Root Canal Disinfection Articles with the Highest Relative Citation Ratios. A Bibliometric Analysis from 1990 to 2019.

The relative citation rate (RCR) is a normalized article-level metric useful to assess the impact of research articles. The objective of this bibliometric study is to identify and analyze, in root canal disinfection, the 100 articles having the highest RCRs in the period 1990-2019, then compare them with the top 100 articles most cited. A cross-sectional study was performed, and the search strategy ((Disinfection AND root canal) AND (("1990/01/01"[Date-Publication]: "2019/12/31"[Date-Publication]))) relied on PubMed (n = 4294 documents), and article data were downloaded from the iCite database. The 100 articles with the highest RCRs and the top 100 cited were selected and evaluated in bibliometric terms. Among the 100 articles with the highest RCRs, there were no differences in the three decades for RCRs values, but there were in citations, being 2000-2009 the most cited. The USA was the predominant country (n = 30), followed by Brazil (n = 14). The most frequent study designs were reviews (n = 27) and in vitro (n = 25) and ex vivo (n = 24) studies. All subfields were well represented, although they varied over time. In 2010-2019, regenerative procedures and irrigation/disinfection techniques were predominant. Considering the RCR's top 100 articles, 76 were common with the 100 most cited articles. Using the RCR metric allowed us to identify influential articles in root canal disinfection, a research field with topics of significance that fluctuate over time. Compared to citations, RCR reduces the time from publication to detection of its importance for the readership and could be a valid alternative to citation counts.

Influential variables in the Journal Impact Factor of Dentistry journals.

OBJECTIVE: The aim of this contribution is to determine what variables influence the position, by quartiles of the impact factor, as a quality indicator of a journal in the field of Dentistry. METHODS: To this end, 24 journals included in Journal Citation Reports, 6 pertaining to each quartile were selected by a stratified sampling and then an ordinal regression model was estimated stepwise considering the journal impact factor quartile as response variable. RESULTS: The estimation procedure concluded that the average number of papers published yearly by a journal and the percentage of systematic reviews are the most significant variables to be considered, along with the factor representing the journal's degree of adherence to recommendations by the International Committee of Medical Journal Editors. CONCLUSIONS/CLINICAL SIGNIFICANCE: Systematic reviews have significant effect on the Journal Impact Factor position of a journal as well as adherence to ICMJE recommendations, while papers publishing clinical trials bear no influence on this factor. Greater yearly average of published papers in a journal means a higher impact factor.

Bibliometric analysis and evaluation of the journal Medicina Oral Patología Oral y Cirugía Bucal (2008-2018)

BACKGROUND: In 2008 the journal Medicina Oral Patología Oral y Cirugía Bucal was included in Journal Citation Reports. To appraise its evolution and current status, this study carried out a bibliometric analysis and evaluation of the journal for the period 2008-2018. MATERIAL AND METHODS: From the Web of Science, Journal Citation Reports we obtained the indicators Journal Impact Factor (JIF), 5-year JIF, JIF without self-cites, Eigenfactor score and Article Influence score (2010-2017); and from the Core Collection database the following variables: number and article types, institutions and countries of origin of the authors (2008-2018), and the variable cited and citing journal data in 2017. Twelve articles/year (n = 132) were randomly selected to gather: the time between submittal and acceptance of an article, number of authors/article, representation of each section, gender of first author, and funding. RESULTS: The journal occupied the third quartile of the JCR from 2010 to 2017, when it moved up to the second quartile. From 2008 to 2018 it published a total of 1,518 documents, 90% articles and 9.5% reviews. Sixty countries were represented, 48.68% of the documents coming from Spain, and overall 1,293 institutions were involved. Between submittal and acceptance of articles, the average time was 134.42 days, without differences between years. The mean of authors/article was 5.15, increasing over time. The sections most represented were Oral Medicine and Pathology, and Oral Surgery. There were no differences regarding the gender of the first author, and in general the authors did not provide information about funding received. CONCLUSIONS: The bibliometric results indicate a steadily improving position of this journal, along with a tendency to reduce self-citation. The time between reception of an article and its acceptance was very stable, the number of authors per article showed an increase, and there was a nearly equal representation of males and females as the first autor

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Is the trend to publish reviews and clinical trials related to the journal impact factor? Analysis in dentistry field.

