Preoperative evaluation of bone quality for dental implantation using an ultrasound axial transmission device in an ex vivo model.

This study investigated the clinical utility of an ultrasound axial transmission device in preoperative evaluation of bone quality for dental implantation, by clarifying the relationship between cortical bone speed of sound (cSOS), insertion torque values (ITV), and implant stability quotient (ISQ) in porcine femur bone. Eleven fresh porcine femurs, without soft tissue, were prepared. The cSOS of these bones were measured using the axial transmission device. Bone mineral density (BMD) and porosity (Po) were measured in cortical bone samples obtained from the region of ultrasound measurements by X-ray microcomputed tomography. Thirty-three implants were inserted into these samples (three implants per bone sample), and ITV and ISQ were measured for all implants. Then, cortical bone thickness (CbTh) of the area for implantation was measured for all implants using a micrometer. The mean cSOS was 3962 m/s; mean BMD and Po were 0.822 g/cm2 and 0.185%, respectively. cSOS and BMD values were positively correlated, and cSOS values and Po values were negatively correlated. Mean ITV, ISQ, and CbTh were 37.95 Ncm, 71.172, and 2.869 mm, respectively. There was a positive correlation between cSOS values and ISQ values. The cSOS of each bone did not correlate with ITV for all of the bone samples. However, when the CbTh ranges from 3.0 to 3.5 mm, ITV are correlated with cSOS. These findings suggest that cSOS, which reflects the cortical bone quality, may be clinical utility as a preoperative diagnosis of the implant.

Molar loss and powder diet leads to memory deficit and modifies the mRNA expression of brain-derived neurotrophic factor in the hippocampus of adult mice.

BACKGROUND: It is known that tooth loss is known to be a risk factor for Alzheimer's disease and soft diet feeding induces memory impairment. Recent studies have shown that brain-derived neurotrophic factor (BDNF) is associated with tooth loss or soft diet in young animal model, and that BDNF expression is decreased in patients with Alzheimer's disease. However, single or combined effect of tooth loss and/or soft diet on brain function has not fully understood. Here we examined the effect of molar loss and powder diet on memory ability and the expression of BDNF mRNA in the hippocampus of adult C57BL/6J mice. Twenty eight-weeks-old C57BL/6J mice were divided into intact molar group and extracted molar group. They were randomly divided into the I/S group (Intact upper molar teeth/Solid diet feeding), the E/S group (Extracted upper molar teeth/Solid diet feeding), the I/P group (Intact upper molar teeth/Powder diet feeding), and the E/P group (Extracted upper molar teeth/Powder diet feeding). The observation periods were 4 and 16-week. To analyze the memory ability, the step-through passive avoidance test was conducted. BDNF-related mRNA in the hippocampus was analyzed by real-time polymerase chain reaction (RT-PCR). RESULTS: At 4 weeks later, we performed memory test and isolated brains to analyze. There were no differences in memory function and BDNF mRNA level between these four groups. However, at 16 weeks later, E/S and E/P group showed memory impairment, and decreased level of BDNF mRNA. Whereas, the powder diet had no effect on memory function and BDNF mRNA level even at 16 weeks later. CONCLUSIONS: These results suggest that the effect of molar loss and powder diet on memory function and BDNF mRNA levels were different, molar loss may have a greater long-term effect on memory ability than powder diet does.

Tooth loss might not alter molecular pathogenesis in an aged transgenic Alzheimer's disease model mouse.

