Comparison of morphological quantitative characteristics of the newly formed alveolar bone after the application of demineralized bone matrix and cortical bone allografts / Comparación de las características morfológicas cuantitativas del hueso alveolar recién formado después de la aplicación de matriz ósea desmineralizada y aloinjertos de hueso cortical

The allografts were used to obtain sufficient alveolar bone tissue for proper dental implant placement. The objective of the present study was to evaluate the morphological and quantitative characteristics (cellular and collagen densities) of the newly formed alveolar bone with the application of cortical bone (CB) and demineralized bone matrix (DBM) allografts. Six samples of alveolar bone tissue from 5 patients (50 ± 6.3 years) were obtained after 6 months of application of the allografts and immediately before the placement of the dental implants. The samples were fixed (buffered formaldehyde, pH7.2), decalcified (EDTA 10 %) and histologically processed (HE and Picro-Sirius) for histologic analysis. Morphological analysis revealed presence of osteocytes and trabeculae in neoformed bone tissue near the allografts and absence of inflammatory and allergic cells; the remnants of CB were located mainly in the periphery of the bone tissue and the remnants of DBM were more incorporated into the tissue. Osteogenitor cells were observed around the remaining material. The cell density was not modified in newly formed bone tissue with the application of both allografts as compared to mature bone tissue. The density of the type I and III collagens present in the osteoids interspersed with the remainder of the materials showed a tendency to increase in the samples treated with DBM. It was concluded that by the histological characteristics observed both grafts were biocompatible, however the bone treated with DBM presented better incorporation and a tendency of increase of the collagen content in the remnant region of the allografts.

Los aloinjertos son utilizados para obtener tejido óseo alveolar apropiado para la colocación correcta del implante dental. El objetivo de este trabajo fue evaluar las características morfológicas y cuantitativas (densidades celulares y de colágeno) del hueso alveolar recién formado con la aplicación de aloinjertos de hueso cortical (CB) y matriz desmineralizada de hueso (DBM). Seis muestras de tejido óseo alveolar fueron obtenidas de 5 pacientes (50 ± 6,3 años) después de 6 meses de aplicación de los aloinjertos e inmediatamente antes de la colocación de los implantes dentales. Las muestras fueron fijadas (formaldehído tamponado, pH 7,2), descalcificadas (EDTA al 10%) y procesadas histológicamente (HE y Picro-Sirius) para el análisis histológico. El análisis morfológico reveló la presencia de osteocitos y trabéculas en el tejido óseo neoformado cerca de los aloinjertos y la ausencia de células inflamatorias y alérgicas; los remanentes de CB se ubicaron principalmente en la periferia del tejido óseo y los remanentes de DBM se incorporaron más en el tejido. Se observaron células osteogenitoras alrededor del material restante. La densidad celular no se modificó en el tejido óseo recién formado con la aplicación de ambos aloinjertos en comparación con el tejido óseo maduro. La densidad de los colágenos de tipo I y III presentes en los osteoides intercalados con el resto de los materiales mostró una tendencia a aumentar en las muestras tratadas con DBM. Se concluyó que, debido a las características histológicas observadas, ambos injertos fueron biocompatibles, sin embargo, el hueso tratado con DBM presentó una mejor incorporación y una tendencia al aumento del contenido de colágeno en la región remanente de los aloinjertos.

TLR2 Signaling Pathway in Alveolar Bone Osteogenesis Induced by Aloe vera and Xenograft (XCB)

Abstract The aim of this study was to find the role of TLR2 signaling pathway in reducing osteoclast activity and promoting osteoblast growth by inducing a combination of Aloe vera and cancellous bovine xenograft (XCB) into dental extraction socket. Forty-eight Cavia cobayas were used. They were divided into eight groups (n=6). For control group, their mandibular incisors were extracted and filled with PEG. For treatment groups, they were extracted and filled with XCB, Aloe vera and the combination of Aloe vera and XCB. The first four groups were sacrificed after 7 days and the other groups after 30 days. Immunohistochemistry and histopathology examination were conducted to examine TLR2, TNFa, OPG, collagen-1, and the osteoblast and osteoclast expressions. The expressions of TLR2, OPG and Collagen-1, as well as the number of osteoblast were increased. Meanwhile, the expressions of TNFa and osteoclast were decreased. The study finding was that TLR2 signaling pathway influenced alveolar bone osteogenesis process by reducing osteoclast activity and stimulating osteoblast growth induced by the combination of Aloe vera and XCB.

