Time-dependent periimplant bone reaction of acidic monomer-treated injection molded zirconia implants in rabbit tibiae.

PURPOSE: The aim of this study was to evaluate and compare the osseointegration of zirconia implants in rabbit tibiae with and without 10-methacryloyloxydecyl dihydrogen phosphate (MDP) treatment. MATERIALS AND METHODS: Twenty-eight rabbits received a total of 112 external hex-type implants made by the powder injection molding technique with and without MDP treatment before installation in the tibiae. The contact angles on the zirconia implants and zirconia discs before and after MDP application were evaluated. Removal torque (RT) and bone-implant contact (BIC) ratios were measured. RESULTS: The MDP treatment markedly enhanced the hydrophilicity and seemed to alter the topography and chemical composition of the implant and disc surface. As the healing time increases, the BIC and RT were increased in both groups. The MDP-treated implants exhibited higher BIC values than the control implants after 2 and 4 weeks of healing. The RT was higher in MDP-treated implants after 2 weeks of healing but not after 4 weeks of healing. CONCLUSION: The 10-MDP treatments made the surface more hydrophilic and enhanced the osseointegration of the implants in the early healing phase.

Peri-implant bone formation of non-thermal atmospheric pressure plasma-treated zirconia implants with different surface roughness in rabbit tibiae.

OBJECTIVES: The aim of this study was to evaluate and compare the osseointegration of powder-injection molded (PIM) zirconia implants in rabbit tibiae with or without He plasma treatment. MATERIAL AND METHODS: Twenty-five rabbits received 4 types of external hex implants with identical geometry in the tibiae: PIM zirconia implants, roughened PIM zirconia implants, plasma-treated PIM zirconia implants, and plasma-treated roughened PIM zirconia implants. The contact angles of the four types of implants were evaluated. Removal torque tests and histomorphometric analyses were performed. RESULTS: The plasma treatment markedly enhanced the hydrophilicity, but did not seem to change the surface topography of the PIM zirconia implants. There were statistically significant differences in the bone-to-implant contact (BIC) ratios, bone volume (BV/TV), and removal torque values (RTQ) among the tested implant types (P < 0.001). The plasma-treated implants exhibited significantly higher BIC and BV/TV values than the untreated implants. However, the removal torque values favored the rough surface. CONCLUSIONS: The He plasma treatments on PIM zirconia implants made the surface more hydrophilic and enhanced the osseointegration of the implants without changing the micro-topography.

Submorphotypes of the maxillary first molar and their effects on alignment and rotation.

INTRODUCTION: The aim of this study was to explore the shape differences in maxillary first molars with orthographic measurements using 3-dimensional virtual models to assess whether there is variability in morphology that could affect the alignment results when treated by straight-wire appliance systems. METHODS: A total of 175 maxillary first molars with 4 cusps were selected for classification. With 3-dimensional laser scanning and reconstruction software, virtual casts were constructed. After performing several linear and angular measurements on the virtual occlusal plane, the teeth were clustered into 2 groups by the method of partitioning around medoids. To visualize the 2 groups, occlusal polygons were constructed using the average data of these groups. RESULTS: The resultant 2 clusters showed statistically significant differences in the measurements describing the cusp locations and the buccal and lingual outlines. The rotation along the centers made the 2 cluster polygons look similar, but there was a difference in the direction of the midsagittal lines. CONCLUSIONS: There was considerable variability in morphology according to 2 clusters in the population of this study. The occlusal polygons showed that the outlines of the 2 clusters were similar, but the midsagittal line directions and inner geometries were different. The difference between the morphologies of the 2 clusters could result in occlusal contact differences, which might be considered for better alignment of the maxillary posterior segment.

The growth trends of Korean adolescents with bialveolar protrusion: a nine year longitudinal cephalometric study.

