Characterization of the bone matrix and its contribution to tooth loss in human cadaveric mandibles.

OBJECTIVE: It is uncertain as to what extent the major bone matrix constituents, mineral and collagen, show inter-individual variation and dependence on age and sex in jawbones. The purpose of this study was to clarify this uncertainty using cadaveric mandibles and investigate the association of bone matrix with the number of existing teeth. MATERIALS AND METHODS: Cortical bone samples (1 × 1 cm) collected from the mental of 48 cadaveric mandibles (27 men and 21 women; age range = 56-93 years and 63-103 years, respectively) were used to quantify three bone matrix indices: mineral content, collagen content and extent of lysine hydroxylation of collagen. Associations with age and comparisons by sex were evaluated based on bone matrix indices and the numbers of existing teeth. The numbers of existing teeth were compared between the groups showing low and high bone matrix index values. RESULTS: A great amount of inter-individual variation was seen in all bone matrix indices. No bone matrix indices were associated with age, while the number of existing teeth was negatively associated with age. The bone matrix indices and number of existing teeth did not differ by sex. The number of existing teeth was nearly twice as high in the group showing high collagen content as in the low collagen group; however, an analysis of covariance showed a significant inter-group difference not from bone matrix indices, but rather from age. Interestingly, in comparison to femoral collagen, mandibular collagen showed lower lysine hydroxylation, which can represent an aspect of bone quality. CONCLUSIONS: Mandibular bone matrix shows great inter-individual variation and is independent of age and sex, but did not show as strong a relationship with tooth loss as age. Even so, mandibular collagen may represent a unique characteristic of bone matrix and deserves to be further investigated.

Prosthodontic treatment can improve the ingestible food profile in Japanese adult outpatients.

PURPOSE: To investigate the effect of prosthodontic treatment on the ingestible food profile in adult Japanese outpatients, and to identify the related risk factors that can deteriorate the profile. METHODS: The participants were 277 outpatients who visited university-based specialty clinics in Japan for prosthodontic treatment. The demographic data, number of present teeth assessed via intraoral examination, and oral health-related quality of life assessed by the total Oral Health Impact Profile (OHIP-J54) scores of all participants were recorded before treatment. Ingestible food profile score (IFS) was recorded using a validated food intake questionnaire. Eligible participants who answered the questionnaire before and after treatment were categorized into five groups based on the prosthodontic treatments they received (i.e., crowns, bridges, removable partial dentures, removable complete dentures, and removable complete and partial dentures). RESULTS: Multivariate analysis of covariance revealed a statistically significant main effect of prosthodontic intervention (time course: before and after treatment) on mean IFS (P=0.035, F=4.526), even after adjusting for covariates (age, number of present teeth, and treatment modality). Multiple linear regression analysis revealed that the low number of present teeth (r=0.427, P<0.001) and a high OHIP-J54 total score (r=-0.519, P<0.001) of the patients at the baseline were significantly associated with their baseline IFSs, even after adjusting for confounding variables. CONCLUSIONS: The findings of this multicenter follow-up study indicate the importance of prosthodontic rehabilitation in improving patients' ingestible food profiles.

Influence of carbon dioxide laser irradiation on the healing process of extraction sockets.

OBJECTIVE: To clarify the healing-promoting effects of carbon dioxide laser irradiation in high and low reactive-level laser therapies (HLLT and LLLT, respectively) on extraction sockets after tooth extraction. MATERIAL AND METHODS: Forty-two 5-week-old male Wistar rats were divided into laser irradiation and non-irradiation (control) groups and compared. The laser-irradiation group underwent HLLT immediately after tooth extraction and then LLLT 1 day post-extraction. Tissue was excised 6 h and 3, 7, or 21 days after extraction and histopathologically investigated. The alveolar crest height was measured osteomorphometrically 21 days post-extraction, and granulation tissue in the extraction socket surface layer was immunohistologically investigated using anti-α-smooth muscle actin (anti-α-SMA) antibody 3 and 7 days post-extraction. RESULTS: Many osteoclasts appeared and active bone resorption was noted in the irradiation group 3 days after extraction compared to the controls. On Day 7, new bone formation started around the extraction socket in the control group, but from the superficial to over the middle layer of the socket in the irradiation group. On Day 21, a concavity existed in the alveolar crest region in the controls, whereas this region was flat, with no concavity, in the irradiation group. On osteomorphometry, the alveolar crest height was significantly higher in the irradiation (0.7791 ± 0.0122) than the control (0.6516 ± 0.0181) group (P < 0.05). On immunostaining, many α-SMA-positive cells were noted in the control group, but very few in the irradiation group. CONCLUSION: Laser-irradiated extraction wound healing showed characteristics different from those of the normal healing process, suggesting a favorable healing-promoting effect.

