Viscoelastic properties of the periodontal ligament and mucous membrane

Rational design of viscoelastic hydrogels for periodontal ligament remodeling and repair

The periodontal ligament (PDL) is a distinctive yet critical connective tissue vital for maintaining the integrity and functionality of tooth-supporting structures. However, PDL repair poses significant challenges due to the complexity of its mechanical microenvironment encompassing hard-soft-hard tissues, with the viscoelastic properties of the PDL being of particular interest. This review delves into the significant role of viscoelastic hydrogels in PDL regeneration, underscoring their utility in simulating biomimetic three-dimensional microenvironments. We review the intricate relationship between PDL and viscoelastic mechanical properties, emphasizing the role of tissue viscoelasticity in maintaining mechanical functionality. Moreover, we summarize the techniques for characterizing PDL's viscoelastic behavior. From a chemical bonding perspective, we explore various crosslinking methods and characteristics of viscoelastic hydrogels, along with engineering strategies to construct viscoelastic cell microenvironments. We present a detailed analysis of the influence of the viscoelastic microenvironment on cellular mechanobiological behavior and fate. Furthermore, we review the applications of diverse viscoelastic hydrogels in PDL repair and address current challenges in the field of viscoelastic tissue repair. Lastly, we propose future directions for the development of innovative hydrogels that will facilitate not only PDL but also systemic ligament tissue repair. STATEMENT OF SIGNIFICANCE.

Trueness of intraoral scanning of edentulous arches: A comparative clinical study

PURPOSE

To compare the accuracy of intraoral scanning (IOS) of the edentulous arch with the hybrid protocol of cast digitization (CD), and to investigate the effect of arch type and area on trueness.

MATERIALS AND METHODS

Participants that were edentulous in both arches were recruited. Two impression protocols were used; the IOS as the test protocol with an IOS device (TRIOS 4; 3Shape, Denmark), and the CD as the control, including tracing compound (TRACING STICKS; Kemdent, UK) for border molding, polyvinyl siloxane (Hydrorise Monophase; Zhermack, Italy) for impression, and cast digitization with a laboratory scanner (ceramill® map400, AMANNGIRRBACH, Germany). Scanned files were exported to a 3D inspection software (Geomagic Control X; 3D Systems, NC) for trueness analysis. The CD file (reference file) for each participant was split into 2 areas; the dynamic area representing the mobile tissues at the peripheral border, and the static area representing the rest of the arch. Statistical analyses were performed with 1-sample t-test for the difference between CD and IOS protocols, paired sample t-test for the difference between the static and dynamic areas for each arch, and an independent sample t-test for the difference between the maxillary and mandibular arches for each area, with α = 0.05. Effect size was calculated with Cohen's d (d), with 0.2 as small, 0.5 as medium, and 0.8 as large.

RESULTS

A total of 21 participants were included. The difference between the IOS and CD protocol was significant for all subset comparisons (p < 0.001, d: 2.5-6.2, large effect size). Dynamic areas had lower trueness in comparison with static areas (p < 0.001, d = 4.57, large effect size for the maxillary arch, p < 0.001, d = 3.96, large effect size for the mandibular arch). Mandibular arch had lower trueness in comparison with the maxillary arch (p < 0.001, d = 1.45, large effect size for the static areas, p = 0.009, d = 0.85, large effect size for the dynamic areas, p < 0.001, d = 1.71, large effect size for all areas). Color difference map showed marked positive deviation in the buccal dynamic areas of both arches, and nonmatching areas with evident overstretching.

CONCLUSIONS

While the IOS of edentulous arches could be feasible for attached mucosa, providing a functional shape for the peripheral border remains a challenge, with a thinner and more outward border for the IOS in comparison with the CD protocol. The IOS of the mandibular arch is more difficult and has lower trueness in comparison with the maxillary arch.

Collagenase Administration into Periodontal Ligament Reduces the Forces Required for Tooth Extraction in an Ex situ Porcine Jaw Model

Minimally invasive exodontia is among the long-sought-for development aims of safe dental medicine. In this paper, we aim, for the first time, to examine whether the enzymatic disruption of the periodontal ligament fibers reduces the force required for tooth extraction. To this end, recombinantly expressed clostridial collagenase G variant purified from Escherichia coli was injected into the periodontal ligament of mesial and distal roots of the first and second split porcine mandibular premolars. The vehicle solution was injected into the corresponding roots on the contralateral side. Following sixteen hours, the treated mandibles were mounted on a loading machine to measure the extraction force. In addition, the effect of the enzyme on the viability of different cell types was evaluated. An average reduction of 20% in the applied force (albeit with a large variability of 50 to 370 newton) was observed for the enzymatically treated roots, reaching up to 50% reduction in some cases. Importantly, the enzyme showed only a minor and transient effect on cellular viability, without any signs of toxicity. Using an innovative model enabling the analytical measurement of extraction forces, we show, for the first time, that the enzymatic disruption of periodontal ligament fibers substantially reduces the force required for tooth extraction. This novel technique brings us closer to atraumatic exodontia, potentially reducing intra- and post-operative complications and facilitating subsequent implant placement. The development of novel enzymes with enhanced activity may further simplify the tooth extraction process and present additional clinical relevance for the broad range of implications in the oral cavity.

Three-dimensional finite element analysis of the effect of alveolar cleft bone graft on the maxillofacial biomechanical stabilities of unilateral complete cleft lip and palate

BACKGROUND

The objective is to clarify the effect of alveolar cleft bone graft on maxillofacial biomechanical stabilities, the key areas when bone grafting and in which should be supplemented with bone graft once bone resorption occurred in UCCLP (unilateral complete cleft lip and palate).

