Evaluation of the effect of 3D-bioprinted gingival fibroblast-encapsulated ADM scaffolds on keratinized gingival augmentation.

BACKGROUND AND OBJECTIVES: The keratinized gingiva plays an important role in maintaining healthy periodontal and peri-implant tissue. Acellular dermal matrix (ADM), as a substitute biomaterial, has a porous structure and good biocompatibility. 3D-bioprinting has the potential for tissue engineering because it enables precise loading of cells layer-by-layer. Herein, we bioprinted ADM scaffold encapsulating gingival fibroblasts (GFs) and evaluated its efficacy in keratinized gingiva augmentation in vivo to assess its potential for clinical periodontal tissue regeneration. METHODS: GFs were extracted from the gingiva of beagles and transfected with a green fluorescent protein (GFP). The ADM scaffold (ADM cell-free group) was constructed using ADM, gelatin, and sodium alginate mixed at an appropriate ratio via 3D-bioprinting. The ADM cell scaffold (ADM cell group) was established by adding extra GFs in the same manner. Six beagles were divided into blank control, ADM cell-free, and ADM cell groups; and implant surgery was performed. The keratinized gingiva was clinically and histologically evaluated at baseline and after 2 months. RESULTS: GFs transfected with GFPs expressed green fluorescence and were present in new tissue in the ADM cell group and not observed in the ADM cell-free group. At 2 months after surgery, the keratinized gingival augmentation in the ADM cell group was significantly more than that in the ADM cell-free group. Attached gingival augmentation was also observed more in the ADM cell group than that in the ADM cell-free group. Histological staining showed that the tissue in the ADM cell group displayed a more integrated structure and higher expression of COL I, COL III, and VEGF-A than those in the ADM cell-free group. CONCLUSION: 3D-bioprinted GF-encapsulated ADM scaffolds increased the amount of keratinized gingiva in vivo, suggesting that 3D-bioprinting has great potential for oral soft tissue regeneration.

Psychological impact and perceptions of orthodontic treatment of adult patients with different motivations.

INTRODUCTION: Motivations, perceptions, and psychosocial states of adult patients with orthodontic disorders in China have not been widely studied. The study assessed the psychosocial states and perceptions of adult patients undergoing orthodontic treatments with different motivations. METHODS: Two hundred forty-three adult patients (mean age, 30.2 ± 7.4 years; women, 79.0%) undergoing orthodontic treatment were recruited from a tertiary stomatology hospital. The patients answered a patient-centered questionnaire regarding motivations and perceptions of orthodontic treatment and the Psychosocial Impact of Dental Aesthetics Questionnaire. Data were analyzed using the chi-square test on the basis of multiple responses. Multiple linear regression analyses were performed to determine the association between motivation factors and the Psychosocial Impact of Dental Aesthetics Questionnaire subscale scores (P <0.05). RESULTS: Patients with various motivations were as follows: occlusal function reason (70.4%), dental esthetic reason (54.7%), facial esthetic reason (24.3%), and following others' suggestions (18.5%). Patients with esthetic or occlusal motivations exhibited significantly greater need and interest for orthodontic treatment (P <0.001). Multiple linear regression analyses revealed that the scores of social impact, psychological impact, and esthetic concern subscales were significantly associated with both dental and facial esthetic motivations (P <0.001). CONCLUSIONS: The primary motivations of Chinese patients were observed to be improved esthetics and occlusal function. Patients with esthetic or occlusal motivations exhibited significantly greater need and interest in treatment. Patients with facial or dental esthetic motivations experienced greater impacts of psychosocial states. Therefore, the patient motivations and impacts of esthetic-related psychosocial states on them should be considered during treatment.

Biomechanical evaluation of customized root implants in alveolar bone: A comparative study with traditional implants and natural teeth.

