Use of transforming growth factor-ß loaded onto ß-tricalcium phosphate scaffold in a bone regeneration rat calvaria model.

BACKGROUND: Transforming growth factor-ß (TGF-ß1 ) enhances mesenchymal stem cell (MSC) differentiation into osteoblasts. PURPOSE: The aim of the study was to assess whether TGF-ß1 loaded onto ß-tricalcium phosphate (ß-TCP) synthetic scaffold enhances bone regeneration in a rat calvaria model. The release kinetics of TGF-ß1 from ß-TCP scaffold was evaluated in vitro. MATERIALS AND METHODS: TGF-ß1 in various concentrations (1-40 ng/mL) was loaded onto the ß-TCP scaffold, and release kinetics was monitored by ELISA. The effect of TGF-ß1 on the proliferation of MSCs was assessed using AlamarBlue, and MSC differentiation was evaluated by Alizarin Red quantification assay.Bone augmentation following transplantation of TGF-ß1 loaded onto ß-TCP in a rat calvaria model was evaluated in vivo. RESULTS: Greater TGF-ß1 release from the 40 ng/mL concentration was found. A suppressive effect of TGF-ß on the MSCs proliferation was observed with maximum inhibition obtained with 40 ng/mL compared to the control group (P = .028). A positive effect on MSCs osteogenic differentiation was found.Bone height and bone area fraction in vivo were similar with or without TGF-ß1 ; however, blood vessel density and degradation of the scaffold were significantly higher in the TGF-ß1 group. CONCLUSION: TGF-ß1 adsorbed to ß-TCP stimulated angiogenesis and scaffold degradation that may enhance bone formation.

Soft and Hard Tissue Changes around Tissue-Oriented Tulip-Design Implant Abutments: A 1-Year Randomized Prospective Clinical Trial.

BACKGROUND: The advantages of platform switching using narrower abutments remain controversial. Many researchers suggest that platform switching can yield enhanced clinical results, while others remain skeptical. We hypothesize that the effectiveness of platform switching might be associated with the degree of reduction in size of the abutment. PURPOSE: To radiographically and clinically examine a new abutment design created to move the implant-abutment interface farther medially. MATERIALS AND METHODS: This was a prospective, randomized controlled clinical trial that included 27 patients (41 MIS Lance Plus® implants; MIS Implant Technologies, Karmiel, Israel). The patients' age ranged from 39 to 75 years. At the second stage of the surgery, the implants were randomly assigned to either the new platform switch Tulip abutment (TA) design or to the standard platform abutment (SA). Implant probing depth (IPD) and bleeding on probing (BOP) were recorded at baseline and after 12 months. Standardized periapical radiographs were taken (at baseline and at 12 months) and the marginal bone height measured. RESULTS: All implants were successfully integrated. The mean IPD at 1 year post-op was 2.91 mm for the SA group and 2.69 mm for the TA group (p > .05). Similarly, the BOP at 1 year was almost identical in both groups. The mean values of bone resorption at baseline were 0.98 ± 0.37 mm and 0.69 ± 0.20 for the TA and SA groups, respectively (p > .05). Bone loss (baseline to 12 months) was significantly greater in the SA group compared with the TA group. CONCLUSIONS: Use of the new TA, with its significantly downsized diameter, resulted in reduced bone loss at 1 year. Further research will be required to assess the long-term effect of this abutment on peri-implant health.

Dynamic high-resolution sonography compared to magnetic resonance imaging for diagnosis of temporomandibular joint disk displacement.

OBJECTIVES: The purpose of this study was to determine the value of dynamic high-resolution sonography for evaluation of temporomandibular joint (TMJ) disk displacement compared to magnetic resonance imaging (MRI) with the mouth closed and during the maximal mandibular range of motion. METHODS: Dynamic high-resolution sonography with the mouth closed and during the maximal mandibular range of motion was performed on 39 consecutive patients (78 joints; 13 male and 26 female; age range, 18-77 years; mean age ± SD, 37.23 ± 16.26 years) with TMJ disorders. A TMJ MRI study was performed 1 to 7 days after sonography. We searched for signs of disk displacement and findings compatible with degenerative joint disease. Both studies were performed and interpreted independently by blinded operators. RESULTS: Magnetic resonance imaging depicted 22 normal joints (28.2%), 21 (26.9%) with anterior disk displacement with reduction, 15 (19.2%) with anterior disk displacement without reduction, and 20 (25.6%) with degenerative disease. Sonography depicted 30 normal joints (38.5%), 22 (28.2%) with anterior disk displacement with reduction, 12 (15.4%) with anterior disk displacement without reduction, and 14 (17.9%) with degenerative disease. The overall sensitivity, specificity, and accuracy of sonography for diagnosis of disk displacement were 74.3%, 84.2%, and 77.7%, respectively. The sensitivity, specificity, and accuracy for diagnosis of disk displacement with reduction were 78.6%, 66.7%, and 73.0%, and the values for diagnosis of disk displacement without reduction were 66.7%, 78.6%, and 73.0%. CONCLUSIONS: Dynamic high-resolution sonography is a potential imaging method for diagnosis of TMJ disk displacement and degenerative diseases. Further studies are needed to make dynamic high-resolution sonography the first-line test for diagnosis of TMJ disk displacement.