METHODS

Maxillofacial CAD (computer aided design) models of non-bone graft and full maxilla cleft, full alveolar cleft bone graft, bone graft in other sites of the alveolar cleft were acquired by processing the UCCLP maxillofacial CT data in three-dimensional modeling software. The maxillofacial bone EQV (equivalent) stresses and bone suture EQV strains under occlusal states were obtained in the finite element analysis software.

RESULTS

Under corresponding occlusal states, the EQV stresses of maxilla, pterygoid process of sphenoid bone on the corresponding side and anterior alveolar arch on the non-cleft side were higher than other maxillofacial bones, the EQV strains of nasomaxillary, zygomaticomaxillary and pterygomaxillary suture on the corresponding side were higher than other maxillofacial bone sutures. The mean EQV strains of nasal raphe, the maximum EQV stresses of posterior alveolar arch on the non-cleft side, the mean and maximum EQV strains of nasomaxillary suture on the non-cleft side in full alveolar cleft bone graft model were all significantly lower than those in non-bone graft model. The mean EQV stresses of bilateral anterior alveolar arches, the maximum EQV stresses of maxilla and its alveolar arch on the cleft side in the model with bone graft in lower 1/3 of the alveolar cleft were significantly higher than those in full alveolar cleft bone graft model.

CONCLUSIONS

For UCCLP, bilateral maxillae, pterygoid processes of sphenoid bones and bilateral nasomaxillary, zygomaticomaxillary, pterygomaxillary sutures, anterior alveolar arch on the non-cleft side are the main occlusal load-bearing structures before and after alveolar cleft bone graft. Alveolar cleft bone graft mainly affects biomechanical stabilities of nasal raphe and posterior alveolar arch, nasomaxillary suture on the non-cleft side. The areas near nasal floor and in the middle of the alveolar cleft are the key sites when bone grafting, and should be supplemented with bone graft when the bone resorbed in these areas.

Tooth Mobility Reproduction in Dental Material Research: A Scoping Review

Background:

Introducing tooth mobility simulation in laboratory studies can provide results with high accuracy and predictability.

Objectives:

This study aims to review in vitro methodologies replicating tooth mobility and provide a recommended approach for future laboratory models.

Methods:

Databases, such as PubMed, Cochrane Database of Systematic Review, BioMed Central and Chinese databases are searched, and twelve articles are included in the final review.

Results:

Simulation methods of tooth mobility involving socket enlargement, screw loosening, alveolar bone loss simulation and a combination approach are identified from the extracted data. The materials used in preparing artificial teeth, artificial sockets and periodontal ligament simulator are discussed with a focus on their limitations. The achieved degrees of mobility and the presence of the centre of rotation are also evaluated. A timeline of the review articles is constructed to understand the trend of the preferred methods in tooth mobility simulation.

Conclusion:

Future in vitro investigations can achieve clinical reliability, particularly for materials tested in the field of dental traumatology and periodontology, by recognising the importance of incorporating tooth mobility in laboratory studies. Improvised methods are proposed to ensure that potential laboratory models can resemble the actual oral environment.

Frequency-related viscoelastic properties of the human incisor periodontal ligament under dynamic compressive loading

Studies concerning the mechanical properties of the human periodontal ligament under dynamic compression are rare. This study aimed to determine the viscoelastic properties of the human periodontal ligament under dynamic compressive loading. Ten human incisor specimens containing 5 maxillary central incisors and 5 maxillary lateral incisors were used in a dynamic mechanical analysis. Frequency sweep tests were performed under the selected frequencies between 0.05 Hz and 5 Hz with a compression amplitude that was 2% of the PDL's initial width. The compressive strain varied over a range of 4%-8% of the PDL's initial width. The storage modulus, ranging from 28.61 MPa to 250.21 MPa, increased with the increase in frequency. The loss modulus (from 6.00 MPa to 49.28 MPa) also increased with frequency from 0.05 Hz- 0.5 Hz but remained constant when the frequency was higher than 0.5 Hz. The tanδ showed a negative logarithmic correlation with frequency. The dynamic moduli and the loss tangent of the central incisor were higher than those of the lateral incisor. This study concluded that the human PDL exhibits viscoelastic behavior under compressive loadings within the range of the used frequency, 0.05 Hz- 5 Hz. The tooth position and testing frequency may have effects on the viscoelastic properties of PDL.

Mechanical properties of human oral mucosa tissues are site dependent: A combined biomechanical, histological and ultrastructural approach

Aim

To investigate load‐deformation properties of Thiel‐embalmed human oral mucosa tissues and to compare three different anatomical regions in terms of mechanical, histological and ultrastructural characteristic with focus on the extracellular matrix.

Materials and Methods

Thirty specimens from three different regions of the oral cavity: attached gingiva, buccal mucosa and the hard palate were harvested from two Thiel‐embalmed cadavers. Mechanical properties were obtained, combining strain evaluation and digital image correlation in a standardised approach. Elastic modulus, tensile strength, strain at maximum load and strain to failure were computed and analysed statistically. Subsamples were also analysed using scanning electron microscopy (SEM) and histological analysis.

Results

The highest elastic modulus of 37.36 ± 17.4 MPa was found in the attached gingiva group, followed by the hard palate and buccal mucosa. The elastic moduli of attached gingiva differed significantly to the buccal mucosa (p = .01) and hard palate (p = .021). However, there was no difference in the elastic moduli between the buccal mucosa and hard palate (p > .22). The tensile strength of the tissue samples ranged from 1.54 ± 0.5MPa to 3.81 ± 0.9 MPa, with a significant difference between gingiva group and buccal mucosa or hard palate (p = .001). No difference was found in the mean tensile strength between the buccal mucosa and hard palate (p = .92). Ultrastructural imaging yielded a morphological basis for the various mechanical properties found intraorally; the attached gingiva showed unidirectional collagen fibre network whereas the buccal mucosa and hard palate showed multi‐directional network, which was more prone to tension failure and less elasticity.

