Parabrachial Nucleus Activity in Nociception and Pain in Awake Mice.

The parabrachial nuclear complex (PBN) is a nexus for aversion and for the sensory and affective components of pain perception. We have previously shown that during chronic pain PBN neurons in anesthetized rodents have amplified activity. We report a method to record from PBN neurons of behaving, head-restrained mice while applying reproducible noxious stimuli. We find that both spontaneous and evoked activity are higher in awake animals compared with urethane anesthetized mice. Fiber photometry of calcium responses from calcitonin-gene-related peptide-expressing PBN neurons demonstrates that these neurons respond to noxious stimuli. In both males and females with neuropathic or inflammatory pain, responses of PBN neurons remain amplified for at least 5 weeks, in parallel with increased pain metrics. We also show that PBN neurons can be rapidly conditioned to respond to innocuous stimuli after pairing with noxious stimuli. Finally, we demonstrate that changes in PBN neuronal activity are correlated with changes in arousal, measured as changes in pupil area.SIGNIFICANCE STATEMENT The parabrachial complex is a nexus of aversion, including pain. We report a method to record from parabrachial nucleus neurons of behaving mice while applying reproducible noxious stimuli. This allowed us to track parabrachial activity over time in animals with neuropathic or inflammatory pain. It also allowed us to show that the activity of these neurons correlates with arousal states and that these neurons can be conditioned to respond to innocuous stimuli.

Microbiological profile of peri-implantitis: Analyses of peri-implant microbiome.

PURPOSE: To characterize the microbiome composition in peri-implant pocket of peri-implantitis and peri-implant sulcus controls using 16S rRNA gene sequencing. MATERIALS AND METHODS: In this controlled clinical cross-sectional study, 23 subjects with control implants (n = 14) and diseased implants (peri-implantitis, n = 21) were included. The peri-implant pocket/sulcus was sampled and used to extract DNA and amplify the 16S rRNA gene using universal primers targeting the V3-V4 regions. The resulting 16S PCR amplicons were sequenced on Illumina MiSeq, and the sequences were processed using DADA2 and the Human Oral Microbiome Database (HOMD) as references. Alpha and Beta diversity, as well as core microbiome and differential abundance analyses, were performed using the MicrobiomeAnalyst workflow. RESULTS: There were no significant differences in microbial diversity between control implants and implants with peri-implantitis (Shannon p = 0.82). Overall bacterial community structure assessed through beta diversity analysis was also not significantly different between the two groups (p = 0.18). However, high levels of Gram-negative bacteria were detected in peri-implant pockets compared to the control sulcus. Abundant species in peri-implantitis were Capnocytophaga leadbetteri, Treponema maltophilum, Peptostreptococcus, Neisseria, P. gingivalis, and Porphyromonas endodontali, Lactococcus lactis and Filifactor alocis (p < 0.05). Gram-positive bacteria such as Streptococcus salivaris, Prevotella melaninogenica, L. wadei, and Actinomyces spp. serve were more abundant in peri-implant control sulcus. CONCLUSIONS: Peri-implant sulcus in control implants harbors predominantly Gram-positive bacteria, whereas pockets of implants with peri-implantitis harbor predominantly Gram-negative bacteria.

Comparing the accuracy of occlusal vertical dimension transfer in CAD-CAM dentures.

