Post-extraction remodeling of the adult mandible

Exploring Genetic Link of Residual Ridge Resorption in Completely Edentulous Individuals: A Prospective Case-Control Clinical Study

BACKGROUND

Residual ridge resorption presents obstacles in prosthodontic treatment, affecting denture stability and the success of dental implants. Genetic elements, specifically the single nucleotide polymorphism (SNP) 1772C>T variant within the hypoxia-inducible factor 1 subunit alpha (HIF-1α) gene, are hypothesized to contribute to residual ridge resorption progression. Nevertheless, its impact remains insufficiently investigated, especially within the context of South Indian populations. We sought to investigate the connection between SNP 1772C>T and residual ridge resorption (RRR) among fully edentulous individuals, considering demographic factors, genotyping methodologies, and statistical evaluations.

METHODS

In a prospective case-control study, we recruited 100 completely edentulous participants from South India. Participants were categorized based on alveolar ridge height. Saliva samples were non-invasively collected for DNA extraction, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was employed to determine genotype distribution using the HphI restriction enzyme. The statistical evaluations comprised the utilization of chi-square and Fisher's exact tests.

RESULTS

We observed no significant variations in genotype distributions between the case and control cohorts (CT: p=0.24; CC: p=0.65; TT: p=0.30). The heterozygous genotype CT was prevalent in both groups.

CONCLUSIONS

Although we did not observe significant associations between SNP 1772C>T and RRR, our findings imply a genetic predisposition to residual ridge resorption that warrants further exploration. Variations in genetic susceptibility across ethnicities and the influence of other genetic variants on residual ridge resorption require additional investigation. This study lays the groundwork for personalized prosthodontic care by highlighting the potential of genetic analysis in routine dental practice to improve treatment strategies.

Is alveolar ridge preservation an overtreatment?

The morphology and dimensions of the postextraction alveolar ridge are important for the surgical and restorative phases of implant treatment. Adequate new bone formation and preservation of alveolar ridge dimensions following extraction will facilitate installation of the implant in a restorative position, while preservation of soft tissue contour and volume is essential for an aesthetic and implant-supported restoration with healthy peri-implant tissues. Alveolar ridge preservation (ARP) refers to any procedure that aims to: (i) limit dimensional changes in the alveolar ridge after extraction facilitating implant placement without additional extensive bone and soft tissue augmentation procedures (ii) promote new bone formation in the healing alveolus, and (iii) promote soft tissue healing at the entrance of the alveolus and preserve the alveolar ridge contour. Although ARP is a clinically validated and safe approach, in certain clinical scenarios, the additional clinical benefit of ARP over unassisted socket healing has been debated and it appears that for some clinicians may represent an overtreatment. The aim of this critical review was to discuss the evidence pertaining to the four key objectives of ARP and to determine where ARP can lead to favorable outcomes when compared to unassisted socket healing.

Extra-short implants (≤ 6.5 mm in length) in atrophic and non-atrophic sites to support screw-retained full-arch restoration: a retrospective clinical study

PURPOSE

Increasing scientific evidence support extending the application of short dental implants to non-atrophic dental arches. The purpose of this study has been the evaluation of extra-short implants (≤ 6.5 mm in length) that were placed in atrophic and non-atrophic anatomical sites to support the same prosthesis.

METHODS

For that, a retrospective study was conducted by including complete dentures that were solely supported by extra-short implants in the maxilla and/or the mandible. Clinical data about patients, implants, anatomy, and prosthesis were obtained. Statistical analysis was performed to assess implant- and prosthesis-survival, changes in the marginal bone level and prosthetic complications.

RESULTS

A total of 87 implants in 15 screw-retained complete dentures were assessed. None of the prostheses nor the extra-short implant failed during the follow-up of 27.2 ± 15.4 months. The changes in the mesial and distal marginal bone level were + 0.15 ± 0.51 mm and + 0.11 ± 0.50 mm, respectively. Comparing the implants according to the availability of sufficient bone to place longer implants, indicated the absence of significant differences in the changes of the mesial marginal bone level. However, the changes in the distal marginal bone level showed a statistically significant difference in favor of implants that were placed in non-atrophic sites. Two events of screw loosening were reported that were resolved by retightening the screws.

CONCLUSIONS

Implant- and prosthesis-related outcomes support the use of extra-short implants in atrophic and non-atrophic site to support complete prosthesis.