Conclusion

This is the first study assessing the various morphological‐mechanical relationships of intraoral soft tissues, utilising Thiel‐embalmed tissues. The findings of this study suggest that the tissues from different intraoral regions showed various morphological‐mechanical behaviour which was also confirmed under the SEM and in the histological analysis.

Service Evaluation of Recording Jaw Registrations for Removable Partial Dentures in NHS General Dental Practices

AIMS

To establish the prevalence of jaw registrations being taken for removable partial dentures (RPDs) in primary dental NHS practices.

METHOD

271 RPDs made by 16 general dental practitioners across four NHS dental practices were evaluated prospectively. The number of teeth replaced, whether jaw registration was undertaken, and the number of denture adjustment appointments were recorded. Telephone interviews with dental technicians were held to establish their preferred jaw registrations material.

MAIN FINDINGS

Jaw registrations were not carried out in 27% (n=72) of RPD. When jaw registration was recorded, 14% (n=28) required a further denture adjustment appointment. 64% (n=46) of dentures where jaw registration was not recorded required at least one further denture adjustment appointment. Dental technicians unanimously preferred a squash-bite wax block, with centre and canine positions marked and cast models secured with elastic bands.

CONCLUSION

Overall, recording a jaw registration reduced the number of denture adjustment appointments required.

Influence of Different Implants on the Biomechanical Behavior of a Tooth-Implant Fixed Partial Dentures: A Three-Dimensional Finite Element Analysis

This study analyzed the biomechanical behavior of rigid and nonrigid tooth-implant supported fixed partial dentures. Different implants were used to observe the load distribution over teeth, implants, and adjacent bone using three-dimensional finite element analysis. A simulation of tooth loss of the first and second right molars was created with an implant placed in the second right molar and a prepared tooth with simulated periodontal ligament (PDL) in the second right premolar. Configurations of two types of implants and their respective abutments-external hexagon (EX) and Morse taper (MT)-were transformed into a 3D format. Metal-ceramic fixed partial dentures were constructed with rigid and nonrigid connections. Mesh generation and data processing were performed on the 3D finite element analysis (FEA) results. Static loading of 50 N (premolar) and 100 N (implant) were applied. When an EX implant was used, with a rigid or nonrigid connection, there was intrusion of the tooth in the distal direction with flexion of the periodontal ligament. Tooth intrusion did not occur when the MT implant was used independent of a rigid or nonrigid connection. The rigid or nonrigid connection resulted in a higher incidence of compressive forces at the cortical bone as well as stress in the abutment/pontic area, regardless of whether EX or MT implants were used. MT implants have a superior biomechanical performance in tooth-implant supported fixed partial dentures. This prevents intrusion of the tooth independent of the connection. Both types of implants studied caused a greater tendency of compressive forces at the crestal area.

The Mechanical Effect of the Periodontal Ligament on Bone Strain Regimes in a Validated Finite Element Model of a Macaque Mandible

The primary anatomical function of the periodontal ligament (PDL) is to attach teeth to their sockets. However, theoretical and constitutive mechanical models have proposed that during mastication the PDL redistributes local occlusal loads and reduces the jaw's resistance to torsional deformations. These hypotheses imply that accurately modeling the PDL's material properties and geometry in finite element analysis (FEA) is a prerequisite to obtaining precise strain and deformation data. Yet, many finite element studies of the human and non-human primate masticatory apparatus exclude the PDL or model it with simplicity, in part due to limitations in μCT/CT scan resolution and material property assignment. Previous studies testing the sensitivity of finite element models (FEMs) to the PDL have yielded contradictory results, however a major limitation of these studies is that FEMs were not validated against in vivo bone strain data. Hence, this study uses a validated and subject specific FEM to assess the effect of the PDL on strain and deformation regimes in the lower jaw of a rhesus macaque (Macaca mulatta) during simulated unilateral post-canine chewing. Our findings demonstrate that the presence of the PDL does influence local and global surface strain magnitudes (principal and shear) in the jaw. However, the PDL's effect is limited (diff. ~200-300 με) in areas away from the alveoli. Our results also show that varying the PDL's Young's Modulus within the range of published values (0.07-1750 MPa) has very little effect on global surface strains. These findings suggest that the mechanical importance of the PDL in FEMs of the mandible during chewing is dependent on the scope of the hypotheses being tested. If researchers are comparing strain gradients across species/taxa, the PDL may be excluded with minimal effect on results, but, if researchers are concerned with absolute strain values, sensitivity analysis is required.

Three-dimensional differences between intraoral scans and conventional impressions of edentulous jaws: A clinical study

STATEMENT OF PROBLEM

Using intraoral scans for removable dentures has been questioned because of a suggested lack of accuracy. However, data regarding the accuracy of digital intraoral complete-arch scans are sparse, present some methodological issues, and mostly come from in vitro studies on dentate casts, which are very different from edentulous arches.

PURPOSE

The purpose of this clinical study was to evaluate 3D differences between intraoral scans (IOS) and conventional impressions of edentulous arches by means of digital analysis.

MATERIAL AND METHODS

Ten maxillary and 10 mandibular edentulous arches were investigated. For each of them, IOS was performed, and a custom tray was digitally designed based on these scans. Trays were built by using a 3D printer and used to make a conventional impression with a polysulfide impression material. The conventional impression was scanned immediately by using the same intraoral scanner and by the same dentist. Standard tessellation language (STL) files of IOS and the scans of the corresponding conventional impressions (CIS) were superimposed with a 2-phase best-fit alignment in a reverse engineering software program. The corresponding full-scan, 3D mean distance was measured. This procedure was repeated after trimming the IOS and CIS to eliminate peripheral areas not present in both files, as well as nonmatching areas caused by practical aspects related to obtaining the IOS (mobile tissue stretching) and the conventional impressions (mobile tissue compression and folding at the margin of impression), which could have impaired alignment and, consequently, measurement accuracy. The mean distance between the full and trimmed IOS and CIS was statistically investigated, and subgroup analysis was performed for the maxillary and mandibular arches. The statistical significance of the differences between the 2 impression methods was also investigated.