Oral and dental restoration of wide alveolar cleft using distraction osteogenesis and temporary anchorage devices.

Closure of large alveolar clefts and restoration by a fixed bridge supported by implants is a challenge in cleft alveolus treatment. A major aesthetic concern with distraction osteogenesis is obtaining a predictable position of the implant in relation to the newly generated bony alveolar ridge. We describe the treatment of a large cleft alveolus and palate reconstruction by distraction osteogenesis utilizing temporary anchorage devices (TADs) followed by a fixed implant-supported bridge. The method consists of segmental bone transport by distraction osteogenesis using a bone-borne distractor to minimize the alveolar cleft, followed by closure of the residual small defect by bone grafting three months later. During the active transport distraction, TADs were used exerting multidirectional forces to control the distraction vector forward and laterally for better interarch relation. A vertical alveolar distraction of the newly reconstructed bone of 15 mm facilitated optimal implant placement. The endosseous implants were osteointegrated and supported a fixed dental prosthesis. In conclusion, the large cleft alveolus defect was repaired in three dimensions by distraction osteogenesis assisted by TADs, and the soft tissues expanded simultaneously. Endosseous implants were introduced in the newly reconstructed bone for a fixed dental prosthesis enabling, rehabilitation of aesthetics, eating and speaking.

Short and long-term usage of a dental device in sleep apnea syndrome.

OBJECTIVE: To assess the efficacy, the compliance, and the complications of the anterior mandibular positioning (AMP) device in obstructive sleep apnea syndrome (OSA) patients. MATERIAL & METHODS: Polysomnographic sleep studies were performed on 38 patients before and two weeks (+/- 3 days) after continuous use of the AMP device. Twenty patients also underwent polysomnographic follow-up recordings after 1 year. RESULTS: The mean apnea-hypopnea index (AHI) before treatment was 35.6 +/- 17.7 and decreased significantly to 22.7 +/- 15.8 after 2 weeks of treatment (p = 0.01). The mean AHI after 1 year of usage was 25.3 +/- 12.9, differing significantly from the pretreatment AHI (p = 0.01). Seventy-one percent of patients used the device for 18.4 months (range 12-27). One-year clinical evaluation showed preserved dental status, preserved action of the masticatory muscles, and preserved function of the temporo-mandibular joint (TMJ). Eleven (29%) of the patients did not use the AMP device because of TMJ pain and/or unsatisfying results. CONCLUSIONS: The AMP device is well tolerated in 76% of patient. When tolerated, its compliance and efficiency are preserved across the year without long-term oral and jaw dysfunctions.

Dental implants for immediate fixed restoration of partially edentulous patients: a 1-year prospective pilot clinical trial in periodontally susceptible patients.

BACKGROUND: The aim of this study was to evaluate the survival of dental implants in periodontally susceptible patients using immediate loading/restoration (ILR) protocols and the factors that modulate this response. METHODS: Systemically healthy patients who were treated previously for chronic periodontitis and who required implant therapy were recruited. Following data collection, "surgical templates" and provisional fixed restorations were fabricated. Transgingival implants were inserted, and surgical measurements were performed. After abutment connection, the crown/bridge was relined and cemented. Patients were monitored for 12 months, at which time final measurements were performed. RESULTS: Twenty patients (49 implants) completed this study; five implants failed and were removed (90% survival rate). All implants were removed during the first 6 months. At 12 months, the mean implants' probing depth was 2.87 +/- 0.9 mm. The mean electronic mobility testing device value (-1.3 +/- 0.7) was slightly higher than at baseline (-3.53 +/- 10.7). Radiographic bone loss ranged between -1.24 and 2.77 mm (mean +/- SD: 0.91 +/- 0.2 mm). All of the implants (16) that were inserted in the premolar region were successful, whereas three of nine implants in the molar region and two of 24 implants in the canine/incisor region failed (P = 0.0278). Survival in the immediately loaded group (83%) was slightly lower than in the immediately restored group (96%); however, these differences did not reach statistical significance. None of the other variables (smoking, arch, stability, implant length and diameter, and bone width) affected the outcome of this procedure. CONCLUSIONS: ILR protocols are predictable alternatives in periodontally susceptible patients. Results in the molar regions suggested that careful consideration should be given to implants placed in these sites. Long-term success in these patients has not been addressed.