Resumo O objetivo deste estudo foi investigar o papel da via de sinalização de TLR2 na redução da atividade osteoclástica e na promoção do crescimento de osteoblastos, induzindo uma combinação de Aloe vera e enxerto de osso esponjoso bovino (EOEB) em alvéolo de extração dentária. Quarenta e oito Cavia cobayas foram utilizados e divididos em 8 grupos (n = 6). Para o grupo de controle, seus incisivos mandibulares foram extraídos e preenchidos com polietilenoglicol (PEG). Para grupos de tratamento, os dentes foram extraídos e preenchidos com EOEB, Aloe vera e a combinação de Aloe vera e EOEB. Os primeiros quatro grupos foram sacrificados após 7 dias e os outros grupos após 30 dias. As análises de imunohistoquímica e histopatologia foram realizada para examinar TLR2, TNFa OPG, colágeno-1 e as expressões de osteoblastos e osteoclastos. Houve maior expressão de TLR2, FGF2, OPG e colágeno-1, bem como maior número de osteoblastos. Enquanto isso, a expressão de TNFa e osteoclastos estava diminuída. O principal achado do estudo foi que a via de sinalização de TLR2 influenciou o processo de osteogênese do osso alveolar, reduzindo a atividade dos osteoclastos e estimulando o crescimento de osteoblastos induzido pela combinação de Aloe vera e EOEB.

TLR2 Signaling Pathway in Alveolar Bone Osteogenesis Induced by Aloe vera and Xenograft (XCB).

The aim of this study was to find the role of TLR2 signaling pathway in reducing osteoclast activity and promoting osteoblast growth by inducing a combination of Aloe vera and cancellous bovine xenograft (XCB) into dental extraction socket. Forty-eight Cavia cobayas were used. They were divided into eight groups (n=6). For control group, their mandibular incisors were extracted and filled with PEG. For treatment groups, they were extracted and filled with XCB, Aloe vera and the combination of Aloe vera and XCB. The first four groups were sacrificed after 7 days and the other groups after 30 days. Immunohistochemistry and histopathology examination were conducted to examine TLR2, TNFa, OPG, collagen-1, and the osteoblast and osteoclast expressions. The expressions of TLR2, OPG and Collagen-1, as well as the number of osteoblast were increased. Meanwhile, the expressions of TNFa and osteoclast were decreased. The study finding was that TLR2 signaling pathway influenced alveolar bone osteogenesis process by reducing osteoclast activity and stimulating osteoblast growth induced by the combination of Aloe vera and XCB.

Facial development disorders due to inhibition to endochondral ossification of mandibular condyle process caused by malnutrition.

OBJECTIVE: To analyze the effect of protein restriction on histomorphometric parameters of bone remodeling in mandibular condyle process and its possible influence in facial development in growing rats. MATERIALS AND METHODS: Wistar rats weaned at the age of 21 days were assigned to one of the following groups: control (fed a regular hard diet ad libitum) and protein restricted (PR) (fed a hard diet lacking in protein ad libitum). The animals were euthanized on day 35 after the onset of the experiment. Mandibles were resected, fixed in 10% formalin, hemisected at the symphysis, and then radiographed in order to perform cephalometric studies of the condylar process length and the height of the lower alveolar process. Mandibles were then processed for light microscopy, and histomorphometric determinations were performed on histologic sections of the condylar process subchondral bone. RESULTS: The PR group showed a significantly lower body weight than control group at the end of the experiment. The length of the condylar process was lower in the PR group; however, the diet used in this study did not affect the height of the lower alveolar process. The histomorphometric analysis showed that the PR group exhibited a statistically significant decrease in bone formation and bone volume in condylar process subchondral bone. CONCLUSION: Protein restriction inhibits bone formation and longitudinal growth in the mandibular condylar process. This result suggest that protein restriction can alter normal facial development.

Mandibular growth and dentoalveolar development in the treatment of class II, division 1, malocclusion using Balters Bionator according to the skeletal maturation.

