Experimental and histological investigations of the bone using two different oscillating osteotomy techniques compared with conventional rotary osteotomy.

Over the past decade, coinciding with the appearance of a number of new ultrasonic surgical devices, there has been a marked increase in interest in the use of ultrasound in oral surgery and implantology as alternative osteotomy method. The aim of this study was the comparison of the effect of osteotomies performed using ultrasonic surgery (Piezosurgery(®)), sonic surgery SONICflex(®) and the conventional bur method on the heat generation within the bone underneath the osteotomy and light-microscopy observations of the bone at different cutting positions in porcine mandibular segments. It was found that the average heat generated by SONICflex(®) sonic device was close to that by conventional rotary bur (1.54-2.29°C), whereas Piezosurgery(®) showed a high generated heat up to 18.17°C. Histological investigations of the bone matrix adjacent to the defect radius showed intact osteocytes with all three instruments and similar wide damage diameter at the bottom region. SONICflex(®) showed smooth cutting surfaces with minimal damage in the upper defect zone. Finally, presented results showed that sonic surgery performed with SONICflex(®) is an alternative osteotomy method and can be used as an alternative to the conventional bur method.

Variations in the inclination of the condylar path in children and adults.

OBJECTIVE: To test the null hypothesis that there are no differences between children and adults in the condylar path inclination angle on the right and left sides. MATERIALS AND METHODS: A group of 80 children aged 6 to 10 years (subgroups I through V, according to chronologic age) was compared with an adult group with regard to the condylar path inclination angle (CPIA) on the right and left sides. The CPIA was measured using the ultrasonic JMA-System for registration. RESULTS: During development of the temporomandibular joint the condylar path inclination angle increased with age in the subgroups of children. A significant difference was found in the CPIA between the groups of adults and children. In the group with the oldest children (mean age: 10.3 years) the condylar path inclination angle had reached 81.87% on the right side and 78.85% on the left side compared with the adult group at a 5 mm protrusive path. In the pooled group of children the CPIA amounted to 73.08% on the right side and 72.13% on the left side compared with the values for the adults. No significant difference was found between the right and left CPIA in any group. CONCLUSION: The hypothesis is rejected. The CPIA on the right and left sides increased with age in the group of children and was significantly smaller in the group of children compared with the group of adults.

Shear and tensile bond strength comparison of various contemporary orthodontic adhesive systems: an in-vitro study.

INTRODUCTION: The purpose of this study was to compare the shear and tensile bond strengths of 8 common adhesive systems for bonding in orthodontics. METHODS: One hundred sixty freshly extracted bovine mandibular permanent incisors were randomly divided into 8 groups. Self-ligating esthetic Damon 3 brackets (Ormco, Orange, Calif) were bonded by using the following adhesive systems: Quick Bond (chemically and light-cured; Forestadent, Pforzheim, Germany), Blugloo (Ormco), Enlight LV (Ormco), Kurasper F (Kuraray Dental, Frankfurt, Germany), Transbond LR (3 M Unitek, Monrovia, Calif), Light Bond (Reliance Orthodontic Products, Itasca, Ill), and Fuji Ortho LC (GC America, Alsip, Ill). After 24 hours, half of each group was debonded measuring the shear bond strength and half measuring the tensile bond strength. RESULTS: Blugloo showed the best shear bond strength values, whereas Transbond LR and Quick Bond (chemically and light-cured) had the lowest. Tensile strength was the highest with Fuji Ortho LC and the lowest with Quick Bond (chemically and light-cured) and Kurasper F. The tensile strength of light-cured Quick Bond was about 47% lower than that of Fuji Ortho LC. CONCLUSIONS: Blugloo, Fuji Ortho LC, Light Bond, and Enlight LV are among the materials of choice for bonding fixed orthodontic appliances to teeth. All bond strength values were clinically satisfactory except for the tensile strength of chemically and light-cured Quick Bond and Kurasper F.

Growth-related differences in maximum laterotrusion and retrusion between children and adults.

