The biological effects of Piezocision™ on bone for accelerated tooth movement: A systematic review of animal studies.

OBJECTIVES: This systematic review aimed to assess the biological response at tissue, cellular, and molecular levels following Piezocision™ surgery, and its efficacy in accelerating orthodontic tooth movement. MATERIAL AND METHODS: A systematic review of the literature was conducted across 4 databases following the PRISMA guidelines up to May 2022. Prospective controlled animal studies involving healthy animals under active orthodontic treatment assisted by corticotomy performed with a piezotome (Piezocision™) published in the English language without time restrictions were included. The article selection, data extraction and risk of bias assessment (SYRCLE tool) were performed by two independent blinded review authors. RESULTS: Out of 738 articles screened, 10 studies were included with various level of bias. Biological responses were categorized into tissue, cellular, and molecular levels. Tissue-level changes included a global decrease in bone mineral content post-Piezocision™. At the cellular level, increased bone turnover activity was noted. Molecularly, elevated RANKL and OPG expression, along with increased TRAP+ and cytokines, were observed after Piezocision™. Studies confirmed Piezocision's efficacy, reporting 1.35 to 3.26 times faster tooth movements, peaking between the 3rd and 50th day post-surgery. Biological responses were transient, reversible, and proportional to surgical insult, with reactivation possible through a second Piezocision™. CONCLUSIONS: After Piezocision™ surgery, a transient and reversible biological response was described at the tissue, cellular and molecular levels, which induced faster orthodontic tooth movements. This biological response could be re-activated by an additional Piezocision™ and is proportional to the surgical injury. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42022303237.

Optical accuracy assessment of robotically assisted dental implant surgery for partially edentulous patients: a single arm clinical trial.

PURPOSE: To quantify the clinical accuracy of a robotically assisted implant guidance system in partially edentulous patients without the use of postoperative cone-beam radiography. MATERIALS AND METHODS: A total of 10 implants (7 patients) were placed in partially edentulous patients utilizing robotically assisted implant guidance system. Following the implant placement a intraoral scan was performed to register the implant position after attaching a scan body. The virtual plan and the postoperative intraoral scan with the scan bodies were exported as STL files, superimposed and discrepancies were analyzed using Geomagic Control X software. Positional deviations were measured between the midpoint of the platform and apex of the planned and achieved implant positions. RESULTS: Seven of the 10 samples in this study were defined as fully robotically dynamically guided, while 3 were partially robotically guided. For the fully robotic dynamically guided group the mean deviation at the midpoint of the restorative platform of the implant, the apex of the implant, the top of the scanbody, and the mean angular deviation were 1.31mm (SD0.46mm), 1.58mm (SD0.61mm), 1.11mm (SD0.57mm), and 2.34 degrees (SD1.71°), respectively. While for the partially robotic dynamically guided cases it was 1.31mm (SD0.49mm), 1.45mm (SD0.3mm), 1.74mm (SD0.47mm), and 3.75 degrees (SD2.53°). Eight out of the 10 implants (irrespective of full or partial guidance) showed a buccal displacement. CONCLUSION: Robotic surgery offers a level of accuracy similar to fully guided implant placement, without the need for a physical template, and allowing for changes in the surgical plan at any time. The analytical method described in this study is an effective and radiation free quality control tool that can be used in implant dentistry as well as in other areas of dental research dentistry.

Artificial Intelligence Chatbots in Patient Communication: Current Possibilities.

ChatGPT, an artificial intelligence (AI) chatbot can generate text prompts based on user input. This study investigated the possibility of generating adequate and relevant patient education and management documents in the context of dental implant surgery utilizing this tool. METHODS: Twenty-seven (n=27) periodontists were surveyed on the accuracy and usefulness of AI-generated documents comprising patient information handouts on surgical risks and post-operative instructions sheets for dental implant placement either in smokers or patients with diabetes. They were also asked in a blinded fashion about their preferences between the generic dental implant placement consent form currently used at Boston University and two AI-generated consent forms: one generic and one tailored to patients with diabetes. RESULTS: A vast majority of participants found that the information in the AI-generated forms was accurate, useful and would feel comfortable using them with their own patients. The AI-generated generic consent performed as least as well as the human-written one, while the personalized informed consent for patient with diabetes performed significantly better (p<0.001). CONCLUSIONS: Within the limitations of this study, ChatGPT was able to independently generate accurate and useful patient information and management documents.

Robot assisted implant surgery: Hype or hope?

