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Sanjar F, Silliman DT, Johnson IJ, Htut Z, Peacock TJ, Thompson SF, Dion GR, Nahid MA, Decker JF, Leung KP. Identification of temporal shifts of oral bacteria in bone regeneration following mandibular bone defect injury and therapeutic surgery in a porcine model. Mol Oral Microbiol 2024. [PMID: 38511906 DOI: 10.1111/omi.12460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 12/07/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Considered the second largest and most diverse microbiome after the gut, the human oral ecosystem is complex with diverse and niche-specific microorganisms. Although evidence is growing for the importance of oral microbiome in supporting a healthy immune system and preventing local and systemic infections, the influence of craniomaxillofacial (CMF) trauma and routine reconstructive surgical treatments on community structure and function of oral resident microbes remains unknown. CMF injuries affect a large number of people, needing extensive rehabilitation with lasting morbidity and loss of human productivity. Treatment efficacy can be complicated by the overgrowth of opportunistic commensals or multidrug-resistant pathogens in the oral ecosystem due to weakened host immune function and reduced colonization resistance in a dysbiotic oral microbiome. AIMS To understand the dynamics of microbiota's community structure during CMF injury and subsequent treatments, we induced supra-alveolar mandibular defect in Hanford miniature swine (n = 3) and compared therapeutic approaches of immediate mandibullar reconstructive (IMR) versus delayed mandibullar reconstructive (DMR) surgeries. METHODS Using bacterial 16S ribosomal RNA gene marker sequencing, the composition and abundance of the bacterial community of the uninjured maxilla (control) and the injured left mandibula (lingual and buccal) treated by DMR were surveyed up to 70-day post-wounding. For the injured right mandibula receiving IMR treatment, the microbial composition and abundance were surveyed up to 14-day post-wounding. Moreover, we measured sera level of biochemical markers (e.g., osteocalcin) associated with bone regeneration and healing. Computed tomography was used to measure and compare mandibular bone characteristics such as trabecular thickness between sites receiving DMR and IMR therapeutic approaches until day 140, the end of study period. RESULTS Independent of IMR versus DMR therapy, we observed similar dysbiosis and shifts of the mucosal bacteria residents after CMF injury and/or following treatment. There was an enrichment of Fusobacterium, Porphyromonadaceae, and Bacteroidales accompanied by a decline in Pasteurellaceae, Moraxella, and Neisseria relative abundance in days allotted for healing. We also observed a decline in species richness and abundance driven by reduction in temporal instability and inter-animal heterogeneity on days 0 and 56, with day 0 corresponding to injury in DMR group and day 56 corresponding to delayed treatment for DMR or injury and immediate treatment for the IMR group. Analysis of bone healing features showed comparable bone-healing profiles for IMR vs. DMR therapeutic approach.
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Affiliation(s)
- Fatemeh Sanjar
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - David T Silliman
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Ian J Johnson
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Zayer Htut
- Walter Reed Army Institute of Research, Silver Spring, Maryland, USA
| | - Trent J Peacock
- Office of Research Compliance, Mississippi State University, Meridian, Mississippi, USA
| | - Samira F Thompson
- Carl R. Darnall Army Medical Center, Fort Hood Dental Activities-AEGD, Fort Hood, Texas, USA
| | - Gregory R Dion
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Md A Nahid
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - John F Decker
- Carl R. Darnall Army Medical Center, Fort Hood Dental Activities-AEGD, Fort Hood, Texas, USA
| | - Kai P Leung
- Combat Wound Care Group, US Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
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Puljic D, Petricevic N, Celebic A, Kovacic I, Milos M, Pavic D, Milat O. Mandibular Overdenture Supported by Two or Four Unsplinted or Two Splinted Ti-Zr Mini-Implants: In Vitro Study of Peri-Implant and Edentulous Area Strains. Biomimetics (Basel) 2024; 9:178. [PMID: 38534864 DOI: 10.3390/biomimetics9030178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 03/28/2024] Open
Abstract
Clinical indications for the newly released Ti-Zr (Roxolid®) alloy mini-implants (MDIs) aimed for overdenture (OD) retention in subjects with narrow alveolar ridges are not fully defined. The aim of this study was to analyze peri-implant and posterior edentulous area microstrains utilizing models of the mandible mimicking a "real" mouth situation with two (splinted with a bar or as single units) or four unsplinted Ti-Zr MDIs. The models were virtually designed from a cone beam computed tomography (CBCT) scan of a convenient patient and printed. The artificial mucosa was two millimeters thick. After MDI insertion, the strain gauges were bonded on the oral and vestibular peri-implant sites, and on distal edentulous areas under a denture. After attaching the ODs to MDIs, the ODs were loaded using a metal plate positioned on the first artificial molars (posterior loadings) bilaterally and unilaterally with 50, 100, and 150 N forces, respectively. During anterior loadings, the plate was positioned on the denture's incisors and loaded with 50 and 100 N forces. Each loading was repeated 15 times. The means with standard deviations, and the significance of the differences (two- and three-factor MANOVA) were calculated. Variations in the MDI number, location, and splinting status elicited different microstrains. Higher loading forces elicited higher microstrains. Unilateral loadings elicited higher microstrains than bilateral and anterior loadings, especially on the loading side. Peri-implant microstrains were lower in the four-MDI single-unit model than in both two-MDI models (unsplinted and splinted). Posterior implants showed higher peri-implant microstrains than anterior in the four-MDI model. The splinting of the two-MDI did not have a significant effect on peri-implant microstrains but elicited lower microstrains in the posterior edentulous area. The strains did not exceed the bone reparatory mechanisms, although precaution and additional study should be addressed when two Ti-Zr MDIs support mandibular ODs.