OBJECTIVE: To test the null hypothesis that there are no differences between children and adults in maximum laterotrusion and maximum retrusion on the right and left sides. MATERIALS AND METHODS: This population-based study included 81 randomly selected children between the ages of 6 and 10 years and 67 adults. Kinematic variables were measured with the ultrasonic JMA-System for registration. RESULTS: The mean maximum laterotrusion of the children's group (10.6 +/- 1.5 mm on the left, 11.0 +/- 1.7 mm on the right) was significantly smaller than that of the adult group (11.7 +/- 2.0 mm on the left, 12.2 +/- 1.7 mm on the right). The maximum laterotrusion of the children's group corresponded to about 90% on the left and right sides of that of the adult group. The mean maximum retrusion of the children's group was significantly bigger than that of the adult group. There, the adult values corresponded to 66.7% on the left and 50% on the right side of the children's values. No significant difference in maximum laterotrusion and retrusion was noted on the right and left sides, and no significant differences according to gender specificities were observed in either group. CONCLUSIONS: The hypothesis is rejected. In development of the temporomandibular joint, maximum laterotrusion on the right and left sides increases significantly with age, and maximum retrusion decreases significantly with age.

Comparison of maximum mouth-opening capacity and condylar path length in adults and children during the growth period.

A group of 80 children ranging in age from 6 to 10 years (subdivided into groups 1-5 according to chronological age) has been compared with an adult group on the basis of condylar path length and maximum mouth-opening capacity. The condylar path length and the mouth-opening capacity were measured using the ultrasonic JMA-System for registration. In the development of the temporomandibular joint (TMJ), condylar path length and mouth-opening capacity were found to increase with age in the juvenile group. In the oldest juvenile subgroup (subgroup 5; average age: 10.3 years) the condylar path length reached 17.6mm on the left and 17.3mm on the right. This is equivalent to 90.3% (left) and 91.1% (right) of the size in the adult group. The mean maximum mouth-opening capacity of the oldest juvenile subgroup was 56.3mm and reached 98.9% of the size in the adult group.

The role of apoptosis in early embryonic development of the adenohypophysis in rats.

BACKGROUND: Apoptosis is involved in fundamental processes of life, like embryonic development, tissue homeostasis, or immune defense. Defects in apoptosis cause or contribute to developmental malformation, cancer, and degenerative disorders. METHODS: The developing adenohypophysis area of rat fetuses was studied at the embryonic stage 13.5 (gestational day) for apoptotic and proliferative cell activities using histological serial sections. RESULTS: A high cell proliferation rate was observed throughout the adenohypophysis. In contrast, apoptotic cells visualized by evidence of active caspase-3, were detected only in the basal epithelial cones as an introducing event for fusion and closure of the pharyngeal roof. CONCLUSION: We can clearly show an increasing number of apoptotic events only at the basic fusion sides of the adenohypophysis as well as in the opening region of this organ. Apoptotic destruction of epithelial cells at the basal cones of the adenohypophysis begins even before differentiation of the adenohypophyseal cells and their contact with the neurohypophysis. In early stages of development, thus, apoptotic activity of the adenohypophysis is restricted to the basal areas mentioned. In our test animals, the adenohypophysis develops after closure of the anterior neuroporus.

Cranial base features in skeletal Class III patients.

OBJECTIVE: To investigate the cranial base configuration in skeletal Class III patients to clarify the conflicting findings from literature. MATERIALS AND METHODS: Initial lateral radiographs of 54 skeletal Class III patients and 54 matched controls (Class I, II/1, II/2) aged 14 to 24 years were analyzed retrospectively for 21 cephalometric basicranial variables and jaw lengths relative to anterior cranial base length. RESULTS: In contrast to overall cranial base length, the anterior (N-S) and posterior (S-Ba, S-Ar) sections failed to show a significant reduction in Class III patients. The significantly more acute angles Ca-S-Ba and Se-S-Ba reflected increased cranial base flexure. Resulting anterior condylar displacement was shown by significant reduction of Se-S-Cd and Ar-Ca. Relative mandibular length was significantly increased. CONCLUSIONS: Decreased basicranial angulation associated with Class III mandibular protrusion was clearly confirmed for skeletal Class III patients. Overall shortening of the cranial base apparently resulted from various minor alterations. The results are compatible with the deficient orthocephalization hypothesis of Class III morphogenesis. The basicranial-maxillary relationship in skeletal Class III remains unclear.

Cryopreserved tissue engineered mucosa.