The 21st century is characterized by accelerated technological innovation, resulting in digitization of most areas of medicine and dentistry. Dental implant surgical planning has evolved from using analog static guides to computer generated guides and dynamic surgical guidance. Dynamic surgical placement has started gaining ground with the use of navigated surgery and robot assisted implant placement. Have static surgical guides become obsolete? Although innovative and cutting edge, the use of dynamic guidance requires a learning curve and added expenses for the dental team. Also, could dynamic guidance, and specifically robot assisted implant surgery lead to more accurate fixture placement? In this article we will share our experience using robotic implant surgery from the perspective of an academic institution that has used the YOMI robot for several years now.

Piezocision Through Computer-Guided Navigation.

Numerous surgical techniques have been developed as effective means to facilitate orthodontic treatment, although they may cause significant postoperative discomfort. Piezocision was established as a flapless and minimally invasive technique to accelerate orthodontic tooth movement by combining small vertical incisions and piezoelectric corticotomies. Computed tomography has been combined with the piezocision technique to fabricate computer-aided design and computer-aided manufacturing (CAD/CAM) surgical guides to prevent iatrogenic damage. A method to combine computer-assisted dynamic navigation with piezocision is introduced here. Cone-beam computed tomography was combined with motion-tracking technology to allow real-time tracing of the piezoelectric instruments during the surgical procedure. This technique delivers the location of piezoelectric knife in regard to roots and important anatomical structures to increase the safety and accuracy during corticotimies.

A hybrid technique for measurement of intra/extracellular proteins.

ELISA or Western blot is known as a basic technique to be used for measurement of intracellular proteins, but in some cases, they cannot overcome problems such as normalization between samples or extraneous costs for required commercial kits. In order to address this problem, we developed a rapid and effective method (a hybrid of Western blot and ELISA). We use this new hybrid method to detect and normalize trace protein changes in gene expression intracellularly at a lower cost.

Quantification and comparison of the regional acceleratory phenomenon in bone following piezosurgery or bur osteotomy: A pilot study in rats.

BACKGROUND/OBJECTIVE: The Regional Acceleratory Phenomenon (RAP) can be induced surgically via decortication (selective cortical penetrations) of bone to accelerate orthodontic tooth movement. Few studies have compared the impact and efficiency of different decortication methods to induce the RAP. The aim of this study was to determine if there is a significant difference in the intensity of the RAP induced by a surgical defect created either using a piezoelectric knife or a rotary bur. METHODS: Twenty-two Sprague-Dawley rats were divided into two treatment groups (each n = 8) and a control group (n = 6). The treatment groups were subjected to transcortical penetrations (TP) of the right tibia using either a piezoelectric knife (PTP) or a rotary bur (BTP). The right tibias of the control group animals had reflection of tissues (SHAM) and the left legs were kept for comparison (INTACT). The animals were killed at 7 and 14 days after the operation in an equally distributed manner. Microcomputed tomography images were obtained and analyzed utilizing artificial intelligence for bone cortical porosity (Ct.Po) locally and regionally. RESULTS/CONCLUSION: Regionally, TP using a PTP induced significantly (p < .05, Kruskal-Wallis test) more Ct.Po than BTP or INTACT for both the 7- and 14-day time points. PTP was not found to induce significantly more Ct.Po than SHAM at any time point. However, PTP induced significantly more Ct.Po than the INTACT group for each time point, while SHAM did not. The local analysis did not reveal any relevant significant differences between groups.

The pathogenic mechanism of oral bacteria and treatment with inhibitors.

OBJECTIVES: The objective of this study was to introduce the evidence obtained through extensive research that periodontitis increases risk of many systemic diseases. METHOD: Analysis of some oral bacteria (P. gingivalis, T. denticola, T. forsythia, A. actinomycetemcomitans, and F. nucleatum) and its related treatments and mediators by the specific methods (western blot, ELISA, etc). RESULTS: This article reviews in detail the evidence obtained through extensive research that periodontitis increases risk of many systemic diseases, including cardiovascular disease, rheumatoid arthritis, and Alzheimer's disease. These diseases are known to be associated with some certain specific gram-negative bacteria as periodontal pathogens, which induce inflammation and related diseases through TLR receptors, kinases, transcriptional factors and other cytokines. We also reviewed the latest research for inhibitors against inflammation and related diseases that have potential to be further applied clinically. In addition, based on a large amount of research evidence, we draw two tables about the mechanism of disease caused by periodontal bacteria, so that readers can easily search and analyze these research results. DISCUSSION: This review details how the periodontal bacteria and their virulence factors can trigger host immune defense and induce many systemic diseases via inflammation and invasion. This Review also addressed the latest research around inhibitors against inflammation.