PURPOSE: There are different methods to transfer occlusal vertical dimension (OVD) when fabricating complete dentures, but it is not clear which method yields the most accurate transfer. This study investigated the accuracy of transferring the OVD of the maxillary/mandibular relationship when designing and fabricating digital dentures by evaluating two commonly used workflows: duplicate dentures (DDs) and occlusion rims (ORs). MATERIALS AND METHODS: Mounted edentulous casts were used to simulate a completely edentulous patient. These casts were used in two workflows: (1) DD workflow where complete dentures were fabricated and relined (n = 15), and (2) OR where final impressions and ORs were constructed (n = 15). Relined dentures and ORs with fiduciary markers were then scanned and virtually articulated, then exported as STL files. A scan of the articulated casts (simulated patients) with fiduciary markers embedded was also exported as an STL file and used as a control. STL files for each workflow were superimposed over the control and analyzed in 3D inspection software (Geomagic Control X, 3D Systems, NC) for deviations (mm) at three different locations. Average 3D deviations were compared among the groups using a two-way ANOVA (α-0.05). RESULTS: The average deviation for OR was significantly larger than DD at all locations of measurement [F = 46.00, p < 0.0001]. The majority of the measurements (98.9%) had a positive deviation value, indicating increased OVD. The overall deviation for the OR group from the control was 0.72 ± 0.13 mm versus 0.45 ± 0.23 mm for the DD group. There was no difference in deviation between the points of measurement and no interaction between the location and method [F = 0.02, p < 0.98]. CONCLUSIONS: The DD workflow exhibited less deviation in the transfer of OVD than the OR workflow. However, the deviation was small and may not be clinically significant.

Shear bond strength of porcelain to milled and stereolithography additively manufactured zirconia with and without surface treatment: An in vitro study.

STATEMENT OF PROBLEM: Delamination of veneering ceramic is one of the most common challenges relating to veneered zirconia restorations. Additive manufacturing (AM) is a fast-expanding technology that has gained widespread acceptance in dentistry and is increasingly being used to produce dental restorations. However, information about bonding of porcelain to AM zirconia is lacking. PURPOSE: The purpose of this in vitro study was to investigate the shear bond strength (SBS) of porcelain to milled and additively manufactured zirconia, and the effect of surface treatment on bond strength. MATERIAL AND METHODS: A Ø12×5-mm disk was designed virtually to fabricate all specimens, which were divided into 2 groups according to the manufacturing technique: additively manufactured or milled zirconia. The effect of airborne-particle abrasion and a zirconia liner before porcelain application was investigated in both groups. Veneering porcelain was fired into an alumina ring mold on the zirconia surface. SBS was measured by using a universal testing machine at a crosshead speed of 1 mm/min before and after aging (n=10). SBS data were analyzed with 3-way ANOVA (α=.05) RESULTS: A significant difference was found between milled and AM zirconia. The SBS of porcelain to milled zirconia was significantly higher (1.38 MPa) than to AM zirconia (0.68 MPa) (P<.001). The surface treatment of zirconia had no significant effect on porcelain SBS in either group (P=.254), whereas thermocycling significantly reduced the SBS of porcelain to zirconia in both milled and AM groups (P=.001). CONCLUSIONS: Porcelain bonding to milled zirconia was better than to AM zirconia. Pretreating the zirconia substrate before porcelain application did not improve the porcelain bond.

Microbiological profile of peri-implantitis: Analyses of microbiome within dental implants.

PURPOSE: To characterize the microbiome composition within dental implants of peri-implantitis subjects and healthy controls using 16S rRNA gene sequencing. MATERIALS AND METHODS: Twenty-three subjects with healthy (n = 11 implants) and diseased (peri-implantitis, n = 21) implants were included in this controlled clinical cross-sectional study. Samples were obtained from internal surfaces of dental implants using sterile paper points for microbiological analysis. DNA was extracted, and the16S rRNA gene was amplified using universal primers targeting the V3-V4 regions. The resulting 16S polymerize chain reaction amplicons were sequenced on Illumina MiSeq, and the sequences were processed using DADA2 and the Human Oral Microbiome Database (HOMD) as references. Alpha and Beta diversity, as well as core microbiome and differential abundance analyses were then performed using the MicrobiomeAnalyst workflow. RESULTS: A significant increase in microbial diversity was observed in the internal implant surface of healthy implants compared with the internal surfaces of peri-implantitis (Shannon p = 0.02). Bacterial community structure was significantly different among groups (p = 0.012). High levels of Gram-positive bacteria were detected inside implants with peri-implantitis compared to healthy implants, especially Enterococci. CONCLUSIONS: There is a shift in bacterial diversity inside implants with peri-implantitis from the healthy control. The microbial colonization within that space might contribute to the etiology of peri-implant disease.

