Entire Dental Arch Mesial Movement after Extraction of Maxillary Right Central Incisor due to Root Fracture Treated with Temporary Anchorage Devices.

This case report describes a 19-year-old woman with skeletal Class I crowding and an unsalvageable maxillary right central incisor. She visited our clinic with the chief complaint of mobility of the maxillary right central incisor due to a traffic accident. After extraction of the maxillary right central incisor, the space was closed orthodontically. All the maxillary right teeth were moved mesially with an elastic chain attached to a palatal lever arm which was connected to palatal temporary anchorage devices (TADs). After orthodontic treatment had been completed, the maxillary right lateral incisor and peg-shaped left lateral incisor were restored with a porcelain laminate veneer. The maxillary right canine was morphologically reshaped and built up with composite resin. Consequently, esthetically ideal occlusion and functional lateral guidance with uncontacted molars were obtained. These results show that mesial movement of the entire dental arch with TADs is a useful orthodontic treatment option in patients in whom the maxillary central incisor has been extracted.

Influences of mouth breathing on memory and learning ability in growing rats.

This study was to investigate the influences of habitual mouth breathing on memory and learning ability during the growth period. At age 5 weeks, the experimental rats were subjected to surgery to close completely one side of the nasal cavity. An 8-arm radial maze was used to evaluate memory and learning ability at age 7, 11, and 15 weeks. Moreover, the brain was extracted at age 7, 11, and 15 weeks, and subjected to histomorphometric examination for the distribution and number of pyramidal cells in the hippocampal CA1 and CA3 regions after Nissl staining. The trial time to accomplish each task was significantly longer in the experimental group than in the control group throughout the experimental period. The number of pyramidal cells was significantly less in the experimental rats than in controls in both the CA1 and CA3 regions for the entire experimental period. Thus, the functional deterioration of the respiratory system during the growth phase exerts a substantial effect on the growth and development of the central nervous system.

A case of tooth autotransplantation after long-term cryopreservation using a programmed freezer with a magnetic field.

This case report describes the treatment of a skeletal Class III malocclusion with autotransplantation of a cryopreserved tooth. To gain an esthetic facial profile and good occlusion, extraction of bimaxillary premolars and surgical therapy were chosen. The patient had chronic apical periodontitis on the lower left first molar. Although she did not feel any pain in that region, the tooth was considered to have a poor prognosis. Therefore, we cryopreserved the extracted premolars to prepare for autotransplantation in the lower first molar area because the tooth would probably need to be removed in the future. The teeth were frozen by a programmed freezer with a magnetic field (CAS freezer) that was developed for tissue cryopreservation and were cryopreserved in -150°C deep freezer. After 1.5 years of presurgical orthodontic treatment, bilateral sagittal split ramus osteotomy was performed for mandible setback. Improvement of the facial profile and the occlusion were achieved in the retention phase. Six years after the initial visit, the patient had pain on the lower left first molar, and discharge of pus was observed, so we extracted the lower left first molar and autotransplanted the cryopreserved premolar. Three years later, healthy periodontium was observed at the autotransplanted tooth. This case report suggests that long-term cryopreservation of teeth by a CAS freezer is useful for later autotransplantation, and this can be a viable technique to replace missing teeth.

Ultrasound stimulation attenuates resorption of tooth root induced by experimental force application.

