Effect of varying auxiliaries on maxillary incisor torque control with clear aligners: A finite element analysis.

INTRODUCTION: This study aimed to evaluate the effects of varying auxiliaries on tooth movement and stress distribution when maxillary central incisors were torqued 1° with a clear aligner through finite element analysis. METHODS: Three-dimensional finite element models, including maxillary alveolar bone, periodontal ligament, dentition, and clear aligner, were constructed. According to the auxiliaries designed on the maxillary central incisor, 5 models were created: (1) without auxiliaries (control model), (2) with the power ridge, (3) with the semi-ellipsoid attachment, (4) with the horizontal rectangular attachment, and (5) with the horizontal cylinder attachment. The tooth movement and periodontal ligament stress distribution after a palatal root torque of 1° were analyzed for each of the 5 models. RESULTS: With 1° torque predicted, the maxillary central incisor without auxiliaries showed a tendency of labial tipping, mesial tipping, and intrusion. The rotation center moved occlusally in the power ridge model. The labiolingual inclination variation increased in the semi-ellipsoid attachment model but decreased in the power ridge model. The maxillary central incisor is twisted in the distal direction in the power ridge model. The maxillary central incisor of the horizontal rectangular attachment and the horizontal cylinder attachment model behaved similarly to the control model. Periodontal stresses were concentrated in the cervical and apical areas. The maximum von Mises stresses were 11.6, 12.4, 3.81, 1.14, and 11.0 kPa in the 5 models. The semi-ellipsoid attachment model exhibited a more uniform stress distribution than the other models. CONCLUSIONS: Semi-ellipsoid attachment performed better efficacy on labiolingual inclination, and power ridge performed better efficacy on root control. However, a distal twist of maxillary incisors could be generated by the power ridge.

Efficacy of upper-incisor torque control with clear aligners: a retrospective study using cone-beam computed tomography.

OBJECTIVES: The objectives of this retrospective clinical study were to evaluate the efficacy of clear aligners on upper-incisor torque control, with the expectation of providing guidance for clinics. MATERIALS AND METHODS: Pretreatment (T0) and posttreatment (T1) cone-beam computed tomography (CBCT) scans of 47 patients with a nonextraction treatment using clear aligners were obtained and 120 upper-incisors with torque ≥5° were selected. Voxel-based superimpositions were performed using Dolphin imaging software and achieved movements were then measured. Difference between achieved and predicted movement (DAPM) and the efficiency for upper-incisor torque were used to evaluate the torque control efficacy. RESULTS: The achieved torque movement with clear aligners was lower than predicted significantly, as the mean efficiency was 46.81±33.95%. Additionally, the achieved incisor movement of the crown and root differed significantly from the predicted movement, especially root movement. CONCLUSIONS: Clear aligners struggle to control upper-incisor torque, particularly root movement. In that case, overcorrection is necessary to prevent torque loss. CLINICAL RELEVANCE: Clear aligners remain a limitation on torque control and overcorrection should be considered.

Silencing of Gasdermin D by siRNA-Loaded PEI-Chol Lipopolymers Potently Relieves Acute Gouty Arthritis through Inhibiting Pyroptosis.

Gasdermin D (GSDMD) plays a causal role in NOD-like receptor protein 3 (NLRP3) inflammasome-mediated pyroptosis eruption, which has been regarded as a potential therapeutic target for pyroptosis-related diseases including acute gouty arthritis. In the present study, the synthesized PEI-Chol (cholesterol grafted polyethylenimine) was assembled with GSDMD small interfering RNA (siRNA) to form PEI-Chol/siGSDMD polyplexes, which provided high transfection efficiency for siRNA-mediated GSDMD knockdown. Then we evaluated the effect of GSDMD siRNA-loaded PEI-Chol on inflammatory cascades in bone-marrow-derived macrophages (BMDMs) and acute gouty arthritis animal models under MSU exposure. When accompanied by pyroptosis blockade and decreased release of interleukin-1 beta (IL-1ß), NLRP3 inflammasome activation was also suppressed by GSDMD knockdown in vivo and in vitro. Moreover, in MSU-induced acute gouty arthritis mice, blocking GSDMD with siRNA significantly improved ankle swelling and inflammatory infiltration observed in histopathological analysis. Furthermore, investigation using a mouse air pouch model verified the effect of siGSDMD-loaded PEI-Chol on pyroptosis of recruited macrophages and related signaling pathways in response to MSU. These novel findings exhibited that GSDMD knockdown relieved acute gouty arthritis through inhibiting pyroptosis, providing a possible therapeutic approach for MSU-induced acute gouty arthritis molecular therapy using PEI-Chol as a nucleic acid delivery carrier.