PURPOSE: To compare and evaluate density changes in alveolar bones and biomechanical responses including stress/strain distributions around customized root implants (CRIs), traditional implants, and natural teeth. MATERIALS AND METHODS: A three-dimensional finite element model of the maxillary dentition defect, CRI models, traditional restored implant models, and natural teeth with periodontal tissue models were established. The chewing load of the central incisor, the traditional implant, and the CRI was 100N, and the load direction was inclined by 11° in the sagittal plane. According to the bone remodeling numerical algorithm, the bone mineral density and distribution were calculated and predicted. In addition, animal experiments were performed to verify the feasibility of the implant design. The results of the simulation calculations were compared with animal experimental data in vivo to verify their validity. RESULTS: No significant differences in bone mineral density and stress/strain distribution were found between the CRI and traditional implant models. The animal experimental results (X-ray images and histological staining) were consistent with the numerical simulated results. CONCLUSIONS: CRIs were more similar to traditional implants than to natural teeth in terms of biomechanical and biological evaluation. Considering the convenience of clinical application, this biomechanical evaluation provides basic theoretical support for further applications of CRI.

A prospective, multicentre study of 6-mm short implants in posterior alveolar bone supporting splinted crowns: A 5-year follow-up study.

AIM: To evaluate the clinical and radiographic outcomes of 6-mm short implants, placed in the posterior jaws and supporting splinted crowns, at 5 years after early loading. MATERIALS AND METHODS: Forty-five patients with 95 implants (diameter: 4 mm; length: 6 mm) were enrolled at three centres. Two to three implants were placed in either the maxillary or the mandibular posterior region in each patient and restored with screw-retained splinted crowns at 6 weeks later. Clinical and radiographic outcomes were evaluated at implant placement, at loading, and at 6, 12, 24, 36, and 60 months after loading. Biological and mechanical complications were recorded. Marginal changes in bone level in relation to clinical parameters were evaluated using a generalized linear mixed model. RESULTS: During the 5 years of follow-up, the mean change in the marginal bone level (MBL) was 0.04 ± 0.14 mm. Four implants in four patients were lost before loading, one implant in one patient was lost at the 5-year follow-up, and two patients were lost to follow-up. The survival and success rates were 88.4% (38/43) at the patient level. The incidence rates of peri-implant mucositis and peri-implantitis were 29.4% and 7.0%, respectively. The rate of technical complications was 14.0%. CONCLUSIONS: Over a 5-year period, 6-mm short implants supporting early loaded splinted crowns in maxillary or mandibular posterior regions showed stable MBLs and acceptable technical and biological complication rates.

Influence of different diameter reductions in the labial neck region on the stress distribution around custom-made root-analogue implants.

This study was designed to investigate the influence of diameter reductions on the stress distribution around root-analogue implants via 3D finite element analysis. Four root-analogue implant models with different diameter reductions (0, 1, 2, or 3 mm), a traditional threaded implant and congruent bone models were created through reverse engineering. A 100-N force was applied parallel with and in a 45° angle to the implant axis, respectively. The stress concentration in the labial neck area around implants with 1-2 mm diameter reduction was lower than seen with no reduction. When the implant diameter was reduced by 3 mm, there were obvious stress concentrations in both implant and bone (the maximum stress was 206  and 111 MPa, respectively). In other groups, the maximum stress was 65.1 MPa in the bone and 108 MPa in the implant. Additionally, the stress concentration in the bone around the root-analogue implant when the implant diameter was reduced by 0-2 mm (maximum stress of 65.1 MPa) was obviously smaller than that around the traditional implant (maximum stress 130.4 MPa). Reducing the diameter of maxillary central incisor root-analogue implants by up to 2 mm next to the labial cortical bone could help disperse stress.

Individual Factors of Botulinum Type A in Treatment of Gummy Smile: A Prospective Study.

