Periodontal Tissue Responses to Restorations with and without Cervical Finish Line: A Systematic Review and Meta-analysis.

The purpose of this review was to evaluate the periodontal and peri-implant tissue responses to restorative approaches with and without cervical finish line on teeth and dental implants. An electronic search was performed in PubMed/MEDLINE, Embase, Cochrane Library, LILACS, Web of Science, and Scopus databases, and in the gray literature. Controlled clinical trials and prospective cohort studies were included. Analyzed outcomes included gingival index (GI), bleeding on probing (BOP), probing depth (PD), gingival thickness (GT), marginal stability (MS), and marginal bone loss (MBL). A meta-analysis was then performed in two parts: the first compared results of restorations on teeth with and without cervical finish line, and the second compared results of restorations on implant abutments with and without cervical finish line. Regarding the tooth-based restoration analysis, 7 out of 1,388 selected articles were included in the systematic review, and 2 were selected for the meta-analysis. For implantbased restorations on abutments with and without cervical finish line, 6 out of 707 selected articles were included in the systematic review, and 2 in the meta-analysis. No significant differences in periodontal and peri implant indexes were identified between both prosthetic approaches in situations with and without cervical finish lines.

Long-term clinical performance of short 6-mm implants supporting single crowns in the posterior region: A 10-year cohort study.

INTRODUCTION: Long-term clinical success of non-splinted, posterior, and short implants still is unclear. This prospective cohort study reports the 10-year follow-up of 6-mm implants supporting single crowns in the posterior region, and patient-reported outcomes. METHODS: Baseline sample comprised 20 patients treated with 46 screw-retained crowns supported by 6-mm implants with moderately rough implant surface. Participants were recalled for a 10-year clinical follow-up to assess survival rates, biologic and mechanic conditions, quality of life (OHIP-14), and treatment satisfaction. Data were collected with clinical-radiographic exams and analyzed using descriptive and inferential statistics. RESULTS: Fourteen patients with 35 implant-crown units were examined after 127.6 ± 11.8 months. For the entire cohort period, 7/46 implants were lost (survival estimate: 77.7% at 133 months), and mechanic complications occurred in 14/46 units (survival estimate: 66.4% at 116 months). In the Cox models, "maximum occlusal force" had a significant effect for implant loss (p = 0.038) and for prosthetic screw loosening (p = 0.038); "arch" and "bruxism" were not significant. Peri-implant bone loss was 0.4 ± 0.6 mm at 10 years. For peri-implant bone level, "crown-to-implant ratio" (p < 0.001) and "time" (p = 0.001) were significant. Bone levels differed from baseline to 12, 48, and 120 months. Satisfaction VAS was 94.0 ± 7.9 mm and OHIP-14 was 2.3 ± 2.2. CONCLUSION: Single screw-retained crowns supported by 6-mm implants have an acceptable long-term clinical performance, with stable peri-implant bone levels after 10 years of function.

Biomechanical variables affect peri-implant bone loss in implant-supported fixed complete dentures: A methodological and prospective study.

PURPOSE: Implant-supported fixed complete dentures (IFCD) experience failures and complications related to biological and technical risk factors. This study investigated the effect of biomechanical variables of IFCD on 1-year peri-implant bone loss at the buccal, palatal/lingual, mesial, and distal implant sides. A new method was used to measure the geometric biomechanical variables of IFCD using cone beam computed tomography (CBCT). METHODS: The study sample consisted of 246 external hexagon implants supporting 48 hybrid IFCD in 44 patients. CBCT images obtained immediately (T0) and 1 year (T1) after prosthesis installation were used to measure the support polygon area, clinical crown/implant (C/I) ratio (vertical lever), anteroposterior power and resistance arms, anterior and posterior cantilevers (horizontal levers), and peri-implant bone remodeling (T1-T0). Data were analyzed using multilevel multivariable models. RESULTS: The average total bone loss in the mandible and maxilla were 0.88 mm, with a loss of 0.62 mm in the mandible and 1.08 mm in the maxilla. The C/I ratio had a significant effect on bone loss on the mesial, distal, and palatal/lingual sides (P <.05). The anterior cantilever had a protective effect on the lingual side of the anterior implant. No effect on bone loss was found for the support polygon area, posterior cantilever, resistance arm, or power arm (P >.05). CONCLUSIONS: The results suggest that the C/I ratio and anterior cantilever in IFCD affect peri-implant bone loss according to the implant side and position in the arch.

