Effect of denture adhesives on masticatory performance: Multicenter randomized controlled trial.

PURPOSE: The purpose of this study is to investigate the effects of denture adhesives on masticatory performance via a 10-center, parallel, randomized, controlled trial of complete denture wearers in Japan. METHODS: The trial was conducted between September 2013 and October 2016. The inclusion criteria were complete edentulism, willingness to undergo new complete denture treatment, and willingness to return for recall treatment. The exclusion criteria were age 90 years or older, presence of severe systemic illness, inability to understand the questionnaires, wearing metal base complete dentures, denture adhesive user, wearing prosthetics for maxillofacial defects, wearing complete dentures with tissue conditioners, and severe xerostomia. Randomization of the powder-type denture adhesive (powder), cream-type denture adhesive (cream), and control (saline) groups was performed using a sealed envelope system. Masticatory performance was measured using color-changeable chewing gum. Intervention blinding was not feasible. RESULTS: Sixty-seven control, 69 powder, and 64 cream participants are analyzed using the intention-to-treat principle. The participants in all groups show significantly improved masticatory performance at post-intervention (paired t-test with Bonferroni correction P < 0.0001). However, no significant difference in masticatory performance is detected among the three groups (one-way analysis of variance). A significant negative correlation between pre- and post-changes in masticatory performance and intraoral condition scores is observed (Pearson's correlation coefficient, P < 0.0001). CONCLUSIONS: Although denture adhesives improved the masticatory performance of complete denture wearers, their clinical effects are comparable to those of saline solution. The use of denture adhesives is more effective in complete denture wearers with unsatisfactory intraoral conditions.

Effects of denture adhesives on denture retention and occlusal forces in complete denture wearers: A multicenter, randomized controlled trial.

PURPOSE: This study aimed to determine the effects of denture adhesives on denture retention and occlusal force in complete denture wearers in a multicenter, randomized, parallel-group controlled trial. METHODS: Two hundred edentulous patients wearing complete dentures were allocated to three groups: powder-type denture adhesive, cream-type denture adhesive, and control (saline solution). Denture adhesives and saline solution were applied to the dentures for 4 days. The retentive force of the dentures and occlusal force were measured using a force transducer occlusal force meter at baseline and after 4 days of intervention. In addition to between-group comparisons, subgroup analyses of denture retention and occlusal force were performed based on the level of difficulty of the edentulism treatment. The levels were ranked as I (easy), II, III, and IV (difficult). RESULTS: Cream-type denture adhesives significantly improved the retentive force of the dentures (P<0.01) and occlusal force (P<0.05), with no significant differences between baseline and post-intervention forces in the powder-type denture adhesive and control groups. In within-group comparisons, cream-type denture adhesives improved both the retentive and occlusal forces at Level II (P<0.05), and powder-type denture adhesives improved the occlusal force at Level II (P<0.01). CONCLUSIONS: Application of cream-type denture adhesives effectively improves the denture retention and occlusal force in complete denture wearers with a moderate degree of difficulty during edentulism treatment.

An in vitro study on the selection of surfactants for removal of cream denture adhesives from dentures and their application to denture cleaners.

Purpose Denture adhesives improve the stability of incompatible dentures; however, complete removal of adhesives after use is difficult. Only a few studies have focused on the removal of denture adhesives. Hence, this study aimed to assess the efficacy of surfactants in removing cream denture adhesives from acrylic resin materials.Methods Solutions of twelve surfactants with various hydrophilic-lipophilic balance (HLB) values were prepared. Two cream denture adhesives, colored for visualization, were spread onto transparent acrylic resin plates. After immersion into surfactant solutions, the effects of the surfactants on residual adhesives were evaluated. We also investigated the effect of denture cleaners (with or without the surfactants) on the removability of adhesives and artificial oily dirt, and their effects on the surface properties of denture materials. The obtained data were analyzed using appropriate statistical methods.Results Five surfactants [BT-5, BL-4.2, BT-7, BT-9, and Triton X-100 (TX)] with HLB values in the 10.5-13.5 range effectively removed adhesives. Addition of BT-9 and TX (HLB=13.5) to denture cleaners improved the adhesives' removal. Furthermore, the addition of TX to the cleaners did not interfere with the removal of artificial oily dirt and did not damage the denture materials' surface.Conclusions Surfactants with HLB values in the 10.5-13.5 range are suitable for removal of cream denture adhesives from acrylic resin materials. In particular, TX (HLB=13.5) efficiently removes adhesives without damaging denture materials or impairing original detergency.