Root resorption is an adverse outcome of orthodontic tooth movement. However, there have been no available approaches for the protection and repair of root resorption. The aim of this study was to evaluate the effects of low-intensity pulsed ultrasound (LIPUS) on root resorption during experimental tooth movement and the effects of LIPUS in the RANKL/OPG mechanism in osteoblasts and cementoblasts in vitro. Twenty four Wistar strain male rats of 12-week-old were used in this study. The upper first molars were subjected to experimental movement in the mesial direction for 1-3weeks. Through the experimental periods, the right upper first maxillary molar was exposed to LIPUS (LIPUS group) every day for 1, 2 or 3weeks. The nature of root resorption was observed and then quantified by histomorphometric analysis. In the 2weeks period, significantly greater amount of tooth movement was observed in the LIPUS group (p<0.05). In addition, LIPUS group showed less root resorption lacunae and lower number of odontoclasts. In the period of 3weeks, LIPUS group presented significantly shorter length of root resorption lacunae and smaller amount of root resorption area (p<0.01). The number of odontoclasts and osteoclasts was also significantly lower in the LIPUS group (p<0.01 and p<0.05, respectively). However, no significant differences could be found regarding the amount of tooth movement. It is shown that LIPUS exposure significantly reduced the degree of root resorption during tooth movement without interrupting tooth movement. In vitro experiments showed that MC3T3-1 constitutively expressed higher levels of RANKL and RANTES mRNA comparing to OCCM-30. However, OPG mRNA expression was much higher in OCCM-30. LIPUS stimulation significantly increased the mRNA expression of RANKL in MC3T3-E1 at 4 (p<0.01) and 12h (p<0.05), although OPG mRNA expression was not affected by LIPUS. In contrast, the expression of RANKL and OPG mRNAs were both significantly increased by LIPUS in OCCM-30 at 12h (p<0.01). Moreover, LIPUS application suppressed the up-regulation of RANKL mRNA induced by compression force in OCCM-30, but no similar effect could be observed in MC3T3-E1. In conclusion, it is suggested that LIPUS exposure significantly reduces root resorption by the suppression of cementoclastogenesis by altering OPG/RANKL ratio during orthodontic tooth movement without interfering tooth movement. LIPUS may be an effective tool to prevent root resorption during tooth movement and is applicable to clinical use in near future.

Effects of vascular endothelial growth factor-C and -D on osteoclast differentiation and function in human peripheral blood mononuclear cells.

OBJECTIVE: The purpose of this study was to clarify the interaction of vascular endothelial growth factors (VEGFs)-C and -D with cell surface foetal liver kinase-1 (Flk-1) and fms-like tyrosine kinase-4 (Flt-4) receptors in the induction and activity of osteoclasts in cultured human peripheral blood mononuclear cells (PBMCs). DESIGN: PBMCs were cultured on chamber slides or on ivory discs for 2 or 3 weeks in the presence of macrophage-colony stimulating factor (M-CSF), VEGF-A, -C or -D, or placental growth factor (PlGF) with or without receptor activator of nuclear factor kappa-B ligand (RANKL). The number of osteoclasts in each group was counted and the area of ivory resorption was measured. In addition, osteoclast differentiation was further analysed under the same conditions, but with the addition of specific neutralizing antibodies against Flk-1 and Flt-4. RESULTS: RANKL was essential for the induction of osteoclasts in PBMCs. However, significant differences were found in the number of osteoclasts induced by VEGF-A, -C, -D or M-CSF with RANKL compared with control groups lacking or containing RANKL. Blocking of either Flk-1 or Flt-4 resulted in a reduction in the enhancement of osteoclast differentiation in PBMCs by VEGF-C or -D with RANKL. The osteoclasts induced by VEGF-A, -C, -D or M-CSF with RANKL formed significantly larger resorption lacunae than those formed by osteoclasts induced by RANKL alone. CONCLUSIONS: This study showed that VEGF-C and -D play a role in the induction of osteoclast differentiation through both Flk-1 and Flt-4 receptors and influence the area of the ivory resorption in PBMCs.

Team management and treatment outcomes for patients with hemifacial microsomia.

INTRODUCTION: Hemifacial microsomia is the most common congenital craniofacial anomaly after cleft lip and palate. The purpose of this study was to evaluate the final outcome of team care for patients with hemifacial microsomia after a protocol of growth management, orthodontic treatment, orthognathic surgery, and soft-tissue augmentation. METHODS: This was a retrospective study with chart reviews, radiographs, and photographs to document the treatment interventions and outcomes. Six patients, 2 in each of 3 mandibular types, who had recently completed treatment and had complete records available and were not previously reported, were included. Facial midlines and maxillary and mandibular deviations from the midline were measured. RESULTS: The maxillary deviation changed by 10.0 ± 4.6 mm to a deviation from the midline of 1.1 ± 0.6 mm. The chin deviation improved by 8.1 ± 2.7 mm to a mean distance of 0.6 ± 0.5 mm from the midline. The occlusal plane can't changed from 7.0° ± 4.2° to 2.3° ± 1.4°. All changes were significant. CONCLUSIONS: Facial asymmetry in patients with hemifacial microsomia can be significantly improved by stepwise orthodontic treatment, orthognathic and facial surgery, and soft-tissue augmentation. As for most craniofacial conditions, team care is essential.