The Hyrax appliance with tooth anchorage variations in surgically assisted rapid maxillary expansion: a finite element analysis.

PURPOSE: It is known that a correct transverse maxillary dimension is a key factor for a stable occlusion, which brings functional and esthetic benefits for the patient. In patients presenting maxillary atresia and the completion of bone growth, a highly recommended option for correction is the surgically assisted rapid maxillary expansion (SARME) associated with the Hyrax appliance. The objective of this study was to evaluate the influence of tooth anchorage variations of the Hyrax appliance in SARME through finite element analysis, evaluating which anchorage option might be associated with more effective orthopedic results with less undesired side effects. METHODS: Five different dental anchoring conditions for the Hyrax appliance were simulated through FE analysis applying premolars and molars as anchorage, having the same force applied by the activation of the Hyrax screw (0.5 mm) in all groups. The maxillary displacement results (axes X, Y, and Z) and generated stresses for both teeth and maxillary bone were calculated and represented using a color scale. RESULTS: All groups presented significant bone displacement and stress concentration on anchoring teeth, with the group presenting anchorage in the 1st and 2nd molars showing the greatest maxillary horizontal displacement (axis X) and suggesting the lowest tendency of dental vestibular inclination. CONCLUSIONS: Variations in dental anchorage might substantially affect the maxillary bone and teeth displacement outcome. The protocol for the Hyrax apparatus in SARME applying the 1st and 2nd molars as anchorage might generate less tilting and inclination of the anchoring teeth.

Effect of hyaluronic acid on paracrine signaling of osteoblasts from mesenchymal stromal cells: potential impact on bone regeneration.

OBJECTIVES: This study evaluated hyaluronic acids (HA) with different molecular weights as potential matrices for tissue-engineered bone grafting and their possible influence on the paracrine mechanisms of adipose-derived mesenchymal stromal cells. MATERIAL AND METHODS: Murine adipose mesenchymal stromal cells (mASCs) on the fourth passage were seeded in 96-well plates, osteoinduced for 27 days and exposed for 3 days to low (HA-LW) and high/low molecular weight (HA-HLW) at previously defined concentrations. Cytokines IGF-1, VEGF, FGF-2, and BMP-2 were evaluated by quantification in the supernatant. RESULTS: Greater expression of growth factors was observed in groups with HA-HLW compared to HA-LW. Results indicated that differentiated cells secreted fewer cytokines, namely VEGF, FGF, and BMP-2 than undifferentiated mASCs (p < 0.05). IGF-1 showed its greatest expression in the mASC HA-LW group (p < 0.05). CONCLUSIONS: The application of HA-HLW as cell matrix in tissue engineering did not compromise mASC paracrine effect. Also, the association of HA-HLW matrix and mASCs resulted in greater expression of osteogenic growth factors. Longer periods of cell differentiation seemed to negatively affect their capacity for local paracrine stimulation. CLINICAL RELEVANCE: The use of HA-HLW as matrix for undifferentiated ASCs can be positive for bone regeneration, favoring its application as cell matrix in bone grafting procedures.

Osteoblastic Cell Behavior and Early Bacterial Adhesion on Macro-, Micro-, and Nanostructured Titanium Surfaces for Biomedical Implant Applications.

PURPOSE: Surface treatments may significantly affect physical-chemical properties and surface biologic responses. This study aimed to investigate the influence of alterations in the physical-chemical properties of pure titanium with different surface topographies on biocompatibility and early microbiologic response. MATERIALS AND METHODS: Titanium disks were exposed to five different surface treatments created through acid etching and anodizing methods. Surface morphology, 2D and 3D roughness, wettability, biocompatibility, and cell viability were evaluated. Osteoblast adhesion and bacterial adhesion tests were also executed. Data were statistically analyzed using analysis of variance followed by Tukey test, roughness (P < .05), and bacterial proliferation (P < .05). RESULTS: Five different surface morphologies were developed; double acid etching was shown to be significantly rougher than the others. The 2D roughness measurements were shown to be less consistent than the 3D measurements. All surfaces presented biocompatibility to allow cell behavior and differentiation. Osteoblasts presented better evolution in terms of adhesion and behavior in the nanomorphologies. High roughness significantly increased bacterial adhesion. CONCLUSION: Surface treatments may critically alter titanium properties and morphology. Therefore, roughness measurements with a wide area should be used in their evaluation. Nanotextured surfaces show a positive effect on bone cells and antibacterial response; their application is suggested when considering surface texturization for biomedical implants.