Properties and characteristics of foam denture cleaners as denture adhesive removers.

The need for denture adhesives is increasing worldwide, but few denture-care products target denture adhesive users. Foam denture cleaners have been recently marketed to assist brush denture cleaning, but there is a lack of objective evaluation. In this study, we compared the detergency of denture adhesives using six commercial foam-denture cleaners. For removing the adhesives, most of the tested cleaners were effective in immersion experiments, and three cleaners were more effective in the denture cleaning experiment compared to control water. However, only one could effectively remove the slime that is derived from the adhesive and detergency of artificial dirt. The surface roughnesses of the denture base and the relining material revealed that prolonged immersion in some cleaners could be affected. The results suggest that different commercial foam denture cleaners have different detergency levels, and that some cleaners may affect the properties of denture materials upon long-term use.

Multivariate analysis reveals oral health-related quality of life of complete denture wearers with denture adhesives: a multicenter randomized controlled trial.

Purpose To investigate the difference in improvement of oral health-related quality of life (OHR-QoL) depending on the oral and denture conditions of a complete denture wearer when using a cream or powder type denture adhesive in a 10-center parallel randomized clinical trial.Methods Two hundred edentulous subjects who wore complete dentures were allocated to each of the three groups according to denture adhesive type: cream, powder, and control (saline solution). The materials were applied to the mucosal surface of the dentures for 4 days, and baseline data and data after the intervention were collected. OHR-QoL was assessed using the Japanese version of the modified Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT-J) scale for outcome. Multivariate analysis was used to investigate improvements in OHR-QoL according to participant characteristics among complete denture wearers using these materials.Results OHIP-EDENT-J scores were significantly decreased in all groups after the intervention (p < 0.05); however, there were no statistically significant differences among the groups. Multiple logistic regression analysis revealed a significant association between the vertical height of the maxillary and mandibular alveolar ridge and OHIP-EDENT-J scores in the cream-type denture adhesive group. In contrast, there were no significant association between participant characteristics and OHIP-EDENT-J scores in the powder-type adhesive and control groups.Conclusions The use of denture adhesives could improve OHR-QoL for complete denture wearers. The cream-type denture adhesives may be expected to improve OHR-QoL in patients with poor residual ridge conditions compared with patients with good residual ridge conditions.

Potential of pure cellulose nanofibers as a denture base material.

A study was conducted to evaluate the basic mechanical properties of a pure cellulose nanofiber (CNF) material in comparison with a commercial denture base material (polymethylmethacrylate [PMMA] acrylic resin). The working hypothesis was that CNFs have potential for use as denture base materials. Pure CNF specimens fabricated under various conditions were examined. The flexural strength (FS) and flexural modulus (FM) of the specimens were measured using the three-point bending test, and the morphologies of the fractured surfaces were examined using scanning electron microscopy. Addition of tricalcium phosphate to dehydrate the CNFs did not improve their FS or FM. Conversely, substitution with methanol effectively improved the dehydration process and significantly affected the mechanical properties of the CNFs. As the degree of CNF defibration increased, the physical properties of the specimens improved significantly. However, addition of CNFs to PMMA liquid to create CNF-reinforced PMMA did not improve the mechanical properties. Pure CNF specimens fabricated under particular conditions had higher FS and FM values than the control, suggesting that CNFs have potential as a "petroleum-free" alternative to acrylic resin denture base materials. Pure CNF would be potentially useful as a denture base material, and presumably applicable to computer-aided design/manufacture (CAD/CAM).

Effect of denture adhesives on oral moisture: A multicenter randomized controlled trial.