Use of Digital Technology to Improve Objective and Reliable Assessment in Dental Student Simulation Laboratories.

The aim of this study was to assess inter-and intra-grader agreement with the use of digital scanning and a tooth preparation assessment software program in comparison to the current traditional visual grading method in a dental student simulation laboratory. Students' typodont teeth preparations from previous practical examinations were used (cast crown n=50; cast fixed partial denture abutments n=50). Five preclinical instructors received calibration training and evaluated each of the preparations by the traditional visual grading method using a rubric. The same preparations were assessed by the same instructors using a tooth preparation assessment software program (PrepCheck, Sirona). The results showed that intra-grader agreement was significantly higher when grades were determined by PrepCheck compared to the traditional visual grading method. The traditional method was associated with significantly greater inter-grader disagreement in comparison to grading using PrepCheck (p<0.05). When the average final grade for students' crown preparations by each grader was compared for the traditional method and PrepCheck, significant differences were found for all graders (p<0.001). In this study, the use of the PrepCheck software program greatly improved intra-and inter-grader agreement during grading in a student simulation laboratory. Digital technology may improve the objectivity and reliability of assessments by preclinical evaluators.

Longitudinal study on risk indicators for peri-implantitis using survival-time analysis.

PURPOSE: The purpose of this study was to evaluate the incidence of peri-implantitis and to identify potential associated risk indicators. METHODS: This longitudinal study included 477 patients treated with 1420 implants. Medical and dental histories were evaluated in all patients. The location, size, connection type, surgical protocol, use of prosthesis splinting and fixation type were evaluated for each implant. In peri-implant evaluation, minimum keratinized tissue width around implants, peri-implant probing depths, peri-implant bleeding and peri-implant suppuration were assessed. Bone resorption around implants was evaluated with intraoral radiographs at baseline and at follow-up examinations. The study endpoint was peri-implantitis, which was defined as the presence of bleeding on probing and/or suppuration with bone resorption >1mm, in accordance with previous studies. Data were analyzed with mixed-effects Cox models. RESULTS: Peri-implantitis occurred in 15.3% of patients and 9.2% of implants. The overall 5- and 10-year cumulative implant survival rates were 0.95 (95% confidence interval [CI]: 0.93-0.96) and 0.83 (95% CI: 0.8-0.87), respectively. Age (hazard ratio [HR]=0.94, 95% CI: 0.90-0.98, p<0.01), plaque control record >20% (HR=2.61, 95% CI: 1.02-6.67, p=0.04), maxillary placement (HR=1.90, 95% CI: 1.11-3.23, p=0.02) and number of occlusal supports (HR=0.87, 95% CI: 0.77-0.99, p=0.03) were significantly correlated with peri-implantitis development. CONCLUSIONS: Within the limitations of this longitudinal study on risk indicators for peri-implantitis, age, inadequate plaque control, insertion in the maxilla and less occlusal support of natural teeth correlated with peri-implantitis development.

Characterization of mandibular bones in senile osteoporotic mice.

At present, little is known about the age-related changes in jaw bones. The aim of this study was to characterize the mandibles of 6 month-old senile osteoporotic mice, SAMP6, and compare with those of age-matched controls, SAMR1. In comparison to SAMR1, SAMP6 showed thinner cortical bone, lower bone volume, and poorly organized collagen matrix. The collagen fibril diameter in SAMP6 was significantly smaller than that of SAMR1. In SAMP6 both collagen content and cross-links were lower than those of SAMR1, but the ratio of the major mature cross-link (pyridinoline) to its precursor reducible cross-link (dehydrodihydroxylysinonorleucine/its ketoamine) was higher in comparison to SAMR1. In addition, the extent of lysine hydroxylation of collagen was higher in SAMP6 than that of SAMR1. These results indicate that not only the quantity of collagen but also its quality are altered in SAMP6 and may result in the age-associated osteoporotic defects of mandibles.