The role of Rho-GEF Trio in regulating tooth root development through the p38 MAPK pathway.

Trio, the Rho guanine nucleotide exchange factor (Rho-GEF), plays diverse roles in cell migration, cell axon guidance and cytoskeleton reorganization. Conserved during evolution, Trio encodes two guanine nucleotide exchange factor domains (GEFs) and activates small GTPases. The Rho-family small GTPases RhoA and Rac1, which are target molecules of Trio, have been described to engage in craniofacial development and tooth formation. However, the exact role of Trio in tooth development remains elusive. In this study, we generated Wnt1-cre;Triofl/fl mice to address the potential function of Trio in tooth development. Wnt1-cre;Triofl/fl mice showed short root deformity as well as decreased expression of odontogenic makers such as RUNX2, OSX, OCN, and OPN. In vitro, Trio was silenced in human stem cells of dental papilla (SCAPs). Compared with the control group, the proliferation and migration ability in the experimental group was disrupted. After knocking down Trio in SCAPs, the cells showed phenotypes of poor odontogenic differentiation and weak mineralized nodules. To study the underlying mechanism, we investigated the p38 MAPK pathway and found that loss of Trio blocked the cascade transduction of p38 MAPK signaling. In conclusion, we identified Trio as a novel coordinator in regulating root development and clarified its relevant molecular events.

Solvent-dependent intramolecular charge transfer delocalization/localization in multibranched push-pull chromophores.

The effect of the solvent polarity on excitation delocalization/localization in multibranched push-pull chromophores has been thoroughly explored by combining steady state absorption and fluorescence, as well as femtosecond transient spectral measurements. We found that the excited-state relaxations of the push-pull chromophores are highly dependent on both solvent polarity and the polar degree of the excited intramolecular charge transfer states. The symmetry of multibranched chromophores is preserved in less polar solvents, leading to excitation delocalization over all of the branches because of the negligible solvent reaction field. In contrast, symmetry is broken for multibranched chromophores in more polar solvents because of intense solvent reaction field, and the excitation is consequently localized on one of the dipolar molecular branches. The results provide a fundamental understanding of solvent-dependent excitation delocalization/localization properties of the multibranched chromophores for the potential applications in nonlinear optics and energy-harvesting applications.

[Effect of Er:YAG laser in pulp revascularization in miniature pigs].

PURPUSE: To compare the effectiveness of Er:YAG laser and Ca(OH)2 in pulp revascularization in miniature pigs. METHODS: The second and third premolars of three 14-15-month-old miniature pigs were randomly divided into three groups: laser group, medication group and negative control group. After establishment of pulp necrosis model in each group, the negative control group had no more procedures, while the laser group and medication group were treated with pulp revascularization. Intracanal antisepsis operation was conducted using Er:YAG laser in laser group and Ca(OH)2 in medication group. The maxillary first premolars, as a positive control group, were left untreated and grew naturally. Three months after surgery, X-ray and cone-beam CT(CBCT) were taken. The animals were sacrificed, and the teeth were used to make H-E staining sections. The development of the teeth and the histological manifestations in the root canals of both groups were compared and evaluated by radiographic and histological assessment. SPSS 24.0 software package was used for statistical analysis of the data. RESULTS: Radiographic results showed that 3 months after surgery, apical foramen was closed in the laser group and the medication group. It also showed that intracanal calcification, and some specimens manifested root absorption. There was no significant difference between the two groups in the aspects of increase of root length, root thickness, or decrease of apical foramen size(P>0.05). Histological results showed that there was dentin-like and cementum-like tissue deposition along the root canal walls; apical closure was apparent; and fibrous connective tissue and cementum-like tissue or bone-like tissue formation in the root canal space were evident in the laser group and the medication group 3 months after surgery. There was no significant difference in the histological findings between the two groups(P>0.05). CONCLUSIONS: Er: YAG laser can be applied to pulp revascularization in miniature pigs, and the effect is equivalent to that of intracanal medication using Ca(OH)2.