RESULTS

The full-scan mean distance between the IOS and CIS (-0.19 ±0.18 mm) was significantly different from that of the trimmed scan mean distance (-0.02 ±0.05 mm), with no significant differences for maxillary and mandibular arches. The differences between the IOS and CIS were statistically significant for full scans; they were not significant for trimmed scans, except for the maxillary subgroup.

CONCLUSIONS

The mean distance between the IOS and CIS may be significantly different if they are not properly superimposed. The mean distance (-0.02 ±0.05 mm) between the IOS and CIS falls within the range of mucosa resilience. Thus, 3D differences between the IOS and CIS can be attributed to the different physics behind the 2 impression methods and not to defects in accuracy of one method compared with the other. The size of the measured difference between the 2 impression methods was not statistically significant and was not clinically significant for removable denture fabrication.

Biomechanics of oral mucosa

The prevalence of prosthodontic treatment has been well recognized, and the need is continuously increasing with the ageing population. While the oral mucosa plays a critical role in the treatment outcome, the associated biomechanics is not yet fully understood. Using the literature available, this paper provides a critical review on four aspects of mucosal biomechanics, including static, dynamic, volumetric and interactive responses, which are interpreted by its elasticity, viscosity/permeability, apparent Poisson's ratio and friction coefficient, respectively. Both empirical studies and numerical models are analysed and compared to gain anatomical and physiological insights. Furthermore, the clinical applications of such biomechanical knowledge on the mucosa are explored to address some critical concerns, including stimuli for tissue remodelling (interstitial hydrostatic pressure), pressure–pain thresholds, tissue displaceability and residual bone resorption. Through this review, the state of the art in mucosal biomechanics and their clinical implications are discussed for future research interests, including clinical applications, computational modelling, design optimization and prosthetic fabrication.

Mechanobiological Bone Reaction Quantified by Positron Emission Tomography

While nuclear medicine has been proven clinically effective for examination of the change in bone turnover as a result of stress injury, quantitative correlation between tracer uptake and mechanical stimulation in the human jawbone remains unclear. This study aimed to investigate the relationship between bone metabolism observed by 18F-fluoride positron emission tomography (PET) images and mechanical stimuli obtained by finite element analysis (FEA) in the residual ridge induced by the insertion of a removable partial denture (RPD). An 18F-fluoride PET/CT (computerized tomography) scan was performed to assess the change of bone metabolism in the residual ridge under the denture before and after RPD treatment. Corresponding patient-specific 3D finite element (FE) models were created from CT images. Boundary conditions were prescribed by the modeling of condylar contacts, and muscular forces were derived from the occlusal forces measured in vivo to generate mechanobiological reactions. Different mechanobiological stimuli, e.g., equivalent von Mises stress (VMS), equivalent strain (EQV), and strain energy density (SED), determined from nonlinear FEA, were quantified and compared with the standardized uptake values (SUVs) of PET. Application of increased occlusal force after RPD insertion induced higher mechanical stimuli in the residual bone. Accordingly, SUV increased in the region of residual ridge with higher mechanical stimuli. Thus, with SUV, a clear correlation was observed with VMS and SED in the cancellous bone, especially after RPD insertion (R2 > 0.8, P < 0.001). This study revealed a good correlation between bone metabolism and mechanical stimuli induced by RPD insertion. From this patient-specific study, it was shown that metabolic change detected by PET in the loaded bone, in a much shorter duration than conventional x-ray assessment, is associated with mechanical stimuli. The nondestructive nature of PET/CT scans and FEA could potentially provide a new method for clinical examination and monitoring of prosthetically driven bone remodeling.

Modeling stress-relaxation behavior of the periodontal ligament during the initial phase of orthodontic treatment

The periodontal ligament is the tissue that provides early tooth motion as a result of applied forces during orthodontic treatment: a force-displacement behavior characterized by an instantaneous displacement followed by a creep phase and a stress relaxation phase. Stress relaxation behavior is that which provides the long-term loading to and causes remodelling of the alveolar bone, which is responsible for the long-term permanent displacement of the tooth. In this study, the objective was to assess six viscoelastic models to predict stress relaxation behavior of rabbit periodontal ligament (PDL). Using rabbit stress relaxation data found in the literature, it was found that the modified superposition theory (MST) model best predicts the rabbit PDL behavior as compared to nonstrain-dependent and strain-dependent versions of the Burgers four-parameter and the five-parameter viscoelastic models, as well as predictions by Schapery's viscoelastic model. Furthermore, it is established that using a quadratic form for MST strain dependency provides more stable solutions than the cubic form seen in previous studies.

An in vitro study of the effect of different restorative materials on the reliability of a veneering porcelain

STATEMENT OF PROBLEM

Implant-supported, porcelain veneered restorations experience a greater rate of porcelain fracture than tooth-supported restorations. For completely edentulous patients, one approach to minimizing porcelain fracture is to use acrylic resin in the mandible, although its efficacy is unknown.

PURPOSE

The purpose of this study was to evaluate the reliability of a veneering porcelain fatigued with different restorative materials in vitro.

MATERIAL AND METHODS

Fifty-nine veneering porcelain disk specimens were fabricated by layering veneering porcelain on nickel-chromium base metal alloy disks. Four groups of different indenter materials fatigued the porcelain specimens: group WC, tungsten carbide served as a control; group FC, pressed leucite glass ceramic; group NHC, nanohybrid composite resin denture tooth; and group AR, unfilled acrylic resin denture tooth. Porcelain specimens were randomly divided into 4 groups (n=14). A step-stress accelerated life-testing model was used. Use-level probability Weibull plots were generated, and the reliability of each group was estimated for a theoretical completion of 50 000 cycles at 150 N.

