High-resolution MR imaging for dental impressions: a feasibility study.

OBJECTIVES: Magnetic resonance imaging is an emerging technology in dental medicine. While low-resolution MRI has especially provided means to examine the temporomandibular joint due to its anatomic inaccessibility, it was the goal of this study to assess whether high-resolution MRI is capable of delivering a dataset sufficiently precise enough to serve as digital impression of human teeth. MATERIALS AND METHODS: An informed and consenting patient in need of dental restoration with fixed partial dentures was chosen as subject. Two prepared teeth were measured using MRI and the dataset subjected to mathematical processing before Fourier transformation. After reconstruction, a 3D file was generated which was fed into an existing industry standard CAD/CAM process. RESULTS: A framework for a fixed dental prosthesis was digitally modeled and manufactured by laser-sintering. The fit in situ was found to be acceptable by current clinical standards, which allowed permanent placement of the fixed prosthesis. CONCLUSIONS: Using a clinical whole-body MR scanner with the addition of custom add-on hardware, contrast enhancement, and data post-processing, resolution and signal-to-noise ratio were sufficiently achieved to allow fabrication of a dental restoration in an acquisition time comparable to the setting time of common dental impression materials. Furthermore, the measurement was well tolerated. CLINICAL RELEVANCE: The herein described method can be regarded as proof of principle that MRI is a promising option for digital impressions when fixed partial dentures are required.

Diagnosis of dental abnormalities in children using 3-dimensional magnetic resonance imaging.

PURPOSE: To assess the feasibility of magnetic resonance imaging (MRI) of dental abnormalities in children. MATERIALS AND METHODS: The study included 16 patients (mean age, 10.8 yr) prospectively selected from 1,500 orthodontic patients. The selected patients included 3 with a mesiodens, 9 with supernumerary teeth other than a mesiodens, 1 with gemination, 1 with dilacerations, 1 with transmigration, and 1 with transposition. Three-dimensional (3D) images were acquired on a 1.5-T MRI scanner using a 3D turbo spin echo pulse sequence with a voxel size of 0.8 × 0.8 × 1 mm. The measurement time was 4 to 5 minutes. RESULTS: Using natural MRI contrast, the teeth, dental pulp, mandibular canal, and cortical bone could be clearly delineated. The position and shape of malformed teeth could be assessed in all 3 spatial dimensions. CONCLUSION: MRI was found to be a well-tolerated imaging modality for the diagnosis of dental abnormalities in children and for orthodontic treatment and surgical planning. Compared with conventional radiography, dental MRI provides the advantage of 3-dimensionality and complete elimination of ionizing radiation, which is particularly relevant for repeated examinations in children.

Measurement of tooth and implant mobility under physiological loading conditions.

In vivo measurement of the mobility of teeth under physiological loading has been subject of research for years. Comparing the deflection under load of dental implants with teeth provides valuable input for designing restorations spanning both teeth and implants. Physiological force rise time of about 50-100 ms and displacement of 10-100 µm requires high spatial and temporal resolution of the measurement set-up. Using an optical system attached to the teeth/implants to be measured and a light source attached to a point of reference, displacement of teeth and implants under axial and lateral loading was measured on a series of volunteers. Axial displacement of teeth shows strong time dependence consistent with (hydraulic) damping not observed for lateral loads. Displacement under lateral loading was found to be about one order of magnitude higher than under axial load. For dental implants elastic deflection was observed in axial and lateral direction without measurable influence of the load rise time. For purely axial loading, dental implants and teeth show similar deflection under physiological force rise time but for lateral loading the considerably difference between teeth and implant may put some restrictions on the construction of tooth-implant-bridges, especially for teeth in the anterior region.

The effects of recombinant human growth/differentiation factor-5 (rhGDF-5) on bone regeneration around titanium dental implants in barrier membrane-protected defects: a pilot study in the mandible of beagle dogs.