Single cells suspensions used for grafting in the clinical setting may be reliably cryopreserved by established protocols. However, for tissue engineered constructs which now also get used as grafts in the clinic such established protocols and assays which indicate graft viability and their function as graft do not exist. a) The purpose was to develop a cryoprotocol and an animal model to test the efficacy of tissue engineered to act as graft after cryopreservation. b) Therefore, tissue engineered mucosa grafts consisting of keratinocytes and fibroblasts grown in a collagen sponge were cryopreserved and grafted in the nude rat to test its efficacy to function as mucosa graft. At different points after cryopreservation the mucosa was grafted into the nude rats. Healing of grafts was allowed for one or three weeks. c) Sufficient cells survived the cryopreservation allowing for the development of epithelial-fibroblast tissue in the collagen sponge. After three weeks of healing the formation of mucosa tissue was more complete and more collagen sponge had disappeared. d) The nude rat model is suitable to assess the efficacy of tissue engineered mucosa to function as graft after cryopreservation. The formation of human epithelial-fibroblast tissue in vivo has to be interpreted as proof of principle that the approach of cryopreservation of tissue engineered grafts is working.

Morphological structures and protrusive cranial border guidance of the temporomandibular joint of Cercopithecus mona.

Morphological parameters of the temporomandibular joint (TMJ) of Cercopithecus mona were analyzed by sagittal medial/lateral slicing of the entire joint. The slice contours of the osseous structures of the joint surfaces were approximated by circles. In this manner, the main parameter of the protrusive cranial border guidance, the protrusive dimeric Link chain (DLC), could be measured. In each joint, all slices yielded protrusive DLCs which were nearly parallel to each other. In medial/lateral direction all parts of the joints participate in force transmission in initial protrusive cranial border function.

Bone welding--a histological evaluation in the jaw.

The expansion of biodegradable osteosynthesis systems in clinical application correlates well to the progress in development of new materials as to the improvement of application methods. One of those new application methods is the ultrasound-aided insertion of Resorb-X pins. The aim of this study was the histological evaluation of possible thermal damage to bone due to the ultrasound insertion. For this purpose, condylar neck fractures in 12 sheep were produced, repositioned and fixed by Resorb-X plates and pins. The animals were sacrificed in two groups, one after 2 weeks and one after 9 weeks. The bone-pin interlinkage and the structure of the bone were histologically evaluated. After 2 weeks a tight bone-polymer interlinkage was seen. Neither a pronounced foreign body reaction nor an interposition of fibrous tissue at the interface or a thermally induced necrosis was observed. The late phase of wound healing after 9 weeks showed pathomorphological characteristics within the normal range of bone healing. The bone seemed to be free of any alteration caused by process engineering. We conclude that thermal stress caused by ultrasound-aided pin insertion does not lead to cellular reaction in the bone. The fast and easy application of this improved biodegradable osteosynthesis system will bring a clear advantage in clinical use.

A michigan-type occlusal splint with spring-loaded mandibular protrusion functionality for treatment of anterior disk dislocation with reduction.

For treatment of temporomandibular disorders Michigan-type splints are frequently used, as are mandibular advancement appliances for patients diagnosed with anterior disk dislocation. As both types show good results, the combination of these two mechanisms into one bimaxillary appliance was tested on eight patients where splint therapy had brought reduction but not complete elimination of the symptoms. An existing maxillary Michigan splint was modified so that advancement springs could be fitted and the generated forces were transmitted to a mandibular retainer, which did not interfere with the function of the splint. Treatment progress was monitored with computerized axiography and in all cases the axiographic tracings after the bimaxillary treatment showed no pattern indicative of disk dislocation under normal jaw movements. Myofascial pain symptoms, already improved by the pre-treatment with the Michigan splint, were found to be reduced further or eliminated completely. The approach of retrofitting a Michigan splint with the springs allowed for a versatile appliance, which required no occlusal alteration to the finely adapted splint but could as easily be brought back to the simple splint-functionality either for daytime use or for a period of stabilization of the result after successful treatment. Compliance was found to be very good and the short treatment period, together with the small force levels did not produce any detectable dental side effects.

Correlation of MRT imaging with real-time axiography of TMJ clicks.