Incidental findings in cone beam computed tomography volumes: Calcified head-and-neck atheromas detected during dental evaluation.

PURPOSE: Atheromas can be detected incidentally in routine dental cone beam computed tomography (CBCT) images. This study aims to assess prevalence and risk factors associated with these vascular lesions. MATERIALS AND METHODS: The maxillofacial CBCTs of 458 subjects were evaluated and divided into 4 groups based on the presence of calcified atheroma: subjects with no calcified atheroma, subjects with intracranial calcified atheroma (ICA), subjects with extracranial calcified atheroma (ECA), and subjects exhibiting combined lesions. Age, sex, medical conditions, family history, and size were documented. Analysis of variance followed by a multiple comparison test was used for data satisfying parametric test assumptions. Chi-squared tests were used to assess categorical data. The Spearman Rho test was used to assess the correlation between the incidence of calcified atheroma and subjects' medical condition. RESULTS: Of the 458 CBCTs evaluated, 29.90% presented with calcified atheroma. Calcified atheroma prevalence was significantly higher in older patients versus younger patients (p = 0.004) and in males compared to females (p = 0.004). Males were more likely to have the combination of ICA and ECA, whereas females were more likely to have ICA alone (p ≤ 0.040). Patients with calcified atheroma were significantly more likely to have a history of hyperlipidemia (p = 0.001), hypertension (p = 0.001), and myocardial infarction/coronary artery diseases (p = 0.001). Overall, patients exhibiting both intracranial and extracranial lesions were more likely to have cardiovascular risk factors (p = 0.001). CONCLUSION: Incidentally detected calcified atheromas in CBCTs are common. Subjects with combined atheroma lesions are at higher risk for cardiovascular disease. The diagnosis of incidental calcified atheromas in CBCT's warrants early referral to medical specialists, especially if there is no medical history of existing cardiovascular disease.

Effect of silver diamine fluoride on the surface roughness of dental ceramics.

STATEMENT OF PROBLEM: Application of silver diamine fluoride (SDF) can be a straightforward and efficient way to manage recurrent caries around the margins of crowns. However, its effect on ceramic surfaces is unknown. PURPOSE: The purpose of this in vitro study was to evaluate and compare the effect of SDF, acidulated phosphate fluoride (APF), and distilled water on the surface roughness of dental ceramics. MATERIAL AND METHODS: Forty-five rectangles (10×10×2 mm) each of 5% yttria-stabilized tetragonal zirconia polycrystal (5Y-TZP) zirconia (Zir), lithium disilicate (LDS), overglazed feldspathic porcelain (FO), and polished feldspathic porcelain (FP) were fabricated. The specimens were treated with 38% SDF, 1.23% APF, and distilled water to simulate 3 years of topical applications. The surface roughness (Ra) of each rectangle was measured with a profilometer before and after treatment with the solutions, and the change in Ra (△Ra) was calculated. Scanning electron microscope images were obtained of each treatment group. Multiple comparison of the means among the ceramics and testing solutions was done using 2-way ANOVA followed by the Tukey Honestly Significant test (α=.05). RESULTS: ANOVA revealed significant differences in the 2 main factors, as well as their interaction (P<.001). The surface roughness of the treated rectangles was significantly dependent on the type of ceramic and the testing solution. The greatest surface roughness increase was seen in the interaction of LDS:APF (△Ramean=0.51 ±0.13 µm), closely followed by FO:APF (△Ramean=0.49 ±0.20 µm) and FP:APF (△Ramean=0.41 ±0.17 µm) (P<.001). SDF increased the surface roughness of LDS, FO, and FP; however, the increase was not significant (△Ramean LDS=0.25 ±0.11 µm; △Ramean FO=0.17 ±0.16 µm; △Ramean FP=.1 ±0.14 µm; P >.118). None of the solutions had any effect on zirconia (P>.977). CONCLUSIONS: SDF is safe to use around zirconia restorations. Long-term and repeated application of SDF on lithium disilicate and feldspathic porcelain must be considered with caution.