Bialveolar protrusion and dental crowding seems to have common features in terms of aetiology and treatment method, although they result in different facial profiles and tooth alignment. The aim of this longitudinal study is to determine when children begin to show bialveolar protrusive traits in order to get more clue about the aetiology of bialveolar protrusion. Longitudinal lateral cephalometric data of children followed from 6 to 14 years of age were used. A total of 155 children (81 girls and 74 boys) with showing Class molar relationships at the age of 14 were assigned to either the protrusive group (PG) or the non-protrusive group (NPG), based on 5 cephalometric measurements. The cephalometric measurements of these 2 groups were compared at each age separately in both sexes by independent t-tests. Throughout the entire observation period, there were differences between PG and NPG in both sexes in measurements which were used for classification at 14 years of age. There were differences between sexes in both PG and NPG in several measurements of at several different ages. Individuals with bialveolar protrusive traits at the age of 14 exhibited the signs early in life, at least from the early mixed dentition.

Peri-implant bone formations around (Ti,Zr)O(2) -coated zirconia implants with different surface roughness.

AIM: The aim of this study was to evaluate and compare the osseointegration in rabbit tibiae of smooth and roughened powder injection moulded (PIM) zirconia implants with or without (Ti,Zr)O2 surface coatings. MATERIAL AND METHODS: Twenty-five rabbits received four types of external hex implants with identical geometry on the tibiae: PIM zirconia implants, roughened PIM zirconia implants, (Ti,Zr)O2 -coated PIM zirconia implants and (Ti,Zr)O2 -coated roughened PIM zirconia implants. The surface characteristics of the four types of implants were evaluated. Removal torque tests and histomorphometric analyses were performed. RESULTS: The (Ti,Zr)O2 coatings substantially changed the surface topography and chemical composition of the both type of PIM zirconia implants. There were statistically significant differences in the bone to implant contact ratios and removal torque values (RT) among the tested implant types (p < 0.001). The histological response favoured the coated surface at smooth PIM zirconia implants. The removal torque values favoured the rough surface whether coated or uncoated. CONCLUSIONS: Within the limit of this study, the (Ti,Zr)O2 coated PIM zirconia implants, both smooth and rough, showed enhanced histological response (bone to implant contact) compared with uncoated ones. On the other hand, the mechanical anchorage (RT) was higher for rough surface implants, coated or uncoated.

Patterns of vertical facial growth in Korean adolescents analyzed with mixed-effects regression analysis.

INTRODUCTION: To understand the growth patterns of skeletal open bite and deepbite, we present observations from 9 years of pure longitudinal data based on lateral cephalometric radiographs using mixed-effects regression model analysis. METHODS: In total, 51 children (14 years old) with extreme values for the ratio of lower anterior facial height to total anterior facial height were assigned to 1 of 2 groups: a skeletal open-bite group (11 boys, 14 girls) or a skeletal deepbite group (14 boys, 12 girls). Measurements of total anterior facial height, upper anterior facial height, lower anterior facial height, total posterior facial height, ramus height, and ratio of lower anterior facial height to total anterior facial height were obtained for all subjects. All data were analyzed and interpreted using a mixed-effects regression model analysis with random effects. RESULTS: From these 4 groups at 14 years old, statistically significant differences were observed between the groups when subjects of the same sex were compared; however, statistical significance was not reached between subjects of opposite sexes in each group. Morphologic differences were clearly evident from the start and became more pronounced with age. There were statistical significances in the initial values and increases with age in all 6 variables except for increases with age in the ratio of lower anterior facial height to total anterior facial height. Statistical significance was also reached for morphologic differences between the annual increases in the ratio of lower anterior facial height to total anterior facial height and lower anterior facial height. In general, individual random variability was high in all variables when compared with the annual changes over time. CONCLUSIONS: Divergent patterns were established early and became more pronounced with age, with anterior facial height dimensions primarily contributing to these differences. Individual variations were so pronounced that caution is recommended for all clinical decisions.

Different mandibular first molar shapes according to groove and cusp configuration in relation to suggested bracket position.

The aim of this study was to explore the shape differences in the mandibular first molars through orthographic measurements using three-dimensional (3D) virtual models, and study the possibility of new morphologic categories that require more than subjective visual inspection. A total of 164 mandibular first molars with five cusps were selected for classification. Using 3D laser scanning and reconstruction software, virtual casts were constructed. After several linear and angular measurements on the virtual occlusal plane, the teeth were clustered using the partitioning around medoids methods-an unsupervised classification. The cluster analysis presented two clusters that showed statistically significant differences in the measurements over the cusp locations and groove configurations. However, gender differences were not shown in the angular groove and cusp configurations. Two clusters were found in the population of the present study, and this result suggested the existence of a diverse morphologic trait in the mandibular molar even in the same origin and could be considered in positioning orthodontic brackets that have built-in prescriptions.