Comparing the physicochemical properties of dicalcium phosphate dihydrate (DCPD) and polymeric DCPD (P-DCPD) cement particles.

We developed a new and injectable poly-dicalcium phosphate dihydrate (P-DCPD) forming cement. The key structural difference between P-DCPD and classical DCPD is that P-DCPD is composed of interconnected P-DCPD crystals by interlocking to the polyphosphate chains. In contrast, DCPD is composed of a package of DCPD crystals with weak mutual ionic bonding. The purpose of this continuing study was to compare the physicochemical properties between P-DCPD and DCPD cement particles. Data collected from SEM, X-ray diffraction, and Raman Spectroscopy approaches demonstrated that P-DCPD has a more stable chemical structure than DCPD as evidenced by much less transformation to hydroxyapatite (HA) during setting. Nanoindentation showed a similar hardness while the elastic modulus of P-DCPD is much lower than DCPD that might be due to the much less HA transformation of P-DCPD. P-DCPD has much lower zeta potential and less hydrophilicity than DCPD because of its entangled and interconnected polyphosphate chains. It is expected that superhydrophilic DCPD undergoes faster dissolution than P-DCPD in an aqueous environment. Another interesting finding is that the pH of eluent from P-DCPD is more neutral (6.6-7.1) than DCPD (5.5-6.5). More extensive experiments are currently underway to further evaluate the potential impacts of the different physiochemical performance observed of P-DCPD and DCPD cement particles on the biocompatibility, degradation behavior and bone defect healing efficacy both in vivo and in vitro.

Mechanism insights into bio-floc bound water transformation based on synchrotron X-ray computed microtomography and viscoelastic acoustic response analysis.

This study visually tracked the micro-spatial water distribution in bio-flocs of waste activated sludge through in situ synchrotron X-ray computed microtomography. Primarily, the two fractions of bound water, the vicinal water adhering to the surface of organic compositions and the interstitial water mechanically trapped in the net-like structure of bio-flocs, were proposed based on the cross-section imaging results. Furthermore, the determinants on bound water occurrences were explored in terms of viscoelastic acoustic responses of extracellular polymeric substances (EPS). The joint roles of hydrophilic substance removal, EPS aggregation compaction and colloidal instability of sludge flocs in bound water reduction were confirmed by the strong correlations (Pearson correlation coefficient, Rp > 0.95, p-value<0.04) among protein levels of EPS, EPS viscosity and bound water contents. Accordingly, providing adhering sites for vicinal water and forming bio-flocs with high viscosity for trapping interstitial water were proposed to be the contributions of EPS on bound water occurrences.

Calcium-Polystyrene Sulfonate Decreases Inter-Dialytic Hyperkalemia in Patients Undergoing Maintenance Hemodialysis: A Prospective, Randomized, Crossover Study.

Hyperkalemia is a life-threatening emergency in maintenance hemodialysis (MHD) patients. This clinical trial investigated the efficacy and safety of calcium-polystyrene sulfonate (Ca-PS) in MHD patients with interdialytic hyperkalemia. A total of 58 hemodialysis patients with hyperkalemia (≥5.5 mol/L) were selected and administered either a 3-week Ca-PS (3 × 5 g/day) or a blank control following the model of a prospective, randomized, crossover clinical trial with a 1-week washout period. All patients were followed up for another 3 weeks for safety evaluations. The primary outcome was the magnitude of the change in serum potassium levels. The secondary outcomes were electrocardiography (ECG) changes and treatment safety (volume overload, electrolyte imbalance). Compared with the control group, Ca-PS treatment significantly reduced serum potassium levels (P <0.01). More patients in the Ca-PS group had lower serum potassium levels than the safety level of <5.5 mmol/L (32% for control vs. 61% for Ca-PS, P <0.01). Peaked T-wave occurred less frequently in patients in the Ca-PS group (13.8% for Ca-PS vs. 31.03% for control, P <0.01). In addition, Ca-PS reduced serum phosphorus levels with no effects on serum levels of calcium and sodium, fluid volume, blood pressure, or interdialytic weight gain. Ca-PS treatment decreases serum levels of potassium and phosphorus in MHD patients with interdialytic hyperkalemia. Ca-PS does not induce volume overload or disrupt electrolyte balance.