An Amygdalo-Parabrachial Pathway Regulates Pain Perception and Chronic Pain.

The parabrachial (PB) complex mediates both ascending nociceptive signaling and descending pain modulatory information in the affective/emotional pain pathway. We have recently reported that chronic pain is associated with amplified activity of PB neurons in a rat model of neuropathic pain. Here we demonstrate that similar activity amplification occurs in mice, and that this is related to suppressed inhibition to lateral parabrachial (LPB) neurons from the CeA in animals of either sex. Animals with pain after chronic constriction injury of the infraorbital nerve (CCI-Pain) displayed higher spontaneous and evoked activity in PB neurons, and a dramatic increase in after-discharges, responses that far outlast the stimulus, compared with controls. LPB neurons in CCI-Pain animals showed a reduction in inhibitory, GABAergic inputs. We show that, in both rats and mice, LPB contains few GABAergic neurons, and that most of its GABAergic inputs arise from CeA. These CeA GABA neurons express dynorphin, somatostatin, and/or corticotropin releasing hormone. We find that the efficacy of this CeA-LPB pathway is suppressed in chronic pain. Further, optogenetically stimulating this pathway suppresses acute pain, and inhibiting it, in naive animals, evokes pain behaviors. These findings demonstrate that the CeA-LPB pathway is critically involved in pain regulation, and in the pathogenesis of chronic pain.SIGNIFICANCE STATEMENT We describe a novel pathway, consisting of inhibition by dynorphin, somatostatin, and corticotropin-releasing hormone-expressing neurons in the CeA that project to the parabrachial nucleus. We show that this pathway regulates the activity of pain-related neurons in parabrachial nucleus, and that, in chronic pain, this inhibitory pathway is suppressed, and that this suppression is causally related to pain perception. We propose that this amygdalo-parabrachial pathway is a key regulator of both chronic and acute pain, and a novel target for pain relief.

Leveraging Digital Technology for Treatment of Young Patients with Congenital Conditions: A Clinical Report.

Young patients with ectodermal dysplasia and Ehlers-Danlos Syndrome present with unique characteristics and corresponding treatment challenges. Congenitally missing teeth or conditions leading to premature tooth loss may be exhibited. Underdeveloped or easily traumatized oral structures are commonly seen and must be rehabilitated with care. These oral features can have a negative impact on the patients' quality of life and may require special considerations during dental treatment. This report follows the initial treatments of a 6-year-old patient with ectodermal dysplasia and a 20-year-old patient with Ehlers-Danlos Syndrome, with the incorporation of digital technologies in their subsequent oral rehabilitation.

Microbiological Profile and Human Immune Response Associated with Peri-Implantitis: A Systematic Review.