Assessment of Maxillary Expansion by Piezocision-Assisted Orthodontics: A Pilot Study.

The correction of transverse malocclusions due to maxillary width deficiency in adults is challenging. Multiple surgical and nonsurgical procedures have been used in conjunction with orthodontics to address this situation, and most common is the surgically assisted rapid maxillary expansion (SA-RME). Although successful, it is quite aggressive. The present investigation assesses the usefulness of Piezocision-assisted orthodontics as a less-invasive option for treatment of transverse maxillary deficiencies in adults. Dental casts were taken before and after Piezocision-assisted palatal expansion in four patients. They were digitized into STL files and superimposed. Differences on cross-arch tooth torque, angulation/tipping, and movement distances between time points were quantified using a digital static and a novel digital 3D-movement evaluation method. For the buccolingual movement per tooth, first premolars averaged 3.33 ± 1.3 mm, second premolars averaged 3.63 ± 0.6 mm, and first and second molars averaged 1.56 ± 1.2 mm and 0.36 ± 1.2 mm, respectively. Bodily movement of the teeth was observed with minimal tipping and no development of gingival recessions. Piezocision-assisted palatal expansion is a safe and reliable procedure that can help patients with maxillary width deficiency. It is a new tool in the orthodontist's armamentarium that can be used as an accelerator of treatment and as a new way to solve orthodontic challenges in selected adult patients.

The role of TNF-α induced protein 1 in the activation of pro-apoptotic proteins.

It is known that Porphyromonas gingivalis/lipopolysaccharide (P. gingivalis/LPS) induces inflammatory diseases via TNF-α-mediated transcription factors. Our recent data shows that TNFAIP1 (TNF-α induced protein 1) is related to TNF-α. However, little is known regarding how TNFAIP1 is involved in the TNF-α-dependent pathway. We therefore focused on the biological function of TNFAIP1 and examined how TNFAIP1 mediates TNF-α and other genes. We found that TNF-α was upregulated and peaks before the upregulation of apoptotic genes such as Bad, Bcl-x, Caspase 3, Catalase, Claspin, Cytochromic, Ho-1/HMOX1/HSP32, or MCI-1 in our time course with TNFAIP1-treated cells. Our findings here may serve as the foundation for future studies linking regulation of TNFAIP1 and intervention of inflammatory disease.

Corticotomy depth and regional acceleratory phenomenon intensity.

OBJECTIVES: To determine if the depth of corticotomy done with the piezoelectric knife could play a role in the intensity of the regional acceleratory phenomenon (RAP). MATERIALS AND METHODS: Eighteen Sprague-Dawley rats were divided into two groups: untreated (3 rats) and treatment (15 rats). In the treatment group, a split-model design was used. The right tibia received transcortical (deep) penetrations with the piezoelectric knife, while intracortical (shallow) penetrations were performed on the left tibia of the same animal. The rats were euthanized at day 1, 3, 7, 14, and 28. Cone-beam computed tomography scans were taken for each sample and then assessed by histological analysis. RESULTS: Higher amounts of osteoclastic activity and new collagen formation were observed in the deep penetration group when compared with the shallow penetration group. The former peaked at day 14 for both groups (1.53% ± 0.01% vs 0.03% ± 0.0004%, respectively), and the latter peaked at day 28 (0.65 × 106 ± 0.01 vs 0.08 × 106 ± 0.0008, respectively). CONCLUSIONS: Within the limitations of this study, it appears that the intensity of the RAP in the rat is corticotomy depth dependent. This is to be kept in mind when decorticating the bone during surgically facilitated orthodontic procedures.

Strategic Use of Ultrasonic Frequencies for Targeted Bone Biomodification Following Piezoelectric Bone Surgery in Rats. Part II: Late Phase.

Piezoelectric surgery utilizes ultrasonic vibrations to cut bone more precisely and less traumatically than conventional methods. The regional acceleratory phenomenon following bone injury has a demineralization phase followed by a remineralization phase. Part I of this study on rats assessed the biologic modifications following bone injuries with the piezoelectric knife at 10-Hz and 30-Hz modulation frequencies. Part II focuses on piezoelectric surgery-regulated osteoblast activity and changes occurring in the bone during the regeneration phase. The results indicate that at 30 Hz, the remineralization process starts at day 14 and continues until day 70, with osteoblast progenitor cells observed in the periodontal ligament around acellular new bone as early as day 14. These findings emphasize the potential for regeneration in the late postoperative phase and the possible use of the piezoelectric knife as an adjunct for guided bone regeneration, site development, or site preparation for dental implants.

