Immunohistochemical, tomographic and histological study on onlay bone graft remodeling. Part II: calvarial bone

Objectives Little information is available on the molecular events that occur during graft incorporation over time. The calvarial bone (Cb) grafts have been reported to produce greater responses compared with other donor regions in maxillofacial reconstructions, but the scientific evidences for this are still lacking. The objectives of this study are (1) to study the morphological pattern of Cb onlay bone grafts and compare them with the biological events through immunohistochemical responses and (2) to establish the effects of perforations in maintaining the volume and bone density of the receptor bed. Material and methods Sixty New Zealand White rabbits were submitted to Cb onlay bone grafts on the mandible. In 30 rabbits, the receptor bed was perforated (perforated group), while for the remaining animals the bed was kept intact (non-perforated group). Six animals from each group were sacrificed at 5, 7, 10, 20 and 60 days after surgery. Histological sections from the grafted area were prepared for immunohistochemical and histological analyses. Immuno-labeling was found for proteins Osteoprotegerin (OPG), receptor activator of nuclear factor-kappa beta ligand (RANKL), alkaline phosphatase (ALP), osteopontin (OPN), vascular endothelial growth factor (VEGF), tartrate-resistant acid phosphatase (TRAP), Type I collagen (COL I) and osteocalcin (OC). The tomography examination [computerized tomography (CT) scan] was conducted just after surgery and at the sacrifice. Results The histological findings revealed that the perforations contributed to higher bone deposition during the initial stages at the graft-receptor bed interface, accelerating the graft incorporation process. The results of the CT scan showed lower resorption for the perforated group (P < 0.05), and both groups showed high bone density rates at 60 days. This set of evidences is corroborated by the immunohistochemical outcomes indicating that proteins associated with revascularization and osteogenesis (VEGF, OPN, TRAP and ALP) were found in higher levels in the perforated group. Conclusions These findings indicate that the bone volume of calvarial grafts is better maintained when the receptor bed is perforated, probably resulting from more effective graft revascularization and greater bone deposition. The process of bone resorption peaked between 20 and 60 days post-operatively in both groups although significantly less in the perforated group. To cite this article:Pedrosa Jr WF, Okamoto R, Faria PEP, Arnez MFM, Xavier SP, Salata LA. Immunohistochemical, tomographic and histological study on onlay bone grafts remodeling. Part II: calvarial bone.Clin. Oral Impl. Res. 20, 2009; 1254-1264.doi: 10.1111/j.1600-0501.2009.01747.x.

Evaluation of Low Intensity Laser Therapy In Myofascial Pain Syndrome

Limited studies have demonstrated that low intensity laser therapy (LILT) may have a therapeutic effect on the treatment of myofascial pain syndrome (MPS). Sixty (60) patients with MPS and having one active trigger point in the anterior masseter and anterior temporal muscles were selected and assigned randomly to six groups (n=10): Groups I to III were treated with GaAIAS (780 nm) laser, applied in continuous mode and in a meticulous way, twice a week, for four weeks. Energy was set to 25 J/cm(2), 60 J/cm2 and 105 J/cm2, respectively. Groups IV to VI were treated with placebo applications, simulating the same parameters as the treated groups. Pain scores were assessed just before, then immediately after the fourth application, immediately after the eighth application, at 15 days and one month following treatment. A significant pain reduction was observed over time (p<0.001). The analgesic effect of the LILT was similar to the placebo groups. Using the parameters described in this experiment, LILT was effective in reducing pain experienced by patients with myofascial pain syndrome. Thus, it was not possible to establish a treatment protocol. Analyzing the analgesic effect of LILT suggests it as a possible treatment of MPS and may help to establish a clinical protocol for this therapeutic modality.