BACKGROUND: Botulinum type A (BTX-A) injection is a promising treatment for gummy smile (GS), although its effects are varied and inconsistent. OBJECTIVES: The aim of this study was to explore the effect of individual factors on BTX-A treatment for GS, and to establish treatment expectations. METHODS: In this prospective clinical study, a standardized technique comprising bilateral single-point injections of 2 U BTX-A (total, 4 U) was administered to all GS patients. Data were collected at baseline and after 4, 12, and 32 weeks of follow-up. Twenty-nine potential individual factors were analyzed by correlation and regression analysis to exclude confounding bias. RESULTS: Ninety-four patients completed the BTX-A treatment. After adjusting for potential confounding factors, the correlation and regression analysis confirmed the following formula: anterior gingival exposure (GE) at 4 weeks = 1.44 + (0.94 × baseline anterior GE) - (1.88 × sex) (where male = 1 and female = 2). The confidence interval (CI) of the prediction showed that for all female participants with baseline anterior GE <5.3 mm, the 95% CI of anterior GE was 0.3 to 3.0 mm after 4 weeks of treatment, and 3.0 to 8.9 mm with baseline anterior GE ≥6 mm. For male patients with baseline anterior GEs of 3 and ≥4.6 mm, the 95% CIs were 1.5 to 3.3 mm and 3.2 to 8.9 mm, respectively. CONCLUSIONS: The effect of average-dose BTX-A treatment for GS depended on GS severity and patient's sex, rather than GS etiology and other factors. Female participants with baseline anterior GE <5.3 mm were more likely to show complete improvement after 4 weeks of treatment. However, female participants with baseline anterior GE ≥6.0 mm or male participants were less likely to show complete improvement at 4 weeks.

Influence of sagittal root positions on the stress distribution around custom-made root-analogue implants: a three-dimensional finite element analysis.

BACKGROUND: Stress concentration may cause bone resorption even lead to the failure of implantation. This study was designed to investigate whether a certain sagittal root position could cause stress concentration around maxillary anterior custom-made root-analogue implants via three-dimensional finite element analysis. METHODS: The von Mises stresses in the bone around implants in different groups were compared by finite element analysis. Six models were constructed and divided into two groups through Geomagic Studio 2012 software. The smooth group included models of unthreaded custom-made implants in Class I, II or III sagittal root positions. The threaded group included models of reverse buttress-threaded implants in the three positions. The von Mises stress distributions and the range of the stresses under vertical and oblique loads of 100 N were analyzed through ANSYS 16.0 software. RESULTS: Stress concentrations around the labial lamella area were more prominent in the Class I position than in the Class II and Class III positions under oblique loading. Under vertical loading, the most obvious stress concentration areas were the labial lamella and palatal apical areas in the Class I and Class III positions, respectively. Stress was relatively distributed in the labial and palatal lamellae in the Class II position. The maximum von Mises stresses in the bone around the custom-made root-analogue implants in this study were lower than around traditional implants reported in the literature. The maximum von Mises stresses in this study were all less than 25 MPa in cortical bone and less than 6 MPa in cancellous bone. Additionally, compared to the smooth group, the threaded group showed lower von Mises stress concentration in the bone around the implants. CONCLUSIONS: The sagittal root position affected the von Mises stress distribution around custom-made root-analogue implants. There was no certain sagittal root position that could cause excessive stress concentration around the custom-made root-analogue implants. Among the three sagittal root positions, the Class II position would be the most appropriate site for custom-made root-analogue implants.

Antimicrobial and Antifouling Polymeric Agents for Surface Functionalization of Medical Implants.