Microstrain Analysis of Selective Pressure Techniques for Mandibular Complete Denture Impression: An In Vivo Study

Aim

The present in vivo study was undertaken for microstrain analysis of the selective pressure impression technique using strain gauges in mandibular complete denture impression.

Methodology

Ten completely edentulous patients undergoing complete denture treatment were selected for the study. For each patient, mandibular casts were made, and two custom trays were fabricated on the mandibular cast. These mandibular trays were divided into two groups: those with mandibular impressions made in the custom tray with the use of a spacer (MST) and those without a spacer (MWS). For each patient, a primary impression was made by using an impression compound. After that, the primary cast was obtained, and the custom tray was fabricated by using auto polymerizing resin. Then strain gauges were attached to the particular areas of the tray. The customized tray with zinc oxide eugenol impression material was seated in the patient's mouth for the final impression. The strain produced during impression making at different areas was recorded by a multi-channel (six) strain amplifier and data logger (8-channel digital strain indicator NIC, Jaipur, India). The data obtained were subjected to statistical analysis using an independent t-test (for quantitative data within two groups). The level of significance was set at p=0.05 (p<0.05-significant, p<0.01-highly significant, p<0.0001-very highly significant).

Results

The comparison of the percentage of microstrain produced at the relief area with and without spacer tray design showed a statistically significant (p=0.001) result with a greater number of percentages of microstrain among those without spacers (94.19) than with spacer (72.09) tray design.

Conclusion

The use of a tray with relief for selective pressure impression of an edentulous mandible resulted in a desirable pressure distribution at the alveolar crests and buccal shelves.

Short Narrow Dental Implants versus Long Narrow Dental Implants in Fixed Prostheses: A Prospective Clinical Study

There is a paucity of studies that assess short and narrow dental implants. This prospective study aimed to evaluate the performance of both short (≤8 mm) and narrow (≤3.5 mm width) dental implants supporting fixed prostheses in the atrophic maxilla or mandible. Towards that aim, patients with short implants were included in the study. The control group was those with long and narrow dental implants (length > 8 mm and diameter ≤ 3.5 mm). Clinical and demographic variables were extracted from clinical records. During the follow-up, implant survival and marginal bone loss were evaluated and statistically analysed. Forty-one implants were included (18 and 23 implants in the test and control groups, respectively). The median follow-up time was 26 months since insertion in both groups. The results revealed that there was no implant failure and no statistically significant differences in terms of marginal bone loss. Only one screw-loosening effect occurred in the short implants group. Short, narrow dental implants could be an alternative for the restoration of severely resorbed jaws.

Regional differences in microarchitecture and mineralization of the atrophic edentulous mandible: A microcomputed tomography study

OBJECTIVE

The aim of the present study was to assess mineralization and trabecular microarchitecture in atrophic edentulous mandibles and to identify regional differences and relations with the extent of resorption.

METHODS

Cortical and trabecular bone volumes in anterior, premolar and molar regions of 10 edentulous cadaveric mandibles (5 males and 5 females; mean age ± SD: 85.4 ± 8.3 years) were assessed by microcomputed tomography. Mandibular height and Cawood & Howell classes were recorded. Concerning trabecular volumes, bone mineral density (BMD), bone volume fraction, trabecular tissue volume fraction, connectivity density, trabecular number, trabecular thickness, trabecular separation, degree of anisotropy, and structural model index were measured; concerning cortical volumes porosity, BMD and cortical thickness were measured.

RESULTS

In molar regions, the bone volume fraction and trabecular number were lower, whereas trabecular separation, degree of anisotropy and cortical BMD were higher compared to anterior regions. In premolar regions, mandibular height correlated negatively with trabecular number (Spearman's correlation r = 0.73, p = 0.017) and connectivity density (Spearman's correlation r = 0.82, p = 0.004), and correlated positively with trabecular separation (Spearman's correlation r = - 0.65, p = 0.04). Cortical BMD was higher at bucco-inferior cortex of molar and inferior border of premolar region and lower at anterior cranial buccal and lingual surface.

CONCLUSIONS

In the premolar region, increased resorption coincides with local impairment of trabecular bone quality. Cortical bone BMD is higher in areas with highest strains and lower in areas with most mandibular resorption. Trabecular bone volume and quality is superior in the anterior region of the edentulous mandible, which might explain improved primary stability of dental implants in this region.