There is a series of tools useful for gathering diagnostic information on patients with temporomandibular joint disorders. Tracings of the joint movement (axiography) provide useful information about the motion of the joints. Since the availability of electronic axiographic tracers, the movement of the condyles can be resolved with high resolution both in space and in time. In order to obtain information about the anatomical relation of the joint surfaces and the disc, magnetic resonance tomography imaging (MRI) is routinely carried out. It is common practice to take MR images of the joints with the mouth closed and fully open. In order to correlate the MR images with the axiographic tracings, a series of images can provide much more information. In this study we examined patients with distinct temporomandibular joint (TMJ) clicks. In one case, the click occurs once a day, while in the other case the click happens every time the mouth is opened. In order to obtain information about both motion and anatomical relation of the TMJ at and around the position where the clicks occur, we recorded a series of MRI scans with the mouth gradually opened and before and after joint clicks. Real-time axiographic tracings during the click were taken with an optimized system where the polar moments were reduced as much as possible to follow the movement during the click. These tracings were correlated with the MRI scans to determine the exact internal conditions of the TMJ and the changes during the click. In particular cases, the additional information provided by this procedure can be useful in deciding whether and which therapeutic intervention is advisable.

Functional magnetic resonance imaging of brain activity during chewing and occlusion by natural teeth and occlusal splints.

Brain imaging based on functional magnetic resonance (fMRI) is a useful tool for examination of neuronal networks and cerebral structures subserving visiospatial function. The purpose of this study was to compare the brain activity during chewing and occlusal function in centric occlusion on natural teeth or on occlusal splints. Four tasks were performed by 13 healthy, fully dentate subjects (21-32 years old, 6 female and 7 male): occlusal tap-tap movements in centric occlusion by natural teeth, after application of a maxillary occlusal splint and chewing movements on left and right sided rubberdam strips. In order to reveal which areas of the brain were more strongly activated, conjunction analyses between the different tasks were performed for each subject and for the average values of brain signal activity of all subjects. Whilst several known foci of activity were subtracted, differences of significant activity rested in areas of the sensorimotor cortex. Mainly ipsitaterality of hemispheres concerned the left and right sided chewing, whereas the conjunction between tap-tap movements on natural teeth and splint occlusion indicated only one weak, but significant activation foci. The study confirms fMRT as one of the most useful developing methods to clear up neuro-cortical effectiveness of occlusion and occlusal therapy.

Study on treatment of condylar process fractures of the mandible.

Treatment of mandibular condylar process fractures may be conservative or surgical. Both treatment approaches aim to reconstruct the articulating joint surfaces in a physiological position to the discoligamentary structures. The study comprised 1812 patients of Wuerzburg University who presented with a fracture of the mandibular condylar process between 1981 and 2001. Besides conservative management options, surgical interventions using mini-plate osteosynthesis and the Wuerzburg lag screw plate were studied for post-treatment changes. Statistical analysis revealed that surgical osteosynthesis is superior to merely conservative therapy in terms of post-treatment dysgnathic severity. Hence, surgical osteosynthesis is advocated especially in patients with high condylar fractures or dislocated fractures in order to ideally achieve 'restitutio ad integrum'.

Functional state of the mandible and rolling-gliding characteristics in the TMJ.

For the physiological intact stomatognathic system, the three main functional states (occlusat articular functions, free mandibular movements, and ideal bolus function) were biomechanically discussed concerning the structure of movement, rolling-gliding characteristics, and force transfer in the temporomandibular joint (TMJ). In all three cases, rolling is not possible in the TMJ since the instantaneous rotational axis is positioned outside of the joint-rolling is not necessary because the TMJ is not loaded by appreciable forces. In the aged stomatognathic system with a lost discus and considerable Loads in the TMJ, however, the attrition of the joint is eased by rolling movement at the articulating surfaces. The destruction of the discus can be seen as a physiological adaptation which brings back the joint to an original odontogen condition.

Effects of centric relation prematurities of the frontal teeth.

Centric relation prematurities of frontal teeth are frequently found with patients who have severe orthodontic anomalies or received extensive restorative treatment. They can cause a range of symptoms ranging from loosening of the teeth to temporomandibular disorders (TMD). The objective of this work has been to derive a mathematical description of the mandibular and periodontal forces generated by anterior prematurities for different incisor relations. In order to quantify the effect of contact area (location and inclination) and the tooth inclination, a two-dimensional mathematical approach was used. Vectorisation of the forces and bending moments makes it possible to predict under which conditions the load increase mainly affecting the anterior teeth can and may cause localized pain and eventually loosening and flaring/crowding of the upper/lower incisors and under which conditions the temporomandibular joint will suffer a large increase in retrusive force, which potentially leads to TMD. For 10 patients with anterior prematurities, analysis of the incisor relation was carried out. For all cases the conclusions drawn from the mathematical model were in full agreement with the reported symptoms, which could be successfully treated.