OBJECTIVE: The purpose of the study was to evaluate the influence of the skeletal maturation in the mandibular and dentoalveolar growth and development during the Class II, division 1, malocclusion correction with Balters bionator. METHODS: Three groups of children with Class II, division 1, malocclusion were evaluated. Two of them were treated for one year with the bionator of Balters appliance in different skeletal ages (Group 1: 6 children, 7 to 8 years old and Group 2: 10 children, 9 to 10 years old) and the other one was followed without treatment ( CONTROL GROUP: 7 children, 8 to 9 years old). Lateral 45 degree cephalometric radiographs were used for the evaluation of the mandibular growth and dentoalveolar development. Tantalum metallic implants were used as fixed and stable references for radiograph superimposition and data acquisition. Student's t test was used in the statistical analysis of the displacement of the points in the condyle, ramus, mandibular base and dental points. One-fixed criteria analysis of variance was used to evaluate group differences (95% of level of significance). RESULTS: The intragroup evaluation showed that all groups present significant skeletal growth for all points analyzed (1.2 to 3.7 mm), but in an intergroup comparison, the increments of the mandibular growth in the condyle, ramus and mandibular base were not statically different. For the dentoalveolar modifications, the less mature children showed greater labial inclination of the lower incisors (1.86 mm) and the most mature children showed greater first permanent molar extrusion (4.8 mm).

Mandibular growth and dentoalveolar development in the treatment of Class II, division 1, malocclusion using Balters Bionator according to the skeletal maturation

OBJECTIVE: The purpose of the study was to evaluate the influence of the skeletal maturation in the mandibular and dentoalveolar growth and development during the Class II, division 1, malocclusion correction with Balters bionator. METHODS: Three groups of children with Class II, division 1, malocclusion were evaluated. Two of them were treated for one year with the bionator of Balters appliance in different skeletal ages (Group 1: 6 children, 7 to 8 years old and Group 2: 10 children, 9 to 10 years old) and the other one was followed without treatment (Control Group: 7 children, 8 to 9 years old). Lateral 45 degree cephalometric radiographs were used for the evaluation of the mandibular growth and dentoalveolar development. Tantalum metallic implants were used as fixed and stable references for radiograph superimposition and data acquisition. Student's t test was used in the statistical analysis of the displacement of the points in the condyle, ramus, mandibular base and dental points. Analysis of variance one-fixed criteria was used to evaluate group differences (95% of level of significance). RESULTS: The intragroup evaluation showed that all groups present significant skeletal growth for all points analyzed (1.2 to 3.7 mm), but in an intergroup comparison, the increment of the mandibular growth in the condyle, ramus and mandibular base were not statically different. For the dentoalveolar modifications, the less mature children showed greater labial inclination of the lower incisors (1.86 mm) and the most mature children showed greater first permanent molar extrusion (4.8 mm).

OBJETIVO: avaliar a influência da maturação óssea no processo de crescimento e de desenvolvimento mandibular e dentoalveolar durante a correção da Classe II, divisão 1, com o Bionator de Balters. MÉTODOS: foram avaliados três grupos de crianças com Classe II, divisão 1. Dois grupos foram tratados por um ano com o aparelho Bionator de Balters, em diferentes idades esqueléticas (Grupo 1: 6 crianças, com 7 a 8 anos de idade; e Grupo 2: 10 crianças, com 9 a 10 anos); e um grupo sem tratamento (Grupo controle: 7 crianças, com 8 a 9 anos). Telerradiografias laterais em norma de 45º foram utilizadas para a avaliação do crescimento mandibular e para o desenvolvimento dentoalveolar. Implantes metálicos de tântalo foram usados como referência fixa e estável para sobreposições radiográficas e aquisição de dados. Na análise estatística do deslocamento de pontos localizados na região de côndilo, corpo e base mandibular e de pontos dentários, foi empregado o teste t de Student; para avaliar as diferenças entre os grupos, usou-se a análise de variância a um critério de classificação (nível de significância de 95%). RESULTADOS: os grupos, quando avaliados individualmente, apresentaram crescimento de todos os pontos esqueléticos de forma significativa (1,2 a 3,7mm); porém, quando comparados entre si, a quantidade de crescimento na região do côndilo, ramo e base da mandíbula não foi estatisticamente diferente. Quanto às alterações dentárias, ocorreu maior inclinação dos incisivos inferiores para vestibular (1,86mm) nos pacientes menos maduros, e maior extrusão dos primeiros molares permanentes (4,8mm) nos pacientes mais maduros.