Influence of bone anatomical morphology of mandibular molars on dental implant based on CBCT

Background

To apply CBCT to investigate the anatomical relationship between the mandibular molar and alveolar bone, aimed to provide clinical guidelines for the design of implant restoration.

Methods

201 CBCT data were reevaluated to measure height of the alveolar process (EF), width of the alveolar process (GH), width of the basal bone (IJ), the angle between the long axis of the first molar and the alveolar bone (∠a) and the angle between the long axis of the alveolar bone and basal bone (∠b). The angle and width were measured to determine the implant-prosthodontic classification of the morphology in the left lower first molar (36) and right lower first molar (46). All measurements were performed on the improved cross-sectional images.

Results

EF, GH and IJ were measured as (10.83 ± 1.31) mm, (13.93 ± 2.00) mm and (12.68 ± 1.96) mm for 36, respectively; and (10.87 ± 1.24) mm, (13.86 ± 1.93) mm and (12.60 ± 1.90) mm for 46, respectively. No statistical significance was observed in EF, GH, IJ, ∠a and ∠b between 36 and 46 (all P > 0.05). The morphology was divided into three categories including the straight (68.7–69.2%), oblique (19.9–20.4%) and concave types (11%). Each type was consisted of two subcategories.

Conclusions

The proposed classification could provide evidence for appropriate selection and direction design of the mandibular molar implant in clinical. The concave type was the most difficult to implant with the highest risk of lingual perforation. The implant length, width, direction required more attention.

Influence of Age on Calvarial Critical Size Defect Dimensions: A Radiographic and Histological Study

Calvarial critical-size defect has been used to assess techniques and materials in the bone regeneration field. Previous studies utilized young adult rats with 3 months of age, which might not reflect the geriatric conditions. This study aimed to assess the dimensions of the calvarial critical-size defect in aged rats.

Seventy-two rats in a randomized block design were allocated into a control young adult (11–12 weeks), and a test old group (22–24 months). Both groups were divided according to bone defect's size: 3 mm, 5 mm, and 7 mm defects, which were surgically created and followed for 4 and 8 weeks. Radiographic and histologic analyses were performed. Based on the results, additional groups with 4 mm defect size were added following the same protocols. Young groups yielded higher bone volumes, defect closure percentages, and density of newly formed bone. Closure of cranial defects was only observed in 3 mm defects in both age groups after 8 weeks; however, the 4 mm defect group demonstrated bony bridging after 8 weeks in young but not old rats. Results confirmed that 5-mm defect is considered a critical size for calvarial bone defects in young adult rats; however, 4 mm defect might be considered critical size for the aged rats after 8 weeks.

Association between ridge morphology and complexity of implant placement planning in the posterior mandible

STATEMENT OF PROBLEM

Uncertainties regarding the 3D ridge morphology of the posterior mandible can greatly increase the risk of surgical complications during dental implant placement. By using cone beam computed tomography (CBCT) imaging and a computer-guided implant treatment software program before any invasive procedure, it is possible to assess ridge morphology and understand the surgical complexity and risk level.

PURPOSE

The purpose of this radiological clinical study was to evaluate a large series of CBCT images to evaluate ridge shape variations along posterior mandibular edentulous regions and to clarify their associations with the level of implant planning complexity.

MATERIAL AND METHODS

One hundred and twenty CBCT files were analyzed retrospectively for a total 240 hemimandibular sites. Images of each edentulous region of the mandibular first and second premolar and first and second molar sites were evaluated in the sagittal plane. Ridge morphology and implant planning complexity per site were assessed. Categorical variables were presented as number of events and percentages. The chi-square test was used to compare the categorical variables (P=.05).

RESULTS

Of 491 partially edentulous mandibular sites, 235 were on the right, and 256 were on the left. Forty-two sites had a distal adjacent tooth, while 266 sites had no distal adjacent tooth. The sagittal bone sections demonstrated oblique (40.53%), straight (31.77%), S-shape (24.24%), hourglass (2.44%), and basal bone (1.02%) ridge morphologies. Implant complexity was deemed straightforward in 66.19% of sites, while 31.6% were identified as advanced and 2.54% as complex. When ridge morphology was evaluated from straight to basal-round bone shape, the implant complexity followed the same trend of change from a straightforward to complex procedure (P=.001) for edentulous second and first molar regions. No significant differences were noted at edentulous second premolar sites (P=.063). The missing second molar sites with oblique morphology were predicted to have 60.9% straightforward complexity, and first molar sites with oblique morphology had 55.8% straightforward implant complexity. Second premolars with straight ridge morphology had 71.7% straightforward complexity, whereas first premolars with the same shape had 92.5% straightforward implant complexity.