PURPOSE: To evaluate and synthesize the existing evidence on the microbiological and human immune response associated with peri-implantitis in comparison to healthy implants. MATERIALS AND METHODS: Three electronic databases (MEDLINE, Embase, and Cochrane Library) were searched in October 2019 to identify clinical studies evaluating the microbiota and the immune response associated with peri-implantitis. Two reviewers independently screened the studies and used the full text to extract the data. A qualitative synthesis was performed on the extracted data and summary tables were prepared. Due to clinical and methodological heterogeneity among included studies, no meta-analysis was performed. RESULTS: Forty studies were included in this review. Of these, 20 studies compared the microbiological profile of peri-implantitis with healthy implants. Nineteen studies focused on the immune response associated with peri-implantitis in comparison to healthy implants. Three studies focus on gene polymorphism associated with peri-implantitis. The most commonly reported bacteria associated with peri-implantitis were obligate anaerobe Gram-negative bacteria (OAGNB), asaccharolytic anaerobic Gram-positive rods (AAGPRs), and other Gram-positive species. In regard to immune response, the most frequently reported pro-inflammatory mediators associated with peri-implantitis were IL-1ß, IL-6, IL-17, TNF-α. Osteolytic mediator, e.g., RANK, RANKL, Wnt5a and proteinase enzymes, MMP-2, MMP-9, and Cathepsin-K were also expressed at higher level in peri-implantitis sites compared to control. CONCLUSIONS: Peri-implantitis is associated with complex and different microbiota than healthy implants including bacteria, archaea, fungi, and virus. This difference in the microbiota could provoke higher inflammatory response and osteolytic activity. All of this could contribute to the physiopathology of peri-implantitis.

Digital Design of a Universal Rat Intraoral Device for Therapeutic Evaluation of a Topical Formulation against Candida-Associated Denture Stomatitis.

Candida-associated denture stomatitis (DS) is a persistent and chronic oral infection of the denture-bearing palatal mucosa. DS stems from the ability of the fungal opportunistic pathogen Candida albicans to adhere to denture material and invade palatal tissue. Although DS is the most prevalent form of oral candidiasis, there are currently no feasible therapeutic strategies for the prevention of this recurrent condition. We developed a peptide-based antimicrobial bioadhesive formulation specifically designed for oral topical formulation. In this study, we aimed to evaluate the applicability of the novel formulation for the prevention of C. albicans colonization on denture material and development of clinical disease. To that end, using the latest technological advances in dental digital design and three-dimensional (3D) printing, we fabricated an intraoral device for rats with universal fit. The device was successfully installed and used to develop clinical DS. Importantly, by taking a preventative therapeutic approach, we demonstrated the potential clinical utility of the novel formulation as a safe and feasible prophylactic agent against DS.

The effect of embryonic origin on the osteoinductive potential of bone allografts.

STATEMENT OF PROBLEM: Allografts with osteoinduction potential are widely used to augment bone in surgical and prosthetic rehabilitations. However, osteoinduction potential varies among commercially available allografts. Donor bones are derived from different embryonic origins, either the neural crest or mesoderm. Whether the origin of the bones affects the osteoinductivity of allograftsis is unclear. PURPOSE: The purpose of this ex vivo study was to investigate the osteoinduction potential of allografts derived from bones with distinct embryonic origins. MATERIAL AND METHODS: Allografts were obtained from human frontal and parietal bones at 2 different ages (fetal and adult). The specimens were divided into 4 groups: adult frontal (n=5), adult parietal (n=5), fetal frontal (n=10), and fetal parietal (n=10). Two investigations were conducted to assess the osteoinductive potential of these allografts. First, the osteogenesis of human osteoblasts exposed to these allografts were evaluated by analyzing the expression of runt-related transcription factor 2 (RUNX2), collagen type 1 alpha 2 chain (COL1A2), and bone gamma-carboxyglutamate protein (BGLAP) genes using quantitative real-time polymerase chain reaction (qRT-PCR). Second, the protein content of the adult frontal and parietal bone matrices was analyzed using liquid chromatography tandem mass spectrometry (LC-MS/MS). One-way ANOVA and the t test were used for statistical analyses of the gene and protein expression of the groups (α=.05). RESULTS: No difference was found in the gene expression of the cells exposed to frontal or parietal bones. However, all 3 genes were significantly overexpressed in cells treated with fetal bones compared with adult bones. No difference was found in protein expression between adult frontal and adult parietal bones. CONCLUSIONS: No difference was found in the osteoinductive capacity of frontal and parietal bones used as allografts. However, the osteoinductivity of fetal bones can be higher than that of adult bones. Further microanalyses are needed to determine the protein content of fetal bones.

Accuracy of Dynamic Virtual Articulation: Trueness and Precision.

