Is the high-performance thermoplastic polyetheretherketone indicated as a clasp material for removable dental prostheses?

OBJECTIVES: To investigate the retention force of polyetheretherketone (PEEK) removable dental prosthesis clasps in comparison with a cobalt-chrome-molybdenum control group after storage in artificial saliva. MATERIALS AND METHODS: Clasps were milled (Dentokeep (PEEKmilled1), NT digital implant technology; breCAM BioHPP Blank (PEEKmilled2), bredent), pressed (BioHPP Granulat for 2 press (PEEKpressed), bredent), or cast (remanium GM 800+ (cobalt-chrome-molybdenum), Dentaurum); N = 60, n = 15/subgroup. Retention force was examined 50 times/specimen in a pull-off test using the universal testing machine (Zwick 1445), where pull-off force was applied with a crosshead speed of 5 mm/minute until the maximum force dropped by 10%, at different aging levels: (1) initial, after storage in artificial saliva for (2) 90 and (3) 180 days. Statistical analysis was performed using one-way ANOVA followed by post hoc Scheffé-test and mixed models (p < 0.05). RESULTS: Cobalt-chrome-molybdenum presented the highest retention force. No differences were observed between polyetheretherketone materials. Cobalt-chrome-molybdenum showed a significant decrease of its values after artificial aging, while polyetheretherketone materials presented similar results over the course of aging. Regarding a repetitive insertion and removal, even though PEEKmilled2 and cobalt-chrome-molybdenum showed an initial increase, ultimately, a decrease in retention force was observed for all tested groups. CONCLUSIONS: Although the control group showed significantly higher results, the retention force of polyetheretherketone materials indicate a potential clinical application. Neither the manufacturing process nor artificial aging showed an impact on the retention force of polyetheretherketone clasps. CLINICAL RELEVANCE: Mechanical properties of novel removable dental prosthesis clasp materials devised to meet the growing esthetic demands of patients need to be investigated to ensure a successful long-term clinical application.

Prophylactic Antiviral Activity of Sulfated Glycomimetic Oligomers and Polymers.

In this work, we investigate the potential of highly sulfated synthetic glycomimetics to act as inhibitors of viral binding/infection. Our results indicate that both long-chain glycopolymers and short-chain glycooligomers are capable of preventing viral infection. Notably, glycopolymers efficiently inhibit Human Papillomavirus (HPV16) infection in vitro and maintain their antiviral activity in vivo, while the glycooligomers exert their inhibitory function post attachment of viruses to cells. Moreover, when we tested the potential for broader activity against several other human pathogenic viruses, we observed broad-spectrum antiviral activity of these compounds beyond our initial assumptions. While the compounds tested displayed a range of antiviral efficacies, viruses with rather diverse glycan specificities such as Herpes Simplex Virus (HSV), Influenza A Virus (IAV), and Merkel Cell Polyomavirus (MCPyV) could be targeted. This opens new opportunities to develop broadly active glycomimetic inhibitors of viral entry and infection.

Ameloblastic fibrosarcoma: clinicopathological and molecular analysis of seven cases highlighting frequent BRAF and occasional NRAS mutations.

AIMS: Ameloblastic fibrosarcoma (AFS) is an aggressive odontogenic neoplasm featuring malignant mesenchymal stroma in addition to an ameloblastic epithelial component, and is hence considered to be the malignant counterpart of ameloblastic fibroma (AF). AFS is exceedingly rare, with <110 cases having been reported so far. Although BRAF mutations are recognised driver mutations in ameloblastoma, the molecular pathogenesis of AFS remains elusive. METHODS AND RESULTS: We herein describe seven AFSs that were analysed, for the first time, for mutations in the BRAF-NRAS pathway. The patients were four females and three males aged 23-57 years (median, 26 years). Three tumours developed after one or multiple recurrences of AF (4-20 years after initial diagnosis), two showed transition from AF-like bland areas, and two developed de novo. All patients were treated with surgery; adjuvant chemotherapy was given to one patient. At the last follow-up, five patients were alive and well (19-344 months). The remainder were lost to follow-up. Histological examination showed variable sarcomatous overgrowth with varying degrees of atypia and increased mitotic activity. The epithelial component varied greatly according to the degree of sarcomatous overgrowth. Molecular testing revealed BRAF V600E mutations in five cases and NRAS p.Gln61Lys mutation in one case. One tumour was wild-type. CONCLUSION: To our knowledge, this is the first study on BRAF/NRAS mutations in AFS. Given the activity of RAF and MEK inhibitors across different cancers harbouring V600E mutations, our data strongly suggest that all AFS cases should be genetically tested, and that targeted treatment approaches for this extremely rare sarcoma subtype should be clinically investigated.

Twisting is key: Removing an infected nitinol wire braided uncovered stent from the aortic arch and the descending aorta.

