Bruxism as a new risk factor of musculo-skeletal disorders?

OBJECTIVES: Musculoskeletal disorders (MSDs), particularly neck and low back pain, constitute a major public health issue worldwide with a heavy morbidity and economic impact. However, the relationships between the stomatognathic system and MSDs are subjected to debate, data sorely lacking. The study objective was to investigate the association between bruxism (BR) and MSDs. Secondary objective includes the study of the association between tooth wear (TW) and MSDs. METHODS: This is a cross-sectional study on 425 participants frequenting a university dental clinic. The presence of MSDs was evaluated with the standardized Nordic questionnaire. The sleep and awake BR assessments were based on clinical examination and self-report. TW was measured with the BEWE index. Socio-demographic factors, medical history, life habits and stress were analyzed as potential confounding variables. RESULTS: 91% of patients reported at least one MSD during the preceding 12 months and 75.5% were diagnosed as bruxers. In multivariate analyses, BR was associated with a 5-fold increased risk of prevalent MSD (OR=5.88 (2.7-12.5), p<0.0001). Regarding TW, for a one-point increase in anterior BEWE score, the risk to present an MSD was increased by 53% (OR=1.53 (1.12-2.08), p = 0.0076). Moreover, BR was independently associated with neck, shoulder, upper back, low back, hip & thigh and knee MSDs. Anterior TW was independently associated with neck, low back and hip & thigh MSDs, and global TW with knee MSDs. CONCLUSIONS: BR and TW were shown to be associated with MSDs. The cause-and-effect relationships between those factors needs to be analyzed to optimize prevention and therapeutic care. CLINICAL SIGNIFICANCE: Results suggest that the body is a whole, a balanced muscular system, where every part constitutes a link of the chain. MSDs management and prevention may require a multidisciplinary team approach and future perspectives include defining the dentist's role in this context, particularly with respect to BR diagnostic and treatment.

Bonding properties of third-generation zirconia CAD-CAM blocks for monolithic restorations to composite and resin-modified glass-ionomer cements.

PURPOSE: To compare the interfacial fracture toughness (IFT) of two MDP-based composite cements and a resin-modified glass-ionomer cement (RMGIC) with third-generation zirconia CAD-CAM restorations using two different airborne-particle abrasion (AB) pressures. METHODS: Blocks were cut into prisms (n=60), split and sintered to the desired equilateral half prisms. Half-prisms were divided into two groups for AB at 0.5 or 2.5 bar with 50 µm Al2O3 particles. Each group was then further divided into 3 subgroups, and half-prisms were bonded to their counterparts with Panavia V5 (V5), Panavia Self Adhesive Cement Plus (SA), or RMGIC Fuji Plus (n=10/group). The IFT was determined using the Notchless Triangular Prism test in a water bath at 36°C after thermocycling (10,000 cycles). Surface roughness and SEM analyses were performed for representative zirconia samples after AB, and composite cements were tested for flexural strength and wettability. RESULTS: SA (2.5 bar) showed a significantly higher IFT. The 3 other groups with SA and V5 showed no significant difference in their IFT values regardless of the AB pressure (1-way ANOVA). Weibull analysis of SA was higher than V5. All RMGIC samples debonded while thermocycling, and were, therefore, not included in the statistical analysis. Surface roughness increased with increasing AB pressure, and both cements showed similar flexural strength values and good wettability. CONCLUSION: Contrary to RMGIC, composite cements show high performance with zirconia after AB. Increasing AB pressure enhances the micromechanical retention of composite cement. Future perspectives should include study of the effect of AB pressure on zirconia surface properties.

One-tooth one-time (1T1T), immediate loading of posterior single implants with the final crown: 2-year results of a case series.