PURPOSE: To study the effects of altering condylar settings and pin openings on the trueness and precision of virtual articulators vs. mechanical articulators. MATERIALS AND METHODS: Maxillary and mandibular typodonts with fiducial markers were mounted on a mechanical Artex-CR articulator, and the mandibular teeth were prepared to allow guidance solely by the posterior determinants of the articulator and the incisal table. The relationship of the mounted typodonts was preserved digitally by scanning using manufacturer transfer plate adaptors. On the mechanical articulator, pattern resin was allowed to set between the maxillary and mandibular occlusal surfaces (area #25-30) at the endpoints of dynamic movements at 3 condylar inclinations (SCI): 10°, 30°, and 45°, n = 12/inclination, or at 3 incisal pin openings (2, 5, and 10 mm, n = 12/opening). All other articulator settings were kept constant. Resin specimens attached to the typodonts were scanned within 5 minutes of setting, then removed, and the articulated typodonts rescanned. Fixed dental prostheses (FDPs) #25-30 were designed on the virtual articulator using identical parameters to the mechanical articulator. Dynamic virtual movements were used to sculpt the design, and a file of the design was saved. The files of both types of samples were aligned and overlaid. Interocclusal separation was measured in triplicate at the indentation created by the mesiolabioincisal point angle on the incisal edge of #8 and the mesiobucco-occlusal point angle of #3. Trueness and precision of both types of articulators were calculated and compared using one-way ANOVA, followed by the Tukey HSD test (α = 0.05). RESULTS: There was no statistically significant difference at altered pin openings in either trueness (F = 0.202, p = 0.37) or precision (F = 3.134, p = 0.09) for the majority of measurements. The only significant difference was in the precision between the 2 types of articulators at 5 mm incisal opening, and only at the anterior measurement point (F = 15.134, p = 0.0008); however, these differences were less than 100 µm. When the SCI was altered, there was no statistically significant difference (F = 3.624, p > 0.05) between the virtual and mechanical articulators in trueness for 5 of the 6 measurements obtained (F = 3.624, p = 0.07) or for all of the precision measurements (F = 3.529, p = 0.07). The one trueness measurement that was significantly different (F = 9.237, p = 0.006) occured at SCI of 10°, and it was less than 100 µm. CONCLUSIONS: Dynamic movements on the virtual articulator were shown to be as true and precise as to the mechanical articulator. When there were deviations, these deviations were less than 100 µm and thus, these deviations may not be clinically relevant.

Cortical Regulation of Nociception of the Trigeminal Nucleus Caudalis.

Pain perception is strongly influenced by descending pathways from "higher" brain centers that regulate the activity of spinal circuits. In addition to the extensively studied descending system originating from the medulla, the neocortex provides dense anatomical projections that directly target neurons in the spinal cord and the spinal trigeminal nucleus caudalis (SpVc). Evidence exists that these corticotrigeminal pathways may modulate the processing of nociceptive inputs by SpVc, and regulate pain perception. We demonstrate here, with anatomical and optogenetic methods, and using both rats and mice (of both sexes), that corticotrigeminal axons densely innervate SpVc, where they target and directly activate inhibitory and excitatory neurons. Electrophysiological recordings reveal that stimulation of primary somatosensory cortex potently suppresses SpVc responses to noxious stimuli and produces behavioral hypoalgesia. These findings demonstrate that the corticotrigeminal pathway is a potent modulator of nociception and a potential target for interventions to alleviate chronic pain.SIGNIFICANCE STATEMENT Many chronic pain conditions are resistant to conventional therapy. Promising new approaches to pain management capitalize on the brain's own mechanisms for controlling pain perception. Here we demonstrate that cortical neurons directly innervate the brainstem to drive feedforward inhibition of nociceptive neurons. This corticotrigeminal pathway suppresses the activity of these neurons and produces analgesia. This corticotrigeminal pathway may constitute a therapeutic target for chronic pain.