A multi-centered epidemiological study evaluating the validity of the treatment difficulty indices developed by the Japan Prosthodontic Society.

PURPOSE: The Japan Prosthodontic Society developed a multi-axis assessment protocol to evaluate the complex variations in patients who need prosthodontic care, and to classify the level of treatment difficulty. A previous report found the protocol to be sufficiently reliable. The purpose of this multi-center cohort study was to evaluate the validity of this multi-axis assessment protocol. METHODS: The treatment difficulty was evaluated using the multi-axis assessment protocol before starting prosthodontic treatment. The time required for active prosthodontic treatment, medical resources such as treatment cost, and changes in the oral health-related QOL before and after treatment, were evaluated after treatment completion. The construct validity of this protocol was assessed by the correlation between the dentist's pre-operative subjective assessment of the treatment difficulty, and the level of difficulty determined by this protocol. The predictive validity was assessed estimating the correlations between a "comprehensive level of treatment difficulty" based on the four axes of this protocol and total treatment cost, total treatment time, and changes in the oral health-related QOL before and after treatment. RESULTS: The construct validity of this protocol was well documented except for psychological assessment. Regarding the predictive validity, the comprehensive level of treatment difficulty assessed before treatment was significantly correlated with the three surrogate endpoints known to be related to the treatment difficulty (total treatment cost, treatment time, and improvement in the oral health-related QOL). To further clarify the validity of the protocol according to patients' oral condition, a subgroup analysis by defects was performed. Analyses revealed that treatment difficulty assessment before treatment was significantly related to one or two surrogate endpoints in the fully edentulous patients and the partially edentulous patients. No significant relationship was observed in the patients with mixture of full/partial edentulism and the patients with teeth problems, possibly due to the small sample size in these groups. CONCLUSION: This study revealed that the multi-axis assessment protocol was sufficiently valid to predict the level of treatment difficulty in prosthodontic care in patients with fully edentulous defects and with partially edentulous defects.

Reliability and validity of the patient disability-oriented diagnostic nomenclature system for prosthetic dentistry.

PURPOSE: The Japan Prosthodontic Society (JPS) has proposed a new diagnostic nomenclature system (DNS), based on pathogenesis and etiology, to facilitate and improve prosthodontic treatment. This system specifies patient disability and the causative factor (i.e. "B (disability) caused by A (causative factor)"). The purpose of this study was to examine the reliability and validity of this DNS. STUDY SELECTION: The JPS Clinical Guideline Committee assessed mock patient charts and formulated disease names using the new DNS. Fifty validators, comprising prosthodontic specialists and dental residents, made diagnoses using the same patient charts. Reliability was evaluated as the consistency of the disease names among the validators, and validity was evaluated using the concordance rate of the disease names with the reference disease names. RESULTS: Krippendorff's α was 0.378 among all validators, 0.370 among prosthodontic specialists, and 0.401 among dental hospital residents. Krippendorff's α for 10 validators (3 specialists and 7 residents) with higher concordance rates was 0.524. Two validators (1 specialist and 1 resident) with the highest concordance rates had a Krippendorff's α of 0.648. Common disease names had higher concordance rates, while uncommon disease names showed lower concordance rates. These rates did not show correlation with clinical experience of the validator or time taken to devise the disease name. CONCLUSIONS: High reliability was not found among all validators; however, validators with higher concordance rates showed better reliability. Furthermore, common disease names had higher concordance rates. These findings indicate that the new DNS for prosthodontic dentistry exhibits clinically acceptable reliability and validity.

A comparative study of computed tomography and magnetic resonance imaging for the detection of mandibular canals and cross-sectional areas in diagnosis prior to dental implant treatment.

