Utility of intraoral scanner imaging for dental plaque detection.

Purpose: Oral hygiene, maintained through plaque control, helps prevent periodontal disease and dental caries. This study was conducted to examine the accuracy of plaque detection with an intraoral scanner (IOS) compared to images captured with an optical camera. Materials and Methods: To examine the effect of color tone, artificial tooth resin samples were stained red, blue, and green, after which images were acquired with a digital single-lens reflex (DSLR) camera and an IOS device. Stained surface ratios were then determined and compared. Additionally, the deviation rate of the IOS relative to the DSLR camera was computed for each color. In the clinical study, following plaque staining with red disclosing solution, the staining was captured by the DSLR and IOS devices, and the stained area on each image was measured. Results: The stained surface ratios did not differ significantly between DSLR and IOS images for any color group. Additionally, the deviation rate did not vary significantly across colors. In the clinical test, the stained plaque appeared slightly lighter in color, and the delineation of the stained areas less distinct, on the IOS compared to the DSLR images. However, the stained surface ratio was significantly higher in the IOS than in the DSLR group. Conclusion: When employing IOS with dental plaque staining, the impact of color was minimal, suggesting that the traditional red stain remains suitable for plaque detection. IOS images appeared relatively blurred and enlarged relative to the true state of the teeth, due to inferior sharpness compared to camera images.

Comparison of plaque control record measurements obtained using intraoral scanner and direct visualization.

OBJECTIVE: Intraoral scanner (IOS) can acquire three-dimensional color images of teeth. Thus, the detection of areas with plaque adhesion stained by plaque-disclosing solutions using an IOS could be a potential oral hygiene evaluation method. This study aimed to verify the usefulness of obtaining O'Leary's plaque control record (PCR) measurements using an IOS in clinical practice. METHODS: Twenty patients with >20% PCR measurements who underwent oral prophylaxis were enrolled in this study. A plaque-disclosing gel was applied to stain the areas with plaque adhesion, and the dentition was scanned using the IOS. The PCR values obtained via the direct method and those obtained using the digital image were compared for the entire dentition, maxillary total area, the labial and palatal aspects of the maxillary anterior teeth, the buccal and palatal aspects of the maxillary posterior teeth, mandibular total area, the labial and lingual aspects of the mandibular anterior teeth, and the buccal and lingual aspects of the mandibular posterior teeth. RESULTS: The IOS group tended to have higher values than the direct observation group. The labial and palatal aspect of the maxillary anterior teeth, the labial and lingual aspects of the mandibular anterior teeth did not differ significantly between the groups. CONCLUSION: Plaque adhesion was visualized easily and conclusively using an IOS. As the large tip size often hinders its use, it is necessary to develop a smaller IOS tip in the future.

Histological and histomorphometric aspects of continual intermittent parathyroid hormone administration on osseointegration in osteoporosis rabbit model.

In implant treatment, primary stability and osseointegration are improved by continual intermittent administration of parathyroid hormone (PTH) in patients with osteoporosis. However, the histological and histomorphometric aspects are not clear. The aim of this study was to investigate the histological and histomorphometric effects of intermittent PTH administration on osseointegration in a glucocorticoid-induced osteoporotic rabbit model. Fifteen female New Zealand rabbits were prepared for the osteoporosis model with ovariectomy and glucocorticoid administration. After 1 week, five rabbits were intermittently administered PTH for 8 weeks until the end point (PTHa group) and five for 4 weeks until implant placement (PTHb group). The remaining rabbits were intermittently administered saline for 8 weeks until the end point (Control group). Dental implants were inserted into the femoral epiphyses 11 weeks after ovariectomy. After 4 weeks, the maximum removal torque (RT) of the placed implant and bone implant contact (BIC) ratio were evaluated. In addition micro-computed tomography and histomorphometric analyses were performed. The RT and BIC values were significantly higher in the PTHa group compared with those of the PTHb and Control groups (p< 0.05). Furthermore, the bone mineral densities and Hounsfield units were significantly higher in the PTHa group than those in the PTHb and Control groups. Histologic and histomorphometric measurements revealed that continuous administration of PTH improved bone density and bone formation around the implant placement site, as well as systemic bone formation. Therefore, favorable implant stability was achieved under osteoporosis.

Investigation to Predict Primary Implant Stability Using Frictional Resistance Torque of Tap Drilling.