Vertical alveolar growth in subjects with infraoccluded mandibular deciduous molars.

INTRODUCTION: Our objective was to compare vertical alveolar growth in areas adjacent to infraoccluded deciduous molars with growth in areas of deciduous molars and normal occlusion for a period of at least 1 year by using digital subtraction radiography. METHODS: This case-control study included 40 pairs of panoramic radiographs of growing patients with infraoccluded deciduous molars and 40 pairs of radiographs of patients without infraoccluded deciduous molars. One radiograph at baseline was obtained at diagnosis, and the other at least 1 year later. The subjects and the controls were matched according to chronologic age and time interval between the 2 radiographs. The 2 groups were compared with regard to vertical alveolar growth and vertical tooth movement. Measurements were assessed by using nonparametric tests (Mann-Whitney and Friedman) and a multiple comparison test. Significance was set at 5%. RESULTS: A statistically significant difference was observed between the groups with regard to vertical alveolar growth measured on the bone crest between the first permanent molars and second premolars. CONCLUSIONS: Vertical alveolar growth between the first permanent molar and the second premolar adjacent to the infraoccluded teeth was smaller than in areas adjacent to teeth with normal occlusion.

Radiographic evaluation of alveolar bone height in the primary dentition: a retrospective follow-up study.

PURPOSE: The aim of this retrospective follow-up study was to verify the distance between the cementoenamel junction (CEJ) and the alveolar bone crest (ABC) in bitewing radiographs. METHODS: Radiographs were digitized and divided into groups by: age, proximal crown surface status (sound→sound and unsound→unsound), tooth, and timing of radiograph. The CEJ-ABC distances were measured on the distal surface of the first primary molar and/or the mesial surface of the second lower primary molar, using the Image Tool software. RESULTS: The results revealed interactions between the following variables: timing of radiograph-age, age-tooth, timing of radiograph - proximal crown surface status and age- proximal crown surface status. It has been detected that CEJ-ABC distances have significantly increased with time, particularly in terms of assessment of primary lower first molars. However, this increase is greater in unsound when compared to sound surfaces. CONCLUSION: This study suggests that an increase in the CEJ-ABC distance is directly associated with aging in a normal periodontium in the primary dentition and that the presence of unsound surfaces can be a risk indicator for the development of alveolar bone loss.

Natural changes of the maxillary first molars in adolescents with skeletal Class II malocclusion.

INTRODUCTION: The objective of this study was to evaluate natural changes in maxillary posterior alveolar height (MPAH) and axial inclination of the maxillary first molars (AIMFM) in subjects with Class II malocclusion to determine the validity of predictive equations. METHODS: Longitudinal records of 30 untreated white subjects (13 girls, 17 boys) with skeletal Class II malocclusion were collected at ages 9, 12, 14, and 16 years. They had participated in the Burlington Growth Centre study, and cephalograms were analyzed with Dentofacial Planner Plus software (version 2.0, Dentofacial Planner, Toronto, Ontario, Canada). Serial means were compared with the Bonferroni post-hoc test (P <0.05). Predictive equations were obtained and studied with the analysis of agreement. RESULTS: Gradually, means of MPAH had statistical increments with sexual dimorphism from 14 to 16 years of age. A distal mean of AIMFM was found at 9 years of age that decreased significantly during growth, with sexual dimorphism between the ages of 9 and 12 years. Changes in AIMFM varied among subjects in distinct stages. Values of MPAH were predicted with high validity at intervals of 3 years or longer, whereas estimations for AIMFM were unreliable. CONCLUSIONS: In this study group, there was significant alveolar growth, with a natural tendency to upright the distal inclination at the maxillary first molars.

Growth-associated changes in the periodontal bone and molar teeth of male rats.