PURPOSE: The purpose of this study was to investigate the effect of denture adhesives on oral moisture in a 10-center parallel randomized clinical trial. METHODS: Two hundred edentulous subjects wearing complete dentures were allocated into three groups: cream-type adhesive, powder-type adhesive and control groups. The adhesives (and saline solution in the control group) were applied to the mucosal surface of the dentures for 4 days, and baseline data and data after the intervention for eight meals over 4 days were obtained. For the main outcome, oral moisture was measured with a moisture checking device. Secondary outcomes were denture satisfaction, masticatory performance, denture retention, and occlusal force. In addition to between-group and within-group comparisons of oral moisture, investigations for secondary outcomes were undertaken in subgroups classified according to the degree of oral moisture at baseline (normal subgroup and dry mouth subgroup). Intention-to-treat analysis was also performed. RESULTS: Between-group and within-group comparisons of oral moisture showed no significant differences. The cream-type and powder-type denture adhesives were significantly effective in the dry mouth group for denture satisfaction ratings of ability to masticate, stability, retention, and comfort of mandibular dentures (p<0.05). The masticatory performance and retentive force of the dry mouth denture adhesive using groups were significantly improved after intervention (p<0.05). CONCLUSIONS: The oral moisture of complete denture wearers was not influenced by the use of denture adhesives. Our findings showed that denture adhesives improved subjective denture satisfaction, masticatory performance, and retention for complete denture patients with oral dryness.

Impact of Oral Intake of Glucosylceramide Extracted from Pineapple on Xerostomia: A Double-Blind Randomized Cross-Over Trial.

Background: The aim of this double-blind randomized cross-over trial was to evaluate the effect of oral intake of glucosylceramide extracted from pineapple on oral moisture and xerostomia symptoms. Methods: Sixteen participants who had xerostomia symptoms were randomly allocated into two groups. One group received, as test samples, tablets containing glucosylceramide extracted from pineapple (GCP) followed by placebo tablets. The other group received the test samples in the reverse order. Participants were instructed to take tablets of the first test sample once a day (after breakfast) for two consecutive weeks. Then, after a washout period of four weeks, participants were instructed to take the other test sample for two consecutive weeks. The oral moisture level of the lingual mucosa, xerostomia symptoms, and the number of fungiform papillae was evaluated. Results: The oral moisture significantly increased, and the visual analog scale (VAS) of "How is the dryness of your mouth?" significantly improved after GCP tablets intake and not after placebo tablets intake. The number of fungiform papillae was not significantly different following the intake of GCP tablets or placebo tablets. Conclusion: Results suggested that oral intake of GCP may improve the moisture level and xerostomia symptoms.

Study protocol for a multi-center, randomized controlled trial to develop Japanese denture adhesive guidelines for patients with complete dentures: the Denture Adhesive Guideline trial: study protocol for a randomized controlled trial.

BACKGROUND: Denture adhesives, characterized as medical products in 1935 by the American Dental Association, have been considered useful adjuncts for improving denture retention and stability. However, many dentists in Japan are hesitant to acknowledge denture adhesives in daily practice because of the stereotype that dentures should be inherently stable, without the aid of adhesives. The aim of this study is to verify the efficacy of denture adhesives to establish guidelines for Japanese users. The null hypothesis is that the application of denture adhesives, including the cream and powder types, or a control (isotonic sodium chloride solution) would not produce different outcomes nor would they differentially improve the set outcomes between baseline and day 4 post-application. METHODS: This ten-center, randomized controlled trial with parallel groups is ongoing. Three hundred edentulous patients with complete dentures will be allocated to three groups (cream-type adhesive, powder-type adhesive, and control groups). The participants will wear their dentures with the denture adhesive for 4 days, including during eight meals (three breakfasts, two lunches, and three dinners). The baseline measurements and final measurements for the denture adhesives will be performed on the first day and after breakfast on the fourth day. The primary outcome is a general satisfaction rating for the denture. The secondary outcomes are denture satisfaction ratings for various denture functions, occlusal bite force, resistance to dislodgement, masticatory performance, perceived chewing ability, and oral health-related quality of life. Between-subjects comparisons among the three groups and within-subjects comparisons of the pre- and post-intervention measurements will be performed. Furthermore, a multiple regression analysis will be performed. The main analyses will be based on the intention-to-treat principle. A sample size of 100 subjects per group, including an assumed dropout rate of 10 %, will be required to achieve 80 % power with a 5 % alpha level. DISCUSSION: This randomized clinical trial will provide information about denture adhesives to complete denture wearers, prosthodontic educators, and dentists in Japan. We believe this new evidence on denture adhesive use from Japan will aid dentists in their daily practice even in other countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT01712802 . Registered on 17 October 2012.

Nutritional status and oral status of the elderly with dementia: a 2-year study.