Technical Complications and Prosthesis Survival Rates with Implant-Supported Fixed Complete Dental Prostheses: A Retrospective Study with 1- to 12-Year Follow-Up.

PURPOSE: To report the rate of technical complications and prosthesis survival in a cohort of edentulous patients treated with implant-supported fixed complete dental prostheses (IFCDPs) after a mean observation period of at least 1 year. MATERIALS AND METHODS: The single-visit examination included clinical and radiographic assessment, occlusal analysis, photographs and questionnaire assessing patient satisfaction in a cohort of 52 patients rehabilitated with 71 IFCDPs (supported by 457 implants). The IFCDPs were assessed for technical complications, number of implants and cantilever extension, retention type and prosthetic material type. Comparison was made between ceramic IFCDPs (Group 1) and metal-resin IFCDPs (Group 2). Kaplan-Meier survival curve analysis was carried out for assessment of prosthesis survival and was done for both Groups 1 and 2 separately. The Cox proportional hazard model was used for survival analysis, adjusting for a number of potential confounders, to evaluate the association between prosthesis survival and several risk factors such as type of opposing occlusion, nightguard use, and presence of bruxism. Responses to patient satisfaction questions were compared with Fisher's exact test. RESULTS: Out of 71 edentulous arches (52 patients) restored with IFCDPs, 6 IFCDPs had failed, yielding a cumulative prosthesis survival rate of 91.6 % after a mean observation period of 5.2 years (range: 1-12 years) after definitive prosthesis insertion. Three IFCDPs were lost due to implant failures after 5.8 to 11 years of functional loading. Additionally, 3 metal-resin IFCDPs failed due to technical complications. Minor complications were the most frequent complications observed, namely wear of the prosthetic material (9.8% annual rate) being the most common, followed by decementation of cement-retained IFCDPs (2.9%), and loss of the screw access filing material of the screw-retained IFCDPs (2.7%). The most frequently observed major complication was fracture of the prosthetic material (1.9% annual rate), followed by fracture of occlusal screw (0.3%), and fracture of framework (0.3%). The annual rate of wear of prosthetic material was 7.3% for porcelain IFCDPs (n = 19/55) and 19.4% for metal-resin IFCDPs (n = 13/16), yielding a statistically significant difference between the 2 groups (p = 0.01). CONCLUSIONS: After a mean exposure time of 5.2 years, 91.6% prosthesis survival rates were achieved (65 out of 71 IFCDPs). The most frequent minor technical complication was wear of the prosthetic material with estimated 5-year rate of 49.0%, while the most frequent major complication was fracture of the prosthetic material with estimated 5-year dental unit-based rate of 9.5%. The cumulative rates for "prosthesis free of minor complications" at 5- and 10-years were 60.5% (95% CI: 47.2-71.3%) and 8.9% (95% CI: 2.9-18.0%), respectively. The cumulative rates for "prosthesis free of major technical complications" at 5- and 10-years were 85.5% (95% CI: 73.0-92.5%) and 30.1% (95% CI: 12.0-50.6%), respectively. Presence of bruxism, and absence of a nightguard were associated with increased risk for chipping of the prosthetic material of the IFCDPs.

Antibacterial potential associated with drug-delivery built TiO2 nanotubes in biomedical implants.

The fast evolution of surface treatments for biomedical implants and the concern with their contact with cells and microorganisms at early phases of bone healing has boosted the development of surface topographies presenting drug delivery potential for, among other features, bacterial growth inhibition without impairing cell adhesion. A diverse set of metal ions and nanoparticles (NPs) present antibacterial properties of their own, which can be applied to improve the implant local response to contamination. Considering the promising combination of nanostructured surfaces with antibacterial materials, this critical review describes a variety of antibacterial effects attributed to specific metals, ions and their combinations. Also, it explains the TiO2 nanotubes (TNTs) surface creation, in which the possibility of aggregation of an active drug delivery system is applicable. Also, we discuss the pertinent literature related to the state of the art of drug incorporation of NPs with antibacterial properties inside TNTs, along with the promising future perspectives of in situ drug delivery systems aggregated to biomedical implants.