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Affiliation(s)
- Dario Puljic
- Department of Removable Prosthodontics, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia
| | - Nikola Petricevic
- Department of Removable Prosthodontics, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia
| | - Asja Celebic
- Department of Removable Prosthodontics, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia
| | - Ines Kovacic
- Department of Removable Prosthodontics, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia
| | - Manuela Milos
- Department of Removable Prosthodontics, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia
| | - Dalibor Pavic
- Department of Removable Prosthodontics, University of Zagreb School of Dental Medicine, 10000 Zagreb, Croatia
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Blanc-Sylvestre N, Bouchard P, Chaussain C, Bardet C. Pre-Clinical Models in Implant Dentistry: Past, Present, Future. Biomedicines 2021; 9:1538. [PMID: 34829765 PMCID: PMC8615291 DOI: 10.3390/biomedicines9111538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
Biomedical research seeks to generate experimental results for translation to clinical settings. In order to improve the transition from bench to bedside, researchers must draw justifiable conclusions based on data from an appropriate model. Animal testing, as a prerequisite to human clinical exposure, is performed in a range of species, from laboratory mice to larger animals (such as dogs or non-human primates). Minipigs appear to be the animal of choice for studying bone surgery around intraoral dental implants. Dog models, well-known in the field of dental implant research, tend now to be used for studies conducted under compromised oral conditions (biofilm). Regarding small animal models, research studies mostly use rodents, with interest in rabbit models declining. Mouse models remain a reference for genetic studies. On the other hand, over the last decade, scientific advances and government guidelines have led to the replacement, reduction, and refinement of the use of all animal models in dental implant research. In new development strategies, some in vivo experiments are being progressively replaced by in vitro or biomaterial approaches. In this review, we summarize the key information on the animal models currently available for dental implant research and highlight (i) the pros and cons of each type, (ii) new levels of decisional procedures regarding study objectives, and (iii) the outlook for animal research, discussing possible non-animal options.
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Affiliation(s)
- Nicolas Blanc-Sylvestre
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
- AP-HP, Department of Periodontology, Rothschild Hospital, European Postgraduate in Periodontology and Implantology, Université de Paris, 75012 Paris, France
| | - Philippe Bouchard
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
- AP-HP, Department of Periodontology, Rothschild Hospital, European Postgraduate in Periodontology and Implantology, Université de Paris, 75012 Paris, France
| | - Catherine Chaussain
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
- AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Dental Medicine Department, Bretonneau Hospital, GHN-Université de Paris, 75018 Paris, France
| | - Claire Bardet
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
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Movahedian B, Rismanchian M, Navaei H, Tavanafar S, Koushaei S. Does the systemic administration of L-arginine affect dental implant stability in nicotine consumer dogs? Maxillofac Plast Reconstr Surg 2021; 43:6. [PMID: 33569754 PMCID: PMC7876185 DOI: 10.1186/s40902-021-00292-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/25/2021] [Indexed: 11/12/2022] Open
Abstract
Background Nicotine can have detrimental effects on dental implant osseointegration. This study aimed to evaluate the influence of systemic l-arginine supplement on the osseointegration of dental implants in nicotine consumer dogs. Methods Twelve 1-year Labrador Retriever dogs had their right and left third and fourth mandibular premolars removed, and the sockets were left to heal for 6 months. Dogs were randomly divided into three groups (n = 16): group 1—0.2 mg/kg nicotine was injected twice daily; group 2—0.2 mg/kg nicotine was injected twice daily in addition to 200 mg/kg l-arginine capsules taken orally; and group 3—placebo. Forty-eight dental implants were inserted into the healed sockets of the dog’s mandible and were assessed by implant stability quotient (ISQ) using resonance frequency analysis (RFA) during 4 weeks and insertion and removal torque value analysis. Results No implant failure occurred during the study period. The change in torque value between insertion and removal was similar in the placebo and nicotine+arginine consumer dogs (p = 0.276), which shows a positive effect of arginine supplementation in nicotine consumers. There was a significant difference in torque value change between nicotine+arginine vs. nicotine consumers (p = 0.049) and placebo vs. nicotine (p = 0.003). After 4 weeks, the placebo had the most significant improvement in torque value (47.0 ± 16.9), followed by nicotine+arginine (25.1 ± 37.8), and the worst torque value was for the nicotine group (− 5.7 ± 24.0) pound per inch. The results show that except in the first week, there are significant differences in ISQ between the groups in different periods. ISQ in all of the groups has reduced at first but then increased over time. At the time of implant placement, insertion torque was significantly higher in the nicotine consumer group than the nicotine+arginine consumer group and placebo group (p = 0.020). Conclusion Arginine supplementation promotes bone healing and implant primary stability by improving dental implant osseointegration biomechanical characteristics.