Gummy smile and facial profile correction using miniscrew anchorage.

This case report describes the treatment of a case involving a skeletal Class II facial profile with a gummy smile. While treating a facial profile and a gummy smile, the outcome may not always be successful with orthodontic therapy alone. For this reason, surgical therapy is often chosen to gain an esthetic facial profile and a good smile. However, sometimes the patients reject surgical treatment and an alternative method must be considered. Skeletal anchorage systems such as miniscrews are now frequently used for correcting severe malocclusion that should be treated by surgical therapy. In this case report, we treated a skeletal Class II malocclusion with a convex profile and a gummy smile using miniscrews, which were placed in the upper posterior and anterior areas. The active treatment period was 3.5 years, and the patient's teeth continued to be stable after a retention period of 36 months.

Age-related production of osteoclasts and the changes of serum levels of vascular endothelial growth factor (VEGF) and receptor activator for nuclear factor (NF)-κB ligand (RANKL) in osteopetrotic (op/op) mice.

OBJECTIVE: Expression of osteoclasts in osteopetrotic (op/op) mice is substantially reduced by the absence of functional macrophage colony-stimulating factor (M-CSF). However, it has been reported that osteoclasts do gradually appear in the bones of op/op mice and spontaneously correct the osteopetrosis. DESIGN: Age-related production of osteoclasts and the changes of serum levels of vascular endothelial growth factor (VEGF) and receptor activator for nuclear factor (NF)-κB ligand (RANKL) in op/op mice were examined. RESULTS: The number of femoral osteoclasts, and the serum levels of VEGF, both gradually increased in op/op mice after birth and reached a peak in 120- and 60-day-old mice, respectively. However, the serum levels of RANKL showed an inverse relationship to osteoclast number. CONCLUSIONS: These findings suggest that the appearance of osteoclasts may be influenced by the serum levels of VEGF and that the serum levels of RANKL may be influenced by the appearance of osteoclasts.

In-vitro and in-vivo study of periodontal ligament cryopreserved with a magnetic field.

INTRODUCTION: The purpose of this study was to examine the effect of a new cryopreservation method with a magnetic field on periodontal regeneration in vitro and in vivo. METHODS: Human periodontal ligament cells were frozen in 10% dimethyl sulfoxide by using a programmed freezer with a magnetic field. Cells were cryopreserved for 3 days at -150°C. Immediately after thawing, collagen type I and alkaline phosphatase gene expression were determined by real-time polymerase chain reaction. Incisors were extracted from 15-week-old Wistar rats and cryopreserved or dried for 3 days. Then the incisors were replanted into the same sockets. Ninety days after transplantation, they were observed under light microscopy. RESULTS: There was no difference in the messenger RNA expression of collagen type I between the cryopreserved and the control groups. The expression of alkaline phosphatase messenger RNA in the cryopreserved group was slightly decreased compared with the control group. There was no progressive root resorption in the teeth that were replanted immediately (control group) or cryopreserved. However, there was widespread root resorption and ankylosis in the dried teeth. CONCLUSIONS: These results show that a magnetic field programmed freezer can be successfully used for cryopreservation of teeth.

Treatment of a case of skeletal class II malocclusion with temporomandibular joint disorder using miniscrew anchorage.

At the present time, there are no reports in the literature on the treatment of temporomandibular joint disorder (TMD) by intrusion of molars using mini-screws. This case report describes the treatment for a female patient, aged 19 years seven months, with a TMD and an excessive lower anterior facial height. Overjet and overbite were +5.0 mm and +0.5 mm, respectively. The patient had a history of orthodontic treatment in which her first premolars were all extracted. During the first orthodontic treatment, a clockwise mandibular rotation was observed as a result of the increase of posterior dentoalveolar height. She had temporomandibular joint (TMJ) pain during mouth opening and complained of difficulty in eating due to masticatory dysfunction. The pretreatment Schuller views of both TMJ showed a posterior condyle position. In order to correct the overjet, molar relationship and the mandibular condyle position, a miniscrew was inserted into the palatal region of the upper first molar to intrude the upper posterior teeth. As the upper molars were intruded, the overjet was decreased, and a class I molar relationship was achieved by a counterclockwise mandibular rotation. After one year of treatment, an acceptable occlusion was achieved, and the condyle moved into centric position in the glenoid fossa. The patient's teeth continued to be stable, and she had no pain in TMJ after a retention period of three years. The result of this treatment showed that molar intrusion using miniscrew anchorage is effective for treatment of a TMD patient with a posterior condyle position.