Adipogenic Mesenchymal Stem Cells and Hyaluronic Acid as a Cellular Compound for Bone Tissue Engineering.

This study investigates the applicability of adipose mesenchymal stem cells (mADSCs) and hyaluronic acid (HA) as a cellular compound for bone tissue engineering. A critical bone defect was created on each femur of 25 rats in vivo, receiving the following 5 graft treatments: I-Control-defect; II-HA; III-mADSCs; IV-mADSCs+HA; and V-previously osteoinduced mADSCs+HA. Evaluation using microcomputed tomography, histomorphometry, and RT-PCR analysis was performed 23 days after implantation. Microcomputed tomography analysis indicated higher means of bone contact surface (BCS) and bone surface density (BSD) for the mADSCs+HA group compared with Control and the HA groups (P < 0.05). Histomorphometric findings showed higher means of bone regeneration in the mADSCs+HA compared with HA and Control groups (P < 0.05). The RT-PCR ratios showed no difference in type 1 collagen (Col1A) gene expression or osteopontin (OP) gene expression, whereas for the osteonectin gene (ON) higher means were found in the HA and mADSCs osteoin+HA groups (P < 0.05). These results suggest that a combination of HA and mADSCs without prior osteoinduction might be applicable for bone tissue regeneration.

Relation between insertion torque and tactile, visual, and rescaled gray value measures of bone quality: a cross-sectional clinical study with short implants.

BACKGROUND: This study assessed the relationship between insertion torque and bone quality evaluated during surgery and in preoperative computed tomographic (CT) images analyzed either visually or by rescaled mean gray values (MGVs). The study also tested the correlation between the clinical and radiographic measures of bone quality. METHODS: The consecutive sample was composed of 45 short implants (4.1 × 6 mm) placed in the posterior region of 20 patients. Intra-surgical tactile bone quality, based on the classification of bone types by Lekholm and Zarb, and insertion torque were recorded during the implant placement. Visual bone quality and normalized MGV were assessed in standardized axial, coronal, and sagittal sections of preoperative CT images. Data were analyzed by ANOVA and Spearman correlation (alpha = 0.05). RESULTS: Insertion torque was associated with all assessment methods of bone quality (tactile, CT visual, MGV). A moderate correlation was found among all methods of bone quality, except for CT visual assessment and tactile evaluation. MGVs varied as a function of arch, dental region, insertion torque, and bone types. CONCLUSIONS: The results suggest that bone quality measures affect primary stability as recorded by insertion torque, and the assessment methods are consistently related.

Analysis of the Marginal Fit and Dimensional Stability of Cast-to Cobalt-Chromium Implant Cylinders Cast from Different Alloys.

PURPOSE: To evaluate the influence of cobalt-chromium (Co-Cr) casting alloys' melting temperatures on the cast-to Co-Cr implant cylinders' marginal fit. MATERIALS AND METHODS: Co-Cr alloys with different melting ranges were cast into 20 Co-Cr cylinders: 10 in a high-melting temperature (HMT) group and 10 in a low-melting temperature (LMT) group. Ten cylinders were used as received as a control group. Cylinders' marginal misfit and dimensional stability were evaluated using scanning electron microscopy (×500). RESULTS AND CONCLUSION: HMT cylinders showed significant differences in marginal misfit (2.48 ± 1.07 µm2) compared to LMT (1.53 ± 0.37 µm2) and control (1.27 ± 0.57 µm2) cylinders, but there were no differences in dimensional stability. HMT Co-Cr alloys produce implant-supported prostheses with poor marginal fit.

The Effects of Sleeping With or Without Prostheses on Sleep Quality, Sleep Bruxism, and Signs of Obstructive Sleep Apnea Syndrome: A Pilot Study.