Electromyographic Evaluation of Neuromuscular Coordination of Subject After Orthodontic Intervention

The aim of this work was to investigate the neuromuscular changes associated with the orthodontic post-treatment using surface electromyography. One hundred (100) young, healthy adults without signs and symptoms of temporomandibular dysfunction (TMD) were divided into two groups: 60 subjects who were undergoing orthodontic intervention (Ortho Group) and 40 subjects who had no orthodontic intervention (Control Group), aged 18-25 years. EMG activity of masseter and temporalis anterior muscle was recorded during two different tests: 1. maximum voluntary clench (MVC) with cotton rolls; and 2. MVC in intercuspal position. In all subjects, both tests were performed with symmetric muscular patterns (more than 85%) and with insignificant latero-deviating of the mandible (lower than 10%). There are no statistically significant differences between the subjects of both groups evaluated. Both groups showed medium index values calculated according to the normal standards established previously.

Histologic Evaluation of the Buccal and Lingual Bone Plates in Anterior Dog Teeth: Possible Influence on Implant Dentistry

Background: Recent studies in animals have shown pronounced resorption of buccal bone plate after immediate implantation. The sectioning of experimental material for histologic evaluation of the bone plates could provide valuable information about the possible effect of bone exposure in periodontal and implant surgeries. Methods: Twenty-four incisors were collected from dogs. After decalcification, the blocks were immersed in paraffin and bucco-lingual histologic sections were examined under light microscope. Some sections were reserved for immunohistochemical analysis. Results: The bone density, the width of the bone plates, and the percentage of vessels presented in the periodontal ligament and periosteum were analyzed in the buccal and lingual bone plates, which were divided corono-apically into thirds. The buccal bone plates showed statistically higher bone density compared to the lingual bone plates in the coronal thirds. The width of both bone plates increased from the coronal to the apical third, but all the buccal thirds were significantly thinner compared to the lingual thirds. No statistically significant differences were found between the bone plates for the percentage of area occupied by the blood vessels in the periodontal ligament or periosteum. Conclusion: It is reasonable to conclude that the higher bone density, represented by the lower number of marrow spaces, in association with the thinner aspect of the buccal bone plates made them more fragile to absorb compared to the lingual bone plates, especially during mucoperiosteal procedures. J Periodontol 2017;82:872-877.

Direct pulp capping with a self-etching adhesive system: Histopathologic evaluation in dogs` teeth

Objective. This study evaluated histopathologically the response of pulp and periradicular tissues after pulp capping with an all-in-one self-etching adhesive system in dogs` teeth. Study design. Forty teeth of 4 dogs were assigned to 3 groups according to the pulp capping material: G1 (n = 20): self-etching adhesive system; G2 (n = 10): Ca(OH)(2); G3 (n = 10): zinc oxide-eugenol. The animals were killed 7 and 70 days after pulp capping. The pieces containing the pulp-capped teeth were removed and processed for histologic analysis. Results. At 7 days, no dentin bridge formation was observed; G1 and G3 exhibited inflammatory pulpal alterations, whereas G2 presented only mild inflammatory infiltrate in the pulp tissue adjacent to the capping material, the remainder being intact. At 70 days, no specimen in G1 or G3 presented dentin bridge formation. The remaining pulp tissue exhibited severe inflammatory alterations and areas of necrosis. In G2, all specimens showed dentin bridge formation and absence of inflammation and mineralized tissue resorption. No bacteria were identified using Brown and Brenn staining techniques in all 3 groups at any observation period. Conclusion. According to the conditions of this study, direct pulp capping with the self-etching adhesive system did not allow pulp tissue repair and failed histopathologically in 100% of the cases. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: e34-e40)

Endodontic Chelators Induce Nitric Oxide Expression by Murine-cultured Macrophages