BACKGROUND AND OBJECTIVE: Previous studies have reported that tooth loss is a risk factor of Alzheimer's disease (AD). However, the association between tooth loss and cognition and the impact of tooth loss on the molecular pathogenesis of AD remain elusive. In this study, we tested the effect of tooth loss on learning and memory and on the molecular pathogenesis of AD in an aged AD model mice. MATERIALS AND METHODS: We divided 14-month-old amyloid precursor protein (APP) transgenic mice, an AD model mouse line, into upper molar extracted group (experimental) and molar intact group (control). At 18 months old, we analysed not only the changes of amyloid-beta (Aß), pyramidal cells in the brain but also the learning and memory ability with step-through passive avoidance test. RESULTS: The amount of Aß and the number of pyramidal cells in the hippocampus were not significantly different between the experimental and control group. Similarly, the difference of learning and memory ability could not be distinguished between the groups. CONCLUSION: Neither molecular pathogenesis of AD nor associated learning and memory were aggravated by tooth loss in these mice. The limited results of this study which used the aged mice may help the dental profession to plan and explain treatments to patients with AD, which must be designed while taking into account the severity of the AD symptoms.

The Effect of Superstructures Connected to Implants with Different Surface Properties on the Surrounding Bone.

The objective of this study was to investigate how the connection of superstructures to implants with different surface properties affects the surrounding bone. The right and left mandibular premolars and molars of 5 dogs were extracted. After 12 weeks, a machined implant was placed mesially and an anodized implant was placed distally on one side of the edentulous jaw, with the positions reversed on the opposite side. Twelve weeks after implantation, splinted superstructures were set to the implants. At 24 weeks after implantation, the implant stability quotient (ISQ) was measured, radiographs were obtained. Removal torque values were measured and histologic observation was performed. The ISQ values at 24 weeks after implantation were not significantly different between the groups. The removal torque values were significantly different between the distal anodized and distal machined implants (p < 0.05). From 12 to 24 weeks, marginal bone losses were not significantly different between the groups. Fluorescent observation of tissue samples revealed bone-remodeling activity around all of the implants. The results of this study suggest that when implants with different surface properties are connected, machined implants at the most distal sites might be a potential risk factor for implant-bone binding.

Tooth loss induces memory impairment and neuronal cell loss in APP transgenic mice.

Tooth loss is a known risk factor of Alzheimer's disease (AD). However, the association of tooth loss with the molecular pathogenesis of AD is still unknown. The hypothesis that the molecular pathogenesis of AD is enhanced by molar tooth loss was tested. Seventeen female transgenic mice (J20) were divided into the experimental (EX, n=10) and control (C, n=7) groups. In the EX group, maxillary bilateral molar teeth were extracted at the age of 6 months. In the C group, however, these teeth remained intact. Passive avoidance test was performed to evaluate learning and memory abilities right after tooth extraction (6 months old) and 4 months later (10 months old). After the test at 10 months, amyloid beta (Aß) deposition and changes of neuronal cell number and area in the hippocampus were investigated using half of the brains. The other half was homogenized and used to determine Aß40 and Aß42 levels by ELISA. At the 10 months of age, learning and memory abilities were significantly impaired in the EX group compared to the C group (P<0.05). The neuronal cell number in the CA1 and CA3 regions was significantly lower in the EX group than in the C group (P<0.05). Total Aß, Aß40, and Aß42 levels showed no significant intergroup difference. Molar tooth loss may cause neuronal cell loss in the hippocampus, leading to memory impairment; this process may be independent of the amyloid cascade.

Increased crown-to-implant ratio may not be a risk factor for dental implant failure under appropriate plaque control.