A three dimensional observation of palatal vault growth in children using mixed effect analysis: a 9 year longitudinal study.

The understanding of palatine vault growth in normal subjects is important to orthodontists. The aim of this study was to evaluate three dimensional (3D) longitudinal changes in the palatal vault from 6 to 14 years of age. Complete dental stone casts were biennially prepared for 50 subjects (25 girls and 25 boys) followed up from 6 to 14 years of age. Virtual casts were constructed using 3D laser scanning and reconstruction software. The reference gingival plane was constructed. The palatal heights were measured from a total of 12 quadrisectional points between the most gingival points of the palatal dentogingival junctions from the canine to the first molar. In addition, the palatal heights were measured from a total of 12 lateral and medial endpoints of the palatine rugae. The measurement changes over time were analyzed using a mixed-effect analysis. There were significant annual increases in all of the variables related to palatal height. However, the individual random variability at baseline was quite large. There was no significant sexual dimorphism in the linear measurements or in the annual increases as fixed effects in the model. During the observation period, increases in palatal vault height were significant in all regions. The growth pattern seemed to differ between genders even though it was not significant. More elaborate methodology is necessary to gain a better understanding of 3D palatal growth.

Three-dimensional biometric study of palatine rugae in children with a mixed-model analysis: a 9-year longitudinal study.

INTRODUCTION: The palatine rugae have been suggested as stable reference points for superimposing 3-dimensional virtual models before and after orthodontic treatment. We investigated 3-dimensional changes in the palatine rugae of children over 9 years. METHODS: Complete dental stone casts were biennially prepared for 56 subjects (42 girls, 14 boys) aged from 6 to 14 years. Using 3-dimensional laser scanning and reconstruction software, virtual casts were constructed. Medial and lateral points of the first anterior 3 rugae were defined as the 3-dimensional landmarks. The length of each ruga and the distance between the end points of the rugae were measured in virtual 3-dimensional space. The measurement changes over time were analyzed by using the mixed-effect method for longitudinal data. RESULTS: There were slight increases in the linear measurements in the rugae areas: the lengths of the rugae and the distances between them during the observation period. However, the amounts of the increments were relatively small when compared with the initial values and individual random variability. Although age affected the linear dimensions significantly, it was not clinically significant; the rugae were relatively stable. CONCLUSIONS: The use of the palatine rugae as reference points for superimposing and evaluating changes during orthodontic treatment was thought to be possible with special cautions.

A novel design of one-side coated biodegradable intrascleral implant for the sustained release of triamcinolone acetonide.

The purpose of this study was to evaluate the efficacy and safety of biodegradable intrascleral implants for the slow release of triamcinolone acetonide (TA). Intrascleral implant (1 mm thick; 3 mm diameter) was made of PLA (poly(D,L-lactide)) containing 6.4 mg of TA with one-side coating of high molecular weight PLA to render unidirectional drug absorption through the sclera. In vitro TA release was evaluated by liquid chromatography-mass spectroscopy for 90 days. In vivo release of TA was measured in aqueous humor, vitreous, and retina-choroid at 1, 2, 4, 8, and 12 weeks after intrascleral implantation in 20 rabbit eyes. Implant toxicity and biocompatibility were evaluated by slit lamp examinations, indirect ophthalmoscopy, intraocular pressure measurements, electroretinography, and histological examinations. In vitro studies demonstrated that the implants released TA in a controlled manner over 90 days. In vivo, TA was detected in aqueous humor until 4 weeks and in retina-choroid until 8 weeks after implantation, but was detected constantly over 12 weeks in vitreous. No significant retinal toxicity was observed. These results suggest that the devised intrascleral implant offers a promising controlled release system for the delivery of TA to the posterior segment of the eye.

Decellularized corneal lenticule embedded compressed collagen: toward a suturable collagenous construct for limbal reconstruction.