Prosthesis infection after aortic surgery is a critical complication that most commonly requires surgical treatment with removal of the infected material. In this video tutorial, we remove a novel nitinol wire braided stent. It was introduced to stabilize the true lumen and prevent distal anastomotic new entry. Both the stent type and surgical approach were new and therefore constituted a major challenge. Despite these issues, removal with bilateral subclavian and femoral cannulation under hypothermic circulatory arrest proved successful.

Risk incidence of fractures and injuries: a multicenter video-EEG study of 626 generalized convulsive seizures.

OBJECTIVE: To evaluate the incidence and risk factors of generalized convulsive seizure (GCS)-related fractures and injuries during video-EEG monitoring. METHODS: We analyzed all GCSs in patients undergoing video-EEG-monitoring between 2007 and 2019 at epilepsy centers in Frankfurt and Marburg in relation to injuries, falls and accidents associated with GCSs. Data were gathered using video material, EEG material, and a standardized reporting form. RESULTS: A total of 626 GCSs from 411 patients (mean age: 33.6 years; range 3-74 years; 45.0% female) were analyzed. Severe adverse events (SAEs) such as fractures, joint luxation, corneal erosion, and teeth loosening were observed in 13 patients resulting in a risk of 2.1% per GCS (95% CI 1.2-3.4%) and 3.2% per patient (95% CI 1.8-5.2%). Except for a nasal fracture due to a fall onto the face, no SAEs were caused by falls, and all occurred in patients lying in bed without evidence of external trauma. In seven patients, vertebral body compression fractures were confirmed by imaging. This resulted in a risk of 1.1% per GCS (95% CI 0.5-2.2%) and 1.7% per patient (95% CI 0.8-3.3%). These fractures occurred within the tonic phase of a GCS and were accompanied by a characteristic cracking noise. All affected patients reported back pain spontaneously, and an increase in pain on percussion of the affected spine section. CONCLUSIONS: GCSs are associated with a substantial risk of fractures and shoulder dislocations that are not associated with falls. GCSs accompanied by audible cracking, and resulting in back pain, should prompt clinical and imaging evaluations.

Al2O3 Particles on Titanium Dental Implant Systems following Sandblasting and Acid-Etching Process.

Dental implants with moderately rough surfaces show enhanced osseointegration and faster bone healing compared with machined surfaces. The sandblasting and acid-etching (SA) process is one technique to create moderately rough dental implant surfaces. The purpose of this study was to analyse different commercially available implant systems with a SA-modified surface and to explore the widespread notion that they have similar surface properties regarding morphology and cleanliness. SA-modified surfaces of nine implant systems manufactured by Alpha-Bio Tec Ltd, Camlog Biotechnologies AG, Dentsply Sirona Dental GmbH, Neoss Ltd, Osstem Implant Co. Ltd, Institute Straumann AG, and Thommen Medical AG were analyzed using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX) and examined for surface cleanliness. Six implants from three different lots were selected per each implant system. Mean particle counts for each implant and the mean size of the particles were calculated from three different regions of interest and compared using ANOVA and Tukey's test. SEM analysis showed presence of particles on the majority of analyzed implant surfaces, and EDX evaluations determined that the particles were made of Al2O3 and thus remnants of the blasting process. SPI®ELEMENT INICELL® and Bone Level (BL) Roxolid® SLActive® implant surfaces showed the highest mean particle counts, 46.6 and 50.3 per area, respectively. The surface of BL Roxolid® SLActive® implant also showed the highest variations in the particle counts, even in samples from the same lot. The mean size of particles was 1120±1011 µm2, measured for USIII CA Fixture implants, while the biggest particle was 5900 µm2 found on a BL Roxolid® SLActive® implant. These results suggest that not all manufacturers are able to produce implant surfaces without particle contamination and highlight that the surface modification process with the SA technique should be appropriately designed and controlled to achieve a clean and consistent final medical device.

Quantitative in vitro comparison of the thrombogenicity of commercial dental implants.

BACKGROUND: Dental implants often have surface modifications that alter surface topography and chemistry to improve osseointegration and thereby increase treatment predictability. Surface contact-induced blood coagulation is associated with the onset of osseointegration. PURPOSE: To quantitatively evaluate the thrombogenicity of two commercially available dental implants that have similar surface roughness but different surface chemistry. MATERIAL AND METHODS: Two commercially available dental implants with anodized or sandblasted acid-etched surfaces were evaluated for thrombogenic properties. Thrombogenicity was assessed by incubating implants for 1 hour in fresh, partially heparinized blood followed by hemocyte quantification, microscopic evaluation, and quantification of thrombogenic biomarkers. RESULTS: Fibrin coverage was significantly higher on the anodized surface compared with the sandblasted acid-etched surface (P < 0.0001). Platelet and white blood cell attachment followed a similar pattern. The increased thrombogenicity was confirmed based on a significant increase in the levels of the coagulation cascade biomarkers, thrombin antithrombin complex, and ß-thromboglobulin (all P < 0.05). CONCLUSION: Dental implants with comparable roughness but differing surface chemistry had differing extents of blood contact activation. These data suggest that surface chemistry from anodization augments implant thrombogenicity compared with that from sandblasting and acid-etching, which could have implications for osseointegration.