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Affiliation(s)
- Bijan Movahedian
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansour Rismanchian
- Department of Prosthodontics, Dental Implants Research Center, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hooman Navaei
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Isfahan University of Medical Sciences, Esfahan, Iran
| | - Saeid Tavanafar
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Soheil Koushaei
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
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Hultin K, Eriksson A, Backe C, Johansson U, Bougas K. A Pilot Study with Randomised Controlled Design Comparing TiZr Alloy Dental Implants to Ti Implants. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2020; 11:e3. [PMID: 33598111 PMCID: PMC7875101 DOI: 10.5037/jomr.2020.11403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
Objectives Evidence on the clinical performance of recently introduced dental implants in titanium-zirconium alloy is sparse. The aim of the present pilot study with randomized controlled design is to compare changes in supporting structures around dental titanium-zirconium alloy implants to commercially pure titanium implants. Material and Methods The present material includes consecutive patients referred to a specialist clinic in Sweden. Two patient groups treated with dental implants in two different materials - titanium (Ti) and titanium-zirconium (TiZr) - were defined after block randomisation for smoking. In total, 40 implants installed in 21 patients were available for one-year follow-up. Marginal bone level, soft tissue height and width of keratinised mucosa were registered at baseline and at one-year follow-up. Results At implant level, the test group (TiZr) yielded significant marginal bone loss (P < 0.001) after one year. Additionally, marginal bone loss after one year was significantly higher for TiZr implants (P < 0.001) as compared to traditional Ti implants. Soft tissue dimensions were stable throughout the evaluation time for both implant materials. Conclusions One-year results indicate more pronounced initial marginal bone loss for dental implants in titanium-zirconium alloy as compared to implants made of commercially pure titanium.
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Affiliation(s)
- Kristina Hultin
- Department of Prosthodontics, Södra Älvsborg Hospital, BoråsSweden
| | - Annelie Eriksson
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, BoråsSweden
| | - Christina Backe
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, BoråsSweden
| | - Ulf Johansson
- Department of Oral and Maxillofacial Surgery, Södra Älvsborg Hospital, BoråsSweden
| | - Kostas Bougas
- Department of Periodontology, Södra Älvsborg Hospital, BoråsSweden
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Histological and Nanomechanical Properties of a New Nanometric Hydroxiapatite Implant Surface. An In Vivo Study in Diabetic Rats. MATERIALS 2020; 13:ma13245693. [PMID: 33322243 PMCID: PMC7764315 DOI: 10.3390/ma13245693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/01/2023]
Abstract
Implant therapy is a predictable treatment to replace missing teeth. However, the osseointegration process may be negatively influenced by systemic conditions, such as diabetes mellitus (DM). Microtopography and implant surface developments are strategies associated to better bone repair. This study aimed to evaluate, in healthy and diabetic rats, histomorphometric (bone to implant contact = %BIC; and bone area fraction occupancy = %BAFO) and nanomechanical (elastic modulus = EM; and hardness = H) bone parameters, in response to a nanometric hydroxyapatite implant surface. Mini implants (machined = MAC; double acid etched = DAE, and with addition of nano-hydroxyapatite = NANO) were installed in tibias of healthy and diabetic rats. The animals were euthanized at 7 and 30 days. NANO surface presented higher %BIC and %BAFO when compared to MAC and DAE (data evaluated as a function of implant surface). NANO surface presented higher %BIC and %BAFO, with statistically significant differences (data as a function of time and implant surface). NANO surface depicted higher EM and H values, when compared to machined and DAE surfaces (data as a function of time and implant surface). Nano-hydroxyapatite coated implants presented promising biomechanical results and could be an important tool to compensate impaired bone healing reported in diabetics.
