Features of the non-contact carotid pressure waveform: Cardiac and vascular dynamics during rebreathing.

This report amplifies and extends prior descriptions of the use of laser Doppler vibrometry (LDV) as a method for assessing cardiovascular activity, on a non-contact basis. A rebreathing task (n = 35 healthy individuals) was used to elicit multiple effects associated with changes in autonomic drive as well as blood gases including hypercapnia. The LDV pulse was obtained from two sites overlying the carotid artery, separated by 40 mm. A robust pulse signal was obtained from both sites, in accord with the well-described changes in carotid diameter over the blood pressure cycle. Emphasis was placed on extracting timing measures from the LDV pulse, which could serve as surrogate measures of pulse wave velocity (PWV) and the associated arterial stiffness. For validation purposes, a standard measure of pulse transit time (PTT) to the radial artery was obtained using a tonometric sensor. Two key measures of timing were extracted from the LDV pulse. One involved the transit time along the 40 mm distance separating the two LDV measurement sites. A second measure involved the timing of a late feature of the LDV pulse contour, which was interpreted as reflection wave latency and thus a measure of round-trip travel time. Both LDV measures agreed with the conventional PTT measure, in disclosing increased PWV during periods of active rebreathing. These results thus provide additional evidence that measures based on the non-contact LDV technique might provide surrogate measures for those obtained using conventional, more obtrusive assessment methods that require attached sensors.

The randomized shortened dental arch study: oral health-related quality of life.

OBJECTIVES: Although the shortened dental arch (SDA) concept is a widely accepted strategy to avoid overtreatment, little is known on its impact on oral health-related quality of life (OHRQoL). This multicenter randomized controlled trial aimed to investigate the OHRQoL for removable partial dental prostheses (RPDP) with molar replacement versus the SDA concept. MATERIAL AND METHODS: In both groups, missing anterior teeth were replaced with fixed dental prosthesis. Two hundred fifteen patients with bilateral molar loss in at least one jaw were included. The Oral Health Impact Profile (OHIP-49) was completed before; 6 weeks (baseline), 6 months, and 12 months after treatment; and thereafter annually until 5 years. RESULTS: Of the initial cohort, 81 patients were assigned to the RPDP group and 71 to the SDA group (age, 34 to 86 years). Before treatment, the median OHIP score was similar in both groups (RPDP, 38.0; SDA, 40.0; n.s.). Results indicate marked improvements in OHRQoL in both groups between pretreatment and baseline (RPDP, 27.0; SDA, 19.0; p ≤ 0.0001) which continued in the RPDP group until the 1-year follow-up (p = 0.0002). These significant reductions in OHIP scores are reflected in its subscales. No further differences were seen within and between groups during the remainder observation period. CONCLUSION: Both treatments show a significant improvement in OHRQoL which continued in the RPDP group until the 1-year follow-up. No significant differences were seen between groups. CLINICAL RELEVANCE: For improving OHRQoL, it is not necessary to replace missing molars with a RPDP.

Dynamic MRI of the TMJ under physical load.

OBJECTIVES: The objective of this study was to examine the kinematics of structures of the temporomandibular joint (TMJ) under physiological load while masticating. METHODS: Radial MRI was chosen as a fast imaging method to dynamically capture the motions of the joint's anatomy. The technique included a golden ratio-based increment angle and a sliding window reconstruction. The measurements were performed on 22 subjects with and without deformation/displacement of the intra-articular disc while they were biting on a cooled caramel toffee. RESULTS: The reconstructed dynamic images provided sufficient information about the size and localization of the disc as well as the change of the intra-articular distance with and without loading. CONCLUSIONS: The feasibility of the golden ratio-based radial MRI technique to dynamically capture the anatomy of the TMJ under physical load was demonstrated in this initial study.

Influence of dental materials on dental MRI.