It is generally accepted that the Journal Impact Factor is a quality criterion. The objective was to determine the evolution along the period 2010-2016 of number of different types of papers, reviews and clinical trials, published by dental journals, as well as if they are related with the quartile occupied in the Journal Impact Factor 2017 ranking. To this end, ten journals per quartile belonging to the field Dentistry, Oral Surgery and Medicine in the 2017 Journal Citation Reports were randomly selected. For each journal and year, the total number of narrative reviews, systematic reviews (with and without meta-analysis), meta-analysis, clinical trials and randomized controlled trials were obtained from Pubmed. To achieve our goal, the slope of these variables over time was estimated using the least squares method, after which one-way analysis of variance of mean values was performed. In Dentistry, the journals of the top quartiles show a trend to publish increasing amounts of systematic reviews and meta-analysis, than the ones of the third and fourth quartile. On the other hand, globally, there was virtually no increase in narrative reviews, clinical trials and randomized controlled trial. Possible causes of this behavior are also discussed in this article.

The role of bacterial biofilm and mechanical forces in modulating dental implant failures.

Currently many assume that bacteria are the primary etiological factor associated with failure of titanium dental implants. However, emerging data indicates a possible role for mechanical forces in implant failure. This study is based on the hypothesis that the synergistic effect of mechanical forces and bacterial biofilm can lead to surface damage resulting in in vivo release of metallic particles. The primary aim of the study was to develop a dynamic fatigue test method for dental implants immersed in wet environments such as; (i) 0.01 M phosphate buffer saline (PBS); (ii) lactic acid (pH = 5); (iii) bacterial polyculture. Four dental implants each were subjected to fatigue loading from 45 N to 450 N at 4 Hz for 2 million cycles while immersed in (i) PBS (negative control); (ii) bacterial culture (test); and (iii) lactic acid (positive control). Post-testing, optical microscopy, x-ray photoelectron spectroscopy, and electrochemical corrosion tests were performed to evaluate the surface morphology, chemistry, and potential, respectively, of titanium implants. Post-testing, surface discoloration was evident in all three groups. However, the surface damage was further established in XPS analyses of test specimens, which showed that the interplay of bacterial biofilm and mechanical forces resulted in thinning of the TiO2. Lower corrosion potential (Ecorr) of the test specimens compared to positive and negative controls also illustrated damage to the oxide layer. However, other electrochemical parameters such as linear polarization resistance (LPR) and corrosion rate (CR) were comparable among the groups indicating the corrosion resistance post-testing. The synergistic effect of cyclic occlusal loading and bacteria biofilm could negatively affect the surface of titanium dental implants.

Evaluation of oral microbial corrosion on the surface degradation of dental implant materials.

BACKGROUND: Titanium (Ti) dominates as the material of choice for dental implant systems. Recently, titanium-zirconium alloy (TiZr) and zirconia (ZrO2 ) have emerged as alternative materials due to higher mechanical strength and lower corrosion susceptibility. Oral pathogenic bacteria can colonize Ti surfaces, leading to surface degradation, which has yet to be investigated on TiZr and ZrO2 . The aim of this study was to compare in vitro oral bacterial adhesion and subsequent surface degradation on commercial Ti, TiZr, and ZrO2 implants. METHODS: Ti, TiZr, and ZrO2 implants with sandblasted, acid-etched (SLA) surfaces in addition to modified SLA-treated (modSLA) Ti implants (n = 3) were immersed for 30 consecutive days in Streptococcus polyculture. Post-immersion, adherent bacterial count was quantified. Optical microscopy was used to assess qualitative degradation and score Ti-based implants based on degree of surface damage while electrochemical testing quantified corrosion behavior. Analysis of variance followed by post-hoc Tukey test was used to statistically compare quantitative results (α = 0.05). RESULTS: Ti-SLA, Ti-modSLA, and TiZr-SLA implants exhibited localized features characteristic of corrosion attack while ZrO2 -SLA implants experienced minimal changes in surface morphology as compared to non-immersed control. Corrosion features were more numerous on Ti-modSLA implants but smaller in size as compared with those on Ti-SLA and TiZr-SLA implants. No significant differences in corrosion resistance (polarization resistance and corrosion rate) were observed between Ti-SLA, Ti-modSLA, and TiZr-SLA implants. CONCLUSION: TiZr and ZrO2 dental implant surfaces were not more susceptible to colonization and surface degradation by oral Streptococcus species than commercially pure Ti implants.

Multifaceted roles of environmental factors toward dental implant performance: Observations from clinical retrievals and in vitro testing.