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Fraulob M, Le Cann S, Voumard B, Yasui H, Yano K, Vayron R, Matsukawa M, Zysset P, Haïat G. Multimodal Evaluation of the Spatiotemporal Variations of Periprosthetic Bone Properties. J Biomech Eng 2020; 142:1086899. [DOI: 10.1115/1.4048399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 12/25/2022]
Abstract
Abstract
Titanium implants are widely used in dental and orthopedic surgeries. However, implant failures still occur because of a lack of implant stability. The biomechanical properties of bone tissue located around the implant need to be assessed to better understand the osseointegration phenomena and anticipate implant failure. The aim of this study was to explore the spatiotemporal variation of the microscopic elastic properties of newly formed bone tissue close to an implant. Eight coin-shaped Ti6Al4V implants were inserted into rabbit tibiae for 7 and 13 weeks using an in vivo model allowing the distinction between mature and newly formed bone in a standardized configuration. Nanoindentation and micro-Brillouin scattering measurements were carried out in similar locations to measure the indentation modulus and the wave velocity, from which relative variations of bone mass density were extracted. The indentation modulus, the wave velocity and mass density were found to be higher (1) in newly formed bone tissue located close to the implant surface, compared to mature cortical bone tissue, and (2) after longer healing time, consistently with an increased mineralization. Within the bone chamber, the spatial distribution of elastic properties was more heterogeneous for shorter healing durations. After 7 weeks of healing, bone tissue in the bone chamber close to the implant surface was 12.3% denser than bone tissue further away. Bone tissue close to the chamber edge was 16.8% denser than in its center. These results suggest a bone spreading pathway along tissue maturation, which is confirmed by histology and consistent with contact osteogenesis phenomena.
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Affiliation(s)
- Manon Fraulob
- MSME, CNRS UMR 8208, Univ Paris Est Creteil, Univ Gustave Eiffel, Creteil F-94010, France
| | - Sophie Le Cann
- MSME, CNRS UMR 8208, Univ Paris Est Creteil, Univ Gustave Eiffel, Creteil F-94010, France
| | - Benjamin Voumard
- ARTORG Centre for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, Bern CH-3010, Switzerland
| | - Hirokazu Yasui
- Laboratory of Ultrasonic Electronics, Applied Ultrasonic Research Center, Doshisha University, Kyotanabe, Kyoto 610-0321, Japan
| | - Keita Yano
- Laboratory of Ultrasonic Electronics, Applied Ultrasonic Research Center, Doshisha University, Kyotanabe, Kyoto 610-0321, Japan
| | - Romain Vayron
- Université Polytechnique Hauts de France, Laboratoire d'Automatique, de Mécanique et d'informatique Industrielles et Humaines, LAMIH UMR CNRS 8201, Valenciennes F-59300, France
| | - Mami Matsukawa
- Laboratory of Ultrasonic Electronics, Applied Ultrasonic Research Center, Doshisha University, Kyotanabe, Kyoto 610-0321, Japan
| | - Philippe Zysset
- ARTORG Centre for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, Bern CH-3010, Switzerland
| | - Guillaume Haïat
- MSME, CNRS UMR 8208, Univ Paris Est Creteil, Univ Gustave Eiffel, Creteil F-94010, France
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Multimodal characterization of the bone-implant interface using Raman spectroscopy and nanoindentation. Med Eng Phys 2020; 84:60-67. [DOI: 10.1016/j.medengphy.2020.07.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/27/2020] [Accepted: 07/13/2020] [Indexed: 02/06/2023]
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Histological, Histomorphometrical, and Biomechanical Studies of Bone-Implanted Medical Devices: Hard Resin Embedding. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1804630. [PMID: 32420323 PMCID: PMC7201441 DOI: 10.1155/2020/1804630] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022]
Abstract
The growing incidence of degenerative musculoskeletal disorders as well as lifestyle changes has led to an increase in the surgical procedures involving implanted medical devices in orthopedics. When studying implant/tissue interface in hard materials (i.e., metals or dense plastics) and/or in large bone segments, the hard plastic embedding of the intact undecalcified tissue envelope with the implant in situ is needed. The aim of this work is to describe the advances and the possibilities of high-temperature methyl methacrylate (MMA) embedding for the histological, histomorphometrical, and biomechanical assessment of bone-implanted medical devices. Unlike routine techniques, undecalcified bone processing histology, using high-temperature MMA, requires a complex and precise sample processing methodology and the availability of sophisticated equipment and software for both sample preparation and analyses. MMA embedding permits the evaluation of biological responses to the presence of implanted medical devices without implant removal, allowing simultaneous qualitative and quantitative histological evaluation, both static and dynamic histomorphometry, and biomechanical analyses not possible with tissue decalcification. MMA embedding, despite being a demanding procedure, is still preferred to other kinds of resin-based embedding because of its peculiar characteristics, which allow the study of samples of big dimensions also implanted with hard materials without reducing the sample or removing the material. Dynamic measurements are allowed together with biomechanical investigations at the bone-biomaterial interface, obtaining a comprehensive and precise evaluation of the safety and effectiveness of medical devices for orthopedic regenerative, reconstructive, and reparative surgery.