Introduction: Endodontic chelators may extrude to apical tissues during instrumentation activating cellular events on periapical tissues. This study assessed in vitro the expression of nitric oxide (NO) concentrations by murine peritoneal macrophages after contact with MTAD (Dentsply/Tulsa, Tulsa, OK), Tetraclean (Ogna Laboratori Farmaceutici, Muggio, Italy), Smear Clear (Sybron Endo, Orange, CA), and EDTA (Biodinamica, Ibipora, PR, Brazil). Methods: Macrophage cells were obtained from Swiss mice after peritoneal lavage. Chelators were diluted in distilled water obtaining 12 concentrations, and MTT assay identified the concentrations, per group, displaying the highest cell viability (analysis of variance, p < 0.01). Selected concentrations were tested for NO expression using Griess reaction. Culture medium and lipopolysaccharide (LPS) were used as controls. Results: Analysis of variance and Tukey tests showed that all chelators displayed elevated NO concentrations compared with the negative control (p < 0.01). MTAD induced the lowest NO expression, followed by Tetraclean, EDTA, and Smear Clear. No difference was observed between MTAD and Tetraclean (p > 0.01), Tetraclean and EDTA (p > 0.01), and EDTA and Smear Clear (p > 0.01). LPS ranked similar to both EDTA and Smear Clear (p > 0.01). Conclusion: The tested endodontic chelators displayed severe proinflammatory effects on murine-cultured macrophages. Citric acid-based solutions induce lower No release than EDTA-based irrigants. (J Endod 2009;35:824-828)

Effect of different bleaching systems on the ultrastructure of bovine dentin

The aim of this study was to evaluate in vitro the effect of different in-office bleaching systems on the surface morphology of bovine dentin. Thirty tooth fragments measuring 4 x 4mm, containing enamel and dentin, were obtained from the crowns of extracted bovine incisors. Samples were subjected to simulated intracoronal bleaching techniques using conventional (Opalescence Endo (R) and Whiteness Super Endo (R)) and light-activated systems (Opalescence Xtra (R) and Whiteness HP Maxx (R)). Controls were treated with either sodium perborate mixed with 10% hydrogen peroxide or no bleaching agent. The samples were observed under SEM and the recorded images were evaluated for topographic alterations. The ultrastructural alterations of dentin observed in this study varied greatly between groups according to the products used. Higher pH products (Whiteness HP Maxx (R) and Opalescence Xtra (R)) associated with in-office techniques yielded better maintenance of dentin ultrastructure. Apparently, both low pH and hydrogen peroxide oxidation play a role in altering the ultrastructure of dentin during internal dental bleaching. The use of alkaline products with reduced time of application (in-office techniques) may decrease such morphological alterations.

Influence of Post and Resin Cement on Stress Distribution of Maxillary Central Incisors Restored with Direct Resin Composite

The current study evaluated the influence of two endodontic post systems and the elastic modulus and film thickness of resin cement on stress distribution in a maxillary central incisor (MCI) restored with direct resin composite using finite element analysis (FEA). A three-dimensional model of an MCI with a coronary fracture and supporting structures was performed. A static chewing pressure of 2.16 N/mm(2) was applied to two areas on the palatal surface of the composite restoration. Zirconia ceramic (ZC) and glass fiber (GF) posts were considered. The stress distribution was analyzed in the post, dentin and cement layer when ZC and GF posts were fixed to the root canals using resin cements of different elastic moduli (7.0 and 18.6 GPa) and different layer thicknesses (70 and 200 mu m). The different post materials presented a significant influence on stress distribution with lesser stress concentration when using the GF post. The higher elastic modulus cement created higher stress levels within itself. The cement thicknesses did not present significant changes.

In vitro and clinical evaluation of specific dentifrices for complete denture hygiene