Combating implant-associated infections is an urgent demand due to the increasing numbers in surgical operations such as joint replacements and dental implantations. Surface functionalization of implantable medical devices with polymeric antimicrobial and antifouling agents is an efficient strategy to prevent bacterial fouling and associated infections. In this work, antimicrobial and antifouling branched polymeric agents (GPEG and GEG) were synthesized via ring-opening reaction involving gentamicin and ethylene glycol species. Due to their rich primary amine groups, they can be readily coated on the polydopamine-modified implant (such as titanium) surfaces. The resultant surface coatings of Ti-GPEG and Ti-GEG produce excellent in vitro antibacterial efficacy toward both Staphylococcus aureus and Escherichia coli, while Ti-GPEG exhibit better antifouling ability. Moreover, the infection model with S. aureus shows that implanted Ti-GPEG possessed excellent antibacterial and antifouling ability in vivo. This study would provide a promising strategy for the surface functionalization of implantable medical devices to prevent implant-associated infections.

Digital evaluation of absolute marginal discrepancy: A comparison of ceramic crowns fabricated with conventional and digital techniques.

STATEMENT OF PROBLEM: Marginal discrepancy is key to evaluating the accuracy of fixed dental prostheses. An improved method of evaluating marginal discrepancy is needed. PURPOSE: The purpose of this in vitro study was to evaluate the absolute marginal discrepancy of ceramic crowns fabricated using conventional and digital methods with a digital method for the quantitative evaluation of absolute marginal discrepancy. The novel method was based on 3-dimensional scanning, iterative closest point registration techniques, and reverse engineering theory. MATERIAL AND METHODS: Six standard tooth preparations for the right maxillary central incisor, right maxillary second premolar, right maxillary second molar, left mandibular lateral incisor, left mandibular first premolar, and left mandibular first molar were selected. Ten conventional ceramic crowns and 10 CEREC crowns were fabricated for each tooth preparation. A dental cast scanner was used to obtain 3-dimensional data of the preparations and ceramic crowns, and the data were compared with the "virtual seating" iterative closest point technique. Reverse engineering software used edge sharpening and other functional modules to extract the margins of the preparations and crowns. Finally, quantitative evaluation of the absolute marginal discrepancy of the ceramic crowns was obtained from the 2-dimensional cross-sectional straight-line distance between points on the margin of the ceramic crowns and the standard preparations based on the circumferential function module along the long axis. RESULTS: The absolute marginal discrepancy of the ceramic crowns fabricated using conventional methods was 115 ±15.2 µm, and 110 ±14.3 µm for those fabricated using the digital technique was. ANOVA showed no statistical difference between the 2 methods or among ceramic crowns for different teeth (P>.05). CONCLUSIONS: The digital quantitative evaluation method for the absolute marginal discrepancy of ceramic crowns was established. The evaluations determined that the absolute marginal discrepancies were within a clinically acceptable range. This method is acceptable for the digital evaluation of the accuracy of complete crowns.

Adiponectin promotes human jaw bone marrow mesenchymal stem cell chemotaxis via CXCL1 and CXCL8.

Adiponectin (APN) is known to promote the osteogenic differentiation of human jaw bone marrow mesenchymal stem cells (h-JBMMSCs). However, the underlying mechanism has not been fully elucidated. Previously, we showed that APN could promote h-JBMMSC osteogenesis via APPL1-p38 by up-regulating osteogenesis-related genes. Here, we aimed to determine whether APN could promote h-JBMMSC chemotaxis through CXCL1/CXCL8. The CCK-8, wound healing and transwell assays were used to evaluate the proliferation, migration and chemotaxis of h-JBMMSCs with or without APN treatment. Chemotaxis-related genes were screened using RNA-seq, and the results were validated using real-time PCR and ELISA. We also performed Western blot using the AMPK inhibitor, WZ4003, and the p38 MAPK inhibitor, SB203580, to identify the signalling pathway involved. We found that APN could promote h-JBMMSC chemotaxis in the co-culture transwell system. CXCL1 and CXCL8 were screened and confirmed as the up-regulated target genes. The APN-induced CXCL1/8 up-regulation to promote chemotaxis could be blocked by CXCR2 inhibitor SB225002. Western blot revealed that the phosphorylation of AMPK and p38 MAPK increased in a time-dependent manner with APN treatment. Additionally, WZ4003 and SB203580 could suppress the APN-induced overexpression of CXCL1 and CXCL8. The results of the transwell chemotaxis assay also supported the above results. Our data suggest that APN can promote h-JBMMSC chemotaxis by up-regulating CXCL1 and CXCL8.