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Alveolar Ridge Expansion: Comparison of Osseodensification and Conventional Osteotome Techniques. J Craniofac Surg 2019; 30:607-610. [PMID: 30507887 DOI: 10.1097/scs.0000000000004956] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of this in vivo study is to compare the osseointegration of endosteal implants placed in atrophic mandibular alveolar ridges with alveolar ridge expansion surgical protocol via an experimental osseodensification drilling versus conventional osteotome technique. METHODS Twelve endosteal implants, 4 mm × 13 mm, were placed in porcine models in horizontally atrophic mandibular ridges subsequent to prior extraction of premolars. Implants were placed with osseodensification drilling technique as the experimental group (n = 6) and osteotome site preparation as the control group (n = 6). After 4 weeks of healing, samples were retrieved and stained with Stevenel's Blue and Van Gieson's Picro Fuschin for histologic evaluation. Quantitative analysis via bone-to-implant contact (BIC%) and bone area fraction occupancy (BAFO%) were obtained as mean values with corresponding 95% confidence interval. A significant omnibus test, post-hoc comparison of the 2 drilling techniques' mean values was accomplished using a pooled estimate of the standard error with P-value set at 0.05. RESULTS The mean BIC% value was approximately 62.5% in the osseodensification group, and 31.4% in the regular instrumentation group. Statistical analysis showed a significant effect of the drilling technique (P = 0.018). There was no statistical difference in BAFO as a function of drilling technique (P = 0.198). CONCLUSION The combined osseodensification drilling-alveolar ridge expansion technique showed increased evidence of osseointegration and implant primary stability from a histologic and biomechanical standpoint, respectively. Future studies will focus on expanding the sample size as well as the timeline of the study to allow investigation of long-term prognosis of this novel technique.
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Gao X, Fraulob M, Haïat G. Biomechanical behaviours of the bone-implant interface: a review. J R Soc Interface 2019; 16:20190259. [PMID: 31362615 PMCID: PMC6685012 DOI: 10.1098/rsif.2019.0259] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023] Open
Abstract
In recent decades, cementless implants have been widely used in clinical practice to replace missing organs, to replace damaged or missing bone tissue or to restore joint functionality. However, there remain risks of failure which may have dramatic consequences. The success of an implant depends on its stability, which is determined by the biomechanical properties of the bone-implant interface (BII). The aim of this review article is to provide more insight on the current state of the art concerning the evolution of the biomechanical properties of the BII as a function of the implant's environment. The main characteristics of the BII and the determinants of implant stability are first introduced. Then, the different mechanical methods that have been employed to derive the macroscopic properties of the BII will be described. The experimental multi-modality approaches used to determine the microscopic biomechanical properties of periprosthetic newly formed bone tissue are also reviewed. Eventually, the influence of the implant's properties, in terms of both surface properties and biomaterials, is investigated. A better understanding of the phenomena occurring at the BII will lead to (i) medical devices that help surgeons to determine an implant's stability and (ii) an improvement in the quality of implants.