Design and ex vivo characterization of narrow implants with custom piezo-activated osteotomy for patients with substantial bone loss.

OBJECTIVE: Bone augmentation delays implant placement and increases risks due to additional surgeries. Implant systems compatible with reduced alveolar bone volume are required. To design, manufacture, and test a non-cylindrical dental implant system using piezotomes and custom-designed matching titanium mini-implants to address the needs of patients with missing teeth and narrow jawbone. MATERIALS AND METHODS: Tapered mini-implants with a rectangular cross-section (4.6 mm × 2.1 mm) were machined with dimensions that could accommodate narrow alveolar ridges. The performance of the implants were tested in both static and fatigue cycle 30° compression tests. Tapered, rectangular cutting tools that matched the overall trapezoidal morphology of the implant were also designed. These novel tools were engineered to be compatible with commercially available piezoelectric osteotomes. Tools were optimized using finite element analysis and were manufactured accordingly and were used by a periodontal surgery team in a pork rib bone model to monitor utility of the device and ease of use. RESULTS: The rectangular design of the implant allows for a full occlusal load due to the larger implant flexural rigidity compared to a similar diameter mini-implant with a standard cylindrical design. During 30° compression fatigue tests, the implant tested at 340 N did not fail after 5M cycles as shown in Kaplan-Meier survival curves. Finite element analysis allowed for functional optimization of the roughing and finishing tools. In the pork rib model, these tools successfully cut trapezoidal holes that matched the dimensions of the implant. CONCLUSIONS: The implant system here demonstrates the feasibility of a mini-implant system that has superior flexural rigidity and potentially circumvents the need for patient bone augmentation.

Cancer cells resist hyperthermia due to its obstructed activation of caspase 3.

AIM: It is well known that inducing hyperthermia is a type of cancer treatment but some research groups indicate that this treatment is not effective. This article finds and explains the mechanism of this treatment and its possible problems. BACKGROUND: Hyperthermia is commonly known as a state when the temperature of the body rises to a level that can threaten one's health. Hyperthermia is a type of cancer treatment in which body tissue is exposed to high temperatures (up to 45 °C). Research has shown that high temperatures can damage and kill cancer cells, usually with minimal injury to normal tissues. However, this mechanism is not known. MATERIALS AND METHODS: We recently treated cancer cells with different temperatures ranging from 37 °C to 47 °C and further measured their caspase 3 secretion by ELISA, western blot and cell survival rate by microscope. RESULTS: We found that most cancer cells are able to resist hyperthermia more than normal cells most likely via non-activation of caspase3. We also found that hyperthermia-treated (≥41°) cancer cells extend a long pseudopod-like extension in comparison to the same cancer cells under normal conditions. CONCLUSION: Our data here indicates that cancer cells have resistance to higher temperatures compared to normal cells via non-activation of caspase 3. This is a significant issue that needs to be brought to attention as the medical community has always believed that a high temperature treatment can selectively kill cancer/tumor cells. Additionally, we believe that the pseudopod-like extensions of hyperthermia-treated cancer cells must be related to its resistance to hyperthermia.

Retrospective study of the success of dental implants placed in HIV-positive patients.

BACKGROUND: Data related to HIV-positive patients with dental implants is short-termed and limited. Recent data showed that both HIV and antiretroviral therapy (ART) could lead to low bone mineral density (BMD). The aim of this study was to determine the success rate of dental implants in HIV-positive patients. MATERIALS AND METHODS: Dental files of 67 HIV-positive patients were selected and reviewed retrospectively, and 18 subjects agreed to return for examination. All implants were evaluated using periapical radiographs that were calibrated to measure bone loss. Crestal bone loss, mobility, and lack of infection were the parameters used to determine implant success. RESULTS: All dental implants evaluated lacked mobility and infection. Bone loss averaged 0.5 mm in 3.6 years. Subjects were consistent with maintenance and oral hygiene. CONCLUSIONS: Within the limitations of this study, the results suggest that the placement of dental implants on HIV-positive patients is safe and effective.

Strategic Use of Ultrasonic Frequencies for Targeted Bone Biomodification Following Piezoelectric Bone Surgery in Rats. Part I: Early Phase.