Purpose: The purpose of this study was to evaluate the 2-year outcomes of the one-tooth onetime complete digital workflow, allowing the immediate loading of a single implant in the posterior region with a final CAD/CAM crown made of a polymer-infiltrated ceramic network. Materials and methods: A series of 10 implants were placed, and an intraoral scan was taken after surgery. A final screw-retained polymer-infiltrated ceramic network crown was manufactured chairside and placed the same day in full occlusion. Marginal peri-implant bone changes and soft tissue health were evaluated, and restoration performance was assessed using FDI World Dental Federation criteria and pink and white aesthetic scores. Patient-reported outcome measures and data on the time required to perform the procedures were collected. Results: After 2 years, the implant survival rate was 100%. The debonding of one crown from its titanium base led to prosthodontic survival rate of 90% and the remaining crowns were all considered successful. The mean marginal peri-implant bone changes yielded 0.87 mm (standard deviation 0.96 mm) and 0.55 mm (standard deviation 0.53 mm) after 1 and 2 years, respectively. Mild or no inflammation of peri-implant soft tissue was observed in most implants. The total treatment time was 175 minutes and patient-reported outcome measures displayed high patient satisfaction. Conclusions: This study constitutes the first report examining immediate loading of a single implant in the posterior region with a final crown in occlusion. In this case series, the 2-year outcomes of the one-tooth one-time protocol seem rather promising and fulfilled patient expectations. However, these preliminary results need to be confirmed by randomised controlled trials, and patient selection is likely to be a key factor in the success of this procedure.

Silane influence on bonding to CAD-CAM composites: An interfacial fracture toughness study.

OBJECTIVES: To evaluate silane influence on the interfacial fracture toughness (IFT) of composite cement, with the two sub-classes of CAD-CAM composites, polymer-infiltrated ceramic networks (PICN) and dispersed fillers (DF), after hydrofluoric acid etching (HF) or airborne-particle abrasion (AB). A secondary objective was to correlate results with developed interfacial area ratio (Sdr) and surface wettability. METHODS: Experimental PICN and DF blocks were cut into equilateral half-prisms, which were treated with HF or AB, then treated with an experimental silane or not and bonded to their counterparts with an experimental light-cure resin cement. After thermocycling, samples (n=30 per group) were tested for IFT using the notchless triangular prism test in a water bath at 36°C. Moreover, profilometry and contact angle measurement were performed on rectangular samples of each group. Finally, bonding interface was analysed by SEM. RESULTS: PICN-HF treated with silane showed the highest IFT significantly. Three-way ANOVA revealed the influence of silane, material class and surface pre-treatment (HF or AB) on IFT (p<0.05). When silane was used, IFT was correlated with Sdr, while surface wettability was increased. Silane application significantly increased IFT for PICN but not for DF, while PICN performed better with HF and DF with AB. SIGNIFICANCE: Silane increases IFT of composite cement with PICNs, but not with DF materials. Results suggest that silane increases the micromechanical bond by promoting resin cement spreading and penetration in surface roughness. This roughness is significantly higher for pre-treated PICNs than for DF due to their specific honeycomb microstructure when etched, which explains their better bonding properties.

Inflammation-Generated Extracellular Matrix Fragments Drive Lung Metastasis.

Mechanisms explaining the propensity of a primary tumor to metastasize to a specific site still need to be unveiled, and clinical studies support a link between chronic inflammation and cancer dissemination to specific tissues. Using different mouse models, we demonstrate the role of inflammation-generated extracellular matrix fragments ac-PGP (N-acetyl-proline-glycine-proline) on tumor cells dissemination to lung parenchyma. In mice exposed to cigarette smoke or lipopolysaccharide, lung neutrophilic inflammation produces increased levels of MMP-9 (matrix metalloproteinase 9) that contributes to collagen breakdown and allows the release of ac-PGP tripeptides. By silencing CXCR2 gene expression in tumor cells, we show that these generated ac-PGP tripeptides exert a chemotactic activity on tumor cells in vivo by binding CXCR2.

ADAM-8, a metalloproteinase, drives acute allergen-induced airway inflammation.

Asthma is a complex disease linked to various pathophysiological events including the activity of proteinases. The multifunctional A disintegrin and metalloproteinases (ADAMs) displaying the ability to cleave membrane-bound mediators or cytokines appear to be key mediators in various inflammatory processes. In the present study, we investigated ADAM-8 expression and production in a mouse model of allergen-induced airway inflammation. In allergen-exposed animals, increased expression of ADAM-8 was found in the lung parenchyma and in DC purified from the lungs. The potential role of ADAM-8 in the development of allergen-induced airway inflammation was further investigated by the use of an anti-ADAM-8 antibody and ADAM-8 knockout animals. We observed a decrease in allergen-induced acute inflammation both in BALF and the peribronchial area in anti-ADAM-8 antibody-treated mice and in ADAM-8-deficient mice (ADAM-8(-/-) ) after allergen exposure. ADAM-8 depletion led to a significant decrease of the CD11c(+) lung DC. We also report lower levels of CCL11 and CCL22 production in antibody-treated mice and ADAM-8- deficient mice that might be explained by decreased eosinophilic inflammation and lower numbers of DC, respectively. In conclusion, ADAM-8 appears to favour allergen-induced acute airway inflammation by promoting DC recruitment and CCL11 and CCL22 production.