RESULTS

Nanohybrid composite resin and unfilled acrylic resin denture tooth groups had higher reliability than tungsten carbide and leucite glass ceramic groups. No significant differences existed between the reliability of the tungsten carbide and leucite glass ceramic groups and the nanohybrid composite resin and acrylic resin denture tooth groups.

CONCLUSIONS

Veneering porcelain disk specimens fatigued with the unfilled acrylic resin and nanohybrid composite resin denture tooth indenters exhibited higher reliability than the specimens fatigued with either the tungsten carbide or leucite glass ceramic indenters. All of the veneering porcelain disk specimens failed with the same mode of fracture, although the surface posttest exhibited different fracture characteristics among specimens fatigued with the 4 different materials.

Patient-specific finite element analysis of viscoelastic masticatory mucosa

The purpose of this study was to analyze the stress and strain inside of the oral mucosa in partially-edentulous patients. The patient-specific finite element models of the mucosa and the bone were constructed using the CT images and in-vivo surface measurement during a continuous load. The mean initial shear modulus of 8.3 × 10^–5 (GPa) and the mean relaxation time of 503 (s) were determined as the viscoelastic properties of the mucosa. The increase of the highest maximum compressive strain during the continuous loading was observed in all the patients, however; the intensity of strain was not in accordance with the thickness of the mucosa. It is suggested that the variations of the morphology and the initial modulus of the mucosa should be considered in the mathematical approaches to detect the mechanical responses of the oral mucosa.

Reappraisal of the removable partial denture as a treatment option for the shortened dental arch

For patients with shortened dental arches, many treatment options are available. The existing situation can be maintained by stabilizing the present dentition and improving the occlusion without extending the arch. Alternatively, the shortened dental arch can be extended by either a free-end saddle removable partial denture, cantilevered fixed bridge, or by an implant-supported prosthesis. The free-end saddle removable partial denture can be considered a simple, non-invasive, and relatively cheap treatment option for the shortened dental arch. It was believed that such prosthodontic rehabilitation would be beneficial for the patients in terms of improving oral functions. However, the existing literature indicates that the prognosis of free-end saddle removable partial denture is not predictable, it is problematic, and its contribution to oral functions in patients with shortened dental arches is considered to be dubious. This paper reviews and summarizes the current literature about the outcome of extending the shortened dental arch by a free-end saddle removable partial denture. It also outlines factors that may affect the prognosis of this prosthetic treatment.

Periodontal biomechanics: finite element simulations of closing stroke and power stroke in equine cheek teeth

Background

In equine dentistry periodontal diseases, especially periapical inflammation, are frequently occurring problems. Anachoresis is believed to be the most common cause for the development of such disorders. Nevertheless, there is still no substantiated explanation why settlement of pathogen microorganisms occurs in equine periodontal tissues. It is expected that excessive strains and stresses occurring in the periodontal ligament (PDL) during the horse’s chewing cycle might be a predisposing factor. In this study this assumption was examined by finite element (FE) analyses on virtual 3-D models of equine maxillary and mandibular cheek teeth, established on the basis of μCT datasets. Calculations were conducted both under conditions of closing and power stroke.

Results

Results showed a uniform distribution of low stresses and strain energy density (SED) during closing stroke, whereas during power stroke an occurrence of high stresses and SED could be observed in the PDL near the alveolar crest and in periapical regions.

Conclusion

The concentration of forces during power stroke in these specific areas of the PDL may cause local tissue necrosis and inflammation and thus establish a suitable environment for the settlement of microorganisms.

Multicentre prospective evaluation of implant-assisted mandibular bilateral distal extension removable partial dentures: patient satisfaction

OBJECTIVE

To compare the levels of patient satisfaction with either conventional mandibular bilateral distal extension partial dentures or those assisted by bilateral distal implants.

MATERIALS AND METHODS

Forty-eight participants who were dissatisfied with their existing conventional mandibular distal extension dentures opposing complete maxillary dentures were selected for a multicentre prospective study in New Zealand, Colombia and the Netherlands. A control group of 12 participants in New Zealand received conventional mandibular partial dentures. Three test groups involving 36 participants in New Zealand (12), Colombia (12) and the Netherlands (12) received bilateral distal implants in the second molar regions. After conventional loading, the test group participants initially had healing caps placed on the distal implants providing support only, followed after approximately 6 months by ball abutments (retentive anchors) for support and retention. Patient outcomes were determined with questionnaires completed at specific stages of the study for up to 3 years.

RESULTS

Visual analogue scale, Likert and oral health impact questionnaires before and after treatment indicated improved results. There were significantly improved parameters of overall satisfaction, stability, chewing and appearance after 3 years (P < 0.05). There were also improvements on stability, chewing and overall satisfaction. Speech also improved, but not significantly. Ball abutments (retentive anchors) on the distal implants, as opposed to healing caps improved patient satisfaction for stability, chewing and overall satisfaction. Changing to ball abutments (retentive anchors) revealed significant improvement by participant response when evaluating parameters of stability, chewing and overall satisfaction (P < 0.05).

CONCLUSION

Mandibular implant-assisted removable partial dentures are a preferable treatment option for patients with complaints about their conventional distal extension partial dentures.

Experimentally determined mechanical properties of, and models for, the periodontal ligament: critical review of current literature

Introduction. This review is intended to highlight and discuss discrepancies in the literature of the periodontal ligament's (PDL) mechanical properties and the various experimental approaches used to measure them. Methods. Searches were performed on biomechanical and orthodontic publications (in databases: Compendex, EMBASE, MEDLINE, PubMed, ScienceDirect, and Scopus). Results. The review revealed that significant variations exist, some on the order of six orders of magnitude, in the PDL's elastic constants and mechanical properties. Possible explanations may be attributable to different experimental approaches and assumptions. Conclusions. The discrepancies highlight the need for further research into PDL properties under various clinical and experimental loading conditions. Better understanding of the PDL's biomechanical behavior under physiologic and traumatic loading conditions might enhance the understanding of the PDL's biologic reaction in health and disease. Providing a greater insight into the response of the PDL would be instrumental to orthodontists and engineers for designing more predictable, and therefore more efficacious, orthodontic appliances.