CONCLUSIONS

Careful evaluation of sagittal CBCT images can provide significant clinical information regarding ridge shape and anticipated surgical complexity before and at the time of implant placement. Surgical complexity is greatest at the most posterior mandibular edentulous sites, and extra attention and caution should be exercised during the surgical planning phases of implant surgery.

Comparative Analysis of Peri-Implant Bone Loss in Extra-Short, Short, and Conventional Implants. A 3-Year Retrospective Study

Objective: To evaluate the influence of implant length on marginal bone loss, comparing implants of 4 mm, 6 mm, and >8 mm, supporting two splinted crowns after 36-month functional loading. Materials and Methods: this retrospective clinical trial evaluated the peri-implant behavior of splinted crowns (two per case) on pairs of implants of the same length placed in the posterior maxilla (molar area). Implants were divided into three groups according to length (Group 1: extra-short 4 mm; Group 2: short 6 mm; Group 3: conventional length >8 mm). Marginal bone loss was analyzed using standardized periapical radiographs at the time of loading and 36 months later. Results: 24 patients (19 women and 5 men) were divided into three groups, eight rehabilitations per group, in the position of the maxillary first and second molars. The 48 Straumann^® Standard Plus (Regular Neck (RN)/Wide Neck (WN)) implants were examined after 36 months of functional loading. Statistical analysis found no significant differences in bone loss between the three groups (p = 0.421). No implant suffered biological complications or implant loss. Long implants were associated with less radiographic bone loss. Conclusions: extra-short (4 mm); short (6 mm); and conventional length (>8 mm) implants in the posterior maxilla present similar peri-implant bone loss and 100% survival rates in rehabilitation, by means of two splinted crowns after 36 months of functional loading. Implants placed in posterior positions present better bone loss results than implants placed in anterior positions, regardless of the interproximal area where bone loss is measured. Conventional length (>8 mm) implants show better behavior in terms of distal bone loss than short (6 mm) and extra-short (4 mm) implants.

Bioactivating a bone substitute accelerates graft incorporation in a murine model of vertical ridge augmentation

Objective.

Compared to autologous bone grafts, allogeneic bone grafts integrate slowly, which can adversely affect clinical outcomes. Here, our goal was to understand the molecular mechanisms underlying graft incorporation, and then test clinically feasible methods to accelerate this process.

Methods.

Wild-type and transgenic Wnt “reporter” mice were used in a vertical ridge augmentation procedure. The surgery consisted of tunneling procedure to elevate the maxillary edentulous ridge periosteum, followed by the insertion of bone graft. Micro-computed tomographic imaging, and molecular/cellular analyses were used to follow the bone graft over time. Sclerostin null mice, and mice carrying an activated form of β-catenin were evaluated to understand how elevated Wnt signaling impacted edentulous ridge height and based on these data, a biomimetic strategy was employed to combine bone graft particles with a formulation of recombinant WNT protein. Thereafter, the rate of graft incorporation was evaluated.

Results.

Tunneling activated osteoprogenitor cell proliferation from the periosteum. If graft particles were present, then osteoprogenitor cells attached to the matrix and gave rise to new bone that augmented edentulous ridge height. Graft particles alone did not stimulate osteoprogenitor cell proliferation. Based on the thicker edentulous ridges in mice with amplified Wnt signaling, a strategy was undertaken to load bone graft particles with WNT; this combination was sufficient to accelerate the initial step of graft incorporation.

Significance.

Local delivery of a WNT protein therapeutic has the potential to accelerate graft incorporation, and thus shorten the time to when the graft can support a dental implant.

The lingual foramina, a potential risk in oral surgery. A retrospective analysis of location and anatomic variability

OBJECTIVE

This study evaluates the mandibular lingual foramina (LF) using computed tomographic imaging data from a large Central European cohort, focusing on the most relevant anatomical parameters. We aimed to examine whether there are differences in key parameters between ethnic groups, or based on age and gender. Additionally, we analyze the potential effect of tooth loss on the LF and discuss risk management options before and during surgery.