OBJECTIVE: Oral bacteria and periodontal pathogen have been predominantly linked with early- and late- stage failures of titanium (Ti) dental implants (DI) respectively. This study is based on the hypothesis that bacterial colonization can damage the surface oxide (TiO2) layer. Early-failed DI were compared with DI post-in vitro immersion in early colonizing oral bacteria; late failed DI were weighed against DI immersed in late colonizing anaerobic pathogens. METHODS: Retrieval analysis: Seven early- stage failed implants with five of them connected to healing abutments (HAs), and ten late- stage failed retrievals were subjected to surface analysis. Bacteria immersion test: Three dental implants each were immersed in polycultures containing (i) early colonizers (Streptococcus mutans, S. salivarius, S. sanguinis) (ii) late colonizers (Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans). The implants were immersed for 30 days to simulate the healing period and bacterial biofilm adhesion. Optical microscope, x-ray photoelectron spectroscopy (XPS), and electrochemical test were performed to analyze the surface- morphology, chemistry, and potential respectively. RESULTS: Early colonizers inflicted surface morphological damage (discoloration and pitting). Even though, XPS detected thinner oxide layer in 2/3 early retrievals, XPS and electrochemical tests illustrated that the TiO2 layer was intact in HAs, and in DI post- immersion. Late colonizers also caused similar morphological damage (discoloration and pitting), while mechanical wear was evident with scratches, cracks, and mechanical fracture observed in late-stage retrievals. XPS indicated thinner oxide layer in late-stage retrievals (3/4), and in DI post-immersion in late colonizers. This was reflected in electrochemical test results post-immersion but not in the late-stage retrievals, which suggested an intact surface with corrosion resistance. SIGNIFICANCE: This study concluded that bacteria could negatively affect implant surface with late colonizers demonstrating more pronounced damage on the surface morphology and chemistry.

Surface characterization of titanium implant healing abutments before and after placement.

BACKGROUND: Implant healing abutments (IHA) have a vital role in soft tissue healing after implant placement. Although there is thorough investigation on the implant surface, little is known about the effects potentially damaging oral conditions impose on healing abutments. PURPOSE: To characterize the surface of titanium healing abutments before and after clinical placement to understand the effects of the oral environment and time on the device surface. MATERIALS AND METHODS: Ten regular Straumann IHA were subjected to characterization pre and postplacement to elucidate the effects of the oral environment on device surfaces. Changes in surface crystallinity, morphology, and elemental composition were monitored with Raman spectroscopy, scanning electron microscopy, optical microscopy, and x-ray photoelectron spectroscopy, respectively. In addition, corrosion rate and polarization resistance were obtained to assess electrochemical device stability after placement. RESULTS: Control analysis indicated the titanium oxide of IHAs was thicker than natural commercially pure titanium and had the structure of crystalline anatase. After removal, the abutments possessed large amounts of biological debris, visible scratches, and discoloration sparsely on the surface. Spectroscopic analysis revealed the titanium oxide on the surface of IHAs was structurally unchanged, with crystalline titanium dioxide still present on the surface. Electrochemical results revealed that implanted healing abutments possessed a significantly higher corrosion rate than controls (change in corrosion rate = 2.34 ± 0.58 nm/year). CONCLUSIONS: Healing abutments were stable in the oral environment due to the chemical stability of the oxide, and were likely subjected to abrasions from unintentional loading and oral hygiene techniques.

In Vitro Evaluation of the Effects of Multiple Oral Factors on Dental Implants Surfaces.

Presence of metal ions and debris resulting from corrosion processes of dental implants in vivo can elicit adverse tissue reactions, possibly leading to peri-implant bone loss and eventually implant failure. This study hypothesized that the synergistic effects of bacterial biofilm and micromotion can cause corrosion of dental implants and release of metal ions in vivo. The goal is to simulate the oral environment where an implant will be exposed to a combination of acidic electrochemical environment and mechanical forces. Four conditions were developed to understand the individual and synergistic effects of mechanical forces and bacterial biofilm on the surface of dental implants; In condition 1, it was found that torsional forces during surgical insertion did not generate wear particle debris or metal ions. In condition 2, fatigue tests were performed in a wet environment to evaluate the effect of cyclic occlusal forces. The mechanical forces applied on the implants were able to cause implant fracture as well as surface corrosion features such as discoloration, delamination, and fatigue cracks. Immersion testing (condition 3) showed that bacteria ( Streptococcus mutans ) were able to create an acidic condition that triggered surface damage such as discoloration, rusting, and pitting. A novel testing setup was developed to understand the conjoint effects of micromotion and bacterial biofilm (condition 4). Surface damage initiated by acidic condition due to bacteria (condition 3), can be accelerated in tandem with mechanical forces through fretting-crevice corrosion. Permanent damage to surface layers can affect osseointegration and deposition of metal ions in the surrounding tissues can trigger inflammation.