Objectives: The purpose of this experimental study was to investigate the correlation between the frictional resistance torque of tap drilling prior to implant placement and the primary stability after implant placement. Material and Methods: Solid rigid polyurethane bone blocks of four different densities were used in this study. A computerized surgical implant motor device was utilized to measure the frictional resistance torque of tap drilling. After the tap torque was measured, the dental implants were inserted at the prepared sites. During the implantation, the insertion torque was recorded, and resonance frequency analysis was performed, the value of which was calculated as the implant stability quotient. Thereafter, the correlation between the tap torque and the primary stability of the implant was evaluated and compared with the standard drilling protocol. Results: A significant positive correlation was found between the tap torque and insertion torque (Pearson's r = 0.88, P < 0.0001). Similarly, there was a positive correlation between the tap torque and implant stability quotient (Pearson's r = 0.69, P < 0.0001). Conclusions: These results suggest that measurement of the frictional resistance torque of tap drilling prior to implant placement could provide helpful information for implant primary stability.

Osseointegration Aspects of Implants at the Bone Reconstruction Site by a Novel Porous Titanium Scaffold.

OBJECTIVES: Porous titanium is used for the reconstruction of large bone defects due to its excellent mechanical strength. The quality of osseointegration of implants placed in bone reconstructed with porous titanium is unknown. The purpose of this in vivo study was to evaluate the osseointegration of implants at sites reconstructed using porous titanium. MATERIAL AND METHODS: Hollow porous titanium (Ti) (outer-diameter 6 mm, inner-diameter 2 mm, length 4 mm, 85% porosity) and similar-sized porous hydroxyapatite (porous HA: 75% porosity) samples were prepared and implanted in 6 New Zealand white rabbit femurs. Four weeks later, an implant bed was created to receive a Ti implant (diameter 2 mm, length 4 mm). An implant placed at a pristine bone site served as the control. Four weeks later, histological and histomorphometric evaluations of the test and control sites were conducted. RESULTS: Osseointegration was observed in all groups. There was no significant difference in the bone formation ratio and bone-implant contact (BIC) ratio across all groups for the whole area. At the cancellous bone area of the bone defect, superior bone formation ratio and BIC ratio were observed with porous Ti and porous HA compared to the control (bone formation ratio: control 1.8 [SD 3]%, HA 23 [SD 3]%, Ti 23.6 [SD 5]%; BIC ratio: control 5.4 [SD 5.3]%, HA 28.9 [SD 10.7]%, Ti 41.6 [SD 14]%). Porous Ti demonstrated good osteoconduction and osseointegration abilities, similar to porous HA. CONCLUSIONS: To our knowledge, this is the first report of implant treatment after preliminary bone reconstruction using a titanium biomaterial. Porous titanium is a suitable material for bone reconstruction before implant treatment in load-bearing areas that allow subsequent prosthetic treatment.

Use of an intraoral scanner to evaluate oral health.

The purpose of this study was to determine if intraoral scanners (IOS) are useful for dental hygiene instruction. The dental plaque of eight volunteers with healthy dentition was stained with a plaque-disclosing solution, and the O'Leary Plaque Control Record (PCR) was measured by direct observation and by evaluating IOS images. PCR values were higher for IOS images than for direct observation. The difference was greatest for the lingual surface of mandibular anterior teeth. Use of IOS for dental plaque examination might be useful as a novel method for dental hygiene instruction.

Acid bone lysates reduce bone regeneration in rat calvaria defects.

Acid bone lysates (ABLs) represent the growth factors and other molecules released during autologous graft resorption. However, the impact of these bone-derived growth factors on the healing of bone defects has not yet been investigated. The aim of the present study was, therefore, to examine the impact of ABLs adsorbed to collagen membranes on bone regeneration. To this end, in 16 female Sprague Dawley rats, a standardized 5-mm-diameter critical size defect on the calvarial bone was created. The defects were covered with collagen membranes that had been soaked either in serum-free media or ABLs followed by lyophilization. After a healing period of 4 weeks, micro-computed tomography (µCT) and histological analyses by means of undecalcified thin ground sections were performed. µCT analysis of the inner 4 mm of the calvaria defect showed a greater bone defect coverage in the control group when compared to ABL group, 29.8% (confidence interval [CI]: 17.7-50.3) versus 5.6% (CI: 1.0-29.8, p = .03), respectively. Moreover, we found significantly more absolute bone volume (BV) in the control group when compared to ABL group, 0.59 mm3 (CI: 0.27-1.25) versus 0.07 mm3 (CI: 0.06-0.59, p = .04), respectively. Histomorphometry confirmed these findings with a relative BV in the central compartment of 14.1% (CI: 8.4-20.6) versus 5.6% (CI: 3.4-7.9, p = .004), respectively. These findings indicate that bone-derived growth factors contained in ABLs are able to attenuate bone regeneration within collagen membranes.