PURPOSE: To evaluate the effects of sleeping with or without a maxillary mucosa-supported complete denture (CD) in edentulous patients wearing a mandibular fixed implant-supported CD on sleep quality, sleep bruxism (SB) activity, and signs of obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: A total of 18 female patients with maxillary mucosa-supported CDs opposing mandibular fixed implant-supported CDs were selected and tested for sleep quality, SB activity, and signs of OSAS during one night while wearing the maxillary CD and another night without wearing it, with a washout period of 7 days in between. The validated Brazilian Portuguese versions of the Pittsburgh Sleep Quality Index (PSQI-BR), Sleep Assessment Questionnaire (SAQ), and Epworth Sleepiness Scale (ESSBR) were used to assess subjective sleep quality. Diagnosis of OSAS followed the American Academy of Sleep Medicine (AASM) guidelines and was confirmed with an objective and validated type 3 portable cardiorespiratory monitor (ApneaLink Plus v.9.00) by measuring the respiratory disturbance index (RDI). SB activity was assessed with a subjective self-report questionnaire and an objective and validated portable electromyographic device (BiteStrip). RESULTS: The objective measurements of SB activity and the RDI showed significant reduction (ie, improvement) when patients did not wear the maxillary CD. The subjective measurements of sleep quality and self-reports of SB activity showed no significant differences between wearing and not wearing a maxillary CD. CONCLUSION: The present results have shown that not wearing a maxillary CD at night is preferable as far as SB and OSAS are concerned, but larger-scale studies are still needed.

Risk factors for single crowns supported by short (6-mm) implants in the posterior region: A prospective clinical and radiographic study.

BACKGROUND: The use of short implants is still not a consensus for challenging clinical situations, such as unfavorable crown-to-implant (C/I) ratio. PURPOSE: This prospective study evaluated the rates of prosthetic complications and implant failure, the mean marginal bone loss of 6-mm dental implants with single crowns in posterior regions and the potential risk factors. MATERIALS AND METHODS: Forty-six dental implants, 6-mm long and 4.1-mm wide, were placed in the posterior region in 20 patients. Patients were clinically and radiographically examined after the restoration with single crowns and on a yearly basis. Potential risk factors (arch, bruxism, maximum bite force, anatomical and clinical C/I ratios, and occlusal table area) were analyzed according to the following outcomes: implant survival, bone loss, and prosthetic complications. RESULTS: The mean follow-up time was 45 ± 9 (16-57) months. There was no early loss of implants. After prosthetic loading, 4 implants were lost (2 in the mandible and 2 in the maxilla; 91.3% survival), and there were 13 prosthetic complications (28.3%), yielding a 65.2% success rate. The frailty term showed a 95% greater chance of loss in the mandible than the maxilla. Mean peri-implant bone loss was of 0.2 ± 0.4 mm, 0.1 ± 0.2 mm, 0.1 ± 0.3 mm, and 0.2 ± 0.4 mm in the first, second, third, and fourth years, respectively, with a mean cumulative loss of 0.3 ± 0.5 mm at 48 months. In the multilevel model, the effects of the clinical C/I ratio and time were significant for bone loss (P < .001). It was estimated that a mean bone loss of 0.1 mm is associated with both a one-unit increase in time (12 months) and a 0.1 increase in the clinical C/I ratio. The other potential risk factors showed no significant relationship with the outcomes. CONCLUSIONS: The 6-mm implants supporting single crowns performed well, but the mandible shows a higher risk of failure. The time and clinical C/I ratio are predictors for bone loss.

Peri-implant crevicular fluid biomarkers as discriminants of peri-implant health and disease.

AIM: The objective of this cross-sectional study was to examine the potential of peri-implant crevicular fluid (PICF) analytes to discriminate between peri-implant health and disease using a multi-biomarker approach. METHODS: We collected PICF samples from the mesio-buccal site of every implant (n = 145) from 52 subjects with peri-implantitis and measured the levels of 20 biomarkers using Luminex. We grouped implants and subjects based on the clinical characteristic of the sampled sites and implants into: healthy sites from healthy implants (HH), diseased sites from diseased implants (DD) and healthy sites from diseased implants (HD). The significance of the differences between the HH and DD groups was determined using general linear models controlling for false discovery rate. We used logistic regression to determine the best multi-biomarker models that could distinguish HH from DD subjects and HH from HD subjects. RESULTS: There were statistically significant differences between HH and DD groups for 12/20 biomarkers. Logistic regression resulted in a 6-biomarker model (Flt-3L, GM-CSF, IL-10, sCD40L, IL-17 and TNFα) that discriminated HH from DD subjects (AUC = 0.93) and a 3-biomarker model (IL-17, IL-1ra and vascular endothelial growth factor) that distinguished HH from DD subjects (AUC = 0.90). CONCLUSION: PICF biomarkers might help discriminate peri-implant health from disease.