BACKGROUND: Computed tomography (CT) is effective in the diagnosis of dental implants. However, it has the disadvantage of exposing patients to high doses of x-rays, and the mandibular canals cannot be detected by CT in some clinical cases. PURPOSE: The purpose of this study was to examine the detectability of the anatomic morphology of the molar region in the lower jaw (where implantation is common) by CT and magnetic resonance imaging (MRI), to compare the data, and to determine the usefulness of MRI in diagnosis prior to dental implant treatments. MATERIALS AND METHODS: Eleven female subjects (average age, 59 years) who had partially edentulous mandibles (total of 19 sites) were included in the study. CT and MRI were performed with the same subjects, and the degrees of identification of the mandibular canal in the first and second molar regions were compared. Dimensional accuracy in the second molar region was also compared. RESULTS: With CT, the canals of the first molar regions were not identified in 11 of 19 sites; however, MRI identified the canals in all 19 sites. Using the kappa index, we found that the inter- and intraobserver identification reliabilities (0.84 and 0.87, respectively) were excellent, especially for MRI. Dimensional positioning of the canal in the second molar region was almost the same with MRI as with CT. CONCLUSIONS: MRI is an alternative method in diagnosis prior to dental implant treatment in the mandibular molar region.

Determination of the fabricating conditions for the preferable marginal and internal adaptation of the mica crystal castable ceramic crown.

This study was performed to find an acceptable internal adaptation of castable ceramics containing mica and beta-spodumene crystals. The influences of factors, expansion rate of phosphate-bonded investment (A), anisotropic expansion (B), diecoating (C), shrinkage during crystallization (D), and interaction (A x B), and (A x C) were tested by twice repeated experiments under block design according to L8(2)(7) orthogonal array. Estimated mean ranges under the conditions combined with significant factors were judged by considering the criteria of the ideal internal gap (about 50 microm). The ideal marginal fit of less than 50 microm and uniform cement space about 50 microm around the axial wall could be achieved by a combination of optimum levels of A1B1C2D2. However, the estimated mean gap at the cusp tip and central fossa of occlusal inside by this combination were about 120 microm. The near intolerable gaps could not be reduced.

The current status of prosthodontic specialists in Japan--the Japan Prosthodontic Society has played an important role in certification of prosthodontic specialists.

A board certification system for prosthodontic specialists was established in 2005 by the Japan Prosthodontic Society (JPS), significantly later than the system established by the American Board of Prosthodontics in 1947. The purpose of this study is to outline the certification system for prosthodontic specialists in Japan and discuss and evaluate its current status. In 2012, the number of board certified prosthodontic specialists was 1150 and that of mentorial specialists was 693. The number of board certified institutions was 78 and that of certified adjunct institutions was 23. Although the history of the certification system is not very long, we conclude that a well-organized system has been developed. In addition, prosthodontic departments of dental schools also play an important role in the certification system for prosthodontic specialists.

Distinct characteristics of mandibular bone collagen relative to long bone collagen: relevance to clinical dentistry.

Bone undergoes constant remodeling throughout life. The cellular and biochemical mechanisms of bone remodeling vary in a region-specific manner. There are a number of notable differences between the mandible and long bones, including developmental origin, osteogenic potential of mesenchymal stem cells, and the rate of bone turnover. Collagen, the most abundant matrix protein in bone, is responsible for determining the relative strength of particular bones. Posttranslational modifications of collagen, such as intermolecular crosslinking and lysine hydroxylation, are the most essential determinants of bone strength, although the amount of collagen is also important. In comparison to long bones, the mandible has greater collagen content, a lower amount of mature crosslinks, and a lower extent of lysine hydroxylation. The great abundance of immature crosslinks in mandibular collagen suggests that there is a lower rate of cross-link maturation. This means that mandibular collagen is relatively immature and thus more readily undergoes degradation and turnover. The greater rate of remodeling in mandibular collagen likely renders more flexibility to the bone and leaves it more suited to constant exercise. As reviewed here, it is important in clinical dentistry to understand the distinctive features of the bones of the jaw.

A multi-centered epidemiological study evaluating the reliability of the treatment difficulty indices developed by the Japan Prosthodontic Society.