PURPOSE: This dog study sought to evaluate guided bone regeneration (GBR) in peri-implant defects following implantation of beta-tricalcium phosphate (beta-TCP) with and without osteoinductive recombinant human growth/differentiation factor-5 (rhGDF-5). MATERIALS AND METHODS: In five beagle dogs, all mandibular premolars and the first molar were extracted. After 2 months, six buccolingual critical-size defects were created, and an implant was inserted into the center of each defect. One defect was filled with beta-TCP coated with rhGDF-5 (600 microg/g beta-TCP) and covered with a titanium-reinforced e-PTFE membrane (GDF group). A second defect received the same treatment, but pure uncoated beta-TCP was used (TCP group). A third defect was filled with beta-TCP mixed with autograft and not protected with a membrane (control group). The remaining three defects were filled with other biomaterials. After 2 months, total new bone area, regenerated bone height, and residual amount of beta-TCP were determined histomorphometrically. RESULTS: All implants osseointegrated. One membrane in each group became exposed. Mean new bone area for GDF, TCP, and control sites was 43.9 +/- 18.7 mm2, 32.3 +/- 16.1 mm2, and 13.1 +/- 4.0 mm2, respectively, with a significant difference between GDF and control groups. Mean regenerated bone height was 103.8 +/- 29.7%, 75.4 +/- 36.6%, and 67.2 +/- 19.1% for the GDF, TCP, and control groups, respectively. Mean residual matrix volumes were 25.9 +/- 13.6%, 30.0 +/- 13.0%, and 13.4 +/- 6.5%, respectively. Membrane protection of peri-implant defects filled with beta-TCP resulted in a stronger effect on bone regeneration, although this was not statistically significant. The most pronounced regenerative results were achieved in rhGDF-5/beta-TCP filled membrane-protected defects. CONCLUSION: Delivery of rhGDF-5 on beta-TCP might have the potential to enhance the results of GBR in peri-implant defects.

Fracture characteristics of anterior resin-bonded zirconia-fixed partial dentures.

Resin-bonded fixed partial dentures (RBFPD) are used as a minimal invasive, tooth-preventing alternative for replacing anterior teeth. Zirconia cantilever restorations were supposed to show sufficient strength for a clinical application. The aim of this investigation was to determine the fracture characteristics of cantilever and two-retainer RBFPD, which are fabricated by computer-manufactured high-strength zirconia. Human incisors and canines were used to form three groups of 14 RBFPDs with different types of preparation: group 1, an invasive cantilever; group 2, a minimal-invasive cantilever and group 3, a two-retainer RBFPD control. After thermal cycling and mechanical loading, which was performed to simulate oral service, all restorations were loaded to fracture in a universal testing machine. One half of the specimens were investigated as a control without simulated service. Mode of failure was determined for the three designs. Both cantilever groups showed comparable fracture resistance of 227 N (no. 1) and 210 N (no. 2) before thermal cycling and mechanical loading. The resistance after aging was reduced to 210 N for the invasive cantilever RBFPD and to 179 N for the minimal invasive group. Three-unit RBFPDs showed a significantly higher (p < 0.02) fracture resistance than cantilever bridges before (426 N) as well as after aging (360 N). Predominant failure was FPD and retainer fracture for the invasive cantilever design, debonding for the minimal cantilever design and RBFPD fracture for the two-retainer design. The present study revealed a significantly higher fracture resistance for two-retainer RBFPDs than for cantilever RBFPDs. The frequency of adhesive debonding increased for non-retentive prepared cantilever RBFPDs.

Influence of microgap location and configuration on the periimplant bone morphology in submerged implants. An experimental study in dogs.

OBJECTIVES: The vertical location of the implant-abutment connection influences the periimplant bone morphology. It is unknown, however, whether different microgap configurations cause different bone reactions. Therefore, in this study the bone morphologies of two different implant systems were compared. MATERIAL AND METHODS: Three months after tooth extraction in eight mongrel dogs, two grit-blasted screw implants with internal Morse taper connection (ANK group) were placed on one side whereas the contralateral side received two oxidized screw implants with external hex (TIU group). One implant on each side was placed level with the bone (equicrestal), the second implant was inserted 1.5 mm below bone level (subcrestal). After 3 months the implants were uncovered. Three months after stage two surgery, histometrical evaluations were performed in order to assess the periimplant bone levels (PBL), the first bone-to-implant contact points (BICP), the width (HBD) and the steepness (SLO) of the bone defect. RESULTS: All implants osseointegrated clinically and histologically. Bone overgrowth of the microgap was seen in ANK implants only. No significant differences between ANK and TIU could be detected in neither vertical position for PBL and BICP. However, a tendency in favor of ANK was visible when the implants were placed subcrestally. In the parameters HBD (ANK equicrestal -0.23 mm; TIU equicrestal -0.51 mm; ANK subcrestal +0.19 mm; TIU subcrestal -0.57 mm) and SLO (ANK equicrestal 35.36 degrees; TIU equicrestal 63.22 degrees; ANK subcrestal 20.40 degrees; TIU subcrestal 44.43 degrees) more pronounced and significant differences were noted. CONCLUSIONS: Within the limits of this study, it is concluded that different microgap designs cause different shapes and sizes of the periimplant ('dish-shaped') bone defect in submerged implants both in equicrestal and subcrestal positions.

A new design for post and core restorations implementing positive locking.

