Force degradation study on aligner plates immersed in various solutions.

Background/purpose: The strength of aligners themselves has a high decay rate and is susceptible to accelerated degradation in the environment. The purpose of this study was to compare three types of invisible aligner films after being immersed in coffee, tea, cola, and red wine for seven days and to evaluate the changes in their strengths. Materials and methods: Three types of invisible aligner plates with a thickness of 0.75 mm, i.e., Duran T (polyethylene terephthalate glycol, PETG), Biolon (polyethylene terephthalate, PET), and Zendura FLX (polyurethane, PU), were soaked in artificial saliva and four drinks (coffee, tea, cola, red wine) for 1, 4, and 7 days. The strength test was performed by using the three-point bending test method. The residual strength ratio for the same type of invisible correction film at the same time was separately recorded. The independent t-test was used to indicate significant differences at P < 0.05. Results: The Biolon invisible correction film soaked in cola, red wine and artificial saliva showed significant differences on the 1st and 4th days (P < 0.05). The Duran T invisible correction film soaked in coffee and artificial saliva showed significant differences on the first day (P < 0.05). The Zendura FLX invisible correction film had a waterproof layer on the surface, and there was no significant difference between soaking in any drink and soaking in saliva (P > 0.05). Conclusion: Invisible correction films with different ingredients soaked in solutions show a strength decay phenomenon, except for those with TPU ingredients.

An in vitro evaluation of aligner force decay in artificial saliva.

Background/purpose: The present study aimed to compare the force decay of invisible aligners for maxillary anterior teeth with 0.1 mm (D1), 0.2 mm (D2), and 0.3 mm (D3) labial movement within a simulated oral environment over 7 days. Materials and methods: The prepared invisible aligners were immersed in saliva (S) and subjected to applied force (F) for 7 days. The aligners were set and placed on the maxillary right central incisor with 0.1 mm (D1), 0.2 mm (D2), and 0.3 mm (D3) labial movement. Thin-film pressure sensors were used to measure the aligner force changes. The data were collected and analyzed by statistical methods. Results: Significant differences were observed in the initial and first-day force between the D2 and D3 groups under simulated oral environment force (SF) (P < 0.05). There was a significant difference in force decay between Day 1 and Day 7 for all groups (P < 0.05). The SFD1 group showed a significant decrease in force on Day 5 (P < 0.05), while the SFD2 and SFD3 groups showed significant force decay on Day 4 (P < 0.05). The force decay ratio on Day 7 was higher in the SFD3 group than in the SFD1 and SFD2 groups, but no significant difference was observed. Conclusion: Larger labial movement of the aligners resulted in higher force decay under artificial saliva environments, and the force decay of invisible aligners was increased by immersion time in artificial saliva.

Clinical evaluation of 3D-printed zirconia crowns fabricated by selective laser melting (SLM) for posterior teeth restorations: Short-term pilot study.

Background/purpose: Zirconia crowns (ZrC) without veneering porcelain have become an effective alternative in clinical practice. Monolithic zirconia restorations fabricated by the dry milling method do not have acceptable clinical properties. This study evaluated the periodontal qualities of three-dimensional printed ZrC using the modified United States Public Health Service (USPHS) criteria. Materials and methods: A total of 15 patients who required dental crowns were recruited, and all 15 teeth were restored with digital 3D-printed ZrC. All crowns were assessed at the time of crown placement and 2, 6, and 24 weeks post-placement. Clinical parameters, including plaque index, gingival index, probing depth, crown marginal integrity, and attrition of the antagonist's teeth, were evaluated and recorded. Results: According to the Modified California Dental Association quality evaluation system, 100% of the crowns received satisfactory grades. Despite the significant increase in plaque index and gingival index at two weeks post-ZrC placement, there was no deterioration in probing depth. Moreover, there was discard usage of ZrC on the antagonist's teeth at 24 weeks posttreatment. Of the 15 crowns, one tooth had to be extracted due to a vertical root fracture. Overall, the digital 3D-printed crowns showed no adverse effects on periodontal tissues after 24 weeks of follow-up. Conclusion: The 3D-printed ZrC showed no periodontal problems. It can serve as an alternative for patients, particularly those with high esthetic expectations.