Changes in cortical bone mineralization in the mouse mandible with regenerated condyle.

The objective of this study was to evaluate the effects of condylectomy and of a functional appliance on the mineral content, density, and area of the mandibular cortical bone in a growing mouse model. In the condylectomy group, a unilateral condylectomy was performed on the right side of the mouse mandible. In the condylectomy + appliance group, a functional appliance was used to reposition the mandible after the unilateral condylectomy. All mice were killed 4 wk after surgery. Each mandible was then subjected to analyses of cortical bone mineral content (CRT_CNT), cortical bone density (CRT_DEN), and cortical bone area (CRT_A) by peripheral quantitative computed tomography (pQCT). The CRT_CNT, CRT_DEN, and CRT_A values were significantly lower in the condylectomized mandible (right side) than in the non-condylectomized mandible (left side). However, in the condylectomized animals in which a functional appliance was used, the CRT_CNT, CRT_DEN, and CRT_A values became higher than those in the mice treated with condylectomy alone. No significant differences were found in the CRT_CNT, CRT_DEN, and CRT_A between non-condylectomized (left side) mandibles, mandibles treated with condylectomy + functional appliance (right side), and control mandibles. It was thus shown that a functional appliance used to reposition the condylectomized mandible forward in a symmetric position induced improvement of the cortical bone in a mouse model in terms of cortical bone mineral content, density, and area.

Mesenchymal stem cell-induced cranial suture-like gap in rats.

BACKGROUND: Mesenchymal stem cells are used in the reconstruction of many organs and tissues. However, there are no data regarding cranial suture regeneration using mesenchymal stem cells. Because cranial sutures are important for cranial bone growth, the authors examined whether mesenchymal stem cells could aid with suture reformation in adolescent rats. METHODS: Mesenchymal stem cells were isolated from bone marrow of rat femora. Twenty 4-week-old Fischer 344 male rats received sagittal suture and bone defects with a diameter of 6.0 mm, and mesenchymal stem cells were grafted with membranes. Twenty control rats underwent empty membrane transplantation. The mesenchymal stem cell and control groups were killed at 4, 8, 16, and 24 weeks after surgery. The parietal bones, including the sagittal suture, were observed under a light microscope. Bone structures were measured on digitized photomicrographs captured in a computer. For each sample, bone and suture regeneration were observed by dorsoventral cephalograms. RESULTS: In 4- and 8-week control and mesenchymal stem cell groups, a small volume of new bone formation was observed. In the 16- and 24-week mesenchymal stem cell groups, a large amount of new bone formation and a suture-like gap were identified. In contrast, only a small volume of new bone formation along with craniosynostosis was detected in the 24-week control group. CONCLUSION: These results suggest that mesenchymal stem cell grafting may be a novel option for cranioplasty, not only repairing bone tissue but also resulting in suture-like gap formation, which may advance cranial bone growth.

Expression of Sox 9 and type II and X collagens in regenerated condyle.

The present study was designed to examine the expression of Sox 9 and type II and X collagens in regenerated condyle resulting from the use of a functional appliance. Ninety, 3-week-old, mice were divided equally into the following groups: two experimental groups (condylectomy group and condylectomy with functional appliance group) and the corresponding control group. In the condylectomy group, a unilateral condylectomy was performed on the right side. In the condylectomy with appliance group, the mandible was repositioned in a forward direction using a functional appliance after unilateral condylectomy. The expression of Sox 9 and type II and X collagens in the condyle was determined immunohistochemically 4 weeks after surgery. In mice with a condylectomy, the expression was minimal. On the other hand, these factors were highly expressed in the condylectomized side with the appliance. It is thus speculated that cartilaginous regeneration is due to the expression of chondrogenic factors, such as Sox 9 and type II and X collagens. It is also suggested that condyle regeneration results from an optimal intra-articular environment with appropriate joint spaces achieved by condylar repositioning.