The design of a post and core restoration is a trade-off between a series of requirements to achieve stability of the post itself, the surrounding root dentine and the joint between tooth and post, while maintaining a sufficient apical seal of the remaining root canal filling. Post and core restoration systems come in a variety of different designs and dimensions, where each has its specific strength and weakness. With the exception of threaded versions, posts normally rely on either chemical and/or frictional locking between the post and the remaining root. Failure due to fatigue of the joint or root fracture due to overloading of the dentine is a frequent failure mode, especially for posts anchoring removable prostheses. Perforation of the root in an attempt to maximize the post length is a main cause for failure, too. A new design is proposed which uses a short but large diameter post. The risk of decementation is reduced by positive locking. A cavity with an undercut is prepared into the root, into which the post is fitted. Once joined, the post cannot be separated from the tooth without destruction of either the root or the post. The principle of the new design uses preparation tools and a post which is spread at the bottom. A cylindrically prepared hole is re-shaped to a defined inverse taper with the wider diameter at the bottom of the hole. A cylindrical post is inserted and spread at the bottom to a matching shape after placement. A first in vitro test of the stability showed that the positive locking provides at least as good extraction resistance as conventional post without the critical reliance on the luting/bonding agent.

Effect of load angulation and crown shape on forces acting on post and core restored teeth: an in vitro study.

To assess the usefulness of different post and core materials and systems, in vitro testing of fracture strength and fatigue resistance is a useful tool. However, the literature does not present coherent results as to which system can withstand the highest loads. With a geometrical model, the effects of load angulation and contact point location on the generated forces were calculated. To validate the mathematical model, a set of measurements was performed with a set-up that made it possible to measure the critical forces on a post and core restoration. A high level of correlation between the predictions of the model and the measurements was found. It was shown that the resulting forces are strongly dependent on the precise design of the test set-up and results from different geometries cannot be compared directly. Very strong sensitivity to small misalignment was found, all of which serves to explain the large differences in the literature.

Failure analysis of a new post-and-core restoration system using the finite element method.

Human teeth with substantial coronal defects are subject to reconstruction by means of post-and-core restorations. Typically, such a restoration comprises a slightly cylindrical post onto which an abutment of varying shape, depending on the designated restoration, is attached. As clinical results are not satisfactory to date, a new post-and-core design which makes use of positive locking (rather than relying on chemical bonding agents for retention in the residual root) was proposed. Using proprietary burs, an inversely conical hole is machined into the root, into which the prefabricated post-and-core restoration is inserted. This part can be spread at the bottom to match the cavity's undercut form, resulting in a positive lock which can only be separated by destruction of root, restoration or both. Another key feature of this system is a ring/groove geometry which is able to absorb the wedging forces created by said spreading and the stress of loading of the restoration which arises from mascatory forces. To assess the properties, especially in terms of the stress imposed on the remaining tooth at highest possible loading, both finite element simulations and in vitro failure tests were performed and the findings compared. The results suggest that the parameters of the finite element simulations are in good agreement with reality. As calculated and measured force levels immediately before failure of the restoration are high, the introduced new geometry has significant advantages over the classical restoration.

The influence of the root cross-section on the stress distribution in teeth restored with a positive-locking post and core design: a finite element study.

Human teeth with substantial coronal defects are subject to reconstruction by means of post and core restorations. Typically, such a restoration comprises a slightly cylindrical post onto which an abutment of varying shape, depending on the designated restoration, is attached. As clinical results are not satisfactory to date, we proposed a new proprietary post and core design which makes use of positive locking. As this prefabricated system is not customised to an individual root's cross-sectional geometry (usually oval), a varying amount of radicular dentin is left in periphery of the core's outer edge. The aim of this study was to assess the implications of this fact, i.e., whether the root has to endure higher overall stress levels which ultimately may lead to failure of one of the components involved. A series of finite element simulations were performed to evaluate stress and strain on the system, in which the proposed post and core was embedded into a virtual dentin cylinder of different diameters, ranging from flush mounting of the restoration to a dentin excess of 4 mm, and subsequently loaded with forces with two angles of attack (90 degrees and 130 degrees ). The results show that flush mounting yields an agreeable stress and strain distribution within the radicular dentin, but overall stress levels drop significantly with an excess of 0.5 mm of surrounding dentin. More than 1 mm excess was not found to have profound positive effects.

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.

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.

Maxillary removable prostheses retained by telescopic crowns on two implants or two canines.

Precision telescopic attachments allow for rigid connection between removable prostheses and abutments. However, it is still unknown whether implants can bear similar long-term loading forces as teeth when telescopic crowns are used as retention devices. It was the aim of this prospective clinical study to observe maxillary removable partial dentures that were retained by telescopic crowns on two endosseous implants in the canine regions. In a control group, identical dentures were fabricated that were retained by telescopic crowns on the maxillary canines. The implant group consisted of 14 patients, and the control group included 8 patients. Mean observation time of the prostheses was 25.6 months. Radiographic bone levels and periodontal parameters did not reveal specific differences between the two groups. However, five implants failed, and there were no failures in the control group. Survival rates were 48.9% for the implant group and 100% for the control group, with a significant difference between the two groups. Within the limits of this study, it is concluded that the telescopic connection might be too rigid (thus delivering overloading) for two single implants in the canine region of the maxilla supporting a removable denture.