OBJECTIVES: To investigate the potential influence of standard dental materials on dental MRI (dMRI) by estimating the magnetic susceptibility with the help of the MRI-based geometric distortion method and to classify the materials from the standpoint of dMRI. METHODS: A series of standard dental materials was studied on a 1.5 T MRI system using spin echo and gradient echo pulse sequences and their magnetic susceptibility was estimated using the geometric method. Measurements on samples of dental materials were supported by in vivo examples obtained in dedicated dMRI procedures. RESULTS: The tested materials showed a range of distortion degrees. The following materials were classified as fully compatible materials that can be present even in the tooth of interest: the resin-based sealer AH Plus(®) (Dentsply, Maillefer, Germany), glass ionomer cement, gutta-percha, zirconium dioxide and composites from one of the tested manufacturers. Interestingly, composites provided by the other manufacturer caused relatively strong distortions and were therefore classified as compatible I, along with amalgam, gold alloy, gold-ceramic crowns, titanium alloy and NiTi orthodontic wires. Materials, the magnetic susceptibility of which differed from that of water by more than 200 ppm, were classified as non-compatible materials that should not be present in the patient's mouth for any dMRI applications. They included stainless steel orthodontic appliances and CoCr. CONCLUSIONS: A classification of the materials that complies with the standard grouping of materials according to their magnetic susceptibility was proposed and adopted for the purposes of dMRI. The proposed classification can serve as a guideline in future dMRI research.

Three-dimensional localization of impacted teeth using magnetic resonance imaging.

Impacted teeth remain embedded in the jawbone beyond the normal eruption time with completed root growth. They can often get infected or damage neighboring teeth. Information about the three-dimensional position of impacted teeth is invaluable in orthodontic diagnosis and treatment planning. The purpose of this prospective study was to assess the feasibility of using magnetic resonance imaging (MRI) for the three-dimensional localization of impacted teeth in children and adults. The study included 39 patients from the pediatric age group with different tooth impactions and seven adults with impacted wisdom teeth. MRI yielded a clear separation between impacted teeth and the surrounding tissue, and the position and angulation of impacted teeth in all three spatial dimensions could be assessed. Compared to conventional radiography, dental MRI provides the advantage of full volumetric morphology accompanied by complete elimination of ionizing radiation, which is particularly relevant for repeated examinations of the pediatric group.

A novel post-and-core restoration system--results of three years of clinical application of the "Wuerzburg Post".

The Wuerzburg Post is a new post-and-core restoration system designed to eliminate the weak parts of post-and-core restorations and the associated problems, respectively. In contrast to conventional posts, the Wuerzburg Post is a short and thick post, which no longer relies on cementation or luting for retention in the root, but on stress-free positive locking, which it achieves by means of a post which can be spread into a predefined and form-congruent undercut cavity. The second key feature is an annular groove which runs in the dentin, girded by a corresponding structure, ensuring regular force transmission and stress dissipation, as opposed to the classic ferrule design. There are two versions: one with a machined core which can be prepared like a classic build-up to support crowns and bridges, and another one with a 2.25 mm ball end to connect to common dies which can be integrated into removable prostheses. As the system utilizes prefabricated parts made from Titanium, a precise fit is ensured, enabling the user to restore teeth quickly and easily. Over the course of the past three years, 129 posts were inserted, most commonly on upper and lower incisors and canines. The main application was restoration of fractured telescopes. During the observation period, five failures were observed. Two of the failiures did not cause significant damage to the tooth, and were subsequently immediately repairable. The survival rate amounts to over 95% after three years under risk.

Monitoring in-shoe plantar pressures, temperature, and humidity: reliability and validity of measures from a portable device.