OBJECTIVES: To determine the relationship between denture wearing and nutritional status in the elderly with dementia. BACKGROUND: There could be a correlation between nutrition, oral health, dietary habits, patients' satisfaction, and their socio-economic status in the elderly, and the relationship between compromised oral status and nutritional status in the elderly with dementia. SUBJECTS AND METHODS: A 2-year follow-up study of 63 elderly Japanese women with and without dentures from a nursing home was undertaken to investigate their oral, physical and mental, and nutritional status. RESULTS: Each item for 2006 and 2008 in this study showed no significant difference between 2006 and 2008, except the calories/day. The elderly with dementia without complete dentures during the 2 years of the study only significantly decreased the mean of the calories/day. CONCLUSION: The calories/day of the elderly with dementia without dentures decreased after 2 years. Denture wearing for the elderly with dementia could be necessary to maintain a satisfactory intake of calories.

Durability of peel bond of resilient denture liners to acrylic denture base resin.

PURPOSE: The purpose of this study was to determine the durability of the peel bond of commercial resilient denture liners to a denture base resin using a thermal cycling test. METHODS: Eight commercial resilient denture liners (five silicone and three acrylic) were used in the study. The samples were exposed to thermal cycles between 5°C and 55°C for 1 min for 0, 1,250, 2,500, 5,000 and 10,000 cycles. The test samples were placed under tension until failure in a materials testing machine using a crosshead speed of 20 mm/min. The modes of debonding were characterized as tear, peel or snap. Statistical analysis was performed using one-way and two-way analysis of variance and Student-Newman-Keuls multiple comparison tests (α=.05). RESULTS: A significant difference was found between different resilient denture liners for peel bond strength at 0 cycles. No extreme influence on the peel bond strength was observed under any of the thermal cycles. The snap mode of debonding was observed in most samples of all materials for all cycles. CONCLUSION: All resilient denture liners tested had a sufficiently strong bond to the denture base resin. Within the limitations of this study, the results show that all of the materials were acceptable for clinical use, having met the accepted adequate bond strength for resilient denture liners of 0.45 MPa.

Dynamic viscoelastic properties, water absorption, and solubility of home reliners.

Scant rheological information is available regarding home reliners (liner type denture adhesives). We evaluated 6 different home reliners in regard to their viscoelastic properties, water absorption and solubility. Dynamic viscoelastic properties and changes over time were determined using a dynamic viscoelastometer, while weight changes, absorption, and solubility during immersion in water were also investigated. We found that the dynamic viscoelasticity of the tested home reliners was sensitive to changes in frequency, while the materials used had nearly no elasticity and exhibited viscous behaviors. They showed a dramatic change in viscoelastic properties and increase in weight after approximately 1 day of water immersion. A considerably high percentage of water absorption was also observed. From the viewpoint of dynamic viscoelastic properties and durability, our results indicate that the tested home reliners would not be suitable for improvement of ill-fitting dentures.

Compatibility of tissue conditioners and denture cleansers: influence on surface conditions.

Chemical cleansing by denture cleansers is the first choice for denture plaque control of tissue conditioners. This study evaluated the influences of denture cleansers on the surface quality of tissue conditioners by determining surface roughness and porosity. Three tissue conditioners (Hydro-Cast, SR-Ivoseal, Visco-Gel) and 3 types of denture cleansers (Pika [enzyme type], Polident [neutral peroxide type with enzymes], Steradent [alkaline peroxide type]) were evaluated. Five specimens of each tissue conditioner/solution combination for each time period of immersion were prepared. The surface roughness of dental stone casts made from the tissue conditioners was evaluated using a profilometer. The surface quality of Hydro-Cast and Visco-Gel tended to be most deteriorated by the alkaline peroxide cleanser. The enzyme type of denture cleansers is most suitable for tissue conditioners in terms of surface quality. The suitable period for application of the enzyme cleansers would range from 3 to 7 days.

Effect of PMMA polymer on the dynamic viscoelasticity and plasticizer leachability of PEMA-based tissue conditioners.

The purpose of this study was to determine the effect of PMMA polymer on dynamic viscoelasticity and plasticizer leachability of PEMA-based tissue conditioners. One PEMA polymer and one PMMA polymer were used in powder form with four formulations. The combination of 80 wt% ATBC, 15 wt% BPBG and 5 wt% ethyl alcohol was used as the liquid phase. The dynamic viscoelasticity and plasticizer leaching of each specimen were measured after 0, 1, 3, 7, and 14 days of immersion (37 degrees C distilled water) using DMA and HPLC. A significant difference was found among the materials in the dynamic viscoelasticity and leaching of plasticizer. The materials containing 10 wt% PMMA showed the most stable dynamic viscoelasticity, and showed the lowest leaching of plasticizer. The results suggest that the addition of the PMMA polymer to the powder of a tissue conditioner can improve the durability of the PEMA-based tissue conditioner.