OBJECTIVE: The aim of this study was to evaluate whether increased crown-to-implant (C/I) ratio influences implant stability or not under proper healthy control of peri-implant mucosa. The hypothesis of this study is that implant stability can be maintained despite High C/I, under appropriate plaque control. MATERIALS AND METHODS: Five male Beagle-Labrador hybrid dogs (2 years old) were used. Their bilateral mandibular premolar extraction was performed. After allowing 12 weeks for bone healing, 3 types of vertical marginal bone loss were simultaneously prepared randomly. Then, 30 titanium implants were placed in the edentulous areas and defined as High C/I, Mid C/I and Low C/I groups. This time point was designated as the baseline (0 Week). Twelve weeks after implant placement, metal superstructures were cemented to the implants and an occlusal plate was set at the opposite side. At the same time, Calcein green was injected for remodeling evaluation. Implants were loaded by feeding the dogs a hard pellet diet. Tooth brushing was performed 5 days per week during the study to maintain healthy peri-implant mucosa. Twenty-four weeks following implant placement, the interface structure was evaluated clinically, radiologically, and histologically. RESULT: Implant stability quotient (ISQ) increased with time in all 3 groups, without any significant correlation with the C/I value (p >0.05). Moreover, mean marginal bone loss adjacent around implants in all 3 groups ranged between 0.11 and 0.19 mm, with no significant difference (p >0.05). Many fluorescence-labeled bones are shown in the High C/I group. It is considered that high remodeling activity prevent marginal bone loss in the High C/I group and this may provide favorable implant stability under proper plaque control. CONCLUSION: These findings suggest that increased C/I may not be a risk factor for implant failure if the peri-implant mucosa is kept healthy, as was the case in this animal model.

Development of implant/interconnected porous hydroxyapatite complex as new concept graft material.

BACKGROUND: Dental implant has been successfully used to replace missing teeth. However, in some clinical situations, implant placement may be difficult because of a large bone defect. We designed novel complex biomaterial to simultaneously restore bone and place implant. This complex was incorporated implant into interconnected porous calcium hydroxyapatite (IP-CHA). We then tested this Implant/IP-CHA complex and evaluated its effect on subsequent bone regeneration and implant stability in vivo. METHODOLOGY/PRINCIPAL FINDINGS: A cylinder-type IP-CHA was used in this study. After forming inside of the cylinder, an implant was placed inside to fabricate the Implant/IP-CHA complex. This complex was then placed into the prepared bone socket in the femur of four beagle-Labrador hybrid dogs. As a control, implants were placed directly into the femur without any bone substrate. Bone sockets were allowed to heal for 2, 3 and 6 months and implant stability quotients (ISQ) were measured. Finally, tissue blocks containing the Implant/IP-CHA complexes were harvested. Specimens were processed for histology and stained with toluidine blue and bone implant contact (BIC) was measured. The ISQs of complex groups was 77.8±2.9 in the 6-month, 72.0±5.7 in the 3-month and 47.4±11.0 in the 2-month. There was no significant difference between the 3- or 6-month complex groups and implant control groups. In the 2-month group, connective tissue, including capillary angiogenesis, was predominant around the implants, although newly formed bone could also be observed. While, in the 3 and 6-month groups, newly formed bone could be seen in contact to most of the implant surface. The BICs of complex groups was 2.18±3.77 in the 2-month, 44.03±29.58 in the 3-month, and 51.23±8.25 in the 6-month. Significant difference was detected between the 2 and 6-month. CONCLUSIONS/SIGNIFICANCE: Within the results of this study, the IP-CHA/implant complex might be able to achieve both bone reconstruction and implant stability.

Initial bone regeneration around fenestrated implants in Beagle dogs using basic fibroblast growth factor-gelatin hydrogel complex with varying biodegradation rates.

PURPOSE: The purpose of this study was to compare the effectiveness of fast and slow biodegradation of basic fibroblast growth factor (bFGF)-gelatin hydrogel complex on bone regeneration around fenestrated implants as a new augmentation drug delivery system. METHODS: Nine titanium implants (3.3mm diameter and 10mm length) were placed into the edentulous areas of the mandibles of three adult beagle dogs with four screws exposed at the upper buccal side. The effectiveness of bFGF-gelatin hydrogel complexes of varying degradation types used to cover implant screws without membrane were compared with 1 microg and 10 microg bFGF-98 wt% gelatin as the fast degradation type and 10 microg bFGF-95 wt% gelatin as the slow degradation type. After 4 weeks, bone regeneration around the screws was evaluated histologically and histomorphometrically. RESULTS: With use of 10 microg bFGF, regenerated bone around exposed screws was clearly seen in both the fast and slow degradation type groups. In contrast, little bone formation was seen in the fast degradation-type group with 1 microg bFGF. Height of regenerated bone for the slow degradation-type complex group was significantly greater than for the fast degradation-type group with 1 microg bFGF (P<0.05). CONCLUSION: These results suggest that use of slow degradation-type bFGF-gelatin hydrogel complex may accelerate bone regeneration around fenestrated implants at an early stage of bone regeneration.