Irregular Implant Design Decreases Periimplant Stress and Strain Under Oblique Loading.

OBJECTIVES: To investigate whether a different implant geometry with the same potential contact surface area (PCSA) affects the principal stress and strains in bone. MATERIAL AND METHODS: Three-dimensional finite-element models were created with a single endosseous implant embedded in bone. The irregular (IR) dental root-analog implant and regular (R) cylindrical implant with the same PCSA 350 mm were modeled, keeping the size of the thinnest implant wall 0.8 mm, and the thinnest bone wall 1 mm. The regular or irregular abutments were either 4.5 mm lower than the platform of the implants or 5 mm higher than the platform of the implants, both with the taper 1.44°. A 100 N vertical or 100 N vertical/50 N horizontal occlusal loading was applied. The biomechanical behaviors of periimplant bone were recorded. RESULTS: The IR implant design experienced lower periimplant stress and strain under oblique loading than that of R implant design. In the IR implant design, comparable stress in bone, implant, and abutment were found under 100 N vertical loading or 100 N vertical/50 N horizontal loading. In the R implant design, much higher stress in bone, implant, and abutment were found under 100 N vertical/50 N horizontal loading than that under 100 N vertical loading. CONCLUSION: Irregular dental root-analog implant is a biomechanically favorable design principle for decreasing periimplant stress and strain under oblique loading.

A prospective, multicenter study assessing the DENTSPLY Implants, OsseoSpeed(™) TX, length 6 mm in the posterior maxilla and mandible: a 1-year follow-up study.

OBJECTIVE: The aim of this multicenter study was to prospectively assess clinical and radiographic outcomes of short implants (length 6 mm) in the posterior region and early-loading with splinted-fixed dental prostheses. MATERIALS AND METHODS: A total of 45 subjects (77.8% with chronic periodontitis) were enrolled at three study sites. In total, 95 implants (diameter 4 mm, length 6 mm; OsseoSpeed(™) 4.0 S; DENTSPLY Implants; Mölndal, Sweden) were placed, two or three implants per subject, using one-stage surgery and loaded with a screw-retained splinted ceramic-fixed prosthesis 6 weeks later. Clinical and radiographic examinations were performed preoperatively, post-surgery, at loading, and 6 and 12 months after prosthesis placement. RESULTS: Four implants failed before loading; all other implants showed favorable clinical and radiographic findings throughout the observation period (1-year survival and success rate: 95.8%). Postoperative pain and swelling were negligible. Mean changes in marginal bone levels measured from loading were minimal (0.01 ± 0.37 and -0.13 ± 0.46 mm after 6 months and 1 year, respectively). Bone loss less than 1.00 mm was found in 77.5% implants, and bone gain was found in 15.5% implants. Probing depth change less than 2 mm was found in 98.7% of the implants between loading and 1-year follow-up. Prosthetic complications included one ceramic veneer chipping. CONCLUSION: One-year data indicate that the use of 6-mm-long implants is a predictable treatment. This provides a good treatment option in situations with limited bone height in posterior regions.

Influence of Different Abutment Designs on the Biomechanical Behavior of Dental Root-Analog Implant: A Three-Dimensional Finite Element Analysis.