Piezocision can set in motion a cascade of physiologic events that lead to accelerated orthodontics, but do all ultrasonic frequencies generate the same effects on bone? Two different Piezotome modulation frequencies (10 and 30 Hz) were tested on the rat maxilla. The animals were sacrificed at days 1, 3, 7, 14, 28, and 70, and MRI, histologic, and biochemical analyses were performed. The results indicated that at 30 Hz, the demineralization process started at day 1 and peaked at day 7, and was initiated by osteocyte apoptosis. The process was different in the two groups, with bone demineralization increasing significantly in the 30-Hz group compared to the 10-Hz group (P < .05). These results could indicate that bone biomodification is frequency-dependent.

A Randomized, Controlled, Multicenter Clinical Study Evaluating The Crestal Bone Level Change Of SLActive Bone Level Ø 3.3 mm Implants Compared To SLActive Bone Level Ø 4.1 mm Implants For Single-Tooth Replacement.

PURPOSE: The purpose of this prospective randomized clinical trial was to test the hypothesis that narrow-diameter titanium-zirconium (Ti-Zr) alloy implants with a chemically modified hydrophilic surface are not inferior in regard to crestal bone level change compared with standard-diameter implants with the same implant surface and material (control). MATERIALS AND METHODS: This multicenter study included 50 patients in need of a single tooth replacement in the anterior (canine to canine) or premolar region of the mandible or maxilla. Patients were included if the site could accommodate a 4.1-mm-diameter implant. Implants were temporarily restored at 3 to 4 weeks after placement. Definitive restorations were delivered 4 to 6 months after placement. Patients returned 1 year after implant loading for clinical measurements and radiographic examination. The primary outcome was mean crestal bone level changes measured between implant loading and 12 months postloading. Secondary outcomes included implant success, survival, gingival recession, and patient satisfaction. RESULTS: Fifty patients were enrolled; 47 completed the study. Twenty-three patients were in the narrow-diameter implant group (test), and 24 patients were in the standard-diameter implant group (control). The success and survival rates at 12 months postloading were 100% for both groups. The change in the mean crestal bone level from implant loading to 12 months postloading around narrow-diameter implants was -0.27 ± 0.34 mm. For the standard-diameter implants, the change was significantly higher at -0.48 ± 0.67 mm (P = .02). No significant difference was found in gingival recession and patient satisfaction. CONCLUSION: The results of this prospective randomized clinical trial suggest noninferiority of the narrow- vs standard-diameter Ti-Zr implant. In addition, bone remodeling was less pronounced for the narrow-diameter implants.

Single-stage advanced versus rotated flaps in the treatment of gingival recessions: A 5-year longitudinal randomized clinical trial.

BACKGROUND: The objective of the present study was to compare the efficacy of single-stage laterally positioned flap (LPF) and coronally advanced flap (CAF) techniques in the treatment of localized maxillary gingival recession (GR) defects, 1 and 5 years after surgical procedures. METHODS: Thirty-six patients with Miller Class I GR defects were randomly assigned to be treated by either CAF (n = 18) or LPF (n = 18). Recession height (RECH), width of keratinized tissue (WKT), probing depth (PD), vertical clinical attachment level (VAL), visual plaque score (VPS), and bleeding on probing (BOP) were assessed and compared. Clinical recordings were performed at baseline, 1 and 5 years later. The differences between initial clinical recordings and after 1 and 5 years were subjected to statistical analysis. RESULTS: Both flap designs effectively improved RECH and VAL on GR defects. The LPF resulted in significantly more gains in KTW and root coverage (RC) after 5 years. CONCLUSION: LPF and CAF procedures may be used for the treatment of GR, however, LPF results in greater longitudinal stability of RC and increased WKT in the treated areas.

The involvement of Kav001 in inhibition of LPS/P. gingivalis-induced.

TNF-a is an important cytokine mediator of inflammation which suggests that inhibition of TNF activity may provide potential for clinical application. Recent data indicated that treatment of both human and mouse cells with Kavain significantly modulates P. gingivalis- and LPS-induced TNF-α expression. In order to obtain a selective analog with optimized biological activity and structural physico-chemical properties of Kavain, Kavain analogs were designed and synthesized and found one Kavain analogue (named Kav001) that is similar to Kavain but soluble and does not induce a significant toxicity. Both studies in vitro and in vivo treatment by Kav001 showed stronger biological function as compared to Kavain. Furthermore, most mouse bone marrow macrophages up-regulated Bcl-6 while down-regulating LITAF expression after treatment with Kav001 for 36 h. Consequently, this led to an extension of macrophage pseudopods due to its immune response to P.g. infection/LPS stimulation.