Bone marrow-derived mesenchymal cells and MMP13 contribute to experimental choroidal neovascularization.

In this study, we evaluate the potential involvement of collagenase-3 (MMP13), a matrix metalloproteinase (MMP) family member, in the exudative form of age-related macular degeneration characterized by a neovascularisation into the choroid. RT-PCR analysis revealed that human neovascular membranes issued from patients with AMD expressed high levels of Mmp13. The contribution of MMP13 in choroidal neovascularization (CNV) formation was explored by using a murine model of laser-induced CNV and applying it to wild-type mice (WT) and Mmp13-deficient mice (Mmp13 ( -/- ) mice). Angiogenic and inflammatory reactions were explored by immunohistochemistry. The implication of bone marrow (BM)-derived cells was determined by BM engraftment into irradiated mice and by injecting mesenchymal stem cells (MSC) isolated from WT BM. The deficiency of Mmp13 impaired CNV formation which was fully restored by WT BM engraftment and partially rescued by several injections of WT MSC. The present study sheds light on a novel function of MMP13 during BM-dependent choroidal vascularization and provides evidence for a role for MSC in the pathogenesis of CNV.

Prolonged ex vivo culture of human bone marrow mesenchymal stem cells influences their supportive activity toward NOD/SCID-repopulating cells and committed progenitor cells of B lymphoid and myeloid lineages.

BACKGROUND: Bone marrow mesenchymal stem cells support proliferation and differentiation of hematopoietic progenitor cells in vitro. Since these cells constitute a rare subset of bone marrow cells, mesenchymal stem cell preparations for clinical purposes require a preparative step of ex vivo multiplication. The aim of our study was to analyze the influence of culture duration on mesenchymal stem cell supportive activity. DESIGN AND METHODS: Mesenchymal stem cells were expanded for up to ten passages. These cells and CD34+ cells were seeded in cytokine-free co-cultures after which the phenotype, clonogenic capacity and in vivo repopulating activity of harvested hematopoietic cells were assessed. RESULTS: Early passage mesenchymal stem cells supported hematopoietic progenitor cell expansion and differentiation toward both B lymphoid and myeloid lineages. Late passage mesenchymal stem cells did not support hematopoietic progenitor cell and myeloid cell outgrowth but maintained B-cell supportive ability. In vitro maintenance of NOD/SCID mouse repopulating cells cultured for 1 week in contact with mesenchymal stem cells was effective until the fourth passage of the mesenchymal cells and declined thereafter. The levels of engraftment of CD34(+) cells in NOD/SCID mice was higher when these cells were co-injected with early passage mesenchymal stem cells; however mesenchymal cells expanded beyond nine passages were ineffective in promoting CD34(+) cell engraftment. Non-contact cultures indicated that mesenchymal stem cell supportive activity involved diffusible factors. Among these, interleukins 6 and 8 contributed to the supportive activity of early passage mesenchymal stem cells but not to those of late passage cells. The phenotype, as well as fat, bone and cartilage differentiation capacity, of mesenchymal stem cells did not change during their culture. Conclusions Extended culture of mesenchymal stem cells alters the ability of these cells to support hematopoietic progenitor cells without causing concomitant changes in their phenotype or differentiation capacity.

Role of ADAM and ADAMTS metalloproteinases in airway diseases.

Lungs are exposed to the outside environment and therefore to toxic and infectious agents or allergens. This may lead to permanent activation of innate immune response elements. A Disintegrin And Metalloproteinases (ADAMs) and ADAMs with Thrombospondin motifs (ADAMTS) are proteinases closely related to Matrix Metalloproteinases (MMPs). These multifaceted molecules bear metalloproteinase and disintegrin domains endowing them with features of both proteinases and adhesion molecules. Proteinases of the ADAM family are associated to various physiological and pathological processes and display a wide spectrum of biological effects encompassing cell fusion, cell adhesion, "shedding process", cleavage of various substrates from the extracellular matrix, growth factors or cytokines... This review will focus on the putative roles of ADAM/ADAMTS proteinases in airway diseases such as asthma and COPD.