Blockade of LGR4 inhibits proliferation and odonto/osteogenic differentiation of stem cells from apical papillae.

During tooth root development, stem cells from apical papillae (SCAPs) are indispensable, and their abilities of proliferation, migration and odontoblast differentiation are linked to root formation. Leucine-rich repeat-containing GPCR 4 (LGR4) modulates the biological processes of proliferation and differentiation in multiple stem cells. In this study, we showed that LGR4 is expressed in all odontoblast cell lineage cells and Hertwig's epithelial root sheath (HERS) during the mouse root formation in vivo. In vitro we determined that LGR4 is involved in the Wnt/ß-catenin signaling pathway regulating proliferation and odonto/osteogenic differentiation of SCAPs. Quantitative reverse-transcription PCR (qRT-PCR) confirmed that LGR4 is expressed during odontogenic differentiation of SCAPs. CCK8 assays and in vitro scratch tests, together with cell cycle flow cytometric analysis, demonstrated that downregulation of LGR4 inhibited SCAPs proliferation, delayed migration and arrested cell cycle progression at the S and G2/M phases. ALP staining revealed that blockade of LGR4 decreased ALP activity. QRT-PCR and Western blot analysis demonstrated that LGR4 silencing reduced the expression of odonto/osteogenic markers (RUNX2, OSX, OPN, OCN and DSPP). Further Western blot and immunofluorescence studies clarified that inhibition of LGR4 disrupted ß-catenin stabilization. Taken together, downregulation of LGR4 gene expression inhibited SCAPs proliferation, migration and odonto/osteogenic differentiation by blocking the Wnt/ß-catenin signaling pathway. These results indicate that LGR4 might play a vital role in SCAPs proliferation and odontoblastic differentiation.

[Application of robots in stomatology].

Recently, the robot technology has been developed rapidly and the medical robot has been used in many clinical areas, especially in the field of stomatology. The application of robot in stomatology will break the traditional mode of treatment and bring a new technological revolution. This paper introduced the advantages, the current situation and the development prospect of applying robot in stomatology.

[Histological evaluations on periapical tissues after irradiation by erbium-doped yttrium aluminum garnet laser in Labradors dogs].

PURPOSE: To investigate the thermal effects on periapical tissues of Labrador dogs after intra-canal irradiation by erbium-doped yttrium aluminum garnet (Er:YAG) laser at different powers based on the antibacterial experiment of Enterococcus faecalis and Escherichia coli in root canals with an isthmus, to assess the histological changes, and to prove the safety for clinical applications. METHODS: Two hundred root canals of 10 healthy adult Labradors dogs were selected and divided into 5 groups. Excepted one as control group, root canals in other 4 groups were irradiated by Er:YAG laser with 1.5, 2.0, 2.5, 3.0 W for 30 s. Ten Labradors dogs were sacrificed at 0 (immediately after irradiation), 2 days, 2 weeks, 1 and 2 months. After preparation of pathological specimen, histological changes after laser irradiation in periapical tissues were evaluated and scores of inflammation were graded. Statistical analysis was performed using SPSS 13.0 software package. RESULTS: No significant difference was observed at the apical area between 1.5, 2.0, 2.5 W and control groups at most periods (P>0.05), whereas significant difference was observed between 3.0 W and other groups for all periods (P<0.05). CONCLUSIONS: These results suggest that if proper output powers (2.0-2.5 W) of laser irradiation are chosen, disinfection in root canals can be finished successfully and thermal effects on the periapical tissues can be minimized.

[Quality of life and its influential factors of children and adolescents with congenital cleft lip and palate].