Influence of denture cleansers on the color stability of three types of denture base acrylic resin.

STATEMENT OF PROBLEM: Color stability is an important property of denture base acrylic resin. Color changes indicate aging or damaged dental materials. However, little information is available on the influence of denture cleansers on the color stability of acrylic resins. PURPOSE: The purpose of this study was to determine the influence of denture cleansers on the color stability of 3 different types of acrylic resin. MATERIAL AND METHODS: One heat-polymerized (HP) acrylic denture base resin (Acron), 1 autopolymerized (AP) hard direct reline acrylic resin (Denture Liner), and 1 visible-light-polymerized (VLP) hard direct reline acrylic resin (Tokuso Lite-Rebase) were evaluated. Five specimens of each material, 10 x 10 x 2 mm, were immersed in 1 of 9 commercial denture cleanser solutions or distilled water (control). Color changes were measured with a colorimeter and evaluated using the CIE L*a*b* colorimetric system. Data were analyzed using 1-way and 3-way ANOVA and the Student-Newman-Keuls test (alpha=.05). RESULTS: Significant differences (P<.05) were found among the acrylic resins and denture cleansers in terms of color change (DeltaE) produced after 365 days. The DeltaE values of all denture base acrylic resins increased with time. The DeltaE of the AP acrylic resin was larger than that of the other acrylic resins. The least discoloration was found with ZTC denture cleanser (acid type). The influence of alkaline peroxide-type denture cleanser (Steradent) on the color stability of HP acrylic resin and AP acrylic resin was significantly greater (P<.05) than that of the other cleansers. CONCLUSIONS: These results suggest that the color stability of denture base acrylic resins is influenced by polymerization type and the type of denture cleanser used.

The initial effects of occlusal splint vertical thickness on the nocturnal EMG activities of masticatory muscles in subjects with a bruxism habit.

PURPOSE: The objective of this study was to investigate the initial effects of the vertical thickness of occlusal splints on the electromyographic (EMG) activities (integrated EMG values) of temporal and masseter muscles during sleep in subjects with a nocturnal bruxism habit using a portable EMG recorder. MATERIALS AND METHODS: The subjects consisted of 12 volunteers (4 men and 8 women, average age of 25.3 years). All subjects had never worn splints before and had a habit of nocturnal bruxism. Two types of splint were made for every subject: a splint with a 3-mm vertical thickness at the central incisors (S3) and a splint with a 6-mm vertical thickness (S6). The muscle activities of the left anterior temporal muscles and masseter muscles were recorded without occlusal splints (NS), with the S3 splint, and with the S6 splint by a portable EMG recorder. The integrated EMG values were calculated to examine muscle activities under the 3 different conditions. RESULTS: The integrated EMG values of masseter and temporal muscles decreased following insertion of the S3 splint but were not significantly affected by the S6 splint. Six subjects in masseter EMG and 7 subjects in temporal EMG got worse with the S6 splint compared to NS. CONCLUSIONS: When the occlusal splints were used as a bruxism countermeasure, it was suggested from the analysis of muscle activities during sleep at night that the S3 splint was superior to the S6 splint.

Influence of storage methods on the surface roughness of tissue conditioners.

The purpose of this study was to compare the influence of three kinds of storage methods on surface roughness of tissue conditioners. Four commercial tissue conditioners (GC Soft Liner, Softone, Fictioner, and Hydro-Cast) were used in this study. Five samples of each material were stored in distilled water, air, and a denture cleanser (Polident). Mean surface roughness (R(a)) values of dental stone casts made from the tissue conditioners were measured after 0, 1, 3, 7, and 14 days of immersion using a profilometer. Significant differences in the R(a) values of the specimens were found among the three storage methods. The values of R(a) significantly increased with increase in immersion time for each storage method, except for the materials stored in air. It was found that the materials stored in air showed the most stable and lowest values of R(a). Results obtained suggested that a tissue conditioner exhibited smooth and minimal change in surface roughness with time when stored in air than in distilled water and denture cleanser.

The relationships between oral status, physical and mental health, nutritional status and diet type in elderly Japanese women with dementia.