Influence of static overload on the bony interface around implants in dogs.

PURPOSE: The aim of this study was to investigate bony changes around selectively overloaded implants in dogs. MATERIALS AND METHODS: Twelve adult male beagles were used: 4 animals each for control, 4-week-load, and 12-week-load groups. Three implants were placed on the right side of each of the 12 animals and the time point designated as the study's baseline. Superstructures were then fabricated and attached only in the 2 implant-loaded groups 12 and 20 weeks following implant placement. Each lower distal implant was then fit with a cantilever-type superstructure extending in a mesial direction so as to be able to generate a controlled overload. The mesial and central implants were attached via superstructures equipped with a stainless steel screw, which could be tightened to create a controlled overload force. The force was induced by a controlled static 250-microm submerging of the cantilever of the distal implant. After 24 weeks, tissue specimens including implants were evaluated histologically and histomorphometrically. RESULTS: Numerous fluorescence-labeled bone areas were noted in the 4-week-load group, showing a high remodeling activity. Marginal bone loss was significantly greater in the 12-week-load group than in the 4-week-load group. The ratio of fluorescence-labeled bone area in the inner thread region was significantly higher in the 4-week-load group than in the 12-week-load group. CONCLUSIONS: These findings demonstrate that static overload-induced forces can elicit changes in peri-implant bone in experimental animals.

The effect of occlusal rest size and shape on yield strength.

STATEMENT OF PROBLEM: Occlusal rests, essential for conventional removable partial dentures, may fracture and cause failure of the prosthesis. It is unknown whether alterations in the size or shape of occlusal rests might improve their performance. PURPOSE: In this in vitro study, 3-dimensional finite element analysis was used to evaluate the effects of occlusal rest size and shape on yield strength. MATERIAL AND METHODS: An occlusal rest and a minor connector as part of a clasp assembly were modeled for 3-dimensional finite element analysis with 3 variations of width (2.0, 3.0, and 4.0 mm), thickness (0.7, 1.0, and 1.5 mm) and length (2.0, 3.0, and 4.0 mm). A concentrated vertical load of 100 N was applied at the most protruded point of the occlusal rest base. Maximal principal stress and yield strength were calculated. In addition, the following parameters were altered: radius of curvature at the inner connection (r), thickness of the minor connector (m), inclination of horizontal axis of occlusal rest (i), and thickness at the most protruded point (t). RESULTS: Yield strength increased with increased width (183% to 242% from 2.0 to 4.0 mm) and thickness (141% to 230% from 0.7 to 1.5 mm). Alterations in length had a lesser effect on yield strength (120% to 178% from 4.0 to 2.0 mm). All other parameters except thickness at the most protruded point (t) affected yield strength. CONCLUSION: The results of this in vitro study suggest basic principles for optimizing the size and shape of occlusal rests. In general, increased width and thickness are desirable, whereas overrounded or sharp line angles and excessive rest inclination should be avoided. These principles may be useful in removable partial denture design.

An alternative procedure for discrimination of contacts in centric occlusion and lateral excursion.

An alternative procedure for discrimination of contacts in centric occlusion and lateral excursion was introduced for eliminating premature contacts in lateral excursion without the alteration of other intercuspations. This procedure involves the application of red paper for the evaluation of lateral excursive contacts and blue paper for centric occlusion holding contacts to provide improved visibility of occlusal contacts.