The different irradiation parameters of carbon dioxide laser effects on periodontal ligament cells.

Background: /purpose: Photobiostimulation (PBS) can affect cellular functions. The objective of the present study was to evaluate the cellular changes in periodontal ligament (PDL) cells that received different carbon dioxide (CO2) laser irradiation parameters under negative pressure culture. Materials and methods: The negative pressure-cultured PDL cells on normal medium and differentiation medium were subjected to continuous irradiation with a CO2 laser at an energy density of 5 J/cm2 or 10 J/cm2. The irradiated PDL cells were harvested at Days 1, 5 and 7, and their viability was analyzed by the Presto Blue assay and the biologic markers alkaline phosphatase (ALP), bone sialopoietin (BSP), osteopontin (OPN), osteocalcin (OC), matrix metalloproteinase-3 (MMP-3) collagen I (Col I) and cyclooxygenase-2 (COX-2) expression by reverse transcription-polymerase chain reaction (RT-PCR). Results: The PDL cell viability showed that the differentiation medium groups were higher than the normal culture groups. The cell morphologies were all expressed as spindle type. The inflammatory markers in the laser-irradiated groups were higher on the first day and decreased on the seventh day (P < 0.05). Osteogenesis markers were highly expressed at different time periods (P < 0.05). The Col I and OPN genes were highly expressed on the first day, and the Col I high expression lasted until the seventh day. The OC gene was highly expressed on the seventh day. The effects of PDL cultured in differential medium and normal medium were the same in the present study. Conclusion: A low-dose CO2 laser continuously irradiating cultured PDL cells can induce osteogenesis and reduce cell inflammatory expression.

The Effect of Probiotics Use on Salivary Cariogenic Bacteria in Orthodontic Patients with Various Caries Risk Status.

BACKGROUND: The purpose of this study was to evaluate the change in intraoral cariogenic bacteria density after probiotic use in patients with orthodontic treatment, and to compare the impact of probiotics in patients with various caries risk status. METHODS: Patients that planned to receive orthodontic treatment were recruited according to this study's inclusion/exclusion criteria. A probiotic prescription (Lactobacteria 3 mg, Glycobacteria 2 mg) was started one month after the initial orthodontic treatment. Saliva sampling and cultures using a CRT kit (caries risk test) were performed at three time points (T0, T1, T2). Mutans streptococci (MS) and Lactobacilli (LB) density were evaluated and scored using the interpretation chart in the CRT kit to evaluate the change in bacteria density at three time points, to define the high and low caries risk prior to orthodontic treatment, and to evaluate if there were differences in probiotics between the high and low caries risk groups. RESULTS: Thirty-three orthodontic patients were enrolled, twenty-two classified as high caries risk and eleven as low caries risk. After undergoing treatment for one month, the densities of MS and LB increased significantly (p = 0.011, p = 0.001); probiotics for one month decreased the density of MS and LB, but the differences were statistically nonsignificant (p = 0.109, p = 0.109). Patients classified as low risk of caries demonstrated an increase in MS and LB density one month after orthodontic treatment (p = 0.024, p = 0.001), probiotic use did not result in a significant reduction in bacteria density (p = 1000, p = 0.933). In patients with high caries risk, there were no statistically significant changes in MS count between the three time points (p = 0.127); a significant change in LB density occurred at T0-T1 (p = 0.011) only. CONCLUSIONS: Supplemental use of probiotic oral tablets during orthodontic treatment aimed at reducing cariogenic bacteria count in saliva did not achieve significant differences, regardless of patients' risk status for caries.

The Synergistic Effect of Cyclic Tensile Force and Periodontal Ligament Cell-Laden Calcium Silicate/Gelatin Methacrylate Auxetic Hydrogel Scaffolds for Bone Regeneration.