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Affiliation(s)
- Xing Gao
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
- Research Centre for Medical Robotics and Minimally Invasive Surgical Devices, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, People's Republic of China
| | - Manon Fraulob
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
| | - Guillaume Haïat
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, UMR CNRS 8208, 61 avenue du Général de Gaulle, 94010 Créteil cedex, France
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Shah FA, Jergéus E, Chiba A, Palmquist A. Osseointegration of 3D printed microalloyed CoCr implants-Addition of 0.04% Zr to CoCr does not alter bone material properties. J Biomed Mater Res A 2018; 106:1655-1663. [DOI: 10.1002/jbm.a.36366] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/31/2018] [Accepted: 02/06/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Furqan A. Shah
- Department of Biomaterials; Sahlgrenska Academy at University of Gothenburg; Göteborg Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy; Göteborg Sweden
| | - Edvin Jergéus
- Department of Biomaterials; Sahlgrenska Academy at University of Gothenburg; Göteborg Sweden
| | - Akihiko Chiba
- Institute for Materials Research, Tohoku University; Sendai Japan
| | - Anders Palmquist
- Department of Biomaterials; Sahlgrenska Academy at University of Gothenburg; Göteborg Sweden
- BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy; Göteborg Sweden
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Histomorphological and Histomorphometric Analyses of Grade IV Commercially Pure Titanium and Grade V Ti-6Al-4V Titanium Alloy Implant Substrates: An In Vivo Study in Dogs. IMPLANT DENT 2017; 25:650-5. [PMID: 27540838 DOI: 10.1097/id.0000000000000448] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the bone response to grade IV commercially pure titanium (G4) relative to Ti-6Al-4V (G5). MATERIALS AND METHODS Implant surface topography was characterized by optical interferometry and scanning electron microscopy (SEM). Thirty-six implants (Signo Vinces, n = 18 per group) were installed in the radius of 18 dogs. The animals were killed at 1, 3, and 6 weeks, resulting in 6 implants per group and time in vivo for bone morphology, bone-to-implant contact (BIC), and bone area fraction occupancy (BAFO) evaluation. RESULTS SEM depicted a more uniform topography of G4 than G5. Surfaces were statistically homogeneous for Sa, Sq, and Sdr. At 1 week, new bone formation was observed within the healing connective tissue in contact with the implant surface. At 3 weeks, new bone in direct contact with the implant surface was observed at all bone regions. At 6 weeks, the healing chambers filled with woven bone depicted an onset of replacement by lamellar bone. No significant effect of substrate was detected. Time presented an effect on BIC and BAFO (P < 0.001). CONCLUSION Both titanium substrates were biocompatible and osseoconductive at the bone tissue level.
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Eckstein M, Vaeth M, Fornai C, Vinu M, Bromage TG, Nurbaeva MK, Sorge JL, Coelho PG, Idaghdour Y, Feske S, Lacruz RS. Store-operated Ca 2+ entry controls ameloblast cell function and enamel development. JCI Insight 2017; 2:e91166. [PMID: 28352661 DOI: 10.1172/jci.insight.91166] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Loss-of-function mutations in stromal interaction molecule 1 (STIM1) impair the activation of Ca2+ release-activated Ca2+ (CRAC) channels and store-operated Ca2+ entry (SOCE), resulting in a disease syndrome called CRAC channelopathy that is characterized by severe dental enamel defects. The cause of these enamel defects has remained unclear given a lack of animal models. We generated Stim1/2K14cre mice to delete STIM1 and its homolog STIM2 in enamel cells. These mice showed impaired SOCE in enamel cells. Enamel in Stim1/2K14cre mice was hypomineralized with decreased Ca content, mechanically weak, and thinner. The morphology of SOCE-deficient ameloblasts was altered, showing loss of the typical ruffled border, resulting in mislocalized mitochondria. Global gene expression analysis of SOCE-deficient ameloblasts revealed strong dysregulation of several pathways. ER stress genes associated with the unfolded protein response were increased in Stim1/2-deficient cells, whereas the expression of components of the glutathione system were decreased. Consistent with increased oxidative stress, we found increased ROS production, decreased mitochondrial function, and abnormal mitochondrial morphology in ameloblasts of Stim1/2K14cre mice. Collectively, these data show that loss of SOCE in enamel cells has substantial detrimental effects on gene expression, cell function, and the mineralization of dental enamel.
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Affiliation(s)
- Miriam Eckstein
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York, USA
| | - Martin Vaeth
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Cinzia Fornai
- Department of Anthropology, University of Vienna, Vienna, Austria.,Department of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Manikandan Vinu
- Biology Program, Division of Science and Mathematics, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Timothy G Bromage
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York, USA.,Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, New York, USA
| | - Meerim K Nurbaeva
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York, USA
| | - Jessica L Sorge
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York, USA
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, New York, USA
| | - Youssef Idaghdour
- Biology Program, Division of Science and Mathematics, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Stefan Feske
- Department of Pathology, New York University School of Medicine, New York, New York, USA
| | - Rodrigo S Lacruz
- Department of Basic Science and Craniofacial Biology, New York University College of Dentistry, New York, New York, USA
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15