Recently, compressed collagen has attracted much attention as a potential alternative for a limbal epithelial stem cell (LESC) carrier to treat limbal stem cell deficiency (LSCD), in that it can provide mechanically improved collagen fibrillar structures compared to conventional collagen hydrogel. However, its clinical efficacy as an LESC carrier has not yet been studied through in vivo transplantation due to limited mechanical strength that cannot withstand a force induced by surgical suturing and low resistance to enzymatic degradation. This study firstly presents a suturable LESC carrier based on compressed collagen in the form of a biocomposite. The biocomposite was achieved by integrating a decellularized corneal lenticule, which is a decellularized stromal tissue obtained from corneal refractive surgery, inside a compressed collagen to form a sandwich structure. A suture retention test verified that the biocomposite has a much higher suture retention strength (0.56 ± 0.12 N) compared to the compressed collagen (0.02 ± 0.01 N). The biocomposite also exhibited more than 3 times higher resistance to enzymatic degradation, indicating long-term stability after transplantation. In vitro cell culture results revealed that the biocomposite effectively supported the expansion and stratification of the LESCs with expressions of putative stem cell and differentiated corneal epithelial cell markers. Finally, the biocomposite verified its clinical efficacy by stably delivering the LESCs onto an eye of a rabbit model of LSCD and effectively reconstructing the ocular surface.

The Sustained Effects on Tear Volume of Pilocarpine Hydrochloride in Gelatin by Hydrogel Administered by An Implant-mediated Drug Delivery System.

BACKGROUND: Pilocarpine hydrochloride is commonly prescribed to patients with dry mouth and eye using a frequent dosing schedule. The aim of this study was to evaluate the sustained effects of this highly soluble drug carried by a gelatin hydrogel, which was administered by an implant mediated drug delivery system (IMDDS). METHODS: The IMDDS was installed in a total of 24 rabbits. After complete healing, pilocarpine hydrochloride was administered as 30 mg as raw powder (Group 1; n = 8), 30 mg in gelatin hydrogel (Group 2; n = 8), and 60 mg in gelatin hydrogel (Group 3; n = 8). The effects were evaluated by tear volume measured using the Schirmer tear test for 2 weeks after administration. RESULTS: All 3 groups showed an increase in tear volume from the initial measurement at 1 hour. Group 1 exhibited this increase for 24 hours, while Groups 2 and 3 sustained this increase for 5 days and 7.5 days, respectively. CONCLUSION: When provided in gelatin hydrogel, highly water-soluble pilocarpine hydrochloride administered through IMDDS resulted in sustained effects with increased tear volume in normal rabbits.

Dexamethasone Delivery by an Implant-Mediated Drug Delivery System in the Canine Mandible.

BACKGROUND: A newly introduced implant-mediated drug delivery system (IMDDS) showed promising results in a rabbit tibia model. The aim of the present study is to evaluate whether dexamethasone administered by the IMDDS has sustained effects in the canine mandible - a different anatomic location, in a different species. METHODS: IMDDS was installed at the mesial root of the second premolar site in the mandibles of six beagle dogs. After complete healing, 10 mg dexamethasone was administered through the IMDDS. The same amount of drug was administered to five control animals by intramuscular injection. The release pattern was monitored for 2 weeks by measuring plasma drug concentrations. RESULTS: A sustained plasma dexamethasone concentration was detected after a peak at 6 hours until the end of the observation period, despite individual variations. The concentration was lower than reported in the rabbit tibia model. In contrast, plasma concentration of the control group showed an early peak at 2 hours and decreased rapidly. CONCLUSION: Dexamethasone was effectively released from the IMDDS for a prolonged time in the canine mandible model.

Comparison of peri-implant bone formation around injection-molded and machined surface zirconia implants in rabbit tibiae.

The aim of this study was to compare osseointegration and surface characteristics of zirconia implants made by the powder injection molding (PIM) technique against those made by the conventional milling procedure in rabbit tibiae. Surface characteristics of 2 types of implants were evaluated. Sixteen rabbits received 2 types of external hex implants with similar geometry, either machined zirconia implants or PIM zirconia implants, in the tibiae. Removal torque tests and histomorphometric analyses were performed. The roughness of the PIM zirconia implants was higher than that of machined zirconia implants. The PIM zirconia implants exhibited significantly higher bone-implant contact and removal torque values than the machined zirconia implants (p<0.001). The osseointegration of the PIM zirconia implant is promising, and PIM, using the roughened mold etching technique, can produce substantially rougher surfaces on zirconia implants.