The development of 3D printing technologies has allowed us to fabricate complex novel scaffolds for bone regeneration. In this study, we reported the incorporation of different concentrations of calcium silicate (CS) powder into fish gelatin methacrylate (FGelMa) for the fabrication of CS/FGelMa auxetic bio-scaffolds using 3D printing technology. Our results showed that CS could be successfully incorporated into FGelMa without influencing the original structural components of FGelMa. Furthermore, it conveyed that CS modifications both the mechanical properties and degradation rates of the scaffolds were improved in accordance with the concentrations of CS upon modifications of CS. In addition, the presence of CS enhanced the adhesion and proliferation of human periodontal ligament cells (hPDLs) cultured in the scaffold. Further osteogenic evaluation also confirmed that CS was able to enhance the osteogenic capabilities via activation of downstream intracellular factors such as pFAK/FAK and pERK/ERK. More interestingly, it was noted that the application of extrinsic biomechanical stimulation to the auxetic scaffolds further enhanced the proliferation and differentiation of hPDLs cells and secretion of osteogenic-related markers when compared to CS/FGelMa hydrogels without tensile stimulation. This prompted us to explore the related mechanism behind this interesting phenomenon. Subsequent studies showed that biomechanical stimulation works via YAP, which is a biomechanical cue. Taken together, our results showed that novel auxetic scaffolds could be fabricated by combining different aspects of science and technology, in order to improve the future chances of clinical applications for bone regeneration.

Evaluation of skeletal and dentoalveolar changes in class II division I pediatric patients receiving myofunctional appliance therapy: A preliminary study.

BACKGROUND/PURPOSE: The treatment effect of myofunctional appliance therapy has remained debated. The aim of this study was to evaluate the skeletal and dentoalveolar effects in class II division I pediatric patients receiving Education Fonctionnelle (EF) myofunctional appliance therapy. METHODS: Thirteen patients undergoing EF appliance treatment (9 boys and 4 girls；average 9.3years old) met the inclusion criteria and 13 untreated patients (9 boys and 4 girls；average 9.9 years old) served as controls. Initial and one-year follow-up lateral cephalometric measurement was used to assess skeletal and dentoalveolar changes. Gender ratio was analyzed using Chi-square test. Age and cephalometric measurement changes within and between the two groups were analyzed using Mann-Whitney U test and Wilcoxon signed rank test and Benjamini - Hochberg procedure. RESULTS: There were no significant differences in age, gender ratio, and initial cephalometric measurement data between the two groups. One-year follow-up skeletal findings revealed no significant differences between the two groups. Regarding the dentoalveolar changes, only the values of the upper incisor angle related parameters revealed significances between the two group (with adjusted p value). CONCLUSION: In this preliminary small sample size study, the EF group demonstrated significant upper incisor angle decrease, lower incisor angle increase, and lower incisor tip to mandibular plane distance decrease in comparison to the values measured in the control group. However, only the upper incisor angle changes were statistically significant after p-value adjustment. The skeletal effect of the EF appliance could not be verified in one-year follow-up of cephalometric data.

Patients with juvenile idiopathic arthritis are at increased risk for obstructive sleep apnoea: a population-based cohort study.

BACKGROUND AND OBJECTIVES: Juvenile idiopathic arthritis (JIA), an autoimmune disease, has been proposed to be comorbid with obstructive sleep apnoea (OSA). We aimed at testing the hypothesis that patients with JIA may presented with high risk of OSA in a cohort study. SUBJECTS AND METHODS: This is a cohort study including patients with JIA from 1999 to 2013 identified from a longitudinal health registry. A matched non-JIA control group was also included. The primary outcome variable was presence of OSA. A Cox proportional hazard model was developed to estimate the risk of OSA in patients with JIA. A cumulative probability model was adopted to assess the time-dependent effect of JIA on OSA development, implying a causal link of the association. RESULTS: A total of 2791 patients with JIA were included, and 11 164 individuals without JIA were selected as matched controls. A total of 95 included subjects had OSA: 31 in the JIA group and 64 in the control group. Patients with JIA were more likely to have OSA compared with controls (adjusted hazard ratio, aHR = 1.922, 95% confidence interval [CI] = 1.244-2.970). The incidence of developing OSA was particularly high among patients with JIA-associated deformity that presented at age 18-30 years (aHR = 1.993, 95% CI = 1.277-3.113) and males (aHR = 1.786, 95% CI = 1.097-2.906). The risk of developing OSA increased over 60 months (aHR = 2.523, 95% CI = 1.322-4.815) of follow-up after the JIA diagnosis. CONCLUSIONS: Patients with JIA have a significantly increased risk of developing OSA compared with matched individuals without JIA.

