Dimensional profile of oral mucosa around combined tooth-implant-supported bridgework in macaque mandible.

PURPOSE: A stable oral mucosa is crucial for long-term survival and biofunctionality of implants. Most of this evidence is derived from clinical and animal studies based solely on implant-supported prosthesis. Much less is known about the dimensions and relationships of this soft tissue complex investing tooth-implant-supported bridgework (TISB). The aim here was to obtain experimental evidence on the dimensional characteristics of oral mucosa around TISB with two different abutment designs. METHODS: Sixteen 3-unit TISB were constructed bilaterally in the mandible of eight adult Macaca fascicularis. An implant system with a standard progressive thread design was the bone-anchoring implant in the second mandibular molar region while the second mandibular premolar served as the natural tooth abutment. Eight implants were connected with the tapered abutment, the remaining with butt-joint abutment, in a split-mouth design. These were allowed to functional load for 6 months before sacrification for histomorphometry. Six soft tissue indices were scored: coronal gingival mucosa-to-implant top distance (DIM); sulcus depth (SD); junctional epithelium (JE); connective tissue contact (CTC); implant top to first bone-to-implant contact distance (DIB); and biologic width (BW=SD+JE+CTC); corresponding parameters in the natural tooth abutment were also measured. RESULTS: Mucosal dimensions in tapered implants (*BW=3.33±0.43; SD=1.03±0.24; JE=1.08±0.13; CTC=1.22±0.23 mm) were comparable with those of natural tooth abutments (BW=3.04±0.18; SD=0.93±0.1; JE=0.78±0.1; Attachment=1.33±0.09 mm), but differed from butt-joint implants (*BW=4.88±1.24; SD=1.47±0.38; JE=1.49±0.4; CTC=1.92±0.93 mm) (*P<0.05). CONCLUSIONS: Results suggested that soft tissue dimensions around TISB are influenced by the implant-abutment interface and abutment material used. Mucosa investing tapered abutment tends to recapitulate soft tissue physiologic dimensions of natural tooth.

Influence of abutment design on clinical status of peri-implant tissues.

OBJECTIVE: To compare the clinical soft tissue responses around implant tooth-supported 3-unit bridges using tapered abutments with those using butt-joint abutments. METHODS: In a split-mouth design study, 8 mm Ankylos (Dentsply Friadent, Germany) implants were placed in the second mandibular molar region of 8 adult Macaca fascicularis monkeys about 1 month after extraction of all mandibular molars. After 3 months of submerged healing, 3-unit metal bridges were constructed. Clinical data was collected by the author who was blind to the abutment selections. Implants were clinically evaluated using Waite plaque index, sulcus bleeding index, probing pocket depth (PPD), probing attachment loss (PAL), and width of keratinized mucosa at baseline (BL) and 3-month and 6-month intervals. Stability of the implant was assessed using Periotest device at BL and after 6 months. RESULTS: At BL, all the clinical variables did not differ statistically between the tapered and the butt-joint groups except for PPD (P < 0.05), where the mean PPD was greater in the butt-joint group (2.75 ± 1.02 mm) as compared with the tapered group (1.97 ± 0.65 mm). At the 3-month assessment, there was no difference in all clinical variables. After 6-month loading, no significant difference between these 2 groups was detected in all these variables, with the exception of PAL (P = 0.05) where mean PAL was greater for implants with the butt-joint abutments (0.91 ± 0.86 mm) in comparison with the tapered abutments (0.50 ± 0.88 mm), and mean Periotest values (PTVs) that indicate the tapered-abutment implants (PTV = -4.5 ± 1.60) were more stable than butt-joint-abutment implants (PTV = -1.5 ± 3.59) with P < 0.05. CONCLUSIONS: The differences in these mucogingival responses between these 2 groups at BL (during seating of abutments, especially of butt-joint abutments) and after 6-month loading indicated enhanced peri-implant soft tissue stability around the tapered abutments of this system. There was also enhanced-PTV in the test group for clinical mobility assessment after 6-month loading.

Long wave ultrasound may enhance bone regeneration by altering OPG/RANKL ratio in human osteoblast-like cells.

Human osteoblast cell line (MG63) cells were treated with long wave (45 kHz, intensity 30 mW/cm(2)) continuous ultrasound (US) for 5 min and incubated for various time periods following the treatment. The reverse transcriptase polymerase chain reaction (RT-PCR) technique was used for observing the genetic expression and real-time PCR for quantitative analysis of receptor activator of NF-kappaB ligand (RANKL) and osteoprotegerin (OPG) along with alkaline phosphatase (ALP), an early bone marker, and osteocalcin (OCN) a late marker. ELISA was performed to estimate the amount of the cytokine released into the culture media. The osteoblasts responded to US by significantly upregulating both the OPG mRNA and protein levels. There was no RANKL mRNA expression observed in both the US and control groups and the protein levels were also very low in both groups. There was also no TNF-alpha expression and the TNF-alpha protein levels were insignificant. ALP and OCN mRNA were significantly upregulated in the US group. To our knowledge, this is the first study that shows the effect of US on OPG, RANKL and TNF-alpha expression. US appears to upregulate OPG and may downregulate RANKL production. From these findings, we conclude that therapeutic ultrasound may increase bone regeneration by altering the OPG/RANKL ratio in the bone microenvironment.

Osteosarcoma presenting as an aggressive nodular mass in the region of the mandible.

Osteosarcomas are highly malignant neoplasms of bone that are challenging to diagnose. These neoplasms often show atypical behavior. In the initial phase they may present as nondescript bony swellings with an indolent growth rate, only to become overtly aggressive and malignant towards the later phase of the disease. Similarly, the histological growth pattern of this neoplasm can be quite diverse, presenting with areas that mimic benign myofibroblastic tumors, giant cell granulomatous conditions and partial encapsulation. The final diagnosis of an osteosarcoma is often reached after thorough sampling and examination of multiple biopsy specimens. All these clinical features and histological diagnostic difficulties were encountered in a case of osteosarcoma affecting the right mandible of a 62-year-old Chinese woman described here. The diagnostic lessons accrued from this case are discussed.