PURPOSE: To investigate the quality of life of children undergoing clef lip or and palate repair as well as the influential factors of the quality of life, and provide theoretical foundation for future studies such as psychological interventions. METHODS: Totally 164 children and young adolescent patients with cleft lip and palate undergoing maxillofacial surgery and orthodontic treatment in Xuzhou Stomatology Hospital were selected as experimental group, and 102 normal children and young adolescents were selected as control group. Both groups were investigated by general information questionnaire and child and adolescents' quality of life scale (CAQOL). The results were analyzed and the influential factors on quality of life were evaluated by multivariate regression analysis with SPSS 19.0 software package. RESULTS: The overall CAQOL scores and most of the subscale scores (teacher-student relationship, peer relationships, parent-child relationship, self-awareness, physical discomfort, negative emotions, attitude about homework, access to transportation from home, extra curricular activities, self-esteem) in the experimental group were significantly lower compared with the control group (P<0.05). Single factor analysis of the quality of life showed that there was no significant difference between gender distribution; on the contrary, residential areas, parents' level of education, the main caregivers, family income and types of the disease had significant difference (P<0.05). Multiple linear regression equation showed that mother's education level of patients, cleft lip and palate category, family income, the main caregivers and residential areas were the important influential factors on children' quality of life. Among them, the type of disease was the most important influential factor (beta=0.260), followed by mother's education level (beta=0.215). CONCLUSIONS: The quality of life of children with cleft lip/palate is poor. Patients' scores of CAQOL are closely related with mothers' education level, type of cleft lip/palate, family income, the main caregivers and residential areas.

[Evaluation of root canal isthmus debridement efficacy of Er:YAG laser in combination with sodium hypochlorite].

PURPOSE: To histologically evaluate the efficacy of sodium hypochlorite (NaClO) in combination with Er:YAG (erbium-doped yttrium aluminium garnet) laser in dissolving necrotic tissue and cleaning root canals as well as canal isthmuses. METHODS: After scanned by cone-beam CT (CBCT), 50 well-prepared premolars with root canal isthmuses were selected and randomly assigned into 5 groups. They were subsequently subjected to different regimens as followed: group A-irrigated with 1% NaClO for 1 minute, group B- irradiated by Er:YAG laser at 0.5 W combined with 1% NaClO irrigation for 1 minute, group C- irradiated by Er:YAG laser at 1.0 W combined with 1% NaClO irrigation for 1 minute, group D- irradiated by Er:YAG laser at 2.0 W combined with 1% NaClO irrigation for 1 minute,group E- negative control. After histological preparation and staining, the cross-sections were evaluated for percentage of tissue removal from root canals and isthmuses. The cleanliness values were calculated using SPSS 13.0 software package. RESULTS: The mean percentage of root canals in group A, B, C and D was 95.24%, 96.53%、97.63% and 98.22%, respectively, and the mean percentage of isthmuses was 16.50%, 51.48%, 52.56% and 53.83%, respectively. The mean percentage of root canal and isthmus cleanliness values were significantly higher in group B, C and D (P<0.05) than that in group A. There was no significant differences of root canal and isthmus cleanliness among group B, C and D. CONCLUSIONS: Er:YAG laser combined with 1% NaClO irrigation may be used effectively in root canal and root canal isthmus cleanliness as a new method.

[Effect of different decalcification condition on tooth-clearing technique].

OBJECTIVE: To evaluate shrinkage range of cleared teeth caused by nitric acid with different temperature and concentration. METHODS: 48 human teeth were root canal-prepared and filled, then randomly and averagely divided into six groups on the basis of temperature and density of nitric acid and the condition of whether or not added the oscillate. Group A was 20 degrees C with 6% nitric acid, group B was 20 degrees C with 6% nitric acid and oscillate, group C was 20 degrees C with 3% nitric acid, group D was 20 degrees C with 3% nitric acid and oscillate, group E was 30 degrees C with 6% nitric acid and oscillate, group F was 30 degrees C with 3% nitric acid and oscillate. After achieving the standard of the decalcification, all the specimens were gradually dehydrated, and then cleared and conserved using methyl salicylate. Time-consumed and shrinkage range of all the specimens were recorded and analyzed. RESULTS: The time of decalcification in group E was the fastest, then was group F, group B. Group C was the last one. The anastole of the specimens was group E > group B > group A, group F > group D > group C, group B > group D, group E > group D, there was significant difference (P < 0.05). Group C had significant difference with other groups (P < 0.05). The anastole rate of the specimens had no significant difference between group A and group B, group C and group D, group B and group F, group D and group F. CONCLUSION: In 20 degrees C, 3% nitric acid with oscillate to carry out the decalcification can use less time and get less anastole. The result of the tooth-clearing technique is the best.