To study the physical properties of two experimental dentifrices for complete denture hygiene, their effect on denture biofilm removal and antimicrobial properties by means of a clinical trial. The experimental dentifrices comprised two compositions. One was based on the addition of 1% chloramine T (D1) and the other on the presence of 0.01% fluorosurfactant (D2). Measurements of density, pH, consistency, rheological features and abrasiveness were conducted. Sixty complete denture wearers were randomly assigned to three groups and were instructed to brush their dentures with a specific toothbrush: (1) Water (control); (2) D1; or (3) D2. Each method was used for 21 days. Denture biofilm was disclosed by a 1% neutral red solution and quantified by means of digital photos taken from the internal surface. Microbiological assessment was conducted to quantify Candida sp. and mutans streptococci. Data were evaluated by one-way anova and Tukey HSD, or Kruskal-Wallis (alpha = 0.05). Both dentifrices decreased biofilm coverage when compared with the control group. D1 was the most efficacious treatment to reduce mutans streptococci, whereas D2 showed an intermediate outcome (anova, p < 0.040). No treatment influenced Candida albicans or non-albicans species (Kruskal-Wallis, p = 0.163 and 0.746, respectively). It can be concluded that brushing complete dentures with the experimental dentifrices tested could be effective for the removal of denture biofilm.

Clinical comparison between the bleaching efficacy of 37% peroxide carbamide gel mixed with sodium perborate with established intracoronal bleaching agent

Objective. The aim was to evaluate the bleaching efficacy of sodium perborate/37% carbamide peroxide paste and traditional sodium perborate/distilled water for intracoronal bleaching. Study design. Thirty patients with dark anterior teeth were divided into 2 groups (n = 15): group A: sodium perborate/ distilled water; and group B: sodium perborate/37% carbamide peroxide paste. The bleaching treatment limited each patient to the maximum of 4 changes of the bleaching agent. Initial and final color shades were measured using the Vita Lumin shade guide. Results. Data was analyzed with Wilcoxon test for initial and final comparison according to the bleaching agent, demonstrating efficacy of the bleaching treatment with both agents. Mann-Whitney test was used for comparison of the efficacy of the bleaching agents, showing that there was no significant difference between them. Conclusion. The sodium perborate/37% carbamide peroxide association for intracoronal bleaching has proven to be as effective as sodium perborate/distilled water. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: e43-e47)

INFLUENCE OF INTERIMPLANT DISTANCES AND PLACEMENT DEPTH ON PAPILLA FORMATION AND CRESTAL RESORPTION: A CLINICAL AND RADIOGRAPHIC STUDY IN DOGS

Among the factors that contribute to the papilla formation and crestal bone preservation between contiguous implants, this animal study clinically and radiographically evaluated the interimplant distances (IDs) of 2 and 3 mm and the placement depths of Morse cone connection implants restored with platform switch. Bilateral mandibular premolars of 6 dogs were extracted, and after 12 weeks, the implants were placed. Four experimental groups were constituted: subcrestally with ID of 2 mm (2 SCL) and 3 mm (3 SCL) and crestally with ID of 2 mm (2 CL) and 3 mm (3 CL). Metallic crowns were immediately installed with a distance of 3 mm between the contact point and the bone crest. Eight weeks later, clinical measurements were performed to evaluate papilla formation, and radiographic images were taken to analyze the crestal bone remodeling. The subcrestal groups achieved better levels of papillae formation when compared with the crestal groups, with a significant difference between the 3 SCL and 3 CL groups (P = .026). Radiographically, the crestal bone preservation was also better in the subcrestal groups, with statistically significant differences between the 2SCL and 2CL groups (P = .002) and between the 3SCL and 3CL groups (P = .008). With the present conditions, it could be concluded that subcrestal implant placement had a positive impact on papilla formation and crestal bone preservation, which could favor the esthetic of anterior regions. However, the IDs of 2 and 3 mm did not show significantly different results.