Effect of design of all-ceramic resin-bonded fixed partial dentures on clinical survival rate.

In the treatment of single-tooth gaps, the resin-bonded fixed partial denture (FPD) has established itself as an alternative treatment modality. With the advent of high-strength ceramics, such as aluminum oxide ceramics, it appeared to be possible to fabricate all-ceramic resin-bonded FPDs without a metal reinforcement. However, fractures of the traditional two-retainer design of these restorations occurred quite frequently. It was proposed to change the two-retainer design to a single-retainer design with the hope that the survival rate could be improved. Nevertheless, the use of aluminum oxide ceramics can be problematic. The present study strongly suggests that the clinical performance of resin-bonded FPDs made of a high-strength glass-ceramic is in large measure dependent on their design.

Effect of occlusal morphology on the accuracy of bite force measurements using thin film transducers.

PURPOSE: Occlusal transducer foils using piezoelectricity or pressure-dependent electric resistance are potential candidates for a measurement system for both absolute levels and changes in bite force. This preliminary in vitro study evaluated the possible usefulness of such transducer foils in the assessment of occlusal forces in centric occlusion. MATERIALS AND METHODS: Piezoelectric force transducer foils 33 microm thick were placed between pairs of teeth with the dentition in centric occlusion. Occlusal forces were recorded in five patients, who were instructed to bite as hard as possible for about 1 second. Acrylic resin casts of each pair of antagonistic teeth were aligned with the help of interocclusal records. The casts were mounted in a jig, where a defined load could be applied. The ratio of applied force and measured sensor signal permitted a set of calibration factors. RESULTS: A correction factor for each pair of teeth helped determine the ratio by which measured occlusal force exceeded actual tooth load. Differences in occlusal morphology gave rise to a wide span of correction factors (1.01 to 2.80). Steep cusp angles resulted in a wedge action that gave rise to a strong increase in occlusal forces, which were about twice as high as actual tooth load, with wide variation. CONCLUSION: This method of bite force measurement eliminated the influence of occlusal morphology by individual correction for each pair of opposing teeth. To measure the absolute load of antagonistic teeth with thin film transducer foils, one must take into account individual occlusal morphology. Forces measured with the films are a function of both actual tooth load and occlusal morphology.

Osseotite vs. machined surface in poor bone quality. A study in dogs.

Implant sites with low bone content have exhibited lower implant survival rates than dense bone areas. Alterations of the implant surface seem to influence the bone-to-implant contact rate and may have an impact on implant failure rates in such sites. It was the objective of this animal study to histomorphometrically compare two different implant surfaces in so-called poor bone quality sites. All premolars on one side of the mandible were extracted in five fox hounds. After a healing time of 8 months, four screw-type implants (two with a machined surface (ICE group) and two with a double acid-etched (Osseotite) surface (OSS group)) were inserted into the mandible. Upon insertion, the implant apex was located in the 'hollow' part of the dog mandible, where the bone content is low. After 4 months healing, histomorphometric evaluations were performed. All implants osseointegrated clinically and histologically. Periapical density measurements revealed similar bone contents in both groups (ICE 49.9+/-16.7%, OSS 52.2+/-8.4%; P>0.05). Despite these similar amounts of bone content in the apical area around the implant, the Osseotite implant surface had a significantly higher bone-to-implant contact rate than the machined surface (OSS 62.9+/-12.4%, ICE 39.5+/-13.0%; P<0.01). It is concluded from this animal experiment that, in poor bone quality sites, an implant with an Osseotite surface can achieve a significantly higher bone-to-implant contact compared to a machined surface.

Treatment of a juvenile patient with a maxillary all-ceramic resin-bonded fixed partial denture: a case report.

Treatment of juvenile patients with a missing maxillary incisor is difficult, because an implant cannot be placed until growth is completed. The other minimally invasive alternatives are also problematic: Removable dentures are rarely accepted by juvenile patients, and the conventional resin-bonded fixed partial denture often provides a poor esthetic result because the metal retainer causes the abutment teeth to lose their natural translucency and to become grayish. Moreover, the alveolar ridge defect makes it easy to identify the prosthesis in the pontic area. The present case report describes the prosthetic treatment of a juvenile patient who had lost a maxillary incisor to trauma. To avoid the disadvantages of conventional therapies, subepithelial connective tissue was grafted to reshape the alveolar ridge. The space was closed with an all-ceramic resin-bonded fixed partial denture.