BACKGROUND: The diagnostic assessment of the level of difficulty in treating patients who need prosthodontic care is useful to establish a medico-economically efficient system with primary care dentists and prosthodontic specialists. MATERIALS AND METHODS: A multi-axis assessment protocol was established using the newly established treatment difficulty indices. The protocol contains Axis I: oral physiological conditions (e.g., teeth damage and/or missing teeth); Axis II: general health and sociological conditions (e.g., medical disorders); Axis III: oral health-related quality of life (OHRQOL; e.g., oral health impact profile: OHIP); and Axis IV: psychological health (e.g., mood, anxiety, somatoform disorders). A preliminary study on the test-retest consistency of the protocol was conducted to check the levels of reliability of the indices prior to a large-scale, multi-center cohort study on the validity of the protocol. RESULTS: The test-retest consistency in terms of the oral physiological condition (Axis I) after data reduction was 0.82 [corrected] for patients with teeth problems, 0.73 [corrected] for partially edentulous patients, and 0.78 [corrected] for edentulous patients. The reliability for general health and sociological conditions (Axis II), OHRQOL (Axis III), and psychological health (Axis IV) were 0.88, 0.74, and 0.61, respectively. These values reflect either "sufficient agreement" or "excellent agreement" in accordance with the criteria established by Landis and Koch (1977) [1]. CONCLUSION: This protocol is the first multi-axis assessment scheme introduced for prosthodontic treatment with sufficient reliability. This new system is therefore expected to have a significant impact on future dental diagnostic nomenclature systems.

Students' opinion of a predoctoral implant training program.

Implant treatment today is highly predictable and provides valid restorative options for the completely or partially edentulous patient. In Japan, many dental care facilities have incorporated implant treatment, and such treatment is no longer rare. For predoctoral students, the educational environment related to implants is not always applicable in present clinical settings. In this article, we describe the implant training program developed at our university for predoctoral education, and we report the changes in student opinions regarding implant treatment by comparing pre- and post-training opinions. The newly developed models for implant training were effective in increasing student understanding that implant treatment is one prosthetic option for restoring missing teeth. In a survey of predoctoral students, responses indicating negative opinions toward implant treatment decreased after training, and responses indicating positive opinions increased. These findings indicated that this training was effective in deepening student understanding of implant treatment.

Biochemical characterization of collagen in alveolar mucosa and attached gingiva of pig.

Alveolar mucosa and attached gingiva are two continuous but functionally distinct connective tissues covering alveolar bone of the jaw. In this study, the major matrix component of these tissues, collagen, was biochemically characterized and compared. The tissues were obtained from mature pigs and analyzed for collagen content, amino acid composition, collagen types, collagen cross-linking, and gene expression. We found that alveolar mucosa is primarily composed of fibrillar collagens and the collagen content is higher than attached gingiva. The content of type III relative to type I collagen was higher in alveolar mucosa when compared with attached gingiva. The collagen cross-linking pattern also was distinct between the two tissues demonstrating that alveolar mucosa contained fewer reducible cross-links but more non-reducible cross-links in comparison to attached gingiva. The mRNA expression level of type I collagen in alveolar mucosa was significantly lower than that of attached gingiva. These results indicate that alveolar mucosa is a fibrillar collagen-rich tissue and, in comparison to gingival tissue, re-models slowly.

Failure probability of implant-supported restorations using highly filled all-composite crowns.

OBJECTIVES: To evaluate the effect of the surface preparation of a gold cylinder on the failure probability of highly filled all-composite restorations used as implant-supported prostheses, and to determine the effect of the location of load application. METHOD AND MATERIALS: Gold cylinders (Nobel Biocare) were prepared with 1 of 4 different surface preparations (n = 20 per surface treatment), and then an indirect resin composite (Targis, Ivoclar Vivadent) was applied. The 4 surface treatment conditions were (1) untreated (prep 1); (2) airborne-particle abraded with 50-Microm alumina (prep 2); (3) airborne-particle abraded with 50-Microm alumina followed by application of a metal conditioner (Alloy Primer, J. Morita) (prep 3); and (4) airborne-particle abraded with 50-Mum alumina followed by application of the bonding primer for the indirect resin system (Targis Link) (prep 4). A compressive load was applied vertically at 1 mm and 2 mm from the access cavity on the occlusal surface until the restorations failed. RESULTS: The prep 4 specimens had the highest fracture resistance. The fracture resistance at the 1-mm location was significantly higher than that at the 2-mm location. The failure load of the all-composite restorations with any of the surface preparations was lower than that of the resin-veneered restorations used as controls. CONCLUSION: The prep 4 conditions decreased the probability of fracture of the highly filled all-indirect resin composite restorations. Eccentric loading of the all-composite restorations should be minimized in light of the higher probability of failure associated with such a loading condition.