The mechanical function of the periodontal ligament in the macaque mandible: a validation and sensitivity study using finite element analysis

Whilst the periodontal ligament (PDL) acts as an attachment tissue between bone and tooth, hypotheses regarding the role of the PDL as a hydrodynamic damping mechanism during intraoral food processing have highlighted its potential importance in finite element (FE) analysis. Although experimental and constitutive models have correlated the mechanical function of the PDL tissue with its anisotropic, heterogeneous, viscoelastic and non-linear elastic nature, in many FE simulations the PDL is either present or absent, and when present is variably modelled. In addition, the small space the PDL occupies and the inability to visualize the PDL tissue using μCT scans poses issues during FE model construction and so protocols for the PDL thickness also vary. In this paper we initially test and validate the sensitivity of an FE model of a macaque mandible to variations in the Young's modulus and the thickness of the PDL tissue. We then tested the validity of the FE models by carrying out experimental strain measurements on the same mandible in the laboratory using laser speckle interferometry. These strain measurements matched the FE predictions very closely, providing confidence that material properties and PDL thickness were suitably defined. The FE strain results across the mandible are generally insensitive to the absence and variably modelled PDL tissue. Differences are only found in the alveolar region adjacent to the socket of the loaded tooth. The results indicate that the effect of the PDL on strain distribution and/or absorption is restricted locally to the alveolar bone surrounding the teeth and does not affect other regions of the mandible.

Mechanical strength and viscoelastic response of the periodontal ligament in relation to structure

The mechanical strength of the periodontal ligament (PDL) was first measured as force required to extract a tooth from its socket using human specimens. Thereafter, tooth-PDL-bone preparations have extensively been used for measurement of the mechanical response of the PDL. In vitro treatments of such specimens with specific enzymes allowed one to investigate into the roles of the structural components in the mechanical support of the PDL. The viscoelastic responses of the PDL may be examined by analysis of the stress-relaxation. Video polarised microscopy suggested that the collagen molecules and fibrils in the stretched fibre bundles progressively align along the deformation direction during the relaxation. The stress-relaxation process of the PDL can be well expressed by a function with three exponential decay terms. Analysis after in vitro digestion of the collagen fibres by collagenase revealed that the collagen fibre components may play an important role in the long-term relaxation component of the stress-relaxation process of the PDL. The dynamic measurements of the viscoelastic properties of the PDL have recently suggested that the PDL can absorb more energy in compression than in shear and tension. These viscoelastic mechanisms of the PDL tissue could reduce the risk of injury to the PDL.

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

OBJECTIVES

To evaluate the pattern of maxillary complete denture movement during chewing for free-end removable partial dentures (RPD) wearers, compared to maxillary and mandibular complete denture wearers.

MATERIALS AND METHODS

Eighteen edentulous participants (group I) and 10 volunteers with bilateral posterior edentulous mandibles (group II) comprised the sample. Measures of mean denture movement and its variability were obtained by a kinesiographic instrument K6-I Diagnostic System, during the mastication of bread and a polysulphide block. Data were analysed using two-way ANOVA (alpha = 0.05).

RESULTS

Upper movement during chewing was significantly lower for group II, regardless of the test food. The test food did not influence the vertical or lateral position of the denture bases, but more anterior dislocation was found when polysulphide blocks were chewed. Group II presented lower intra-individual variability for the vertical axis. Vertical displacement was also more precise with bread as a test food.

CONCLUSION

It can be concluded that mandibular free-end RPD wearers show smaller and more precise movements than mandibular complete denture wearers.

Differential Gene Expression of Periodontal Ligament Cells After Loading of Static Compressive Force

BACKGROUND

Compressive force is an important mechanical stimulus on the periodontal ligament (PDL) and is closely related to therapeutic tooth movement. In this study, early or late response genes related to the compressive stress in PDL cells were evaluated. Particularly, the expression of interleukin (IL)-6, IL-8, and alkaline phosphatase (ALP) was studied.

METHODS

The primary cultured cells from PDL were grown in a three-dimensional collagen gel, and received a continuous static compressive force (1.76 g/cm(2)). The expressed genes were screened by cDNA microarray assays for 2 or 12 hours after the initiation of the mechanical force application. The genes of interest that showed significant changes in expression in the cDNA microarray assay were analyzed further by quantitative reverse transcriptase polymerase chain reaction (RT-PCR), enzyme-linked immunoabsorbent assays (ELISA), and ALP assays.

RESULTS

ALP, IL-6, and IL-8 were selected among the genes that significantly changed expression (/M/ >0.7) and subsequently were confirmed by quantitative RT-PCR. The secreted protein concentrations for IL-6, IL-8, and ALP activity were measured at 72 hours after application of continuous static compressive force. The protein level of IL-6 was significantly increased at 72 hours (P <0.001), but there was no significant change in IL-8 (P >0.05). ALP activity was decreased approximately 41.5% compared to the control (P = 0.015).

CONCLUSIONS

Considering that IL-6 is a potent osteoclast activator and the compressive side of PDL during orthodontic tooth movement shows the resorption of calcified tissue, the changed expression of IL-6 and ALP in response to the static compressive force in PDL cells may contribute to the orthodontic tooth movement or alveolar bone remodeling.

