the 1200-rpm group showed a higher value than the 50-rpm group at 2 weeks and 4 weeks (P < 0.05). New bone formation around the implant was highest for the 800-rpm group at 2 weeks and the 1200-rpm group at 4 weeks. The bone-implant contact of the superior half of the alveolar bone was highest for the 800-rpm group at 2 weeks and the 1200-rpm group at 4 weeks. There was no statistically significant difference. CONCLUSION: This study suggests that 50, 800, and 1200 rpm are drilling speeds which can expect favorable outcome, yet, higher drilling speed presented overall the best biological responses.

Comparative Study on Osseointegration of Implants After Flap and Flapless Surgery in the Mandible of Dogs.

PURPOSE: The objective of this study was to compare the implant stability and osseointegration of implants using a flap or flapless technique. MATERIAL AND METHODS: Mandibular premolars and molars were extracted from both sides in 6 dogs. After 8 weeks, 4 fixtures were implanted using either a flap or flapless technique. Implant stability quotient was measured on insertion and at 2, 4, and 8 weeks later. The animals were killed while the tissues were histologically analyzed. RESULTS: Implant stability increased for 8 weeks, and no statistically significant differences were observed between the surgical protocols. Bone-implant contact showed 60.27% ± 30.99% for flapless surgery and 59.73% ± 17.12% for flap surgery. And the results of new bone formation area from total area showed 56.07% ± 27.78% for flapless surgery and 57.00% ± 14.66% for flap surgery. There were no statistically significant differences. CONCLUSION: This study showed no significant difference in implant stability as well as osseointegration regardless of flap or flapless technique.

Incidence and Management of Fractured Dental Implants: Case Reports.

The fracture of dental implants is a rare occurrence in clinical settings. Possible causes of implant fracture include design or production flaws, overloaded occlusion force, implant location, metal fatigue, and bone resorption around the implant. This study reports on the successful removal and reimplantation of fractured implants.

Sinus Membrane Elevation by the Crestal Approach Using a Novel Drilling System.

PURPOSE: The purpose of this study was to evaluate the clinical outcomes of patients undergoing sinus membrane elevation by a minimally invasive crestal approach using a novel drilling system. MATERIALS AND METHODS: From May 2008 to November 2009, 21 implants were placed in 19 patients (10 men and 9 women) ranging from 23 to 69 years of age (average of 49.5 years). Implants were placed in maxillary premolar and molar areas that demonstrated insufficient residual bone quality; maxillary sinus membrane elevation was performed using a crestal approach with the sinus crestal approach kit (Neobiotech, Seoul, Korea). RESULTS: There was no sinus perforation or osseointegration failure. The implant survival rate was 100%. The postsurgical, augmented volume of the alveolar height ranged from 2 to 9.2 mm (average of 5.81 ± 2.06 mm). Six months after maxillary sinus elevation, the bone reduction volume ranged from 0.06 to 1.42 mm (average of 0.6 ± 0.38 mm). At final F/U, the amount of bone-height reduction ranged from 0.06 to 2.60 mm (average of 0.82 ± 0.63 mm). CONCLUSION: Sinus membrane elevation by the crestal approach using special reamers is advantageous because of the noticeable reduction in the risk of perforation and the ability to perform the surgery rapidly.

Synthesis and Characterization of ß-Tricalcium Phosphate Derived From Haliotis sp. Shells.