Influence of NaHCO(3) Powder on Translucency of Microfilled Composite Resin Immersed in Different Mouthrinses

The regular use of mouthrinses, particularly when combined with the use of air-powder polishing, could affect the appearance of tooth-colored restorations. The current study sought to evaluate the effect of NaHCO(3) powder on translucency of a microfilled composite resin immersed in different mouthrinses, at distinct evaluation periods. Eighty disk-shaped specimens of composite resin (Durafill VS, Heraeus Kulzer GmbH & Co. KG, Hanau, Germany) were prepared. The composite specimens were then randomly allocated into two groups according to the surface treatment: exposure to NaHCO(3) powder (10 seconds) or nonexposure, and they were randomly assigned into four subgroups, according to the mouthrinses employed (N = 10): Periogard (Colgate/Palmolive, Sao Bernardo do Campo, SP, Brazil), Cepacol (Aventis Pharma, Sao Paulo, SP, Brazil), Plax (Colgate/Palmolive), and distilled water (control group). The samples were immersed for 2 minutes daily, 5 days per week, over a 4-month test period. Translucency was measured with a transmission densitometer at seven evaluation periods. Statistical analyses (analysis of variance and Tukey`s test) revealed that: distilled water presented higher translucency values (86.72%); Periogard demonstrated the lowest translucency values (72.70%); and Plax (74.05%) and Cepacol (73.32%) showed intermediate translucency values, which were statistically similar between them (p > 0.01). NaHCO(3) air-powder polishing increased the changes in translucency associated with the mouthrinses. Air-powder polishing alone had no effect on material translucency. Translucency percent was gradually decreased from 1 week of immersion up to 4 months. It may be concluded that the NaHCO(3) powder and the tested mouthrinses have affected the translucency of microfilled composite resin, according to the tested time. CLINICAL SIGNIFICANCE During the last decade, the demand for composite resin restorations has grown considerably, however, controversy persists regarding the effect of surface roughness on color stability.

COLOR STABILITY OF DENTAL CERAMICS SUBMITTED TO ARTIFICIAL ACCELERATED AGING AFTER REPEATED FIRINGS

Statement of problem. Color stability is an important factor to ensure the long-term clinical success of ceramic restorations. There is a lack of information on how color is affected by fabrication procedures, such as the number of firings. Purpose. The purpose of this study was to evaluate the effects that the number of firings and type of substrate have on the color stability of dental ceramic submitted to artificial accelerated aging. Material and methods. Sixty specimens were fabricated: 30 metal ceramic (Verabond II + IPS d.SIGN) and 30 all-ceramic (IPS d.SIGN). Specimens were divided into 3 groups (n=10), and submitted to 2, 3, or 4 firings (+/- 900 degrees C), respectively, according to the manufacturer`s instructions. Color readings were obtained with a spectro photometer before and after artificial accelerated aging, and L*, a*, and b* coordinates and total color variation (Delta E) were analyzed (2-way ANOVA, Bonferroni, (alpha=05). Results. For metal ceramic specimens, differences for the L* coordinates were significant (P<.05) only for the group submitted to 3 firings. With respect to the all-ceramic specimens, smaller L* coordinates were obtained for greater a* and b* coordinates, indicating that the greater the number of firings, the darker and more reddish/yellowish the specimen. All Delta E values, for all groups, were below 1.0. All-ceramic specimens submitted to 3 and 4 firings presented Delta E means differing statistically (P<.05) from those of the metal ceramic group. Conclusions. The type of substrate and number of firings affected the color stability of the ceramic material tested. Artificial accelerated aging did not produce perceptible color stability changes (Delta E<1.0). (J Prosthet Dent 2009-101:13-18)

Characteristics of TMD noise analyzed by electrovibratography

Studying joint noise is an important parameter for diagnosing temporomandibular dysfunction. In this study, eight groups (n=9) were formed according to joint dysfunction classification, provided by employing vibration analysis equipment. Parameters for analyzing joint noise were: total vibration energy, peak amplitude, and peak frequency. Mouth opening range was also analyzed. Statistical analysis results for each parameter were significant at 1 %. Each analyzed group presented different noise characteristics. This allowed for inclusion of the groups within a determined value category. The patient group with normal condyle/disk relationship always presented the lowest values. The type of joint noise was characterized by analyzing total integral noise, peak amplitude, peak frequency, and mouth opening. Analyzing joint noise using electrovibratography suggests the type of joint dysfunction and may help to establish a diagnosis, as well as a treatment plan.