In Vitro Evaluation of Titanium Exfoliation During Simulated Surgical Insertion of Dental Implants.

Dissolution of titanium wear particles in the oral environment, and their accumulation in the surrounding tissues have been associated with failure of dental implants (DI). The goal of this study is to investigate the effect of mechanical forces involved in surgical insertion of DI on surface wear and metal particle generation. It was hypothesized that mechanical factors associated with implant placement can lead to the generation of titanium particles in the oral environment. The testing methodology for surface evaluation employed simulated surgical insertion, followed by removal of DI in different densities of simulated bone material. Torsional forces were monitored for the insertion and removal of DI. The surface of the simulated bone materials was inspected with optical microscopy to detect traces of metallic particles that may have been generated during the procedure. Further characterization of the composition of powders collected from osteotomy cavities was conducted with powder X-ray diffraction. The results showed that the different densities of simulated bone material affected the torsional forces associated with implant insertion. However, the mechanical factors involved in the implant insertion/removal procedure did not generate wear particles, as confirmed by powder X-ray experiments.

Effects of decontamination solutions on the surface of titanium: investigation of surface morphology, composition, and roughness.

AIM: To investigate the impact of treatments used to detoxify dental implants on the oxide layer morphology and to infer how changes in morphology created by these treatments may impact re-osseointegration of an implant. MATERIALS AND METHODS: Pure titanium (cpTi) and the alloy Ti6Al4V were subjected to a series of chemical treatments and mechanical abrasion simulating surface decontamination of dental implants. The morphology and roughness of the surface layer before and after treatment with these solutions were investigated with optical and atomic force microscopy (OM, AFM). The solutions employed are typically used for detoxification of dental implants. These included citric acid, 15% hydrogen peroxide, chlorhexidine gluconate, tetracycline, doxycycline, sodium fluoride, peroxyacetic acid, and treatment with carbon dioxide laser. The treatments consisted of both immersions of samples in solution and rubbing with cotton swabs soaked in solution for 1, 2, and 5 min. Cotton swabs used were analyzed with energy dispersive spectroscopy (EDS). RESULTS: The microscopy investigation showed that corrosion and pitting of the samples were present in both metal grades with immersion and rubbing methods when employing more acidic solutions, which had pH <3. Mildly acidic solutions caused surface discoloration when coupled with rubbing but did not cause corrosion with immersion. Neutral or basic treatments resulted in no signs of corrosion with both methods. EDS results revealed the presence of titanium particles on all rubbing samples. CONCLUSION: It was demonstrated in this study that acidic environments coupled with rubbing are able to introduce noticeable morphological changes and corrosion on the surface of both titanium grades.

Characterization of Cement Particles Found in Peri-implantitis-Affected Human Biopsy Specimens.

PURPOSE: Peri-implantitis is a disease characterized by soft tissue inflammation and continued loss of supporting bone, which can result in implant failure. Peri-implantitis is a multifactorial disease, and one of its triggering factors may be the presence of excess cement in the soft tissues surrounding an implant. This descriptive study evaluated the composition of foreign particles from 36 human biopsy specimens with 19 specimens selected for analysis. The biopsy specimens were obtained from soft tissues affected by peri-implantitis around cement-retained implant crowns and compared with the elemental composition of commercial luting cement. MATERIALS AND METHODS: Nineteen biopsy specimens were chosen for the comparison, and five test cements (TempBond, Telio, Premier Implant Cement, Intermediate Restorative Material, and Relyx) were analyzed using scanning electron microscopy equipped with energy dispersive x-ray spectroscopy. This enabled the identification of the chemical composition of foreign particles embedded in the tissue specimens and the composition of the five cements. Statistical analysis was conducted using classification trees to pair the particles present in each specimen with the known cements. RESULTS: The particles in each biopsy specimen could be associated with one of the commercial cements with a level of probability ranging between .79 and 1. TempBond particles were found in one biopsy specimen, Telio particles in seven, Premier Implant Cement particles in four, Relyx particles in four, and Intermediate Restorative Material particles in three. CONCLUSION: Particles found in human soft tissue biopsy specimens around implants affected by peri-implant disease were associated with five commercially available dental cements.

