Two-stage extraction by partial grinding of impacted mandibular third molar in close proximity to the inferior alveolar nerve.

BACKGROUND: Extraction of impacted third molars often leads to severe complications caused by damage to the inferior alveolar nerve (IAN). AIM: To proposes a method for the partial grinding of an impacted mandibular third molar (IMM3) near the IAN to prevent IAN injury during IMM3 extraction. METHODS: Between January 1996 and March 2022, 25 patients with IMM3 roots near the IAN were enrolled. The first stage of the operation consisted of grinding a major part of the IMM3 crown with a high-speed turbine dental drill to achieve sufficient space between the mandibular second molar and IMM3. After 6 months, when the root tips were observed to be away from the IAN on X-ray examination, the remaining part of the IMM3 was completely removed. RESULTS: All IMM3s were extracted easily without symptoms of IAN injury after extraction. CONCLUSION: Partial IMM3 grinding may be a good alternative treatment option to avoid IAN injury in high-risk cases.

Long-lasting renewable antibacterial porous polymeric coatings enable titanium biomaterials to prevent and treat peri-implant infection.

Peri-implant infection is one of the biggest threats to the success of dental implant. Existing coatings on titanium surfaces exhibit rapid decrease in antibacterial efficacy, which is difficult to promisingly prevent peri-implant infection. Herein, we report an N-halamine polymeric coating on titanium surface that simultaneously has long-lasting renewable antibacterial efficacy with good stability and biocompatibility. Our coating is powerfully biocidal against both main pathogenic bacteria of peri-implant infection and complex bacteria from peri-implantitis patients. More importantly, its antibacterial efficacy can persist for a long term (e.g., 12~16 weeks) in vitro, in animal model, and even in human oral cavity, which generally covers the whole formation process of osseointegrated interface. Furthermore, after consumption, it can regain its antibacterial ability by facile rechlorination, highlighting a valuable concept of renewable antibacterial coating in dental implant. These findings indicate an appealing application prospect for prevention and treatment of peri-implant infection.

Effect of preparation design on the fracture behavior of ceramic occlusal veneers in maxillary premolars.

OBJECTIVES: The fracture strengths of four types of occlusal veneers and a traditional full crown ceramic restoration and the influence of preparation design on the stress of restorations were examined. METHODS: Forty intact maxillary premolars randomly divided into five groups were prepared based on the demands of type O (occlusal surface coverage), OF (occlusal and lingual surface coverage), POF (occlusal, lingual, and mesial surface coverage), and POFP (occlusal, lingual, mesial, and distal surface coverage) veneers and full crown, and then restored by glass ceramic. Specimens were subjected to fracture resistance tests after cyclic loading. The fracture strengths and modes were analyzed statistically. The level of significance was set at α = 0.05. One maxillary premolar was prepared for type O, OF, POF, POFP veneer and full crown, and then scanned to establish finite element models. The mean fracture load was applied vertically to calculate the maximum principal stress on the ceramic. RESULTS: Type O veneer showed higher fracture strength than type POF and POFP veneers (P < 0.05). Both type O and OF veneers exhibited higher fracture strength than full crown (P < 0.05). No significant difference in failure mode was observed. The maximum principal stress for type O, OF, POF, POFP veneers, and full crown increased progressively and concentrated at the bonding surface directly beneath the loading area. CONCLUSIONS: Four types of occlusal veneer showed fracture strengths that considerably exceeded normal biting forces. They represent conservative alternatives to full crowns and present a viable treatment for severely worn teeth. CLINICAL SIGNIFICANCE: The occlusal veneers with different preparation designs, including type O, OF, POF and POFP veneers, show higher fracture resistances than traditional full coverage crowns that considerably exceed the normal biting forces. Therefore, these represent conservative alternatives to crown restorations and present a viable treatment for restoring severely worn teeth.

Estimation of stress distribution and risk of failure for maxillary premolar restored by occlusal veneer with different CAD/CAM materials and preparation designs.

OBJECTIVES: To compare stress distribution and failure probability in maxillary premolars restored by simple occlusal veneer (SOV) and buccal-occlusal veneer (BOV) with 3 different CAD/CAM materials. MATERIALS AND METHODS: A maxillary premolar was digitized by a micro-CT scanner. Three-dimensional dynamic scan data were transformed, and finite element models of 2 different models (SOV and BOV restored teeth) were designed. Three different CAD/CAM materials, including lithium disilicate glass ceramic (LD) IPS e.max CAD, polymer-infiltrated ceramic-network (PICN) Vita Enamic, and resin nano-ceramic (RNC) Lava Ultimate, were designated to both veneers. Maximum principle stresses were determined by applying a 300-N axial load to the occlusal surface. Weibull analyses were performed to calculate the failure probability of the models. RESULTS: LD-restored teeth showed the highest stress in the veneer, lowest stress in substrate teeth, and lowest failure probability for the overall system; RNC-restored teeth showed the lowest stress in the veneer, highest stress in substrate teeth, and highest failure probability. No significant differences were found in the cement layer among the different models. No significant differences of stress and failure probability existed between SOV and BOV preparations. CONCLUSIONS: CAD/CAM composite resin occlusal veneers bear lower maximum stress than ceramic veneers. Teeth restored by composite veneers are more prone to failure than those restored by ceramic veneers. Additional reduction of the buccal surface did not increase the stress on the occlusal veneer under axial load. CLINICAL RELEVANCE: Both occlusal veneers could be used under physiological masticatory force. CAD/CAM glass ceramic was safer than composite resins.

A three-dimensional hydroxyapatite/polyacrylonitrile composite scaffold designed for bone tissue engineering.

In recent years, various composite scaffolds based on hydroxyapatite have been developed for bone tissue engineering. However, the poor cell survival micro-environment is still the major problem limiting their practical applications in bone repairing and regeneration. In this study, we fabricated a class of fluffy and porous three-dimensional composite fibrous scaffolds consisting of hydroxyapatite and polyacrylonitrile by employing an improved electrospinning technique combined with a bio-mineralization process. The fluffy structure of the hydroxyapatite/polyacrylonitrile composite scaffold ensured the cells would enter the interior of the scaffold and achieve a three-dimensional cell culture. Bone marrow mesenchymal stem cells were seeded into the scaffolds and cultured for 21 days in vitro to evaluate the response of cellular morphology and biochemical activities. The results indicated that the bone marrow mesenchymal stem cells showed higher degrees of growth, osteogenic differentiation and mineralization than those cultured on the two-dimensional hydroxyapatite/polyacrylonitrile composite membranes. The obtained results strongly supported the fact that the novel three-dimensional fluffy hydroxyapatite/polyacrylonitrile composite scaffold had potential application in the field of bone tissue engineering.