Differential gene expression of collagen-binding small leucine-rich proteoglycans and lysyl hydroxylases, during mineralization by MC3T3-E1 cells cultured on titanium implant material.

Titanium implants create a unique ultrastructure (composed of a collagenous zone with relatively disorganized fibril morphology) at the bone-implant interface. The objective of this study was to investigate the temporal mRNA expression patterns, using real-time polymerase chain reaction, of type I collagen (COLI) and regulators for collagen fibrillogenesis, collagen-binding small leucine-rich proteoglycans (SLRPs) and lysyl hydroxylases (LHs), during mineralization, by MC3T3-E1 cells cultured on titanium (Ti). Lysates of the cultures on Ti and on plastic wells (Pl) for 10-50 d were used for the quantification of calcium and mRNA. Although the onset of calcium accumulation in the cultures on Ti (30-40 d) was slower than that of cultures on Pl (20-30 d), the gene expression patterns during mineralization were similar in cells cultured on either material. COLI and fibromodulin were up-regulated just before the onset of mineralization and then down-regulated. Lumican and LH1 were up-regulated just before the onset of mineralization and then returned to the baseline level. Decorin and LH2 were up-regulated at the late mineralization stage. Biglycan was down-regulated once at the early mineralization stage and then returned to the original level. LH3 was maintained at a steady level throughout. This study suggests actual but distinct roles of SLRPs and LHs in the formation of a unique ultrastructure at the bone-implant interface.

Probability of failure of highly filled indirect resin-veneered implant-supported restorations: an in vitro study.

PURPOSE: The study compared the probability of failure of three highly filled resin-veneered restorations to that of conventional metal-ceramic restorations when used as implant-supported prostheses. The effect of the location of load application on the fracture resistance of the restorations was also studied. MATERIALS AND METHODS: Twenty samples each of the three resins, Artglass, Targis, and Estenia, were applied on type IV gold frameworks. Twenty metal-ceramic restorations of equal dimensions (VMK 95 and Degudent Universal) were used as controls. Compressive load was applied vertically at 1 mm (n = 10) and 2 mm (n = 10) from the periphery of the occlusal table until the restorations failed. Weibull analysis was applied to the data. RESULTS: There was no significant difference in the probability of failure among the metal-ceramic restorations and three resin-veneered restoration systems. Loading the resin-veneered restorations at the 1-mm location significantly increased their probability of failure when compared to the 2-mm loading location. The loading location did not significantly change the probability of failure of the metal-ceramic restorations. CONCLUSION: The probability of failure of resin-veneered restorations tested was not significantly different from that of the metal-ceramic restoration under two compressive loading conditions. Eccentric loading of resin-veneered restorations should be minimized in light of the higher probability of failure associated with such a loading condition.

A survey of the use of mandibular implant overdentures in 10 countries.

PURPOSE: This preliminary international survey compared provision of implant-retained overdentures to fixed implant-supported prostheses for edentulous mandibles. MATERIALS AND METHODS: Questionnaires based on a 2001 Swedish study were sent to prosthodontists and specialist clinics in nine additional countries. RESULTS: Response rate varied from 53% to 100% in 10 national surveys and should allow careful comparison of results. The relationship between implant overdentures and fixed implant-supported prostheses in treatment of edentulous mandibles varied much; in Sweden, the proportion of overdentures was 12%, whereas it was 93% in The Netherlands. In all countries, the most common reason for choice of the overdenture was reduced cost. In all but two countries, the majority of respondents thought that patients with implant overdentures were equally or more satisfied with overdentures as those with fixed implant-supported prostheses. CONCLUSION: There were great differences among the 10 countries in choice of implant treatment of the edentulous mandible. The relative proportion of mandibular overdentures to fixed prostheses was low in Sweden and Greece and varied from one to two thirds in the other countries, except The Netherlands.