Comparative Study of Surface Modification Treatment for Porous Titanium.

OBJECTIVES: This study was to investigate suitable surface treatment methods for porous titanium by ex vivo study of material properties and calcium phosphate deposition in simulated body fluid. MATERIAL AND METHODS: Porous titanium with acid (H2SO4 and HCl mixed acid) or alkali (NaOH) treatment was prepared. The surfaces were observed, and the weight change ratio (after and before surface treatment) and compression strength were measured. To investigate the apatite formation ability, each sample was immersed in simulated body fluid (SBF). Surface observations were performed, and the weight change ratio (before/after immersing SBF) and calcification (by alizarin red staining) were measured. RESULTS: The acid group showed a martensitic micro-scale rough structure and the weight and mechanical strength greatly decreased compared to the other groups. The alkali group exhibited a nano-scale roughness structure with similar weight and mechanical strength. Following immersion in SBF, an apatite-like crystal layer in the alkali group was observed. The weight of all samples increased. The change in weight of the samples in the alkali, acid, and control groups were significantly different, showing the following trend: alkali group (1.6%) > acid group (1.2%) > control group (0.8%). Calcium precipitation values were higher in the samples from alkali group than in those from the acid and control groups. CONCLUSIONS: Alkali treatment was found to be a suitable surface modification method for porous titanium, resulting in good mechanical strength and apatite formation ability in simulated body fluid.

miRNA-21 deficiency impairs alveolar socket healing in mice.

BACKGROUND: MicroRNAs (miRNAs) are small noncoding RNAs demonstrated as critical post-transcriptional modulators in dental tissues and bone regeneration, particularly miR-21-5p. However, the role of miR-21-5p in the healing of alveolar sockets following tooth extraction remains unknown. In this study we evaluated the influence of miR-21-5p in the healing of alveolar socket after tooth extraction. METHODS: Eight miR-21-5p knockout mice and eight littermate controls underwent tooth extraction of the upper right incisor. After a healing period of 14 days microCT and histological analyses were performed. RESULTS: MicroCT analysis showed that the percentage of bone in the extraction socket was significantly higher in the control group than in the miR-21 knockout mice; either in the coronal (39.0%, CI 31.8 to 48.0 versus 23.0%, CI 17.8 to 35.2, P = 0.03) or in the middle part of the alveolar socket (56.0%, CI 50.9 to 62.5 versus 43.5% CI 28.6 to 54.6, P = 0.03). These differences were not noted in the apical part of the extraction socket. Histological analysis supported the microCT findings. Newly bone volume per tissue volume (BV/TV) was significantly higher in the control group when compared to miR-21 knockout mice, 27.4% (CI 20.6 to 32.9) versus 19.0% (CI 14.7 to 21.5, P < 0.05), respectively. Surprisingly, no evident signs of buccal bone resorption were observed in both groups. CONCLUSION: Despite the limitation of one observation period, these findings suggest that miR-21-5p delays the early healing of alveolar socket following tooth extraction. Whether miR-21-5p is essential for healing of alveolar sockets remains to be elucidated.

Development of a novel bioactive titanium membrane with alkali treatment for bone regeneration.

This study evaluates a bioactive titanium membrane with alkali treatment for stimulating apatite formation and promoting bone regeneration. The titanium thin membranes were either treated with NaOH (alkali-group) or untreated (control). Each sample were incubated in simulated body fluid. Subsequently, the composition of the surface calcium deposition, its weight increase ratio, and optical absorbance were evaluated. Then, the bone defect was trephined on the rats calvaria and covered with each sample membrane or no membrane, and the bone tissue area ratio (BTA) and bone membrane contact ratio (BMC) were evaluated. The spherical crystalline precipitates formed in both groups. In the alkali-group after 21 days, the precipitates matured, forming apatite-like precipitates. The alkali-group showed higher Ca and P contents and weight increase ratios than the control. The alkali-group exhibited a higher BMC than the control in the central area. Thus, this novel membrane has high apatite-forming and bone regeneration abilities.