OBJECTIVE: The aim of this study was to evaluate cross-sectional area of the abutments, strain distribution in the periimplant bone, stress in the abutments and dental root-analog implant by different abutment design under different loading conditions, through three-dimensional finite element analysis. METHODS: Two three-dimensional finite element models were established. Two types of abutments, oval cross section abutment (OCSA) and circular cross section abutment (CCSA) were designed, keeping the size of the thinnest implant wall 0.75 mm. Two types of load were applied to the abutment in each model: 100 N vertical load (V), 100 N vertical/50 N horizontal load (VH). The biomechanical behaviors of abutments, implants, and periimplant bone were recorded. RESULTS: The cross-section area of OCSA is 36.5% larger than that of CCSA. In implants, the maximum von Mises stress value in OCSA design was 24.6% lower than that in CCSA design under V and under VH. In abutments, the maximum von Mises stress value in OCSA design was 40.0% lower than that in CCSA design under V, the maximum von Mises stress value in OCSA design was 12.2% lower than that in CCSA design under VH. CONCLUSIONS AND CLINICAL SIGNIFICANCE: The irregular design offers advantages over regular design.

Porous deproteinized bovine bone scaffold with three-dimensional localized drug delivery system using chitosan microspheres.

BACKGROUND: Bone substation grafts, such as hydroxyapatite (HA) and tricalciumphosphate (TCP), have been extensively used in clinical applications, but evidence suggests that they offer poor osteoinductive properties compared to allografts and autografts. In order to increase bone growth with such grafts, Bone Morphogenetic Protein 2 (BMP-2) was incorporated into a three dimensional reservoir. The purpose of the present study was to develop a novel drug delivery system which is capable of controlled release of BMP-2. METHODS: DBB were prepared from bovine cancellous bone harvested from fetal bovine femur or tibia and then sinting at 1000°C. BMP-2-loaded chitosan (CS) microspheres were fabricated by cross-linking. Then the treated DBB powders were blended with chitosan microspheres solution. Finally, the composites were lyophilized with a freeze dryer to obtain the DBB/CMs scaffolds. X-ray diffractor (XRD), scanning electron microscopy (SEM) and Fourier transform infrared (FT-IR) were used to characterize the sample. The quantification of the delivery profile of BMP-2 was determined using an enzyme-linked immunosorbent assay (ELISA) kit. The in vitro assays were to characterize the biocompatibility of this composite. RESULTS: In this study, BMP-2/Chitosan (CS) microspheres were successively loaded onto a deproteinized bovine bone (DBB) scaffold. The release profile of BMP-2 indicated an initial burst release followed by a more even sustained release. An in vitro bioactivity assay revealed that the encapsulated growth factor was biologically active. CONCLUSIONS: The cell culture assay suggest that the excellent biocompatibility of the DBB- BMP-2/CS. Therefore, this novel microsphere scaffold system can be effectively used in current tissue engineering applications.

The Osteogenesis Effect and Underlying Mechanisms of Local Delivery of gAPN in Extraction Sockets of Beagle Dogs.

A plastic and biodegradable bone substitute consists of poly (L-lactic-co-glycolic) acid and 30 wt % ß-tricalcium phosphate has been previously fabricated, but its osteogenic capability required further improvement. We investigated the use of globular adiponectin (gAPN) as an anabolic agent for tissue-engineered bone using this scaffold. A qualitative analysis of the bone regeneration process was carried out using µCT and histological analysis 12 weeks after implantation. CBCT (Cone Beam Computed Tomography) superimposition was used to characterise the effect of the different treatments on bone formation. In this study, we also explored adiponectin's (APN) influence on primary cultured human jaw bone marrow mesenchymal stem cells gene expressions involved in the osteogenesis. We found OPEN ACCESS Int. J. Mol. Sci. 2015, 16 24947 that composite scaffolds loaded with gAPN or bone morphogenetic protein 2 (BMP2) exhibited significantly increased bone formation and mineralisation following 12 weeks in the extraction sockets of beagle dogs, as well as enhanced expression of osteogenic markers. In vitro investigation revealed that APN also promoted osteoblast differentiation of primary cultured human jaw bone marrow mesenchymal stem cells (h-JBMMSCs), accompanied by increased activity of alkaline phosphatase, greater mineralisation, and production of the osteoblast-differentiated genes osteocalcin, bone sialoprotein and collagen type I, which was reversed by APPL1 siRNA. Therefore, the composite scaffold loaded with APN exhibited superior activity for guided bone regeneration compared with blank control or Bio-Oss® (a commercially available product). The composite scaffold with APN has significant potential for clinical applications in bone tissue engineering.