Characterization of the interface between cast-to Co-Cr implant cylinders and cast Co-Cr alloys.

STATEMENT OF PROBLEM: The affordable Co-Cr cast alloy should provide an ideal interface with prefabricated cast-to cylinders from the same alloy family. The alloy microstructures should be maintained up to the interface, and porosities and reaction regions should be absent, and sufficient bond strength between alloys should be provided. PURPOSE: The purpose of this in vitro study was to evaluate the metallurgical interfacial compatibility between Co-Cr dental casting alloys and a prefabricated Co-Cr dental implant cast-to-cylinder. MATERIAL AND METHODS: A Co-Cr alloy was cast to Co-Cr implant cylinders. Specimens were cross-sectioned longitudinally and divided into as-cast and heat-treated groups. The microstructures of specimens were evaluated by optical and scanning electron microscopy. The elemental composition of as-received prefabricated implant cylinders and diffusion characteristics of cast interfacial regions were determined by energy dispersive x-ray spectroscopy. Vickers hardness values were defined across the interface on cast specimens and for the as-received implant cylinders. ANOVA and Tukey honest significant differences tests were used for the statistical evaluation of hardness values. RESULTS: No significant reaction regions or porosity were present in the interface. Microstructural aspect and interdiffusion indicated a metal-metal bond between the Co-Cr implant cylinder and cast alloy. Mean hardness values demonstrated a significant rise across the interface (373.5 ±12.8; 363.8 ±12.6, respectively) from the wrought cylinder (338.6 ±10.5; 329 ±9.7, respectively) to the cast alloy (399.8 ±7.4; 392.3 ±10.3, respectively) for the as-cast and heat-treated conditions, respectively. CONCLUSIONS: Co-Cr casting alloy cast on to prefabricated Co-Cr implant cylinders provided interfaces which appear to fulfill the requirements of the established criteria.

The effect of a positioning index on the biomechanical stability of tapered implant-abutment connections.

The biomechanical stability of the implant-abutment connection is critical for the success of implant-supported restorations. This study investigated the effect of a positioning index on the abutment screw preload values of tapered connection implants. Twenty Morse taper implants presenting an internal locking hex received 10 solid and 10 straight screw retained abutments for cemented single-crown restorations. Ten abutments had a positioning index to fit the internal locking hex of the implant (straight), and 10 were locked only by the implant taper (solid). The preload values for each abutment screw after a tightening torque were registered by strain gauges. Prosthetic crowns were placed on each abutment and subjected to mechanical cycling. Detorque forces were applied to each abutment and compared with the initial torque values. Data were statistically analyzed using Kolmogorov-Smirnov and Student t tests. The nonindexed group presented higher initial preload (6.05 N ± 0.95 N) compared with the indexed group (4.88 N ± 0.92 N; P < .05). After cycling, the nonindexed group exhibited less reduction of preload (13.84% ± 6.43%) compared with the indexed group (52.65% ± 14.81%; P < .01). Indexed tapered abutments for single-crown restorations might represent greater biomechanical risk under function.

The Influence of Low-Level Laser on Osseointegration Around Machined and Sandblasted Acid-Etched Implants: A Removal Torque and Histomorphometric Analyses.

Evaluation of the influence of laser application on osseointegration around implants with different surface characteristics is limited. This study aims to evaluate the influence of low-level lasers on the early stages of osseointegration. Ninety-six external hex implants (3.75 mm × 5.0 mm) were placed in 24 rabbits-one machined and one sandblasted acid-etched per tibia. The rabbits were later divided into the laser group, which received a total dose of 24 J/cm(2) of gallium-aluminum-arsenide laser over 15 days, and a control group. At 16 and 30 days after surgery, removal torque and histomorphometric analyses were performed. No statistical differences in removal torque or histomorphometric analyses were verified between laser and control groups regardless of implant surface (P > .05). Time was the only variable presenting significant differences between measurements (P < .05). Low-level laser had no significant short-term effect on bone-to-implant contact and removal torque values regardless of implant surface characteristics.