OBJECTIVE: To investigate the reliability and validity of measures obtained from a portable electronic device used to monitor changes in plantar pressure, temperature, and humidity that occur within the shoe during prolonged activity. DESIGN: Descriptive study comparing electronic sensor output with criterion values. SETTINGS: Indoor level walkway for pressure data; uncontrolled, outdoor environment for step count data; enclosed environmental control chamber for humidity and temperature data. PARTICIPANTS: Convenience sample of 4 healthy, sensate subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Correlations between sensor output and criterion measures were determined for pressure and temperature data. The absolute differences between sensor output and criterion values of temperature, humidity, and step count were also determined. RESULTS: Pressure measurements from electronic sensors correlated highly with criterion values (r > or =.82), both before and after prolonged use. Relative humidity sensor output were within 5% of hygrometer values. In-shoe temperature data correlated highly with criterion values (r > or =.99), and differed from known temperatures by.50 degrees +/-.84 degrees C and.96 degrees +/- 1.56 degrees C at the forefoot and heel, respectively. Electronic step counts recorded at the central forefoot were within 1 step of visual step counts. Pressure tracings obtained from the device during different weight-bearing activities revealed qualitatively distinct pressure patterns. CONCLUSION: The device provides valid and reliable measures of in-shoe plantar pressures, temperature, and humidity during prolonged activity.

In-shoe multisensory data acquisition system.

Patients with diabetes and peripheral neuropathy are susceptible to unnoticed trauma on the foot that can cause skin breakdown. We have designed an electronic system in a shoe that monitors temperature, pressure, and humidity, storing the data in a battery-powered device for later uploading to a host computer for data analysis. The pressure sensors are located at the heel, and under three metatarsal heads. Temperature sensors are located under the medial metatarsal head and under the heel. The humidity sensor is located in the toe of the shoe. Correlations of data from pressure sensors with known values were high (r > 0.85), even after extended use. Although data currently are being collected for descriptive purposes, the design potentially can be used to provide feedback to patients.

Cell culture tests for assessing the tolerance of soft tissue to variously modified titanium surfaces.

The aim of our research project was to achieve an improvement in the integration of enossal dental implants in the region of peri-implantary soft tissue. Improvement in the adhesion of the gingiva of the surface of enossal implants was to be achieved by modification of the titanium surface. The effect of different modifications on the biocompatibility of the modified titanium surfaces was tested: sulfur dioxide plasma treatment of titanium; acetylene plasma treatment of titanium followed by sulfur dioxide plasma etching; plasma nitration of titanium; replacement of titanium by glycidoxypropyltrimethoxy silane; coating titanium with poly[(ethene-co-vinyl acetate)-graft-vinyl chloride] and coating titanium with fibronectin. Determination of the chemical composition of the surface was carried out using X-ray photospectroscopy. The adsorption of fibronectin at the surface of the titanium was tested using an Enzyme Linked Immunosorbent Assay. In selected in vitro tests with human gingival fibroblasts, cell morphology was assessed using scanning electron microscopy and light microscopy. Cell proliferation and protein synthesis, as well as the activity of mitochondrial dehydrogenases were evaluated. By means of centrifugation and by determining initial cell adhesion, the adhesion of gingival fibroblasts was investigated. According to the kind of modification made to the titanium surfaces, it was possible to observe differences in the cellular behavior of gingiva fibroblasts on the differently modified surfaces of the implants. Coating the titanium using fibronectin produced optimization of cell growth and improvement in the adhesion of gingiva fibroblasts to the implant surface. In contrast, modification of the titanium with poly[(ethene-co-vinyl acetate)-graft-vinyl chloride] generally resulted in a deterioration of the biocompatibility of the surface. A marked correlation between the cellular compatibility of the modified titanium and the surface modification made did not become apparent. One reason for this is the large number of parameters determining the interaction between implant and tissue.

In vivo horizontal bending moments on implants.

To date, transverse and vertical forces applied eccentrically to the axis of dental implants in the molar area during oral function have not been quantified. A specially designed load cell placed directly in the implant allowed for measurements of bending moments. Results of both load directions were compared to each other and to the loads applied vertically along the implant axis. The stress in the bone-implant interface area caused by these three different types of loads was calculated by finite element analysis. The transverse loads during chewing resulted in the highest bending moments (170 Nmm mean maximum) and the highest stress in the bone (sigma max approximately 6.2 MPa) at the crest to the buccal side. Mesial implant moment was significantly less (52 Nmm mean maximum moment; sigma max approximately 1.3 MPa). Clenching in centric occlusion caused a bending moment either to the lingual or to the buccal side, depending on the occlusal contour (140 Nmm maximum).