Nanomagnetic-mediated drug delivery for the treatment of dental disease.

Maintaining the vitality of the dental pulp, the highly innervated and highly vascular, innermost layer of the tooth, is a critical goal of any dental procedure. Upon injury, targeting the pulp with specific therapies is challenging because it is encased in hard tissues. This project describes a method that can effectively deliver therapeutic agents to the pulp. This method relies on the use of nanoparticles that can be actively steered using magnetic forces to the pulp, traveling through naturally occurring channels in the dentin (the middle layer of the tooth). This method can reduce the inflammation of injured pulp and improve the penetration of dental adhesives into dentin. Such a delivery method would be less expensive, and both less painful and less traumatic than existing therapeutic options available for treatment of injured dental pulp. This technique would be simple and could be readily translated to clinical use.

Evaluating ceramic crown margins with digital radiography.

STATEMENT OF PROBLEM: Radiographs aid in clinically determining crown fit, specifically interproximal margins where tactile and visual methods may be limited. However, investigations of the utility of digital radiographs as a tool for evaluating the marginal openings of ceramic crowns are lacking. PURPOSE: The purpose of this in vitro study was to assess whether marginal adaptation for ceramic crowns and for metal-ceramic crowns with a metal collar can be identified with digital radiographs. MATERIAL AND METHODS: One lithium disilicate crown, 1 fluorapatite crown, and 1 metal-ceramic crown were fabricated for a maxillary premolar. The crowns were attached to a custom-designed device that allowed the marginal discrepancy to be changed. A total of 10 increments were measured starting at 0 to 20 µm and increasing every 20 µm to a maximum opening of 180 to 200 µm. At each increment, 2 radiographs were made of the crowns, using a digital sensor, 1 perpendicular to and 1 at 80 degrees to the long axis of the tooth. To test whether digital radiographs could be used to accurately identify "acceptable" and "unacceptable" margins, 21 dentists were asked to rate the radiographs as "acceptable" or "unacceptable." The chi square test was used to analyze differences between the dentists' evaluations and the actual marginal opening (α=.05). For the purposes of this study, a marginal discrepancy greater than 80 µm was considered "unacceptable." RESULTS: Of all marginal discrepancies exceeding 80 µm, 78.6% of the metal-ceramic crown radiographs were incorrectly scored as "acceptable" (P<.001). These radiographs were identified as false positives. Lithium disilicate (66.1%) and fluorapatite (45.8%) crowns were more likely to be incorrectly evaluated as "unacceptable" (P<.001) and identified as false negatives. CONCLUSIONS: Using digital radiographs to evaluate marginal adaptation without clinical examination is not by itself an accurate method of evaluating the marginal fit of complete coverage crowns. The marginal fit of the tested metal-ceramic crowns tended to be evaluated incorrectly as acceptable. The marginal fit of the tested ceramic crowns tended to be evaluated incorrectly as unacceptable.

Presynaptic and extrasynaptic regulation of posterior nucleus of thalamus.

The posterior nucleus of thalamus (PO) is a higher-order nucleus involved in sensorimotor processing, including nociception. An important characteristic of PO is its wide range of activity profiles that vary across states of arousal, thought to underlie differences in somatosensory perception subject to attention and degree of consciousness. Furthermore, PO loses the ability to downregulate its activity level in some forms of chronic pain, suggesting that regulatory mechanisms underlying the normal modulation of PO activity may be pathologically altered. However, the mechanisms responsible for regulating such a wide dynamic range of activity are unknown. Here, we test a series of hypotheses regarding the function of several presynaptic receptors on both GABAergic and glutamatergic afferents targeting PO in mouse, using acute slice electrophysiology. We found that presynaptic GABAB receptors are present on both GABAergic and glutamatergic terminals in PO, but only those on GABAergic terminals are tonically active. We also found that release from GABAergic terminals, but not glutamatergic terminals, is suppressed by cholinergic activation and that a subpopulation of GABAergic terminals is regulated by cannabinoids. Finally, we discovered the presence of tonic currents mediated by extrasynaptic GABAA receptors in PO that are heterogeneously distributed across the nucleus. Thus we demonstrate that multiple regulatory mechanisms concurrently exist in PO, and we propose that regulation of inhibition, rather than excitation, is the more consequential mechanism by which PO activity can be regulated.NEW & NOTEWORTHY The posterior nucleus of thalamus (PO) is a key sensorimotor structure, whose activity is tightly regulated by inhibition from several nuclei. Maladaptive plasticity in this inhibition leads to severe pathologies, including chronic pain. We reveal here, for the first time in PO, multiple regulatory mechanisms that modulate synaptic transmission within PO. These findings may lead to targeted therapies for chronic pain and other disorders.