Effect of glycine powder air-polishing as an adjunct in the treatment of peri-implant mucositis: a pilot clinical trial.

BACKGROUND: Glycine powder air-polishing (GPAP) has the potential to effectively erase biofilms and may improve the treatment efficacy of peri-implant mucositis. This pilot clinical trial evaluated the effect of GPAP as an adjunct in treating peri-implant mucositis. MATERIALS AND METHODS: Twenty-four subjects having at least one implant with peri-implant mucositis were randomly assigned to test (12 subjects with 17 implants) and control (12 subjects with 16 implants) groups. Following baseline assessment, all subjects received oral hygiene instruction and non-surgical debridement. In the test group, the sites with probing depth (PD) ≥4 mm were additionally treated by GPAP for 5 sec. Clinical parameters were measured at 1-week, 1-month, and 3-month recall visits. RESULTS: At the 3-month visit, the mean reductions in PD at site level were 0.93 ± 0.93 mm and 0.91 ± 0.98 mm in the test and control groups, respectively (P < 0.05), and no significant difference existed between two groups. Mean bleeding score was also significantly reduced in both groups after the intervention. No complications or discomfort were reported during the study. CONCLUSIONS: This pilot clinical trial suggests that non-surgical mechanical debridement may effectively control peri-implant mucositis, and adjunctive GPAP treatment seems to have a limited beneficial effect as compared with mechanical debridement alone. However, further clinical trials with a large sample size are needed to confirm this preliminary observation.

A finite element analysis of periodontal ligament fluid mechanics response to occlusal loading based on hydro-mechanical coupling model.

OBJECTIVE: Considering fluid stimulation is one of the essential biomechanical signals for periodontal tissues, this study aims to characterizing fluid mechanics response during occlusal loading by a hydro-mechanical coupling model for periodontal ligament. DESIGN: Models simulating periodontium with normal bone height and with intraosseous defects were built with three mechanical modules: tooth, periodontal ligament and alveolar bone. Tooth was modeled as linear elastic, and periodontal ligament and alveolar bone as a hydro-mechanical coupling model. Transient analyses under dynamic occlusal loading were performed. Fluid dynamics within periodontal ligament space was simulated and visualized by post-processing module. RESULTS: Reciprocating oscillatory flow occurred within the periodontal ligament under occlusal loading. Higher pore pressure and fluid velocity were observed in furcation and apical regions compared to mid-root and cervical regions. Intraosseous defects increased pore pressure and fluid velocity within the periodontal ligament, most significantly near the defect. CONCLUSION: Based on the results of the hydro-mechanical coupling model, significant oscillatory fluid motion is observed within the periodontal ligament under occlusal loading. Particularly, higher fluid velocity is evident in the furcation and apical areas. Additionally, Intraosseous defects significantly enhance fluid motion within the periodontal ligament.

An Investigative Study on the Oral Health Condition of Individuals Undergoing 3D-Printed Customized Dental Implantation.