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Galli S, Jimbo R, Naito Y, Berner S, Dard M, Wennerberg A. Chemically modified titanium-zirconium implants in comparison with commercially pure titanium controls stimulate the early molecular pathways of bone healing. Clin Oral Implants Res 2016; 28:1234-1240. [DOI: 10.1111/clr.12947] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Silvia Galli
- Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Ryo Jimbo
- Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö Sweden
- Department of Oral and Maxillofacial Surgery and Oral Medicine; Faculty of Odontology; Malmö University; Malmö Sweden
| | - Yoshihito Naito
- Oral Implant Center; Tokushima University Hospital; Tokushima Japan
| | | | - Michel Dard
- Institut Straumann AG; Basel Switzerland
- College of Dentistry; New York University; New York NY USA
| | - Ann Wennerberg
- Department of Prosthodontics; Faculty of Odontology; Malmö University; Malmö Sweden
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16
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Mechanical properties of bone tissues surrounding dental implant systems with different treatments and healing periods. Clin Oral Investig 2016; 20:2211-2220. [PMID: 26832783 DOI: 10.1007/s00784-016-1734-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The objective of the current study was to examine whether the nanoindentation parameters can assess the alteration of bone quality resulting from different degrees of bone remodeling between bone tissue ages around the dental implant interface with different treatments and healing periods. MATERIALS AND METHODS Dental implants were placed in mandibles of six male dogs. Treatment groups included: resorbable blast media-treated titanium (Ti) implants, alumina-blasted zirconia implants (ATZ), alumina-blasted zirconia implants applied with demineralized bone matrix (ATZ-D), and alumina-blasted zirconia implants applied with rhBMP-2 (ATZ-B). Nanoindentation modulus (E), hardness (H), viscosity (η), and viscoelastic creep (Creep/P max) were measured for new and old bone tissues adjacent to the implants at 3 and 6 weeks of post-implantation. A total of 945 indentations were conducted for 32 implant systems. RESULTS Significantly lower E, H, and η but higher Creep/P max were measured for new bone tissues than old bone tissues, independent of treatments at both healing periods (p < 0.001). All nanoindentation parameters were not significantly different between healing periods (p > 0.568). ATZ-D and ATZ-B implants had the stiffer slope of correlation between E and Creep/P max of the new bone tissue than Ti implant (p < 0.039). CONCLUSIONS Current results indicated that, in addition to elastic modulus and plastic hardness, measurement of viscoelastic properties of bone tissue surrounding the implant can provide more detailed information to understand mechanical behavior of an implant system. CLINICAL RELEVANCE Ability of energy absorption in the interfacial bone tissue can play a significant role in the long-term success of a dental implant system.
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17
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Wen B, Chen J, Dard M, Cai Z. The Performance of Titanium-Zirconium Implants in the Elderly: A Biomechanical Comparative Study in the Minipig. Clin Implant Dent Relat Res 2016; 18:1200-1209. [PMID: 26834004 DOI: 10.1111/cid.12389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/03/2015] [Indexed: 12/24/2022]
Affiliation(s)
- Bo Wen
- Professor, Division of Implant Dentistry, Department of Oral & Maxillofacial Surgery, Nanjing Stomatology Hospital; Medical School of Nanjing University; Nanjing China
| | - Jiang Chen
- professor, Department of Implant Dentistry, School and Hospital of Stomatology; Fujian Medical University; Fuzhou China
| | - Michel Dard
- head and director, Preclinical Research; Institut Straumann AG; Basel Switzerland
- professor, Department of Periodontology and Implant Dentistry; College of Dentistry, New York University; New York NY USA
| | - Zhiyu Cai
- professor, Department of Implant Dentistry, School and Hospital of Stomatology; Fujian Medical University; Fuzhou China
- associate professor, Department of Stomatology; Fujian Medical University Union Hospital; Fuzhou China
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18
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Kim DG, Elias KL, Jeong YH, Kwon HJ, Clements M, Brantley WA, Lee DJ, Han JS. Differences between buccal and lingual bone quality and quantity of peri-implant regions. J Mech Behav Biomed Mater 2016; 60:48-55. [PMID: 26773652 DOI: 10.1016/j.jmbbm.2015.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
The objective of the current study was to examine whether peri-implant bone tissue properties are different between the buccal and lingual regions treated by growth factors. Four dental implant groups were used: titanium (Ti) implants, alumina-blasted zirconia implants (ATZ-N), alumina-blasted zirconia implants with demineralized bone matrix (DBM) (ATZ-D), and alumina-blasted zirconia implants with rhBMP-2 (ATZ-B). These implants were placed in mandibles of six male dogs. Nanoindentation elastic modulus (E) and plastic hardness (H) were measured for the buccal and lingual bone tissues adjacent and away from the implants at 3 and 6 weeks post-implantation. A total of 2281 indentations were conducted for 48 placed implants. The peri-implant buccal region had less bone quantity resulting from lower height and narrower width of bone tissue than the lingual region. Buccal bone tissues had significant greater mean values of E and H than lingual bone tissues at each distance and healing period (p<0.007). Nearly all implant treatment groups displayed lower mean values of the E at the lingual bone tissues than at the buccal bone tissues (p<0.046) although the difference was not significant for the Ti implant group (p=0.758). The DBM and rhBMP-2 treatments stimulated more peri-implant bone remodeling at the lingual region, producing more immature new bone tissues with lower E than at the buccal region. This finding suggests that the growth factor treatments to the zirconia implant system may help balance the quantity and quality differences between the peri-implant bone tissues.