A comparison between the occlusal morphology of virtually reconstructed posterior crowns and natural molars.

This study was performed to evaluate the occlusal morphologic similarities between virtually reconstructed full crowns and original natural teeth. A total of 40 stone cast sets with untreated first molars (22 maxillary and 18 mandibular) were scanned and saved as three-dimensional virtual models. The 40 first molars on the stone casts were prepared for all-ceramic restorations, scanned again, and virtually restored with a full veneer crown using a biogeneric tooth algorithm. For comparison of original and virtually restored teeth, orthographic measurements were performed on the cusp tip configurations from the central pits. The measurements were compared using the concordance correlation coefficient (CCC). For maxillary molars, the ranges of CCC were 0.040 to 0.566 in linear, 0.127 to 0.509 in area, and -0.114 to 0.327 in angular measurements. For mandibular molars, the ranges of CCC were 0.104 to 0.555 in linear, 0.183 to 0.597 in area, and 0.030 to 0.396 in angular measurements. The reproducibility of automatic occlusal construction was relatively low. There is a need for improvement in the biogeneric tooth algorithms to enhance the accuracy of restoring to the original occlusal tooth form in cases of full veneer crown preparation.

Discriminant analysis for the thin periodontal biotype based on the data acquired from three-dimensional virtual models of Korean young adults.

BACKGROUND: There have been no objective criteria for classifying the periodontal biotype. The purpose of this study is to suggest clinical guidelines for discriminating the thin biotype, which might be susceptible to gingival recession, using statistical analyses based on the measurement of the dento-gingival complex on three-dimensional virtual models. METHODS: From canine to canine, the area of the facial papilla, the facial surface area of the anterior tooth, the proportion of the dento-papillary complex, clinical papillary length, and the clinical papillary angle were measured on a three-dimensional virtual model of 133 young participants. In the clinical exam, the gingival transparency when probing was evaluated, and the classification into thin and non-thin biotype groups was used as the gold standard. The data were analyzed by discriminant analysis. RESULTS: Twenty-nine participants (17 males and 12 females) belonged to the "thin group" according to the clinical evaluation. All variables were significantly different between groups (P <0.001). The results of discriminant function analysis showed that the sum of the area between each canine and lateral incisor, each lateral and central incisor, and the two central incisors was the best single determinant of biotype, and the sum of the papillary lengths between each canine and lateral incisor, each lateral and central incisor, and the two central incisors (PLSum5) was the next best choice. The cutoff value of PLSum5 was calculated to be 23.73 mm. CONCLUSIONS: PLSum5 >24 mm is the suggested criterion for identifying high-risk thin biotype patients based on the comparison with the results from gingival transparency inspection. A clinical reevaluation of this criterion should be examined in additional studies for application in real clinical situations.

Fibrin glue-assisted augmented amniotic membrane transplantation for the treatment of large noninfectious corneal perforations.

PURPOSE: To evaluate and report the efficacy of fibrin glue (FG)-assisted augmented amniotic membrane transplantation (AMT) in patients with large corneal perforations. METHODS: In a retrospective case series, 10 patients with corneal perforations more than 2 mm in diameter were treated with "FG-assisted augmented AMT." A 5- or 7-ply "augmented amniotic membrane" (AM) was constructed by applying FG to each sheet of AM to repair the corneal perforation. The augmented AM was designed 0.5 mm larger than the diameter of the perforation. The augmented AM was transplanted onto the perforation site with 10-0 nylon suture. If needed, additional overlay AM was sutured on top. RESULTS: The mean ulceration diameter was 2.7 +/- 0.95 mm (range, 2-5 mm). All patients retained their own globes after the procedure and had well-formed deep anterior chambers, and 90% of patients showed complete epithelialization over the AM. The mean reepithelialization time was 14.9 +/- 4.9 days (range, 10-24 days). No eyes showed evidence of infection or recurrent corneal melting during the follow-up period. CONCLUSIONS: FG-assisted augmented AMT was easily performed for repairing large corneal perforations. This surgical method was very helpful in stabilizing the wound in the early postoperative period.