PURPOSE: To develop a methodology for the synthesis of ß-tricalcium phosphate (ß-TCP, Ca3(PO4)2) from the shell of Haliotis sp. (abalone shell) and to verify its characterization and biocompatibility. MATERIALS AND METHODS: Calcium oxide (CaO) was synthesized from abalone shell by sintering and was suspended in distilled water to prepare calcium hydroxide (Ca(OH)2). For the synthesis of calcium carbonate (CaCO3), carbon dioxide was used to infuse Ca(OH)2 at pH 7.4. CaCO3 was reacted with phosphoric acid at pH 6.0 to obtain dicalcium phosphate (CaHPO4). Subsequently, ß-TCP was synthesized by a chemical reaction between CaHPO4 and CaO at 950°C to 1100°C for 3 hours. Fourier transform infrared spectroscopy (FT-IR) and x-ray diffraction (XRD) was performed to verify the physiochemical characteristics of the composite synthesized from abalone shell. RESULTS: FT-IR and XRD results showed that ß-TCP was successfully synthesized from abalone shell. The synthesized ß-TCP did not affect cell viability of either normal human oral keratinocytes or osteoblastic MG-63 cells. These data indicate that ß-TCP synthesized from abalone shell is biologically safe. CONCLUSIONS: ß-TCP (Ca3(PO4)2) synthesized from abalone shell can be used as a potential source of bone grafting material.

Implants Displaced Into the Maxillary Sinus: A Systematic Review.

OBJECTIVES: Implant displacement into the maxillary sinus often results from features specific to the posterior maxillary teeth, including poor bone quality and insufficient remaining bone. This study reviews implants displaced into the maxillary sinus, the causes and complications of displacement, and how to remove them, according to when the displacement occurs. MATERIALS AND METHODS: The PubMed, Ovid (MEDLINE), and EMBASE databases were searched using the keywords "displacement," "implant," "maxillary sinus," and "removal" for articles published between January 2000 and July 2013. RESULTS: Twenty-two journal articles were selected; these discussed 49 displaced implants. Most of the implants were displaced into the maxillary sinus during implantation, but resulted in a low incidence of complications, such as maxillary sinusitis. The displaced implants were removed using the Caldwell-Luc approach or a transoral or transnasal endoscopic approach. CONCLUSION: Implants displaced into the maxillary sinus have various causes according to when they are displaced. As displaced implants can cause several complications, transnasal endoscopy is recommended to remove them; however, the implants should be examined thoroughly before selecting the removal method.

Histomorphometric Analysis of Contaminated Autogenous Tooth Graft Materials After Various Sterilization.

PURPOSE: The purpose of this study was to evaluate histomorphometrically contaminated autogenous tooth graft materials, which were resterilized. MATERIALS AND METHODS: The intentional defects (diameter: 8 mm, depth: 4 mm) were formed around implant fixture on the iliac crest of 6 mongrel dogs. Autogenous tooth graft materials were made by extracted premolars. After the contamination of the tooth materials, graft procedure was performed; no contaminated group (control group), contaminated groups (nonsterilization group [group 1], ethylene oxide [EO] gas group [group 2], and autoclave group [group 3]). The bone-to-implant contact (BIC) and the new bone formation rate (NBFR) were evaluated after sacrifice. RESULTS: The BIC and NBFR of groups 1 and 3 were significantly lower than the control group after 4 weeks. The BIC and NBRF of group 3 were significantly lower than the control group after 8 weeks. However, the BIC and NBRF of group 2 was not significantly different comparing with the control group after 4 and 8 weeks. CONCLUSION: Sterilization using EO gas may be more favorable than high-pressure sterilization in cases the reuse of contaminated autogenous tooth graft materials.

A Comparative Study of Stability After the Installation of 2 Different Surface Types of Implants in the Maxillae of Dogs.

PURPOSE: This study was performed to investigate the histologic and histomorphometric findings of 2 different types of implant. MATERIALS AND METHODS: Resorbable blasting media (RBM) and sandblasted with larger grit and acid etched (SLA) surfaced implants (24 fixtures in each group) were installed in posterior maxilla of dogs. The initial stability was measured using Periotest (Periotest value [PTV]). After 6 or 12 weeks, fixtures with surrounding bone were harvested. RESULTS: The average initial stability of the SLA group (-1.71 ± 2.9) was higher than that of the RBM group (-1.25 ± 3.21), but there was no significant difference. The mean PTV of the RBM surface was higher than the SLA surface at 12 weeks. The average bone-implant contacts were 67.6% ± 16.0% at 6 weeks and 82.7% ± 8.6% at 12 weeks in the SLA group and 69.9% ± 17.6% at 6 weeks and 78.3% ± 9.2% at 12 weeks in the RBM group. CONCLUSION: The SLA and resorbable blasting media (RBM) surface implants demonstrated good stabilities and healing processes of the surrounding bone in the posterior maxilla. Therefore, the two domestic implants could provide predictable clinical results.