In Vitro Investigation of the Effect of Oral Bacteria in the Surface Oxidation of Dental Implants.

BACKGROUND: Bacteria are major contributors to the rising number of dental implant failures. Inflammation secondary to bacterial colonization and bacterial biofilm is a major etiological factor associated with early and late implant failure (peri-implantitis). Even though there is a strong association between bacteria and bacterial biofilm and failure of dental implants, their effect on the surface of implants is yet not clear. PURPOSE: To develop and establish an in vitro testing methodology to investigate the effect of early planktonic bacterial colonization on the surface of dental implants for a period of 60 days. MATERIALS AND METHODS: Commercial dental implants were immersed in bacterial (Streptococcus mutans in brain-heart infusion broth) and control (broth only) media. Immersion testing was performed for a period of 60 days. During testing, optical density and pH of immersion media were monitored. The implant surface was surveyed with different microscopy techniques post-immersion. Metal ion release in solution was detected with an electrochemical impedance spectroscopy sensor platform called metal ion electrochemical biosensor (MIEB). RESULTS: Bacteria grew in the implant-containing medium and provided a sustained acidic environment. Implants immersed in bacterial culture displayed various corrosion features, including surface discoloration, deformation of rough and smooth interfaces, pitting attack, and severe surface rusting. The surface features were confirmed by microscopic techniques, and metal particle generation was detected by the MIEB. CONCLUSION: Implant surface oxidation occurred in bacteria-containing medium even at early stages of immersion (2 days). The incremental corrosion resulted in dissolution of metal ions and debris into the testing solution. Dissolution of metal ions and particles in the oral environment can trigger or contribute to the development of peri-implantitis at later stages.

Foreign bodies associated with peri-implantitis human biopsies.

BACKGROUND: Peri-implantitis is an inflammatory condition that can lead to implant loss. The aim of this descriptive retrospective study is to describe the histopathologic findings in soft tissue biopsies of implants with peri-implantitis. METHODS: Thirty-six human peri-implantitis biopsies were analyzed using light microscopy (LM) and scanning electron microscopy (SEM). The composition of foreign materials found in the tissues was assessed using an energy dispersive x-ray spectrometer. RESULTS: At the LM level, the inflammatory lesion of peri-implantitis was in most cases a mixture of subacute and chronic inflammation dominated by plasma cells. At the SEM level, radiopaque foreign bodies were identified in 34 of the 36 biopsies. The predominant foreign bodies found were titanium and dental cement. These foreign materials were surrounded by inflammatory cells. CONCLUSIONS: At present, the exact mechanism for introduction of these materials and their role in peri-implantitis is unknown. Further research is warranted to determine their etiology and potential role in pathogenesis.

Detoxification of Implant Surfaces Affected by Peri-Implant Disease: An Overview of Non-surgical Methods.

OBJECTIVE: The aim of this review is to summarize the findings of studies that have evaluated non-surgical approaches for detoxification of implant body surfaces in vitro and in vivo, and to evaluate clinical trials on the use of these methodologies for treating peri-implant disease. MATERIALS AND METHODS: A literature search was conducted using MEDLINE (Pubmed) from 1966 to 2013. In vitro and in vivo studies as well as clinical trials on non-surgical therapy were evaluated. The outcome variables were the ability of the therapeutic method to eliminate the biofilm and endotoxins from the implant surface, the changes in clinical parameters including probing depth, clinical attachment levels, bleeding on probing; radiographic bone fill and histological re-osseointegration. RESULTS: From 134 articles found 35 were analyzed. The findings, advantages and disadvantages of using lasers as well as mechanical and chemical methods are discussed. Most of the in vivo and human studies used combination therapies which makes determining the efficacy of one specific method difficult. Most human studies are case series with short term longitudinal analysis without survival or failure reports. CONCLUSION: Complete elimination of the biofilms is difficult to achieve using these approaches. All therapies induce changes of the chemical and physical properties of the implant surface. Re-osseointegration may be difficult to achieve if not impossible without surgical access to ensure thorough debridement of the defect and detoxification of the implant surface. Combination protocols for non-surgical treatment of peri-implantitis in humans have shown some positive clinical results but long-term evaluation to evaluate the validity and reliability of the techniques is needed.

The case for routine maintenance of dental implants.

The large majority of dental implants are successful over the long term. Failure is usually associated with infection, trauma, inflammation, or a combination of these factors. Early identification and appropriate treatment can identify and eliminate these problems in the majority of cases. Thus routine implant maintenance structured along the guidelines for patients with periodontal diseases is recommended.