Here we report quantitative data associating periodontal bone variables of young conventional rats with the growth process. The hemimandibles of male rats (IIM/Fm stock, 2 to 15 wk of age.) were excised and submitted to conventional morphologic, radiologic, and histologic evaluation. The length, area, or X-ray absorbance of various regions or structures was measured on digital images of radiographs by using an image-analysis program. The sum of periodontal bone areas undergoing resorption (interproximal + intraradicular) increased until 9 or 10 wk of age and decreased thereafter. Mineral accretion rates and mineral density asymptotes were not significantly different among molars. The mineral density of resorption areas in alveolar bone fitted sinusoidal kinetics, indicative of the 'instability' of the tissue due to its high metabolic activity. Mineral accretion rates and mineral density asymptotes were not significantly different among molars. The proportion of root length within alveolar bone exhibited a biphasic curve (minimum at 5 wk of age), due to differences in the growth rates of variables involved in its calculation (distance between the cementoenamel junction to the apex and height of the resorption areas). The distance between the cementoenamel junction and alveolar bone crest over time fitted a sigmoidal function with a point of inflection that did not differ significantly from that of body or mandible dry weight. In summary, the growth process appears to affect periodontal bone support and the distance between the cementoenamel junction and alveolar bone crest in male rats.

Growth and the modeling/remodeling of the alveolar bone of the rat incisor.

The modeling and remodeling of the rat incisor alveolar bone was followed as the animals grew. The weight of the hemimandible, the length of the socket, and the width of the lower incisor were measured. Osteoclasts and resorption areas were identified by tartrate-resistant acid phosphatase staining. Fluorochrome markers were used to detect and measure osteogenic activities. In the socket related to the periodontal ligament, osteoclasts appeared in scattered sites as well as isolated sites of osteogenic activity, apparently without any variation related to the age of the animals. At the socket facing the dental follicle of young rats, the inner surface was lined with osteoclasts. The number of osteoclasts decreased steadily as the rats grew. In 1-year-old rats, in addition to a few scattered osteoclasts, the internal aspect of the labial wall showed some sites lined with osteoblasts and cement lines indicative of prior bone formation. In young rats, there was a continuous osteogenic activity at the external surface of this wall. The thickness of the labial wall of the socket remained apparently constant; therefore, bone resorption must have occurred at the internal side of the wall. Such osteogenic activity was not observed in old rats. The main forces acting on rat incisors, biting and eruption, are continuous through the life of the animals. Thus, these results indicate that the modeling of the alveolar bone related to the dental follicle, in young rats, can only be associated with another force, specifically, the growth of the incisor.

Effect of experimental diabetes on mandible growth in rats.

The aim of the present work was to assess the effects of experimental diabetes on mandible growth in rats. Experimental diabetes was induced in rats, aged 26 d, by a single dose of 100 mg/kg b.w. of Streptozotocin (STZ). Thirty-one d post STZ or vehicle injection, the animals were killed. Mandibles were resected to determine Mandibular Skeletal Units dimensions (MSU) and overall mandible growth. Statistical analysis of results revealed, for STZ treated animals as compared to the control group: 1) a decrease in b.w.; 2) an increase in food intake; 3) an increase in glucemia (200%); 4) normal hemoglobin, creatinine and plasma urea values; 5) a reduction in growth of symphyseal (9%), coronoid (16%), and alveolar (13%) heights, condyloid (11%), angular (8%), and base (3%) lengths, and condyloid width (8%). Mandibular length (4%), height (8%) and length of base (6%) were significantly lower in diabetic animals as compared to the control group. No significant differences in length of symphyseal process, alveolar length and height of base were found between groups. Rats on a restricted diet, resulting in a decreased b.w., and the control group exhibited similar mandibular dimensions. These data show that STZ-induced diabetes reduces mandibular growth, resulting in some deformity of the structure.

Catch-up in mandibular growth after short-term dietary protein restriction in rats during the post-weaning period.

Catch-up growth has been defined as growth with a velocity above the statistical limits of normality for age during a defined period of time which follows a period of impaired growth. Since no data are available on catch-up in mandibular growth, the present study was designed to estimate the dynamics of the mandibular size after short-term dietary protein restriction in rats during the post-weaning period. Weanling male rats, 22 d of age, were divided into two groups, control (C) and experimental (E). E rats were fed a protein-free diet during the first 10 d; from this time on, they were placed on a 20% protein diet, as were C rats during the entire experimental period, which lasted 70 d. Five rats from both groups were randomly selected every 10 d and sacrificed. Mandibular growth was estimated directly on the right mandible by measuring several dimensions (mandibular area, base length, mandibular height, mandibular length, alveolar length and incisor alveolar process length). Alveolar and incisor alveolar process lengths did not change with age or dietary protein. All other dimensions increased with age and were thus negatively affected by protein restriction. After growth restriction ceased, the rate of increase of all affected dimensions was above normal values and deficits were swiftly eliminated. Since age-independent dimensions compose roughly the anterior portion of the mandible, this portion of the bone was not affected by protein restriction. It was, thus, the posterior part of the mandible which stopped growth during the nutritional insult and showed catch-up during nutritional rehabilitation. In summary, the rat mandible has a high potential for catch-up during the post-weaning period, showing the ability to achieve complete catch-up in about 30 d.