Rational design and in vitro characterization of novel dental implant and abutment surfaces for balancing clinical and biological needs.

BACKGROUND: Long-term success and patient satisfaction of dental implant systems can only be achieved by fulfilling clinical as well as biological needs related to maintenance, aesthetics, soft tissue sealing, and osseointegration, among others. Surface properties largely contribute to the biological and clinical performance of implants and abutments. PURPOSE: To decipher the clinical and biological needs in implant dentistry. To address identified needs, next-generation dental implant and abutment surfaces are designed and characterized in vitro. MATERIALS AND METHODS: Novel implant and abutment surface designs were produced and characterized using surface chemical analysis, surface topography analysis, scanning electron microscopy, contact-angle measurements, and cell-culture experiments. RESULTS: The novel anodized implant surface was gradually anodized, increasing the surface roughness, surface enlargement, and oxide-layer thickness from platform to apex. The surface was phosphorus enriched, nonporous, and nanostructured at the collar, and showed micropores elsewhere. The novel anodized abutment surface was smooth, nanostructured, nonporous, and yellow. Pristine surfaces with high density of hydroxyl-groups were protected during storage using a removable cell-friendly layer that allowed dry packaging. CONCLUSIONS: A novel anodized implant system was developed with surface chemistry, topography, nanostructure, color, and surface energy designed to balance the clinical and biological needs at every tissue level.

Improved attachment of mesenchymal stem cells on super-hydrophobic TiO2 nanotubes.

Self-organized layers of vertically orientated TiO(2) nanotubes providing defined diameters ranging from 15 up to 100nm were grown on titanium by anodic oxidation. These TiO(2) nanotube layers show super-hydrophilic behavior. After coating TiO(2) nanotube layers with a self-assembled monolayer (octadecylphosphonic acid) they showed a diameter-dependent wetting behavior ranging from hydrophobic (108+/-2 degrees ) up to super-hydrophobic (167+/-2 degrees ). Cell adhesion, spreading and growth of mesenchymal stem cells on the unmodified and modified nanotube layers were investigated and compared. We show that cell adhesion and proliferation are strongly affected in the super-hydrophobic range. Adsorption of extracellular matrix proteins as fibronectin, type I collagen and laminin, as well as bovine serum albumin, on the coated and uncoated surfaces showed a strong influence on wetting behavior and dependence on tube diameter.

Covalent functionalization of TiO2 nanotube arrays with EGF and BMP-2 for modified behavior towards mesenchymal stem cells.

In the present work we show the covalent immobilization of two bioactive molecules, epidermal growth factor (EGF) and bone morphogenetic protein-2 (BMP-2), on TiO(2) nanotube surfaces and the resulting influence on the behavior of mesenchymal stem cells. Covalent immobilization of these growth factors onto the oxide surfaces was achieved by N,N-carbonyldiimidazole (CDI) coupling via binding to amine groups of the proteins either directly or via a spacer, namely 11-hydroxy-undecylphosphonic acid (PhoA). The behavior of mesenchymal stem cells can be significantly altered by such an activation procedure. The effect is depending on the diameters of the nanotubes. Most importantly, on 100 nm diameter tubes the cell activity and cell number were drastically increased by grafting such nanotube surfaces with EGF. This demonstrates that the strong diameter dependence on cell activity in the range between 15 and 100 nm observed in prior work can be compensated by coating of the nanotube surfaces with EGF.

In vivo evaluation of anodic TiO2 nanotubes: an experimental study in the pig.

Because of their ability to mimic the dimensions of constituent components of natural bone and the possibility to serve as a gene and drug-delivery carrier, nanotubes seem to be a promising coating for medical implants. Aim of this study was to investigate the effects of a TiO(2) nanotube structured surface on periimplant bone formation in vivo when compared with an untreated standard titanium surface. Twenty-five titanium implants covered with an ordered TiO(2) nanotube layer with an individual tube diameter of 30 nm and 25 commercially pure titanium (cp-Ti) implants were placed in the frontal skull of 25 domestic pigs. To evaluate the effects of the nanotube structured implants on the periimplant bone formation, bone-implant contact (BIC), and immunohistochemistry analysis were performed at day 3, 7, 14, 30, and 90. Evaluating immunohistochemistry, a significantly higher collagen type- I expression occurred at day 7 (p = 0.003), day 14 (p = 0.016), and day 30 (p = 0.044), for the nanostructured implants in comparison with the control group. It could be found that a nanotube structured implant surface with a diameter of 30 nm does influence bone formation and bone development by enhancing osteoblast function. SEM evaluation of the specimen surfaces revealed that the nanotube coatings do resist shearing forces that evoked by implant insertion. Because of their simple, low cost, flexible manufacturing and the possibility for the usage as drug or growth factor delivery system, nanotubes seem to be a promising method for future medical implant coatings.