METHODS

460 CT scans of adults (273 females and 186 males) were examined. The number, the location and the diameter of the median and lateral LF were assessed for each patient. The data was analyzed statistically, whereby a p-value lower than 0.05 was considered as significant.

RESULTS

Median and lateral LF were present in 95,9%, and 38,9% of patients, respectively. Male patients had a greater number of LF than females. While the majority of median LF (62%) was located above the mental spine, the majority of lateral LF was located below (84%). The diameter of lateral LF (1,15 mm ± 0,33) was smaller than for median LF (1,22 mm ± 0,35), as well the lateral canals (4,8 mm ± 1,28) were shorter than the median canals (5,32 mm ± 1,74). Lateral LF were equidistant to the symphysis (13,89 ± 3,63 mm) on either side. Critical diameter size >1 mm was found in about 2/3 of our cases. The distance from the foramen to the residual ridge was ∼7 mm less in edentulous patients compared to dentulous patients.

CONCLUSION

The median LF is a near-obligatory structure of the mandible, while the lateral LF is a frequently encountered structure. Age does not seem to affect the frequency of LF. Edentulous patients did not show differences regarding the presence of the LF, but their vertical osseous dimension was diminished by 7 mm and they may, therefore, be at an increased risk of adverse surgical incidents. The main findings of this study relate to the substantial variability in the anatomy and location of the LF and confirm with previous studies. As the LF can be reliably detected using CT/CBCT, the use of three-dimensional-imaging is recommended prior to conducting oral surgery. Careful pre-operative planning and accurate anatomical information may help to avoid surgical complications. To ascertain the potential significance of ethnicity on LF, more data need to be collected using standardized methodologies. A definitive conclusion on the impact of ethnicity on LF thus cannot currently be drawn based on the results of our study and those available from the published medical literature.

Cone-Beam Computed Tomography Analysis of the Prevalence, Length, and Passage of the Anterior Loop of the Mandibular Canal

When placing implants in the anterior mandible, it is important to avoid damaging the mandibular nerve and its terminal extensions. The objective of this study was to determine the prevalence, length, and passage of the anterior loop of the mandibular canal, as well as the quantity of alveolar bone that is coronal to the canal, to help with implant placement in the anterior mandible. Cone-beam computerized tomography (CBCT) scans of 124 patients with 248 hemi-sections were evaluated. Anterior loop prevalence was determined using reconstructed panoramic and cross-sectional views; length was measured as the distance between the most mesial aspect of the mental foramen to the most mesial aspect of the anterior loop on cross-sectional views. The bucco-lingual position of the anterior loop inside the mandible and the apico-coronal dimensions of the alveolar bone above it were measured on cross-sectional views to determine the passage of the anterior loop and the bone available coronally, respectively. The effects of sex, age, side, and dentate status on the prevalence and length of the anterior loop were analyzed statistically. Prevalence of the anterior loop at the patient and hemi-section levels was 25% and 24%, respectively, and its median length was 1.63 mm (range, 0.52-3.92 mm). The anterior loop was apical to the mental foramen and mostly located within the buccal or middle one-third of the alveolar ridge, with an average height of coronal alveolar bone of 17.12 mm. Sex, age, side, and dentate status did not affect anterior loop prevalence and length. In conclusion, because of great variation, a case-by-case CBCT evaluation of the anterior loop is necessary before placing implants in the anterior mandible.

Exploratory study of the three-dimensional morphological variation of the jaw associated to teeth loss

PURPOSE

The aim of this study is to evaluate the morphological variability in mandibles with different types of edentulism, comparing the use of traditional morphometrics and tridimensional geometric morphometrics.

METHODS

Traditional morphometrics and geometric morphometrics (GM) exploratory analysis, by principal components (PCs) and PC scores, were performed on a sample of 24 cadaveric hemi mandibles. A digital reconstruction of 3D surfaces of each specimen was obtained by CT scans segmentation. The mandibles were divided in three groups: full dentition (G1), partial edentition (G2) and total edentition (G3). The results of the two methods were compared in relation to the morphological variability determined with each method.

RESULTS

Both methods were consistent in terms of morphological variability between the defined groups. The main shape variations observed were a decrease in mandibular body height, a widening of the cross sectional morphology on the symphysis, a shorten-narrowed Ramus and a deeper sigmoid notch, in the partially or totally edentition groups, compared to the full dentition group.