The development of novel bioactive porous titanium as a bone reconstruction material.

Porous titanium fabricated by the resin-impregnated titanium substitute technique has good mechanical strength and osteoconduction. The alkali treatment of the titanium surface creates a bioactive surface. Alkali-treated porous titanium is expected to accelerate bone formation. The purpose of this study was to evaluate the bone reconstruction ability of alkali-treated porous titanium. Porous titanium (85% porosity) was treated with an alkali solution (5 N NaOH, 24 h). To assess material properties, we analyzed the surface structure by scanning electron microscopy (SEM) and mechanical strength testing. To assess bioactivity, each sample was soaked in a simulated body fluid (Hank's solution) for 7 days. Surface observations, weight change ratio measurement (after/before being soaked in Hank's solution) and surface elemental analysis were performed. We also designed an in vivo study with rabbit femurs. After 2 and 3 weeks of implantation, histological observations and histomorphometric bone formation ratio analysis were performed. All data were statistically analyzed using a Student's t-test (P < 0.05) (this study was approved by the Hiroshima University animal experiment ethics committee: A11-5-5). Non-treated porous titanium (control) appeared to have a smooth surface and the alkali-treated porous titanium (ATPT) had a nano-sized needle-like rough surface. ATPT had similar mechanical strength to that of the control. After soaking into the Hank's solution, we observed apatite-like crystals in the SEM image, weight gain, and high Ca and P contents in ATPT. There was significant bone formation at an early stage in ATPT compared with that in control. It was suggested that the alkali-treated porous titanium had a bioactive surface and induced bone reconstruction effectively. This novel bioactive porous titanium can be expected to be a good bone reconstruction material.

Novel fabrication of porous titanium by a resin-impregnated titanium substitution technique for bone reconstruction.

The purpose of this study was to develop a novel porous titanium material with superior mechanical strength and osteoconduction for bone reconstruction. Porous titanium samples were fabricated by titanium-slurry impregnate to prepare urethane forms with several porosities (high-porosity; 92%, middle-porosity; 85% and low-porosity; 65%). Porous HA (mean porosity; 75.3%) was used as a control. To evaluate the characteristics of these materials, we performed porosity measurements, scanning electron microscopy (SEM), three-point bending testing, and cell proliferation assays. To evaluate the osteoconduction ability, porous titanium was placed into the femurs of rabbits and histological and histomorphometric evaluations were performed after 3 weeks. In SEM images, porous three-dimensional structures were observed in all samples. The bending strength significantly increased as porosity increased (Ti-65 > Ti-85 > porous HA > Ti-92, P < 0.05; respectively). Ti-65, Ti-85, and porous HA showed good cell proliferation. Newly formed bone was observed in the central portion of Ti-65, Ti-85, and porous HA. Ti-92 was mainly detected in the bone marrow tissue. The bone formation areas of Ti-65, Ti-85, and porous HA were significantly higher than that of Ti-92 (P < 0.05). It was suggested that novel developed porous titanium composed of Ti-65 and Ti-85 showed superior mechanical strength and osteoconduction.

Effects of continual intermittent administration of parathyroid hormone on implant stability in the presence of osteoporosis: an in vivo study using resonance frequency analysis in a rabbit model.

OBJECTIVE: This study aimed to evaluate the effects of continual intermittent administration of parathyroid hormone (PTH) on implant stability in the presence of osteoporosis, using rabbit models. MATERIAL AND METHODS: Fifteen female New Zealand white rabbits underwent ovariectomy and were administered glucocorticoids to induce osteoporosis, following which they were divided into three groups. The first group received intermittent subcutaneous PTH for 4 weeks until implant placement (PTH1), while the second and third groups received PTH (PTH2) and saline (control), respectively, for 4 weeks before and after implant placement. After intermittent administration of PTH or saline, titanium implants were inserted into the left femoral epiphyses of all animals, and the implant stability quotient (ISQ) was measured immediately after placement to assess the primary stability and at 2 and 4 weeks after implant placement to assess osseointegration. At 4 weeks after implant placement, histological and histomorphometric evaluations were conducted and the bone area around the implant socket was measured as a ratio of the total bone area to the total tissue area. RESULTS: Regarding primary stability, the ISQ values for the PTH1 and PTH2 groups were significantly higher than those for the control group (p<0.05). Concerning osseointegration, the ISQ values at 2 and 4 weeks were significantly higher for the PTH2 group than for the PTH1 and control (p<0.05) groups. Histological assessments showed a thicker and more trabecular bone around the implant sockets in the PTH2 specimens than in the PTH1 and control specimens. The bone area around the implant socket was significantly greater in the PTH2 group than in the PTH1 and control groups (p<0.05). CONCLUSIONS: Our results suggest that continual intermittent PTH administration before and after dental implant placement is effective for the achievement of favorable stability and osseointegration in the presence of osteoporosis.