Occlusal contact patterns--population-based data.

The reconstruction of functionally appropriate contacts between antagonistic teeth substantially determines the quality of prosthetic-restorative work. In a population-based sample comprising 2597 subjects, static occlusal contacts were registered and analysed using the GEDAS (Greifswald Digital Analyzing System), which digitally represents the contact point situation by means of silicone bite impressions. The number of contacting teeth is approximately equal on the Left- and right-hand side amounting to 8.3 on the left and 8.4 on the right. Furthermore, it was shown that 39% of the maxillary bridge pontics and 33% of the mandibular bridge units are not in contact. Antagonistic contacts are missing in 41% of the maxillary and 39% of the mandibular removable denture teeth. These results show that the fabrication of fixed dentures, particularly in bridge pontics, and the inspection of removable dentures needs to be done with more care to this detail.

Secondary palatal closure in rats in association with relative maternofetal levels of folic acid, vitamin B12, and homocysteine.

Animal experiments are used in embryological and teratological studies of matters relevant to humans. In gravid rats, a decrease in the levels of folic acid and vitamin B12 was observed in maternal blood and in amniotic fluid. At the time of secondary palatal closure (14th day of pregnancy), the folic acid level of the amniotic fluid was 73% lower than that of the maternal blood. A drop in vitamin B12 in conjunction with an increase in amniotic homocysteine levels is seen as a risk factor for malformation of the palate. The understanding of causes of cleft generation could lead to a prophylactic treatment approach.

Histological and histomorphometric investigation of the condylar cartilage of juvenile pigs after anterior mandibular displacement.

The condylar cartilage of the mandible is considered a secondary growth center and represents a joint cartilage different from other cartilage structures regarding its histological structure, its histochemical and immunohistochemical properties and its growth pattern. This study aimed to histologically and histomorphometrically investigate the condylar cartilage after anterior mandibular displacement similar to functional orthopedic treatment. A total of 12 pigs (sus scrofa domesticus) aged 10 weeks were divided into an experimental group and a control group comprising 6 animals each. The experimental animals were provided bilaterally with synthetic occlusal build-ups in the posterior area which induced anterior displacement of the mandible in terminal occlusion. After 4 weeks, the temporomandibular structures were removed en bloc and the condylar cartilage was analyzed histologically and histomorphometrically. As a result, the experimental animals displayed a significantly increased total cartilage thickness of the posterocranial mandibular condyle which was primarily caused by an increase in thickness of the hypertrophic and chondogenic layers. Similarly, the proliferative layer showed a significant increase, whereas significant differences in thickness were absent in the articular layer. Increased cell proliferation was not observed in the experimental animals as compared to the controls. The changes found in the condylar cartilage area suggest that the zonal structure of the condylar cartilage may be modified by an altered spatial relationship between the mandibular condyle and the glenoid fossa.

Effects of unilateral molar distalization with a modified pendulum appliance.

INTRODUCTION: The purpose of this study was to evaluate skeletal and dentoalveolar changes due to unilateral distalization and to determine side effects. METHODS: Cephalograms and dental casts before and after distal movement of the maxillary molars with pendulum appliances in 15 consecutively treated patients (5 girls and 10 boys, 12.06 +/- 1.32 years), were included in this study. The duration of distalization was 8.46 +/- 2.23 months. RESULTS: Cephalometric analysis showed no remarkable growth between the 2 measurement times. The mean value for distalization of the first molars was 3.83 +/- 1.09 mm, with distal tipping of 6.45 degrees . The maxillary second molars were also moved distally 2.83 +/- 1.32 mm and tipped distally 14.7 degrees . No significant changes in the position of the third molars were measured. The mean reciprocal mesial movement of the premolars was 1.18 +/- 1.31 mm, with distal tipping of 1.94 degrees . The incisors moved 0.84 +/- 0.79 mm mesially, with mesial tipping of 0.02 degrees and extrusion of 1.21 mm. There was also a significant influence on the contralateral anchorage unit. However, unilateral distalization reduced incisor proclination and induced moderate distal movement of the contralateral anchorage unit based on rotation around a virtual axis perpendicular to the Nance button. CONCLUSIONS: Effective distal molar movement and less anchorage loss at the front teeth are advantages of unilateral distalization.