[Characterization of the properties of differently modified titanium surfaces for dental implantology. 1: Methods for surface analysis]. / Charakterisierung der Eigenschaften unterschiedlich modifizierter Titanoberflächen für die zahnärztliche Implantologie. Teil 1: Oberflächenanalytische Verfahren.

Contact between the biological environment and biomaterials takes place at their surfaces. The biocompatibility of a material is determined by interactions at the interface between implant and biological system. The physicochemical surface properties of the materials used, for example, chemical composition, wettability, surface energy and electrical surface charge, therefore play an important role. Within the framework of the investigations described here, specific modifications of the surfaces properties of titanium are effected using various methods with the aim of achieving a positive influence on cell growth and cell attachment. To characterize the physicochemical surface properties, X-ray photoelectron spectroscopy (XPS) have been used. In addition to the clearly altered chemical composition of the modified material surface, it proved possible to determine significant changes in the thermodynamic properties with the aid of contact angle measurements and the determination of surface energy. On the basis of these results, important information about possible interactions at the interface between implant and tissue can be obtained.

[Characterization of the properties of differentially modified titanium surfaces for dental implantology. 2: In vitro biocompatibility studies]. / Charakterisierung der Eigenschaften unterschiedlich modifizierter Titanoberflächen für die zahnärztliche Implantologie. Teil 2: In-vitro-Biokompatibilitätsuntersuchungen.

The aim of the present study was to determine whether specific surface modifications are capable of improving the biocompatibility of a titanium surface, and whether there is a correlation between the physico-chemical properties of the implant material and its biocompatibility. To this end, the properties of titanium surfaces were modified using various methods or the latter were coated with various materials. Plasma treatments under different atmospheric conditions (N2-plasma, SO2-plasma, acetylene plasma) as well as plasma polymerization were used to affect the biological response. Characterization of the physico-chemical surface properties by means of X-ray photoelectron spectroscopy (XPS), contact angle measurements and the calculation of surface tensions or surface energy provided important information on the interactions at the interface between the implant material and the aqueous environment. The influence of the respective surface modification on cell proliferation, cell viability and the activity of mitochondrial dehydrogenases was evaluated in specific in vitro tests with human gingiva fibroblasts. It was show that different modifications of the titanium samples induce different biological responses of the gingiva fibroblasts. The results confirm the existence of correlations between thermodynamic surface properties and cellular reactions under in vitro conditions.

Microbial leakage and marginal fit of the implant-abutment interface.

Two-stage implant systems result in gaps and cavities between implant and abutment that can act as a trap for bacteria and thus possibly cause inflammatory reactions in the peri-implant soft tissues. These gaps between the components are inevitable, and their clinical significance has so far been mostly neglected by both manufacturers and clinicians. The aim of the study was to determine whether there is microbial leakage at the implant-abutment interface. Thirteen different implant-abutment combinations were subjected to an in vitro experiment, in which the penetration of bacteria (Escherichia coli) was observed for 10 assemblies of each type. All implant systems presented microbial leakage. When the Frialit-2 implant was supplied with a silicon washer, there were fewer cases of leakage. The width of the marginal gap between the prefabricated components, measured with a scanning electron microscope, was less than 10 microns in all systems.

A 10-year follow-up study of IMZ and TPS implants in the edentulous mandible using bar-retained overdentures.

This study presents data related to 136 patients who were treated with 300 implants in the edentulous mandible anterior to the mental foramina. Two implant systems were used: the titanium plasma-sprayed screw implant (TPS) and the intramobile cylinder implant (IMZ) in three different modifications. The longest observation time was 11 years, with a mean of 5.7 years. Patients were recalled for regular clinical examinations once every 6 months. After prosthesis placement, only a few implant losses were recorded, although critical states could be found according to periodontal standards. This led to the definition of success criteria according to clinically tolerable bone loss or pocket-probing depths. The 5-year survival rate considering the implant loss was greater than 90% for all implant systems and was lowest for the new type IMZ 3.3. Selecting a vertical bone loss of 4 mm or more as failure criterion reduced the survival rates, which then ranged from 83% to 97% (according to the implant system) for the 5-year interval. The mean annual bone-level change was identified individually for each implant using a linear-regression model.