Implant Stability Measurements in the Long-Term Follow-up of Dentis Implants: A Retrospective Study With Periotest.

PURPOSE: The purpose of this study was to evaluate retrospectively the stability of Dentis implant with the Periotest. METHODS: In total, 36 patients and 88 implants were investigated. Periotest was used to measure implant stability, and a periapical view was taken immediately after surgery and again immediately after, 3 months after, 6 months and 5 years after prosthesis placement. Bone loss on the periapical view, bone quality according to tactile sensation, and area of implant installation were assessed. RESULTS: The mean Periotest value (PTV) immediately after surgery was -1.02, and the mean bone loss rate (bone loss/fixture length × 100) at 6 months after prosthesis placement was 8.42%. PTV was higher with more bone loss (types III, IV vs types I, II bone). The lowest mean PTV was in the lower molar area (-1.48), followed by the lower anterior (-1.41), upper molar (0.11), and upper anterior area (5). One implant failed and survival rates were 98.9%. CONCLUSION: Implant stability was lower in cases with more bone loss and poor bone quality and in the maxilla versus the mandible.

Evaluation of bone formation after grafting with deproteinized bovine bone and mineralized allogenic bone.

PURPOSE: The purpose of this study was to evaluate the ability of new bone formation of deproteinized bovine bone (Bio-Oss) and mineralized allogenic bone (Tutoplast). MATERIALS AND METHODS: Sixty rats were divided into control and experimental groups (groups 1 and 2): control group, unfilled control; group 1, Bio-Oss; group 2, Tutoplast, respectively. The animals were killed after 6 and 12 weeks, and newly formed bone was analyzed histomorphometrically. RESULTS: In the control group, some new bone formed in the rim of the defect area. In the group 1, newly formed bone was thinner than the adjacent normal bone, and Bio-Oss particles were observed. In the group 2, showed a pattern of gradual fusion with adjacent bone, as well as particles in some areas, similar to the Bio-Oss-treated group. In the 12-week groups, the amount of new bone formation was significantly higher in the experimental groups than in the control group, and it was significantly higher in group 2 than in group 1. CONCLUSION: Although Tutoplast and Bio-Oss graft materials seem to be useful for bone grafts, Tutoplast showed more active new bone formation than Bio-Oss.

Downregulation of adenomatous polyposis coli by microRNA-663 promotes odontogenic differentiation through activation of Wnt/beta-catenin signaling.

MicroRNAs (miRNAs) regulate cell differentiation by inhibiting mRNA translation or by inducing its degradation. However, the role of miRNAs in odontogenic differentiation is largely unknown. In this present study, we observed that the expression of miR-663 increased significantly during differentiation of MDPC-23 cells to odontoblasts. Furthermore, up-regulation of miR-663 expression promoted odontogenic differentiation and accelerated mineralization without proliferation in MDPC-23 cells. In addition, target gene prediction for miR-663 revealed that the mRNA of the adenomatous polyposis coli (APC) gene, which is associated with the Wnt/ß-catenin signaling pathway, has a miR-663 binding site in its 3'-untranslated region (3'UTR). Furthermore, APC expressional was suppressed significantly by miR-663, and this down-regulation of APC expression triggered activation of Wnt/ß-catenin signaling through accumulation of ß-catenin in the nucleus. Taken together, these findings suggest that miR-663 promotes differentiation of MDPC-23 cells to odontoblasts by targeting APC-mediated activation of Wnt/ß-catenin signaling. Therefore, miR-663 can be considered a critical regulator of odontoblast differentiation and can be utilized for developing miRNA-based therapeutic agents.

Displaced implants into maxillary sinus: report of cases.