Mandibular defect repair by TGF-beta and IGF-1 released from a biodegradable osteoconductive hydrogel.

PURPOSE: Bone regeneration is crucial in the healing of defects in the craniofacial complex. The ability of transforming growth factor-beta1 (TGF-beta1) and insulin-like growth factor-1 (IGF-1), incorporated into a hydrogel scaffold to induce bone regeneration, was evaluated in a rat mandible defect model. MATERIAL AND METHODS: Hydrogel scaffolds containing either transforming growth factor-beta1 (TGF-beta1), insulin-like growth factor-1 (IGF-1), TGF-beta+ IGF-1, or saline, were implanted in rat mandibular bone defects. In a control group the defects were treated by saline alone. Bone defect healing was tested after 3 and 6 weeks by radiology and morphology. RESULTS: Soft tissue radiographs indicated that the area of new bone formation increased gradually after 3 and at 6 weeks. The percentage of closure after 3 weeks was less than the percentage closure after 6 weeks. The amount of calcified material in the TGF-beta and TGF-beta+IGF-1-treated groups had increased more than in the saline-containing hydrogel and control (saline-treated) defects. The percentages of defect closures were 37, 38, 24, 14, and 11% after 3 weeks, and 94, 91, 84, 72, and 29% after 6 weeks, in the TGF-beta+IGF-1, TGF-beta, IGF-1, saline containing hydrogel and saline-treated animals, respectively. Three-dimensional computerized tomography (3D CT) images showed that the 3D shape of the bones was restored. Morphological analysis of the defects treated with hydrogel containing TGF-beta, IGF-1 or TGF-beta+IGF-1 revealed significant bone formation after 6 weeks. CONCLUSION: It is concluded that the hydrogel scaffold impregnated with growth factors can induce bone regeneration and is therefore a promising surgical tool for enhancement of surgical repair of bone defects.

Association of metalloproteinases, tissue inhibitors of matrix metalloproteinases, and proteoglycans with development, aging, and osteoarthritis processes in mouse temporomandibular joint.

The temporomandibular joint (TMJ) is an important growth and articulation center in the craniofacial complex. In aging it develops spontaneous degenerative osteoarthritic (OA) lesions. Metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPS) play key roles in extracellular matrix remodeling and degradation. Gelatinase activities and immunohistochemical localization of MMP-2, -3, -8, -9, and -13 and TIMP-1 and -2 were examined in mandibular condyle cartilage of neonatal mice up to 18 months old. The most intense immunostaining for all enzymes and TIMPs and the peak of gelatinase activities were found in animals in the stages of early growth (1 week to 3 months) followed by a decrease during maturation and aging. However, clusters of positively immunoreactive chondrocytes were detected in cartilages of old animals displaying OA lesions. Positive safranin-O staining, indicative of sulfated proteoglycans (PGs), was prominent in the TMJ of newborn mice up to 3 months old followed by reduction during maturation and aging, except in regions displaying OA lesions. Temporal codistribution of PGs, MMPs, and TIMPs during skeletal maturation reflected an active growth phase, whereas their reduction coincided with the more quiescent articulating and maintenance phase in the joint cartilage. Osteoarthritic lesions were associated with both increased PG synthesis and MMP immunoreactivity, indicating limited repair activity during initial stages of osteoarthritis.

Early nonsurgical correction of congenital auricular deformities.

Congenital auricular deformation is not an uncommon phenomenon, and it may cause substantial annoyance to the growing child. Many parents of affected children will seek surgical correction of the deformed auricles. The variety of techniques that have been described for the correction of this anomaly suggests that none has been considered satisfying. The consequent possible surgical complications should also be considered, when the surgical procedure can be replaced by an effective conservative treatment. The authors describe their experience using early splinting for congenital auricular deformities. Fifty-two newborn infants with lop, prominent, Stahl's, and constricted ears referred to us by the neonatal department staff were enrolled in this study. Putty Soft, a vinyl polysiloxane impression material, has been used for early molding of the auricles. Surgical tapes were used for the fixation of the mold and to fix the auricle to the scalp. The results were evaluated by one of the parents and by a layperson (medical student) 6 months after completion of the procedure. The above-described early splinting procedure was applied onto 92 auricles of 52 newborn infants aged 1 to 10 days, mostly around day 3. The mean treatment time was 6.8 weeks. All treated auricles were improved, 87 percent were rated as excellent improvement, and there were no complications related to the treatment. The authors conclude that early splinting of deformed auricles should be offered to parents of affected children, and the awareness of this procedure by neonatologists, pediatricians, and nursery staff should be increased.