Free gingival grafts for implants exhibiting lack of keratinized mucosa: a prospective controlled randomized clinical study.

INTRODUCTION: To evaluate clinical and radiographic outcomes following free gingival grafts (FGGs) around implants with limited keratinized mucosa (KM) during 18 months follow-up compared to oral prophylaxis without augmentation. MATERIALS AND METHODS: This prospective controlled randomized blind clinical study investigated 41 implants displaying lack of KM in 28 subjects. After baseline examination, 14 subjects in the experimental group received FGGs followed by oral prophylaxis and 14 subjects in the control group received oral prophylaxis only. The width of KM, the level of mucosal margin, pocket depths, plaque index, and gingival index (GI) were assessed at baseline, 6, 12, and 18 months. Changes in crestal bone levels, from baseline, were assessed at 18 months. RESULTS: There was a significant gain in KM in the FGG group compared to controls at 6, 12, 18 months. The mean GI was significantly lower for the FGG group at all follow-ups. Crestal bone loss in the FGG group was significantly less than the control group (mesial: p = 0.0005, distal: p = 0.042) at 18 months. CONCLUSIONS: Free gingival graft for implants exhibiting lack of KM is a viable treatment option to reduce mucosal inflammation and to maintain crestal bone level in the short term.

Formation of persisters in Streptococcus mutans biofilms induced by antibacterial dental monomer.

Antibacterial monomers can combat oral biofilm acids and caries; however, little is known on whether quaternary ammonium monomers (QAMs) would induce drug persistence in oral bacteria. The objectives of this study were to investigate the interactions of Streptococcus mutans (S. mutans) with dimethylaminohexadecyl methacrylate (DMAHDM), and determine for the first time whether DMAHDM could induce persisters in S. mutans. DMAHDM was synthesized using a modified Menschutkin reaction. Dose-dependent killing curves and time-dependent killing curves of planktonic S. mutans and biofilms were determined to evaluate drug persistence, using chlorhexidine (CHX) as control. The inheritability assay, minimum inhibitory concentration (MIC) and live/dead biofilm assay were determined to investigate persister characteristics. DMAHDM matched the killing potency of the gold standard CHX against S. mutans biofilms. DMAHDM and CHX induced drug persistence in S. mutans biofilms but not in planktonic bacteria. S. mutans biofilm persistence was not inheritable in that the tolerance to DMAHDM or CHX of the surviving persisters in the initial population was not transferred to subsequent generations, as displayed by the inheritability assay. The MIC of S. mutans parental strain and induced persisters remained the same. The induced persisters in S. mutans biofilms could be eliminated via higher doses of 300 µg/mL of DMAHDM and CHX. In conclusion, this study showed for the first time that (1) DMAHDM induced persisters only in biofilms, but not in planktonic bacteria; and (2) both DMAHDM-induced and CHX-induced S. mutans persister biofilms could be completely eradicated by even higher concentrations of DMAHDM and CHX. More studies are needed on the induction of persisters in oral biofilms for the development and use of a new generation of antibacterial dental monomers and resins.