Although the number of implant placement in the edentulous maxillary region is increasing, there are often some cases in which implants accidentally get displaced into maxillary sinus because of low bone quality, insufficient bone height, bone resorption after surgery, and improper treatment plan. Implants displaced into the maxillary sinus can cause some complications, including mucosal thickening and sinusitis; however, there are also many cases causing no symptoms at all. Treatment procedures for implants displaced into maxillary sinus are observation, removal of implants through intraoral approach, and removal through nasal cavity using endoscope. But treatment may vary according to the presence of sinusitis, ostium obstruction, and oroantral fistula. In this study, 4 patients with present illness of implants displaced into maxillary sinus were selected, and appropriate evaluation and treatment for these cases were studied.

Osteogenic ability according to the decalcified modality of auto-tooth bone grafts in peri-implant defects in dogs.

PURPOSE: The purpose of this study was to evaluate the bone generation capacity of the autotransplantation material with clinical and histological analyses after controlled acid treatment conditions. MATERIAL AND METHODS: Bony defects were formed in the femur. Then, autotransplantation material was grafted after hydroxyapatite-coated implant placement. Experimental groups were classified according to the acid treatment method: 2% H2SO4 (group 1), 2% HCl (group 2), 2% HNO3 (group 3), or 2% ethylenediaminetetraacetic acid (EDTA) (group 4). RESULTS: The new bone formation area and bone-implant contact (BIC) of the autotransplantation materials were measured after 8 weeks. The new bone formation area in experimental groups 2, 3, and 4 were greater than that in the control group (no graft) and in experimental group 1 at 8 weeks, and the BIC of experimental group 4 was greater than that in the control group and in experimental group 1; these differences showed statistical significance (P < 0.05). CONCLUSION: Auto-tooth bone treated with EDTA resulted in more effective bone formation in dogs' femurs than bone treated with other solutions.

Guided bone regeneration using autogenous tooth bone graft in implant therapy: case series.

Recently, techniques have been reported that involve the preparation of extracted teeth from patients used as particulated bone graft materials for bone graft purposes. For implant placement and bone graft, autogenous teeth bone graft materials were used in 15 patients, and clinically excellent results were obtained. In histological examination, favorable bony healing by osteoconduction was observed.

Bone graft using block allograft as a treatment of failed implant sites: clinical case reports.

Alveolar bone should be augmented to an adequate height and width for an implant to have satisfactory functional, biological, and aesthetic properties. Large osseous defects often require block grafts harvested from the symphysis or ramus. However, surgical complications and the necessity of donor sites have led to using allogeneic grafting materials. Two patients with severe bone defects on their mandibular posterior and maxillary posterior teeth were selected to be the subjects of this study. These 2 patients needed their implant fixtures removed due to implant failure. They received alveolar ridge augmentation using commercial block allografts, and after an integration period of several months, an implant was placed. The short-term results suggest that block allografts may be suitable bone-replacement materials for augmenting alveolar defects, especially for bone grafts in bone defect areas caused by removing failed implants.

Consideration of various bone quality evaluation methods.

PURPOSE: Bone quality at the implant site has a significant effect on the success and prognosis of implants. The purpose of this article was to evaluate several methods used in evaluating bone quality and discuss the advantages and disadvantages. METHODS: The search was made using PubMed database about quantitative computed tomography (QCT), and quantitative cone-beam computerized tomography (QCBCT), dual energy x-ray absorptiometry (DXA) scans, the resistance force against the hands of the surgeon, assessment of the effect of the torque of the drill, the initial fixed value of the implant, and fractal analysis according to the Lekholm and Zarb, and Misch classifications as the standard. RESULTS: The method for measuring the resistance force and torque during implant placement and the method used to determine the implant's initial implant fixed value were easy and simple. QCBCT was reported to involve less radiation and to be more objective than QCT. DXA and fractal analysis have limits when used to classify bone quality as type II or type III. CONCLUSION: Among the methods used to evaluate bone quality in implants, a method using computed tomography, measured in Hounsfield units, was found to be the most predictive.