The Development of Light-Curable Calcium-Silicate-Containing Composites Used in Odontogenic Regeneration.

Pulp regeneration is one of the most successful areas in the field of tissue regeneration, despite its current limitations. The biocompatibility of endodontic biomaterials is essential in securing the oral microenvironment and supporting pulp tissue regeneration. Therefore, the objective of this study was to investigate the new light-curable calcium silicate (CS)-containing polyethylene glycol diacrylate (PEGDA) biocomposites' regulation of human dental pulp stem cells (hDPSCs) in odontogenic-related regeneration. The CS-containing PEGDA (0 to 30 wt%) biocomposites are applied to endodontics materials to promote their mechanical, bioactive, and biological properties. Firstly, X-ray diffraction and Fourier-transform infrared spectroscopy showed that the incorporation of CS increased the number of covalent bonds in the PEGDA. The diameter tension strength of the CS-containing PEGDA composite was significantly higher than that of normal PEGDA, and a different microstructure was detected on the surface. Samples were analyzed for their surface characteristics and Ca/Si ion-release profiles after soaking in simulated body fluid for different periods of time. The CS30 group presented better hDPSC adhesion and proliferation in comparison with CS0. Higher values of odontogenic-related biomarkers were found in hDPSCs on CS30. Altogether, these results prove the potential of light-curable CS-containing PEGDA composites as part of a 'point-of-care' strategy for application in odontogenesis-related regeneration.

Effects of treatment with local anesthetics on RANKL expression in MG63 and PDL cells.

BACKGROUND/PURPOSE: Local anesthesia (LA) application is a routine dental work in clinic. The aim of present study was to evaluate the extent of biologic effects of LA on periodontal ligaments (PDL) or bone cells (MG63). MATERIALS AND METHODS: Local anesthetics (LAs) at different concentrations were added to PDL and MG 63 cells. The viability of the cells was analyzed using an MTT assay. The inflammatory markers, COX-2, IL-1, IL-6 and TNF-A, of PDL and MG63 cells treated with LAs were analyzed with a Western blot assay. The extract medium of the LA-treated PDL cells was added to the MG63 cells for subsequent culture and to examine the RANKL, ALP, and OPG expression. The data were statistically analyzed with p < 0.05 set as an indication of significance. RESULTS: The viability of the PDL and MG63 cells was less 50% at LAs concentrations above the 10 mM. At high LA concentrations, the PDL and MG63 cells treated with LAs became spherical in shape, or vesicles developed in the cytoplasm. The IL-1, IL-6, and TNF-A expression in the PDL groups showed no statistical differences between Septanest and Scandonest (p > 0.05). The RANKL expression in the MG63 cells increased as the Septanest and Scandonest concentrations were increased in the PDL extract medium (p < 0.05) after 48 h of culturing. CONCLUSION: The LAs with adrenaline increased inflammation in the PDL and MG63 cells. The LA-treated PDL extract medium increased the RANKL expression in the MG63 cells.

Bidirectional Differentiation of Human-Derived Stem Cells Induced by Biomimetic Calcium Silicate-Reinforced Gelatin Methacrylate Bioink for Odontogenic Regeneration.