DISCUSSION

The general patterns of morphological variations associated with edentulism that have been reported in literature could be visualized with GM method, which had not been previously used for this purpose. The GM methods could offer a more detailed definition of shape variations, which is critical in a clinical context. Moreover, GM allowed defining configurations of mean morphologies and an image library with different types of morphological variations.

A 3D characterization method of geometric variation in edentulous mandibles

PURPOSE

The aim of this study was to perform an exploratory analysis of the morphological variations of mandibles at diverse states of edentulousness using tridimensional geometric morphometrics.

METHODS

Twelve cadaveric mandibles were selected and divided in three groups: dentate (G1), partially edentate (G2) and totally edentate (G3). CT scans, segmentation and digital reconstruction of 3D surfaces of each specimen was made. Thirteen landmarks were defined; the measurement error was determined and 3D morphometrics exploratory analysis by principal components (PCs) and PC scores was performed.

RESULTS

The principal shape variations in G2 and G3 compared to G1 can be summarized as follows: (1) decrease in the mid body mandibular height of 24% in G2 and 41% in G3, (2) decrease of symphysis height of 16% in G2 and 37% in G3, (3) a decrease in posterior mandibular height of 30% in both G1 and G2, (4) a deeper sigmoid notch also in both groups and finally (5) a widening of 7.7% in the cross sectional morphology on the symphysis in G3.

CONCLUSIONS

The 3D morphometric methods, combined with surface morphing tools confirmed the main patterns of bone changes in edentulous mandibles, referenced in the literature. The average 3D mandibular morphologies of each edentulousness state group was also defined. These methods could offer more accurate definition of shape variations, which is critical in a clinical context. This study provides clinicians with highlights of 3D morphological mandibular variations at different states of edentulism and not only in 2D projections as they are currently described. The 3D surface model for each group in PDF3D file format, are include in supplementary material.

Resorption of the mandibular residual ridge: A micro-CT and histomorphometrical analysis

OBJECTIVES

The aim of this study was to investigate whether the extent of mandibular resorption and gender is related to the bone turnover and microarchitecture of the edentulous mandible.

PARTICIPANTS AND METHODS

A mandibular bone sample was obtained at canine position from 36 edentulous participants (50% women; mean age: 65 years) during dental implant surgery. All female participants were postmenopausal. Mandibular height, duration of edentulous state and resorption pattern (Cawood classification) were recorded. Microcomputed tomography was used to determine bone mineral density, bone volume fraction, trabecular connectivity density, trabecular number, trabecular thickness and trabecular separation. Histomorphometric analysis was used to assess bone turnover: osteoid area and surface were measured as a parameter for bone formation and osteoclast numbers were determined as a parameter for bone resorption. Correlations between micro-CT, histomorphometrical parameters and clinical data were analysed with correlation coefficients and parametric and non-parametric tests.

RESULTS

Lower mandibular height was strongly associated with higher bone mineral density in trabecular bone. Women showed higher osteoclast numbers in trabecular bone than men. In trabecular bone of women, bone volume was significantly related to osteoclast numbers, osteoid surface and osteoid area.

CONCLUSIONS

The higher trabecular bone mineral density found in the edentulous mandible could either indicate a restructuring process of the resorbed mandible or suggests that the inferior region of the mandible is more highly mineralised. In women, higher bone turnover is associated with lower bone volume, suggesting an effect of postmenopausal oestrogen deficiency on bone turnover in the edentulous mandible.

Alveolar bone remodeling after tooth extraction in irradiated mandible: An experimental study with canine model

OBJECTIVES

The aim of the present study is to investigate the morphological and cellular changes in dental extraction socket that has been irradiated after the tooth extraction and to describe morphological characteristics of the osteocytes and osteocyte-lacunar-canalicular network (LCN) by scanning electron microscopy (SEM).

MATERIAL AND METHODS

Five beagle dogs aged 1-2 years were used in this study. One side of each mandible was irradiated in two sessions and the other side of mandible (non-irradiated) served as a control. The mandible bone blocks were processed by bulk staining en bloc in basic fuchsin and the specimens were embedded routinely in polymethyl methacrylate resin without preliminary decalcification. All blocks were subjected to micro-CT imaging, after that the specimens were prepared for light microscopy and SEM.