Detoxification of implant surfaces affected by peri-implant disease: an overview of surgical methods.

Purpose. Peri-implantitis is one of the major causes of implant failure. The detoxification of the implant surface is necessary to obtain reosseointegration. The aim of this review was to summarize in vitro and in vivo studies as well as clinical trials that have evaluated surgical approaches for detoxification of the implant body surfaces. Materials and Methods. A literature search was conducted using MEDLINE (PubMed) from 1966 to 2013. The outcome variables were the ability of the therapeutic method to eliminate the biofilm and endotoxins from the implant surface, the changes in clinical parameters, radiographic bone fill, and histological reosseointegration. Results. From 574 articles found, 76 were analyzed. The findings, advantages, and disadvantages of using mechanical, chemical methods and lasers are discussed. Conclusions. Complete elimination of the biofilms is difficult to achieve. All therapies induce changes of the chemical and physical properties of the implant surface. Partial reosseointegration after detoxification has been reported in animals. Combination protocols for surgical treatment of peri-implantitis in humans have shown some positive clinical and radiographic results, but long-term evaluation to evaluate the validity and reliability of the techniques is needed.

Titanium Corrosion Mechanisms in the Oral Environment: A Retrieval Study.

Corrosion of titanium dental implants has been associated with implant failure and is considered one of the triggering factors for peri-implantitis. This corrosion is concerning, because a large amount of metal ions and debris are generated in this process, the accumulation of which may lead to adverse tissue reactions in vivo. The goal of this study is to investigate the mechanisms for implant degradation by evaluating the surface of five titanium dental implants retrieved due to peri-implantitis. The results demonstrated that all the implants were subjected to very acidic environments, which, in combination with normal implant loading, led to cases of severe implant discoloration, pitting attack, cracking and fretting-crevice corrosion. The results suggest that acidic environments induced by bacterial biofilms and/or inflammatory processes may trigger oxidation of the surface of titanium dental implants. The corrosive process can lead to permanent breakdown of the oxide film, which, besides releasing metal ions and debris in vivo, may also hinder re-integration of the implant surface with surrounding bone.

Histologic evaluation of an allogeneic mineralized bone matrix in the treatment of periodontal osseous defects.

The aim of this study was to evaluate the potential of an allogeneic bone matrix to regenerate new bone, cementum, and periodontal ligament around a previously diseased root surface. Four patients with severe chronic periodontitis and teeth with hopeless periodontal or restorative prognoses participated in this study. One tooth with a severe intraosseous defect was selected per patient. At baseline, measurements of probing depth, gingival recession, and clinical attachment level were obtained. Following flap reflection, a root notch was placed at the apical extent of the calculus; the root was debrided, and the allogeneic bone graft material was placed into the defect. After a minimum of 6 months of healing, the teeth were removed en bloc and prepared for histologic examination. Two of four teeth demonstrated regeneration of new bone, cementum, and periodontal ligament. One tooth healed by new connective tissue attachment, and another by junctional epthelium.

Trabecular quality and cellular characteristics of normal, diabetic, and charcot bone.

Charcot neuroarthropathy (CN) is a disabling and devastating condition that affects many neuropathic diabetic patients. It can lead to foot deformity, ulceration, and lower extremity amputation. The pathogenesis of CN is not clear, but 1 possible predisposing factor is increased bone turnover and increased osteoclastic activity. Although the affect of diabetes on bone is not entirely clear, studies have shown increased bone fragility in diabetics with neuropathy. The purpose of the present study was to compare the bone quality histologic findings and trabecular histomorphometry, including the cellular characteristics, between normal subjects (N = 7), diabetics without CN (N = 8), and diabetics with CN (N = 8). Histologically, the bone in diabetics with CN displayed an inflammatory, myxoid infiltrate. We also observed a statistically significant decrease in the number of trabeculae in bone in diabetics with CN compared with normal controls (p < .02). However, the difference between the trabeculae in diabetics with CN and diabetics without CN was not statistically significant (p > .05). Histologically, the CN bone appeared to be infiltrated with inflammatory myxoid tissue and had a disorganized trabecular pattern compared with diabetic bone without CN and normal bone. The trabeculae in patients with CN appeared to have poor quality characteristics compared with that of the other groups. The findings from the present study might indicate that diabetes mellitus bone is fragile, and the decrease in the cellular component might impair the reparative process in those with CN foot.