Mechanical behavior of bovine periodontal ligament under tension-compression cyclic displacements

In the present study, the mechanical response of bovine periodontal ligament (PDL) subjected to displacement-controlled tension-compression harmonic oscillations and subsequent rupture was examined. Specimens including dentine, cementum, PDL, and alveolar bone were extracted from different depths and locations of bovine first molars. They were immersed in a saline solution at room temperature and clamped on their bone and dentine extremities. The samples were tested at +/-35% of the PDL's width, with a frequency of 1 Hz. The mechanical parameters evaluated were hysteresis, phase lag, and the modulus of the stress-stretch ratio curves in tension and compression. The tensile strength and the corresponding stretch ratio were also recorded. Stress-stretch ratio curves indicated a non-linear, time-dependent response with hysteresis and preconditioning effects. The hysteresis and phase lag in compression were much higher than in tension, suggesting that the dissipated energy was higher in compression than in tension. The root depth and location did not play essential roles for the tension or compression data, with the exception of limited statistical differences for tensile strength and corresponding stretch ratio. Thus, biological variability in the specimens, as a result of different bone contours, PDL width, and fiber orientation, did not affect the energy-absorbing capacity of the PDL. The evolution of the stress rate with stress demonstrated a constant increase of stiffness with stress. The stiffness values were twofold higher in tension than in compression. The data also showed that the stiffness of the PDL was comparable with data reported for other soft tissues.

In vitro time-dependent response of periodontal ligament to mechanical loading

This study examined the time-dependent response of bovine periodontal ligament (PDL). Applying linear viscoelastic theory, the objective was 1) to examine the linearity of the PDL's response in terms of its scaling and superposition property and 2) to generate the phase lag-vs.-frequency spectrum graph. PDL specimens were tested under three separate straining conditions: 1) tension ramp tests conducted at different strain rates, 2) pulling step-straining to 0.3 in discrete tests and to 0.3 and 0.6 in one continuous run, and 3) tension-compression sinusoidal oscillations. To this effect, bar-shaped specimens of bovine roots that comprised portions of dentin, PDL tissue, and alveolar bone were produced and strained in a microtensile machine. The experimental data demonstrated that neither the scaling nor the superposition properties were verified and that the viscoelastic response of the PDL was nonlinear. The PDL's elastic response was essentially stiffening, and its viscous component was pseudoplastic. The tangent of the PDL's strain-stress phase lag was in the 0-0.1 range in the tensile direction and in the 0.35-0.45 range in the compressive direction. In line with other biological tissues, the phase lag was largely independent of frequency. By use of the data generated, a mathematical model is outlined that reproduces both the elastic stiffening and viscous thinning of the PDL's response.

Effects of relief space and escape holes on pressure characteristics of maxillary edentulous impressions

STATEMENT OF PROBLEM

The selective pressure technique has been recommended for making impressions of maxillary edentulous residual ridges. Although various methods for making impressions have been reported, a definitive procedure has not been clearly elucidated.

PURPOSE

This in vitro study evaluated changes in impression pressure produced by different types of relief space and escape holes in the impression tray for making an impression of a simulated maxillary edentulous arch.

MATERIAL AND METHODS

Silicone impression material (Exadenture) and a maxillary edentulous acrylic cast were used. A miniature pressure sensor was embedded at the mid-palatal suture (point-P) and at the left first molar area on the edentulous ridge (point-R). Three types of tray relief were used: no spacer (NS), a 0.36-mm-thick sheet of wax (SS), or a 1.40-mm-thick base plate wax (BS). Four types of escape holes were made: no hole (NH), or escape holes of 0.5, 1.0, or 2.0 mm in diameter (05H, 10H, and 20H, respectively) in the area opposing point-P. Twelve trays were formed using these relief space and escape hole combinations. The cast and tray were attached to a rheometer for applying a continuous isotonic force of 5.0 kgf and compressive speed of 120 mm/min. Impressions were made and measurement of pressure (kPa) began immediately prior to compression and continued until the materials had polymerized for 2 minutes, with a sampling time of 5 Hz. Measurements were performed 5 times for each tray. The data were analyzed using 3-way analysis of variance and the Bonferroni test (alpha=.05).

RESULTS

At initial pressure, the data obtained at point-P showed significantly higher values for NSNH, NS05H, SSNH, and SS05H (range: 22.29 +/- 1.58 kPa to 29.96 +/- 1.41 kPa) than those at point-R (range: 18.61 +/- 1.12 kPa to 22.71 +/- 2.11 kPa). At end pressure, the data obtained from NSNH at point P showed a significantly higher value (25.36 +/- 1.69 kPa) than that of point-R (15.36 +/- 0.99 kPa) (P<.001), whereas data from NS10H and NS20H at point-P showed a significantly lower value (6.32 +/- 0.84 kPa and 4.50 +/- 0.42 kPa) than at point-R (15.50 +/- 0.49 kPa and 14.98 +/- 0.88 kPa) (P<.001). The data obtained from SS05H, SS10H, and NS20H at point-P showed significantly lower values (range: 3.72 +/- 0.44 kPa to 9.10 +/- 0.26 kPa) than those at point-R (range: 13.40 +/- 1.31 kPa to 14.40 +/- 0.98 kPa). Moreover, the data obtained from BSNH, BS05H, BS10H, and BS20H at point-P showed significantly lower values (range: 3.24 +/- 1.96 kPa to 10.20 +/- 1.84 kPa) than those of point-R (range: 11.69 +/- 1.01 kPa to 14.04 +/- 2.08 kPa).

CONCLUSION

For making impressions of an edentulous maxilla, the data suggest that a tray with an escape hole 1.0 mm or larger or a spacer thickness of base plate wax (1.40 mm) be used.