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Affiliation(s)
- Do-Gyoon Kim
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA.
| | - Kathy L Elias
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA
| | - Yong-Hoon Jeong
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA
| | - Hyun-Jung Kwon
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA
| | - Matthew Clements
- Division of Orthodontics, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA
| | - William A Brantley
- Division of Restorative Science and Prosthodontics, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA
| | - Damian J Lee
- Division of Restorative Science and Prosthodontics, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA
| | - Jung-Suk Han
- Department of Prosthodontics, Seoul National University, Seoul, Republic of Korea
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Ioannidis A, Gallucci GO, Jung RE, Borzangy S, Hämmerle CHF, Benic GI. Titanium-zirconium narrow-diameter versus
titanium regular-diameter implants for anterior and premolar single crowns: 3-year results of a randomized controlled clinical study. J Clin Periodontol 2015; 42:1060-70. [DOI: 10.1111/jcpe.12468] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Alexis Ioannidis
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - German O. Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences; Harvard School of Dental Medicine; Boston MA USA
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Sary Borzangy
- Department of Restorative Dentistry and Biomaterials Sciences; Harvard School of Dental Medicine; Boston MA USA
- Department of Substitutive Dental Sciences; College of Dentistry; Taibah University; Al Madinah Al Munawwarah Kingdom of Saudi Arabia
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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20
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Jimbo R, Naito Y, Galli S, Berner S, Dard M, Wennerberg A. Biomechanical and Histomorphometrical Evaluation of TiZr Alloy Implants: An in vivo Study in the Rabbit. Clin Implant Dent Relat Res 2015; 17 Suppl 2:e670-8. [DOI: 10.1111/cid.12305] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Ryo Jimbo
- Department of Prosthodontics, Faculty of Odontology; Malmö University; Malmö Sweden
| | - Yoshihito Naito
- Department of Oral and Maxillofacial Prosthodontics and Oral Implantology, Institute of Health Biosciences; The University of Tokushima Graduate School; Tokushima Japan
| | - Silvia Galli
- Department of Prosthodontics, Faculty of Odontology; Malmö University; Malmö Sweden
| | | | - Michel Dard
- Institut Straumann AG; Basel Switzerland
- Department of Periodontics; New York University College of Dentistry; New York NY USA
| | - Ann Wennerberg
- Department of Prosthodontics, Faculty of Odontology; Malmö University; Malmö Sweden
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21
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Effect of partially demineralized dentin beneath the hybrid layer on dentin-adhesive interface micromechanics. J Biomech 2015; 48:701-707. [PMID: 25596632 DOI: 10.1016/j.jbiomech.2014.08.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/09/2014] [Accepted: 08/25/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the presence of non-infiltrated, partially demineralized dentin (PDD) beneath the hybrid layer for self-etch adhesive systems, and its effect on micromechanical behavior of dentin-adhesive interfaces (DAIs). This in-vitro laboratory and computer simulation study hypothesized that the presence of non-infiltrated PDD beneath the hybrid layer does not influence the mechanical behavior of the DAI of self-etch adhesive systems. METHODS Fifteen sound third molars were restored with composite resin using three adhesive systems: Scotchbond Multipurpose (SBMP), Clearfil SE Bond (CSEB) and Adper Promp L-Pop (APLP). The thickness and length of all DAIs were assessed using scanning electron microscopy, and used to generate three-dimensional finite element models. Elastic moduli of the hybrid layer, adhesive layer, intertubular dentin, peritubular dentin and resin tags were acquired using a nano-indenter. Finite element software was used to determine the maximum principal stress. Mixed models analysis of variance was used to verify statistical differences (P<0.05). RESULTS Elastic moduli and morphology were found to differ between the adhesive systems, as well as the presence and extension of PDD. SIGNIFICANCE Both self-etch adhesive systems (APLP and CSEB) had PDD. The DAI stress levels were higher for the one-step self-etch adhesive system (APLP) compared with the etch-and-rinse adhesive system (SBMP) and the self-etch primer system (CSEB).
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22
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Benic GI, Gallucci GO, Mokti M, Hämmerle CHF, Weber HP, Jung RE. Titanium-zirconium narrow-diameter versus titanium regular-diameter implants for anterior and premolar single crowns: 1-year results of a randomized controlled clinical study. J Clin Periodontol 2013; 40:1052-61. [DOI: 10.1111/jcpe.12156] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Goran I. Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - German O. Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences; Harvard School of Dental Medicine; Boston MA USA
| | - Muizzaddin Mokti
- Department of Restorative Dentistry and Biomaterials Sciences; Harvard School of Dental Medicine; Boston MA USA
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Hans-Peter Weber
- Department of Prosthodontics and Operative Dentistry; Tufts University School of Dental Medicine; Boston MA USA
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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