RESULTS

Alterations in bone macrostructure are minimal in irradiated bone, but the changes in LCN are clear. In the area of the tooth extraction socket, the connections of osteocytes to the vessels and to neighboring osteocytes were not observed both in irradiated and nonirradiated bone. However, osteoclasts were located in the bone surface entering inside to the bone between osteons. In the lamellar bone of lateral sides, a decrease in canalicular connections between osteocytes and periosteum was found in irradiated bone as compared to the non-irradiated side.

CONCLUSIONS

The novelty of the present study is that radiation disrupts osteocytes and their dendrites.

Autotransplantation of third molars with completely formed roots into surgically created sockets and fresh extraction sockets: a 10-year comparative study

The aim of this study was to analyze and compare the long-term clinical outcomes of mature third molar autotransplantation in surgically created sockets and fresh extraction sockets with regard to survival and functional success rates. A total of 65 third molars with completely formed roots were autotransplanted in 60 patients (average age 33.1 years). Thirty-six of the teeth were autotransplanted into surgically created sockets with or without guided bone regeneration (GBR; delayed autotransplantation), while 29 were autotransplanted into fresh extraction sockets (immediate autotransplantation; control group). All patients underwent annual clinical and radiographic examinations (average follow-up 9.9 years, range 7-13 years). The survival rates for the control, GBR, and no GBR groups were 93.1%, 95.2%, and 80.0%, respectively, with no significant differences among the groups. There were no statistically significant differences among the groups with regard to the frequency of inflammatory root resorption or root ankylosis. Age did not influence the clinical outcomes. These results suggest that the autotransplantation of third molars with completely formed roots is effective in both surgically created and fresh extraction sockets and provides a high long-term success rate if cases are selected and treated appropriately.

Proximity of the mandibular molar root apex from the buccal bone surface: a cone-beam computed tomographic study

Objectives

The purpose of this study was to evaluate the proximity of the mandibular molar apex to the buccal bone surface in order to provide anatomic information for apical surgery.

Materials and Methods

Cone-beam computed tomography (CBCT) images of 127 mandibular first molars and 153 mandibular second molars were analyzed from 160 patients' records. The distance was measured from the buccal bone surface to the root apex and the apical 3.0 mm on the cross-sectional view of CBCT.

Results

The second molar apex and apical 3 mm were located significantly deeper relative to the buccal bone surface compared with the first molar (p < 0.01). For the mandibular second molars, the distance from the buccal bone surface to the root apex was significantly shorter in patients over 70 years of age (p < 0.05). Furthermore, this distance was significantly shorter when the first molar was missing compared to nonmissing cases (p < 0.05). For the mandibular first molars, the distance to the distal root apex of one distal-rooted tooth was significantly greater than the distance to the disto-buccal root apex (p < 0.01). In mandibular second molar, the distance to the apex of C-shaped roots was significantly greater than the distance to the mesial root apex of non-C-shaped roots (p < 0.01).

Conclusions

For apical surgery in mandibular molars, the distance from the buccal bone surface to the apex and apical 3 mm is significantly affected by the location, patient age, an adjacent missing anterior tooth, and root configuration.

A 15-Year Comparative Prospective Study of Surgical and Prosthetic Care and Aftercare of Overdenture Treatment in the Atrophied Mandible: Augmentation Versus Nonaugmentation

BACKGROUND

Different treatment strategies for the atrophied mandible are described in literature. The need for long term care and aftercare for these strategies is sparsely described, however.

PURPOSE

To prospectively assess the need for prosthetic and surgical care and aftercare of two implant treatment strategies for the atrophied mandible.

MATERIALS AND METHODS

Forty edentulous elderly patients were randomly assigned according to a balanced allocation method to a treatment strategy: dental implants in combination with an augmentation procedure versus a nonaugmentation procedure. All surgical and prosthetic care and aftercare were scored from the first visit until 15 years after implant placement.

RESULTS

Twenty elderly patients completed the 15-year follow-up. As expected, the augmentation group needed significantly more surgical time than the nonaugmentation group (338 vs 145 minutes), but the need for prosthetic care and surgical/prosthetic aftercare was comparable. Implant survival was lower in augmented mandibles (88.7% vs 98.7%, p < .05). Aftercare mainly consisted of routine inspections; the need for prosthetic adjustments was minor. Surgical aftercare was hardly needed.

CONCLUSION

The only difference in the need for surgical and prosthetic (after) care was the extra time needed for performing augmentation surgery and the higher risk on implant loss in augmented mandibles. Otherwise, the need for care and aftercare was of the same magnitude. Thus, when applicable, nonaugmentation surgery is preferred as no general anesthesia is needed and the morbidity is low.