In vivo vertical forces on implants.

Vertical forces applied to dental implants during oral functions have not been quantified precisely. The key problem has been the lack of suitable measuring devices. This article introduces a new technique for placing a transducer directly in the implant without any increase in vertical dimension. Results were compared to loads applied to teeth. Implants in the molar position that were fixed to a premolar with a prosthesis withstood maximum vertical forces of 60 to 120 N during chewing. Single molars and premolars carried maximum vertical forces of 120 to 150 N. Clenching in centric occlusion caused a load level of approximately 50 N for both natural and artificial abutments. Occlusal prematurities on the implant restoration that were less than 200 microns in height showed no significant increase of the implant load level.

Bone regeneration around titanium dental implants in dehisced defect sites: a clinical study.

Insufficient bone volume can be a significant problem when placing dental implants. This clinical study was designed to evaluate bone regeneration potential at dehisced dental implant sites. Nineteen titanium dental implants with exposed threads were studied. To create a secluded space for bone formation, an expanded polytetrafluoroethylene (e-PTFE) membrane was placed over the exposed implant sites secured with an implant cover screw and completely covered with the flap. Three membranes perforated the overlying soft tissue during the healing time and were removed prematurely. The remaining membranes were removed after an uneventful healing period of 4.5 to 6 months. Fourteen of 19 dehisced implant sites were completely covered with newly formed bonelike tissue; 4 implants demonstrated partial bone fill at reentry and 1 implant showed partial fill with soft tissue. In five implant sites a reentry was performed between 6 and 9 weeks; nonmineralized fibrous tissue was found to fill the space under the membrane. At 16 of the 19 implant sites there were similar dehiscence-type defects that were evaluated as a group. These dehiscences varied from 2.0 to 9.0 mm. The percentage of bone fill at reentry ranged from 28.4% to 100% (mean 89.6%; SD 22.51; SE 5.63) and was highly significant (P < .0001). Six to 12 months after prosthesis connection, 12 of the 19 implants were available for radiographic interpretation and an average bone loss of 1.73 mm (SD = 0.43) was measured. This surgical application of an e-PTFE membrane suggested a viable clinical method for enhancing bone formation around dental implants.

Dental implant abutment resembling the two-phase tooth mobility.

Natural teeth and dental implants have differing degrees of mobility thus causing a potential biomechanical problem when connected by fixed bridgework. The clinical follow-up often discloses marginal bone loss around an implant neck probably due to high stress factors. An implant with a built-in compliance resembling the tooth mobility could be advantageous for stress distribution. With axial loading the proposed 'elastic'-test model accomplishes this demand. By means of theoretical and experimental studies this 'elastic'-test model is optimized and compared with a stiff implant-model. The results show a 20 times reduction of stress accumulation in bone with the 'elastic'-test model.

[Comparative studies on different full and veneer-ceramic crowns]. / Vergleichende Untersuchungen an verschiedenen Voll- und Verblendkeramikkronen.

Under quasi-clinical conditions, Dicor, Hi-Ceram, Ceraplatin and PFM (porcelain butt margin) crowns with ceramic shoulders manufactured by commercial laboratories for the same metal master die were examined for marginal defects under the electron microscope. With equal cementing conditions and points of measurement for all crowns, the PFM crowns were found to be significantly superior to the other crown types. However, this result becomes relativistic in view of the great statistical variances involved.

[Acceptance of polytetrafluoroethylene by subcutaneous connective tissue]. / Die Akzeptanz von PTFE im subkutanen Bindegewebe.

The suitability of extended PTFE as a supporting matrix for subepithelial connective tissue was studied histologically. The main question was whether tissue was able to grow within the implant. After a maximum of seven months post-implantation, no signs of vascularisation but only isolated cells were found within the implant. The histological examination showed neither inflammation nor encapsulation of the implant.