BACKGROUND: The advent of three-dimensional (3D) printing technology has revolutionized the field of dentistry, enabling the precise fabrication of dental implants. By utilizing 3D printing, dentists can devise implant plans prior to surgery and accurately translate them into clinical procedures, thereby eliminating the need for multiple surgical procedures, reducing surgical discomfort, and enhancing surgical efficiency. Furthermore, the utilization of digital 3D-printed implant guides facilitates immediate restoration by precisely translating preoperative implant design plans, enabling the preparation of temporary restorations preoperatively. METHODS: This comprehensive study aimed to assess the postoperative oral health status of patients receiving personalized 3D-printed implants and investigate the advantages and disadvantages between the 3D-printed implant and conventional protocol. Additionally, variance analysis was employed to delve into the correlation between periodontal status and overall oral health. Comparisons of continuous paired parameters were made by t-test. RESULTS: The results of our study indicate a commendable one-year survival rate of over 94% for 3D-printed implants. This finding was corroborated by periodontal examinations and follow-up surveys using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, revealing excellent postoperative oral health status among patients. Notably, OHIP-14 scores were significantly higher in patients with suboptimal periodontal health, suggesting a strong link between periodontal health and overall oral well-being. Moreover, we found that the operating time (14.41 ± 4.64 min) was less statistically significant than for the control group (31.76 ± 6.83 min). CONCLUSION: In conclusion, personalized 3D-printed implant surgery has emerged as a reliable clinical option, offering a viable alternative to traditional implant methods. However, it is imperative to gather further evidence-based medical support through extended follow-up studies to validate its long-term efficacy and safety.

Application of Botulinum Toxin at the Yonsei Point for the Treatment of Gummy Smile: A Randomized Controlled Trial.

BACKGROUND: Demand for less-invasive procedures for treating gummy smile, such as botulinum toxin A injections, has increased substantially over the years. Meanwhile, the optimal injection site for botulinum toxin A injection is debated. The authors aimed to investigate the efficacy of botulinum toxin A injection at the Yonsei point for treating gummy smile. METHODS: In this double-blind, single-site, randomized clinical trial, healthy participants with a gummy smile (anterior gingival exposure of ≥3.0 mm) were enrolled and randomized (1:1 ratio) into two groups. The experimental group was administered 6 U of botulinum toxin A at the Yonsei point (a single-site injection of 3 U to the right Yonsei point and 3 U to the left Yonsei point), and the control group received the same dose in the bilateral levator labii superioris alaeque nasi muscle sites. The patients were assessed at baseline and 4, 12, 24, and 48 weeks after the first injection using a digital vernier caliper. RESULTS: A total of 49 participants were enrolled. Anterior and bilateral posterior gingival exposure were reduced at 4, 12, and 24 weeks ( P ≤ 0.05) and returned to baseline at 48 weeks in both groups; there was no difference between the groups at these time points. The increase in satisfaction among patients was significant, and few adverse events were observed. CONCLUSION: Both the Yonsei point and the levator labii superioris alaeque nasi muscle site can be used as botulinum toxin A injection sites for treating gummy smile. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Effects of Dose and Injection Site on Gingival Smile Treatment with Botulinum Toxin Type A: A Prospective Study.

BACKGROUND: Botulinum toxin type A is an easy and efficacious treatment for gingival smile. However, the optimal dose and injection site are controversial. The authors compared the reduction in gingival exposure using two methods with different doses and injection sites. METHODS: In this prospective self-controlled study, healthy participants with gingival smile (anterior gingival exposure of >3 mm) underwent two treatment methods. First, participants received a single-point injection of 2 U of botulinum toxin type A per side (simplified method). After 8 months, the individualized method was performed with 2 to 5 U of botulinum toxin type A (total, 4 to 10 U), which was injected at one or two sites according to pretreatment severity. Data were collected at baseline and at 4, 12, and 32 weeks of follow-up. RESULTS: Fifty-five participants were enrolled. Anterior gingival exposure and bilateral posterior gingival exposure were significantly reduced 4 and 12 weeks after botulinum toxin type A injection ( P ≤ 0.05) with both methods. These parameters returned to baseline by 32 weeks ( P > 0.05). Posttreatment anterior gingival exposure at 4 weeks and 12 weeks with the individualized method was significantly lower compared with the simplified method (both P ≤ 0.05). Patient satisfaction with the individualized method was preferred compared with the simplified method ( P ≤ 0.05). Few adverse events were observed with both methods without statistical significance. CONCLUSION: It is necessary to increase the injection dose and tailor the injection site according to the pretreatment severity of anterior gingival smile.