A newly developed snack effective for enhancing bone volume.

BACKGROUND: The incidence of primary osteoporosis is higher in Japan than in USA and European countries. Recently, the importance of preventive medicine has been gradually recognized in the field of orthopaedic surgery with a concept that peak bone mass should be increased in childhood as much as possible for the prevention of osteoporosis. Under such background, we have developed a new bean snack with an aim to improve bone volume loss. In this study, we examined the effects of a newly developed snack on bone volume and density in osteoporosis model mice. METHODS: Orchiectomy (ORX) and ovariectomy (OVX) were performed for C57BL/6J mice of twelve-week-old (Jackson Laboratory, Bar Harbar, ME, USA) were used in this experiment. We prepared and given three types of powder diet e.g.: normal calcium diet (NCD, Ca: 0.9%, Clea Japan Co., Tokyo, Japan), low calcium diet (LCD, Ca: 0.63%, Clea Japan Co.,) and special diet (SCD, Ca: 0.9%). Eighteen weeks after surgery, all the animals were sacrified and prepared for histomorphometric analysis to quantify bone density and bone mineral content. RESULTS: As a result of histomorphometric examination, SCD was revealed to enhance bone volume irrespective of age and sex. The bone density was increased significantly in osteoporosis model mice fed the newly developmental snack as compared with the control mice. The bone mineral content was also enhanced significantly. These phenomena were revealed in both sexes. CONCLUSION: It is shown that the newly developed bean snack is highly effective for the improvement of bone volume loss irrespective of sex. We demonstrated that newly developmental snack supplements may be a useful preventive measure for Japanese whose bone mineral density values are less than the ideal condition.

Fms-like tyrosine kinase (Flt)-4 signaling participates in osteoclast differentiation in osteopetrotic (op/op) mice.

Vascular endothelial growth factor (VEGF) induces osteoclast differentiation as well as neovascularization by binding to the fms-like tyrosine kinase (Flt)-1 and fetal liver kinase (Flk)-1 receptors. The Flt-4 receptor also plays an important role in angiogenesis and lymphangiogenesis. The purpose of this study was to investigate the functions of Flt-4 in the signaling pathway of osteoclast differentiation. We examined the expression of Flt-4 on osteoclast precursor cells (OCPs), and the ability of recombinant human (rh) VEGF-D, one of the ligands of Flt-4, to stimulate the phosphorylation of extracellular-regulated kinase1/2 (ERK1/2) and to activate the nuclear factor-kappa B (NF-kappaB) pathway in OCPs. The number of osteoclasts induced by injection of rhVEGF-D in osteopetrotic (op/op) mice was also evaluated in the absence or presence of neutralizing antibodies to Flt-4. Flt-4 expression was detected on OCPs at both gene and protein levels and stimulation of Flt-4 by rhVEGF-D might induce activation of mitogen-activated protein kinase (MAPK) and NF-kappaB pathways for induction of osteoclast differentiation. Moreover, the number of osteoclasts in op/op mice increased after injection of rhVEGF-D, but was significantly reduced by the injection of Flt-4 neutralizing antibodies. We have therefore shown that Flt-4 expressed on OCPs, might activate MAPK and NF-kappaB pathways and played an important role in osteoclast differentiation.

VEGF and M-CSF levels in periodontal tissue during tooth movement.

It has been reported that both vascular endothelial growth factor (VEGF) and macrophage colonystimulating factor (M-CSF) can induce osteoclast recruitment. Thus, VEGF and M-CSF are considered to be closely involved in the bone remodeling process. The purpose of this study was to evaluate changes in VEGF and M-CSF expression during orthodontic treatment. The expression of VEGF and M-CSF mRNA in osteoblasts and fibroblasts was detected by in situ hybridization during experimental tooth movement in mice. Furthermore, the canine retraction side and the control side of orthodontic patients were compared, revealing a statistically significant increase in both VEGF and M-CSF concentrations in gingival crevicular fluid. These results suggest that orthodontic tooth movement causes an increase in VEGF and M-CSF levels. These factors may induce bone remodeling via osteoclastic bone resorption.