Effects of continual intermittent administration of parathyroid hormone on implant stability in the presence of osteoporosis: an in vivo study using resonance frequency analysis in a rabbit model

Abstract Objective: This study aimed to evaluate the effects of continual intermittent administration of parathyroid hormone (PTH) on implant stability in the presence of osteoporosis, using rabbit models. Material and Methods: Fifteen female New Zealand white rabbits underwent ovariectomy and were administered glucocorticoids to induce osteoporosis, following which they were divided into three groups. The first group received intermittent subcutaneous PTH for 4 weeks until implant placement (PTH1), while the second and third groups received PTH (PTH2) and saline (control), respectively, for 4 weeks before and after implant placement. After intermittent administration of PTH or saline, titanium implants were inserted into the left femoral epiphyses of all animals, and the implant stability quotient (ISQ) was measured immediately after placement to assess the primary stability and at 2 and 4 weeks after implant placement to assess osseointegration. At 4 weeks after implant placement, histological and histomorphometric evaluations were conducted and the bone area around the implant socket was measured as a ratio of the total bone area to the total tissue area. Results: Regarding primary stability, the ISQ values for the PTH1 and PTH2 groups were significantly higher than those for the control group (p<0.05). Concerning osseointegration, the ISQ values at 2 and 4 weeks were significantly higher for the PTH2 group than for the PTH1 and control (p<0.05) groups. Histological assessments showed a thicker and more trabecular bone around the implant sockets in the PTH2 specimens than in the PTH1 and control specimens. The bone area around the implant socket was significantly greater in the PTH2 group than in the PTH1 and control groups (p<0.05). Conclusions: Our results suggest that continual intermittent PTH administration before and after dental implant placement is effective for the achievement of favorable stability and osseointegration in the presence of osteoporosis.

Enhanced Osseointegration of a Modified Titanium Implant with Bound Phospho-Threonine: A Preliminary In Vivo Study.

Implant surface topography is a key factor in achieving osseointegration. l-Threonine can be chemically and stably bonded to titanium surfaces by phosphorylation. This study investigated the degree of in vivo osseointegration of an implant with a novel o-phospho-l-threonine (p-Thr)-binding surface. MC3T3-E1 cells were seeded on the p-Thr binding surface and machined surface disks, and initial cell attachment was evaluated. p-Thr-binding and machined surface implants were tested in vivo by implantation into the femurs of three male New Zealand white rabbits, and the osseointegration was assessed by measurement of removal torque (RT) and bone-implant contact (BIC) ratio. Initial cell attachment was greater for the p-Thr-binding than for the machined surface implant group (P < 0.05). In addition, RT and BIC values were higher for the p-Thr-binding surface than for the machined surface (P < 0.05). These results indicate that our implant with a p-Thr-binding surface can achieve enhanced osseointegration.

Novel Development of Phosphate Treated Porous Hydroxyapatite.

Phosphoric acid-etching treatment to the hydroxyapatite (HA) surface can modify the solubility calcium structure. The aim of the present study was to develop phosphate treated porous HA, and the characteristic structures and stimulation abilities of bone formation were evaluated to determine its suitability as a new type of bone graft material. Although the phosphoric acid-etching treatment did not alter the three-dimensional structure, a micrometer-scale rough surface topography was created on the porous HA surface. Compared to porous HA, the porosity of phosphate treated porous HA was slightly higher and the mechanical strength was lower. Two weeks after placement of the cylindrical porous or phosphate treated porous HA in a rabbit femur, newly formed bone was detected in both groups. At the central portion of the bone defect area, substantial bone formation was detected in the phosphate treated porous HA group, with a significantly higher bone formation ratio than detected in the porous HA group. These results indicate that phosphate treated porous HA has a superior surface topography and bone formation abilities in vivo owing to the capacity for both osteoconduction and stimulation abilities of bone formation conferred by phosphoric acid etching.