Kinesiographic study of complete denture movement related to mucosa displacement in edentulous patients

The mucosa that covers the residual ridges of edentulous patients may present some distortion or displacement when occlusal loading is applied in complete dentures. This distortion and movement of the denture can result in acceleration of residual ridge resorption and loss of retention and stability. The aim of this study was to analyze the pattern of upper complete denture movement related to underlying mucosa displacement. A sample of 10 complete denture wearers was randomly selected, which had acceptable upper and lower dentures and normal volume and resilience of residual ridges. The kinesiographic instrument K6-I Diagnostic System was used to measure denture movements, according to the method proposed by Maeda et al.7, 1984. Denture movements were measured under the following experimental conditions: (A) 3 maximum voluntary clenching cycles and (B) unilateral chewing for 20 seconds. The results showed that under physiological load, oral mucosa distortion has two distinct phases: a fast initial displacement as load is applied and a slower and incomplete recovery when load is removed. Intermittent loading such as chewing progressively reduces the magnitude of the denture displacement and the recovery of the mucosa is gradually more incomplete.

Quasi-linear viscoelastic behavior of the human periodontal ligament

Previous studies have not produced a comprehensive mathematical description of the nonlinear viscoelastic stress-strain behavior of the periodontal ligament (PDL). In the present study, the quasi-linear viscoelastic (QLV) model was applied to mechanical tests of the human PDL. Transverse sections of cadaveric premolars were subjected to relaxation tests and loading to failure perpendicular to the plane of section. Distinct and repeatable toe and linear regions of stress-strain behavior were observed. The amount of strain associated with the toe region differed as a function of anatomical location along the tooth root. Stress relaxation behavior was comparable for different anatomical locations. Model predicted peak tissue stresses for cyclic loading were within 11% of experimental values, demonstrating that the QLV approach provided an improved, accurate quantification of PDL mechanical response. The success of the QLV approach supports its usefulness in future efforts of experimental characterization of PDL mechanical behavior.

Tooth-implant connection: some biomechanical aspects based on finite element analyses

This study investigated, with the use of two- and three-dimensional finite element analysis, the peri-implant stress that occurred during loading of a tooth that was rigidly connected to a distally placed implant. A fixed bond between the bone and the implant was assumed, while the periodontal ligament was represented by means of three-dimensional nonlinear visco-elastic spring elements. Two different loading conditions were compared in the study: i) an axially directed static load of 50 kg that was applied to the tooth for 10 s, and ii) a transitional load of 50 kg that was applied for 5 milliseconds. Load duration appeared to have a greater influence than load intensity on the stress distribution in the bone around an implant and a rigidly connected tooth. Static load is, therefore, potentially more harmful for peri-implant bone than transitional load. The periodontal ligament seems to play a key role in the stress distribution between a tooth and a rigidly connected implant.

Numerical experiments on long-time orthodontic tooth movement

In orthodontic treatment, teeth are moved by the use of specific force systems. The force system used depends on the patient's orthodontic situation characterized by the geometry of the tooth and the surrounding alveolar bone, which defines the position of the center of resistance. Therefore, the simulation of bone remodeling could be helpful for the treatment strategy. In this study, the optimal force system for bodily movement of a single-root tooth, with an orthodontic bracket attached, was determined. This was achieved by the use of the numerical finite element method, including a distinct mechanical bone-remodeling algorithm. This algorithm works with equilibrium iterations separated in 2 calculation steps. Furthermore, a parametric 3-dimensional finite element model, which allows modifications in the root length and its diameter, is described. For different geometries, the ideal moment-by-force ratios that induce a bodily movement were determined. The knowledge of root geometry is important in defining an optimal force system.

Time-dependent mechanical behaviour of the periodontal ligament

The process of tooth displacement in response to orthodontic forces is thought to be induced by the stresses and strains in the periodontium. The mechanical force on the tooth is transmitted to the alveolar bone through a layer of soft connective tissue, the periodontal ligament. Stress and/or strain distribution in this layer must be derived from mathematical models, such as the finite element method, because it cannot be measured directly in a non-destructive way. The material behaviour of the constituent tissues is required as an input for such a model. The purpose of this study was to determine the time-dependent mechanical behaviour of the periodontal ligament due to orthodontic loading of a tooth. Therefore, in vivo experiments were performed on beagle dogs. The experimental configuration was simulated in a finite element model to estimate the poroelastic material properties for the periodontal ligament. The experiments showed a two-step response: an instantaneous displacement of 14.10 +/- 3.21 microns within 4 s and a more gradual (creep) displacement reaching a maximum of 60.00 +/- 9.92 microns after 5 h. This response fitted excellently in the finite element model when 21 per cent of the ligament volume was assigned a permeability of 1.0 x 10(-14) m4/N s, the remaining 97 per cent was assigned a permeability of 2.5 x 10(-17) m4/N s. A tissue elastic modulus of 0.015 +/- 0.001 MPa was estimated. Our results indicate that fluid compartments within the periodontal ligament play an important role in the transmission and damping of forces acting on teeth.

Post-extraction remodeling of the adult mandible

Following tooth loss, the mandible shows an extensive loss of bone in some individuals. This may pose a significant problem in the prosthodontic restoration of function and esthetics. The many factors which have been proposed as being responsible for the inter-individual variation in post-extraction remodeling mean that a perfunctory analysis of the literature, in which well-controlled, relevant studies are scarce, may not provide the whole story. This article reviews the local and systemic factors which may play a role in the post-extraction remodeling of the mandible. Since severe residual ridge resorption may occur even when the bone status in the rest of the skeleton is good and vice versa, it is concluded that local functional factors are of paramount significance. It is now essential to determine how they can be modified and applied to help maintain ridge height and quality in our aging, edentulous population.

Displacement of a mobile tooth during impression procedure: effect of impression tray design

When fabricating prostheses in a partially edentulous arch with some mobile teeth, it is important to minimize tooth displacement during the impression procedure. The present study examined the effect of custom tray designs on the displacement of a mobile central incisor in a mandibular simulation model with six anterior teeth. Twelve custom trays were designed according to the different spaces and perforated holes in the region of the remaining teeth. As a result, the degree of displacement of the mobile tooth could be reduced according to the size of spaces and the location of perforated holes in the custom tray.