Influences of reduced masticatory sensory input from soft-diet feeding upon spatial memory/learning ability in mice.

It has been reported that reduction of masticatory afferent stimulation might influence learning and memory function. In order to clarify the influences of reduced masticatory sensory input on spatial memory/learning ability and neuropathological changes, we conducted the Morris water maze experiment and investigated the number of hippocampal neurons in association with the differences in masticatory afferent stimuli from hard- and soft-diet feeding in mice. The water maze experiment showed no significant difference in learning ability between 180-day-old solid- and powderdiet groups. Meanwhile, the ability was significantly reduced in the 360-day-old powder-diet group as compared with the age-matched solid-diet group. The total number of pyramidal cells in the hippocampal CA1 and CA3 regions was significantly smaller in 360-day-old powder-diet group than in the remaining groups. These results demonstrate that reduction of masticatory afferent stimuli due to long-term soft-diet feeding may induce neuron loss in the hippocampus and reduced memory/learning ability.

Neutralizing effects of an anti-vascular endothelial growth factor antibody on tooth movement.

Our recent studies demonstrated that local administration of recombinant human vascular endothelial growth factor (rhVEGF) during experimental tooth movement enhanced the number of osteoclasts and the rate of tooth movement. The purpose of this study was to examine the effect of anti-VEGF polyclonal antibody on osteoclastic differentiation, the amount of tooth movement, and the degree of tooth relapse in 30-day-old mice. First, these mice were subjected to various doses of anti-VEGF polyclonal antibody, with tooth movement for three days. In the next study, daily injections of 10-microg antibody were administered for 18 days during the experimental tooth movement. The amount of tooth movement was measured as in our previous study. Furthermore, in the third study, we administered daily injection of 10-microg antibody and measured tooth relapse after the experimental tooth movement for 45 days. The osteoclasts number in 10- and 50-microg antibody two-time injection group was significantly smaller than that in the controls (P < .05). The number of osteoclasts was decreased more substantially by daily injection of 10-microg antibody, showing more significant differences from the controls (P < .01). The amount of tooth movement was significantly less in the experimental group than in the controls on days 15 and 18 (P < .05). Furthermore, the amount of relapse in the experimental group was significantly less than that in the controls on days 9 and 11 after removal of the appliance (P < .05). These results show that the treatment of anti-VEGF polyclonal antibody markedly reduced the osteoclasts number and inhibited the amount of tooth movement and relapse of moved teeth.

Guided bone regeneration to repair an alveolar bone defect in a girl whose cleft lip and palate had been repaired.

We report the case of a girl aged 10 years whose alveolar bony defect was closed with a polytetrafluoroethylene membrane, which was incorporated in bone after 4 months. We suggest that the principle of guided bone regeneration can be used to repair cleft defects provided that the mucoperiosteal flaps are handled carefully and that good anti-infective measures are taken to prevent early exposure and microbial contamination of the membrane barrier.

Bactericidal effects of acidic electrolyzed water on the dental unit waterline.

Many studies have been conducted in the United States regarding the microbial contamination of dental unit waterline, but not in Japan. Recently, acidic electrolyzed water has been used in the medical and dental fields. In this study, we investigated the bactericidal effects of the temporary inflow of acidic electrolyzed water on microbial contamination of the dental unit waterline. First, in order to observe the daily bacterial contamination of the dental unit waterline, water samples were collected at the end of handpieces and three-way syringes before the inflow of acidic electrolyzed water. They were cultured to detect viable bacteria. Later, the inflow of acidic electrolyzed water was conducted through the piping box of the dental unit. Before starting operation on next day, water samples were collected and cultured, as described above. The mean viable bacteria count was 910 -/+ 190 CFU/ml at the end of handpieces, and 521 -/+ 116 CFU/ml at the end of three-way syringes before the inflow of acidic electrolyzed water. However, bacteria were detected in only small numbers at the end of handpieces and three-way syringes on the next day. These results indicated that acidic electrolyzed water could be applied as an appropriate measure against bacterial contamination of the dental unit waterline.