Tooth loss or damage is a common problem affecting millions of people worldwide, and it results in significant impacts on one's quality of life. Dental regeneration with the support of stem cell-containing scaffolds has emerged as an alternative treatment strategy for such cases. With this concept in mind, we developed various concentrations of calcium silicate (CS) in a gelatin methacryloyl (GelMa) matrix and fabricated human dental pulp stem cells (hDPSCs)-laden scaffolds via the use of a bioprinting technology in order to determine their feasibility in promoting odontogenesis. The X-ray diffraction and Fourier transform-infrared spectroscopy showed that the incorporation of CS increased the number of covalent bonds in the GelMa hydrogels. In addition, rheological analyses were conducted for the different concentrations of hydrogels to evaluate their sol-gel transition temperature. It was shown that incorporation of CS improved the printability and printing quality of the scaffolds. The printed CS-containing scaffolds were able to release silicate (Si) ions, which subsequently significantly enhanced the activation of signaling-related markers such as ERK and significantly improved the expression of odontogenic-related markers such as alkaline phosphatase (ALP), dentin matrix protein-1 (DMP-1), and osteocalcin (OC). The calcium deposition assays were also significantly enhanced in the CS-containing scaffold. Our results demonstrated that CS/GelMa scaffolds were not only enhanced in terms of their physicochemical behaviors but the odontogenesis of the hDPSCs was also promoted as compared to GelMa scaffolds. These results demonstrated that CS/GelMa scaffolds can serve as cell-laden materials for future clinical applications and use in dentin regeneration.

Effects of different aligner materials and attachments on orthodontic behavior.

BACKGROUND/PURPOSE: The orthodontic aligner becomes popular worldwide in orthodontic therapy as an esthetic alternative to fixed labial braces. This study evaluated orthodontic tooth movement behavior using different aligner materials and attachment shapes for the movement of a single tooth. MATERIALS AND METHODS: First bicuspid extracted resin typodont models were printed with a 3D printer. Three type of attachments, an ellipsoid shape (thick and thin) and a bar, were designed to fit the canine crown surface. Three types of aligner materials, Polyethylene Terephthalate enhanced with glycol (BIOSTAR) Polyethylene Terephthalate (BenQ), and Thermoplastic polyurethanes (TPU) were used to fabricate different aligners. The typodonts with aligners were sunk in a water bath to simulate canine distal movement in vivo. The canine crown, root movement, and long axis angle changes in each step were calculated and recorded. The data were analysed using a oneway ANOVA statistical method. RESULTS: Comparing the three aligners, the changes the long axis of the canine showed that the BENQ group had a smaller change in the long axis angle. The BENQ group canine involved bodily movement, but the canine movement of the BIOSTAR and TPU group involved tipping. Comparing the three attachments, the bar type attachment had more canine crown tipping in the BIOSTAR and TPU groups. The thick and thin ellipsoid-shaped attachments showed no statistical differences in tooth movement. CONCLUSION: Attachment shape or size had little influence on the bodily movement of the tooth. A high modulus material may thus be suitable for clinical applications.

The synergistic effects of Xu Duan combined Sr-contained calcium silicate/poly-ε-caprolactone scaffolds for the promotion of osteogenesis marker expression and the induction of bone regeneration in osteoporosis.

Osteoporosis and its related problems such as fractures are gradually becoming common due to an aging population. Current methods to treat osteoporosis include medical and surgical options such as bone implants. Recent developments in 3D printing and materials science technologies has allowed us to fabricate individualized scaffolds with desired properties. In this study, we mixed Xu Duan into strontium­calcium silicate powder at 5% (XD5) and 10% (XD10) and fabricated 3D scaffolds with polycaprolactone. All scaffolds were assessed for its physical, mechanical, and biological properties to evaluated for its feasibility for bone tissue engineering in the osteoporosis model. Our results showed that such a scaffold could be fabricated using extrusion-based printing techniques and that addition of XD did not alter original structural properties of the SrCS. Furthermore, the XD5 and XD10 scaffolds were found to be non-toxic to cells and cells cultured on the scaffolds had significantly higher proliferation and secreted increased osteogenic-related proteins in in vitro studies as compared to the XD0 groups. Remarkably, the XD10 scaffolds could be used as substitutes for the critical-sized bone defect (7.0 mm diameter and 8.0 mm depth) in the osteoporotic rabbit model. The XD10 scaffolds can enhance bone ingrowth and accelerate new bone regeneration even in complex osteoporotic pathological environments. These results showed that such a Chinese medicine-contained scaffold had potential in osteoporosis bone tissue regeneration and could be considered as a promising tool for future clinical used applications.