OBJECTIVES: To suggest methods for maintaining an adequate nutritional status for elderly patients with dementia by evaluating the relationships between oral status, physical and mental health, and feeding conditions. BACKGROUND: Feeding difficulties in dementia patients are related to food intake, and failure to eat may be associated with weight loss in long-term care facilities. The relationship between compromised oral function and diet is still unclear. MATERIALS AND METHODS: A cross-sectional study of 94 elderly women with dementia (mean age 89.6 +/- 5.6 years) from a nursing home was undertaken to investigate their oral, physical and mental and nutritional status. RESULTS: There were significant differences in serum albumin (p = 0.0284), N-ADL (p = 0.0005), NM scale (p = 0.0004) and HDS-R (p = 0.0004) between denture wearers and non-denture wearers. However, there were no significant differences in body mass index between denture wearers and non-denture wearers. CONCLUSION: A suitable type of diet and assistance with feeding could maintain the nutritional status of elderly patients with dementia if they are still feeding themselves. The nutritional support team will benefit from the participation of a dentist.

Dynamic mechanical properties of hard, direct denture reline resins.

STATEMENT OF PROBLEM: Dynamic mechanical properties of hard, direct reline resins are important factors in the clinical success of dentures. However, little information is available on the nature of these properties. PURPOSE: This study evaluated the dynamic mechanical properties of a variety of hard, direct reline resins: (1) visible light-polymerized, powder-liquid type, (2) visible light-polymerized, paste-type, (3) autopolymerized, powder-liquid type, as classified by component composition and mode of polymerization activation, namely, type of delivery system, and (4) heat-polymerized denture base materials. MATERIAL AND METHODS: The dynamic mechanical analysis (DMA) of 8 commercial hard denture reline materials (HDR) (2 visible light-polymerized, powder-liquid type, 4 visible light-polymerized, paste-type, and 2 autopolymerized, powder-liquid type), and 2 heat-polymerized denture base materials was obtained at a frequency of 1 Hz at 37 degrees C. Five specimens of each material, 40.0 x 7.0 x 2.0 mm, were made to measure the elastic (storage) (E') and inelastic (loss) (E'') moduli, and loss tangent (tan delta). These parameters were compared with MANOVA and Student-Newman-Keuls test (alpha =.05). RESULTS: The E' values of 3 visible light-polymerized, paste-type reline resins were significantly higher than those of the other 5 reline resins. However, the E' values of all reline resins were significantly lower than those of the 2 heat-polymerized denture base resins. Except for 1 autopolymerized reliner, all reline materials had significantly lower E'' than the heat-polymerized denture base resins. The tan delta values of all but 1 visible light- and autopolymerized reliners were significantly higher than those of the heat-polymerized denture base materials. CONCLUSIONS: Three visible light-polymerized, paste-type reline resins showed greater stiffness than the visible light- or autopolymerized, powder-liquid type reline resins. However, all of the hard, direct reline resins, including the 3 paste-type materials, exhibited greater flexibility compared to the heat-polymerized denture base resins.

Comprehensive analysis of chemotactic factors for bone marrow mesenchymal stem cells.

To understand which growth factors/cytokines can affect migration of mesenchymal stem cells (MSCs) to injured tissues, we compared the effects of many (26) growth factors/cytokines on the migration activity of rabbit and human MSCs using a microchemotaxis chamber. Among them, platelet-derived growth factor (PDGF)-BB, PDGF-AB, epidermal growth factor (EGF), HB-EGF, transforming growth factor (TGF-alpha), insulin growth factor (IGF-I), hepatocyte growth factor (HGF), fibroblast growth factor (FGF-2), and thrombin consistently enhanced the migration of rabbit and human MSCs at appropriate concentrations. PDGF-BB showed the greatest effect on migration. Various combinations of these factors further enhanced the migration of MSCs, whereas combinations of factors that shared common cell-surface receptors did not induce the additive stimulation. On the other hand, some combinations, including that of FGF-2 or thrombin with PDGF-BB, suppressed the migration activity of MSCs. These findings suggest that combinations of growth factors are important to eliciting the maximal chemotactic effect. The factors that induced the migration of MSCs also enhanced their proliferation, suggesting that migration and proliferation can take place simultaneously. The above factors were also effective in stimulating the migration of fibroblasts, but thrombin alone selectively enhanced the migration of MSCs, suggesting that thrombin is useful to stimulate migration of MSCs without migration of fibroblasts.