Influence of the patient's clinical information on the diagnostic reproducibility and accuracy of MRI scans of temporomandibular joint pathologies.

PURPOSE: To evaluate the influence of the patient's clinical information on the accuracy as well as interexaminer and intraexaminer reproducibilities of temporomandibular joint (TMJ) magnetic resonance imaging (MRI) scans. MATERIALS AND METHODS: Forty MRI scans from 20 TMJs corresponding to 7 TMJ pathologies (ie, degenerative alterations of the condyle, degenerative alterations of the mandibular fossa, alterations in the morphology of the TMJ disc, disc displacement with reduction, disc displacement without reduction, TMJ effusion, and TMJ hypermobility) were assessed by seven uncalibrated specialists in temporomandibular disorders (TMD) at baseline, 30 day-, and 60-day follow-ups for accuracy and reproducibility. No clinical information was provided before the 60-day follow up. RESULTS: Examiners had a poor to regular accuracy (0.10 to 0.36), kappa index and 5% to 60% correct positive diagnosis) when compared with the radiologist's diagnoses (gold standard). The interexaminer reproducibility ranged from moderate to substantial (kappa = 0.32 to 0.71), and the intraexaminer reproducibility ranged from moderate to perfect (kappa = 0.38 to 1.00). Provision of clinical information improved neither the accuracy nor the reproducibility of the results (P < .05), with the exception of the intraexaminer reproducibility of one examiner. CONCLUSIONS: Calibration is needed in assessing TMJ MRI scans, even when trained specialists are provided with clinical information from the patient.

Analysis of the effects of a mandibular advancement device on sleep bruxism using polysomnography, the BiteStrip, the sleep assessment questionnaire, and occlusal force.

PURPOSE: This before and after study evaluated the effects of a mandibular advancement device (MAD) on sleep bruxism (SB) activity and its associated signs and symptoms. MATERIALS AND METHODS: Nineteen young adults (39.9 ± 12.9 years, 58% women) with a clinical history of SB without sleep or neurologic disorders and no spontaneous temporomandibular disorder pain were selected. SB activity was assessed after a habituation period of 2 weeks. The results of a 3-month treatment with a thermoplastic monoblock MAD were compared to baseline using electromyogram polysomnography and the BiteStrip, a portable EMG device. Sleep disorders were assessed and validated against the polysomnography sleep assessment questionnaire (SAQ). Additionally, common signs and symptoms of SB were evaluated with the research diagnostic criteria for temporomandibular disorders. Occlusal force was compared to baseline using a cross-arch force transducer. RESULTS: There was a significant improvement in both SB activity and sleep scores (including SB episodes per hour) according to the BiteStrip and the SAQ, respectively. There was also a significant reduction in the signs and symptoms of SB, including grinding and/or clenching, temporomandibular joint (TMJ) sounds, muscle pain, and occlusal force. None of the SB subjects experienced MAD breakage, but in 24% of patients, the MAD treatment had to be interrupted due to TMJ/muscle pain and/or discomfort. CONCLUSION: The MAD treatment resulted in the reduction of SB activity, SB signs and symptoms, sleep disorders, and occlusal force.

In vitro evaluation of cytotoxicity of hyaluronic acid as an extracellular matrix on OFCOL II cells by the MTT assay.

OBJECTIVE: To evaluate the cytotoxicity of hyaluronic acid (HA) on a tissue-engineered compound for bone grafting containing osteoblastic cells (OFCOL II), platelet-rich plasma (PRP) with or without thrombin (Thr), and hydroxyapatite (HP) by the MTT assay. STUDY DESIGN: Studied groups were formed as follows: (A) Cells + HA + PRP with Thr + hydroxyapatite (HP); (B) Cells + HA + PRP + HP; (C) Cells + HA + HP; (D) Cells + HP; (E) Cells + HA; (F) Cells + PRP with Thr; (G) Cells + PRP; and (H) Pure Dulbecco's modified Eagle's medium (DMEM) with 15% fetal bovine serum. A 2-way ANOVA and Tukey's test were applied for statistical analysis (P < .05). RESULTS: Results of cell viability for each group were as follows: A: 79%, B: 67%, C: 68%, D: 99%, E: 74%, G: 89%, F: 90%, and Group H: 100%. CONCLUSIONS: Results suggested a decrease in cell viability in the presence of HA.