Effects of unilateral upper incisor extraction on facial growth of young rats.

The effects of unilateral extraction of the upper incisor (one tooth) on facial growth of young rats were studied. The remaining upper incisor showed deviation towards the opposite side, and there was regular dental wear of all the incisors. The effects were evident only in the mid-facial area. Cephalometric measurements showed significant shortening with deviation of the incisor bone on the extraction side. There was no significant disturbance of the growth of the rest of the maxilla and mandible. These results indicate that upper incisor extractions have a localized influence, leading to impairment of incisor bone growth.

P-A cephalometric analysis of nonoperated adult cleft lip and palate.

P-A cephalometric analysis was performed on the craniofacial morphology in 88 Brazilian men with nonoperated and operated cleft lip and palate. For the comparative study, these subjects were divided into the following four groups: (1) 31 nonoperated unilateral cleft lip and palate (UCLP), (2) 24 nonoperated bilateral cleft lip and palate (BCLP), (3) 16 operated UCLP, (4) 17 operated BCLP. Thirty Brazilian men without cleft lip and palate were used as control subjects. In comparison with the control subjects, nonoperated BCLP and UCLP showed remarkable facial deformity characterized by increased width of various facial parts. Facial morphology of surgically treated BCLP and UCLP, however, was very similar to that of noncleft subjects, apart from the immediate cleft region. There was no remarkable difference in the facial morphology between nonoperated BCLP and UCLP, except for the cleft width and the deviation of nasal septum base, while the only significant difference between operated BCLP and UCLP was in the cleft width.

Growth of the skeletal units of the rat mandible in acute renal failure experimental model.

A study of the effect of acute renal failure (ARF) on the growth of the skeletal units of the mandible was performed. Male Wistar rats weighing 35-40 g were assigned to three groups. One of the groups received a basal choline-deficient diet ad libitum. A second group was pair-fed with the first one and was given a basal diet supplemented with 0.35 g choline chloride/100 g of diet. The third group was fed a basal diet plus 0.35 g choline chloride/100 g of diet ad libitum and used as the normal control. Body length, renal function parameters and measurements of the mandible were recorded at the end of a 12-day period on the different diets. Food intake and body weight were recorded every day. Plasma urea and creatinine concentrations markedly increased over the first 12 days of exposure to a choline-deficient diet. Significant increases in urine volume and significant depressions in urine osmolality were also observed. The average body weight and body length gains for rats given the choline-deficient diet were lower than those of control rats. There were no significant differences between the average body weight and body length of pair-fed and normal rats. All skeletal measurements of the mandible of the choline-deficient group differed significantly from those of the control group. These differences varied between 7% and 30%. The skeletal units of the mandible of the pair-fed group did not differ significantly from ad libitum controls. This study suggests that this rat model can be used for the investigation of the different alterations observed in uremia.(ABSTRACT TRUNCATED AT 250 WORDS)

Mandibular growth and tooth eruption after localized x-radiation.

The effect of localized x-radiation on the growth of mandibular bone and molar eruption was evaluated by morphometric methods. A dose of 20 Gy of x-radiation was given to the molar zone of growing rats. The animals were then killed in groups at 30 and 60 days postirradiation. Two groups of nonirradiated, age-matched rats were used as controls. Parameters related to molar eruption, mandibular length, and mandibular height were measured on lateral radiographs. The results obtained showed that the values of the biometric parameters were lower in experimental than in control animals. Odontoblastic atrophy, alveolodentary ankylosis, and meager or no root formation were the most conspicuous histologic findings. Osteodentin was found between canaliculary dentin and bone in cases of ankylosis. The morphometric data presented confirm the probability of alterations in mandibular growth and tooth eruption following x-radiation and suggest that this be considered in planning radiotherapy in children.