High-Frequency Acceleration: Therapeutic Tool to Preserve Bone following Tooth Extractions

A common problem in clinical dentistry is the significant and rapid bone loss that occurs after tooth extraction. Currently there is no solution for the long-term preservation of alveolar bone. Previously, we showed that high-frequency acceleration (HFA) has an osteogenic effect on healthy alveolar bone. However, it is not known if HFA can preserve alveolar bone after extraction without negatively affecting wound healing. The purpose of this study was to evaluate the effect of HFA on alveolar bone loss and the rate of bone formation after tooth extraction. Eighty-five adult Sprague-Dawley rats were divided into 3 groups: control, static (static load), and HFA. In all groups, the maxillary right third molar was extracted. The HFA group received HFA for 5 min/d, applied through the second molar. The static group received the same magnitude of static load. The control group did not receive any stimulation. Some animals received fluorescent dyes at 26 and 54 d. Samples were collected on days 0, 7, 14, 28, and 56 for fluorescence microscopy, micro-computed tomography, histology, RNA, and protein analyses. We found that HFA increased bone volume in the extraction site and surrounding alveolar bone by 44% when compared with static, while fully preserving alveolar bone height and width long-term. These effects were accompanied by increased expression of osteogenic markers and intramembranous bone formation and by decreased expression of osteoclastic markers and bone resorption activity, as well as decreased expression of many inflammatory markers. HFA is a noninvasive safe treatment that can be used to prevent alveolar bone loss and/or accelerate bone healing after tooth extraction.

Functional Impressions in Complete Denture and Overdenture Treatment

Tooth loss can cause loss of occlusal, masticatory, esthetic, physiognomic, phonetic and psychosocial function of patients. The most frequently used treatment method of completely edentulous patients and patients with a small number of remaining teeth are complete dentures or overdentures. One of the most important clinical and laboratory procedures in their fabrication is functional impression taking. The aim of this paper was to present procedures of taking functional impressions in fabrication of complete dentures and overdentures, using standardized techniques and materials. An accurate functional impression together with other correctly performed clinical and laboratory procedures ensure good retention and stability of dentures, which is a precondition for restoring patients' lost functions.

Long-term outcome of transosteotomy bone augmentation of the inferior border of the severely resorbed mandible

We report a case of severe mandibular atrophy with residual crest height as short as 4.3 mm anterior to the mental foramens. The patient was reluctant to accept bone augmentation surgery and that was the motivation to perform transosteotomy bone augmentation of the inferior border of the mandible and the insertion of 4 short implants anterior to the mental foramens. The insertion torque of the 4 implants was about 65 N·cm, which allowed for the application of immediate loading protocol. Detailed follow-up during 8 years showed uneventful healing and successful prosthetic rehabilitation with screw-retained prostheses.

Analysis of occlusal vertical dimension and mandibular Basal bone height in a nigerian population

Background. The actual basal bone height of the reconstructed mandible is relevant to achieve normal occlusal vertical dimension for the prosthesis fabricated. The purpose of the study was to determine the mean and baseline values of the occlusal vertical dimension and height of the mandibular basal bone in a Nigerian population. Method. Each participant was asked to bring the upper and lower teeth into contact, while the distance between the nasal sill and dimple on the lower lip was measured (OVD). The skin at lower border of the mandible was marked and the distance between this point and the landmark on the lower lip was measured, MBH. Result. 200 subjects were evaluated. Age range was 16-30 years, mean ± (SD), 21.6 ± (3.1) years. Males had mean ± (SD) of 42.10 ± (5.34) mm for OVD and females 39.72 ± (5.25) mm; acceptable baseline range of OVD for any population will be 34-48 mm (3.4-4.8) cm. All the males had a mean ± (SD), 30.54 ± (6.13) mm for MBH, and all the females 29.63 ± (5.23) mm. Acceptable baseline range of MBH for any population will be 24-37 mm (2.4-3.7) cm. Conclusion. To reconstruct the mandible and still maintain the OVD, heights of bone grafts must not be less than 2 cm or greater than 4 cm.

The effect of mechanical loading on osteogenesis of human dental pulp stromal cells in a novel in vitro model

Tooth loss often results in alveolar bone resorption because of lack of mechanical stimulation. Thus, the mechanism of mechanical loading on stem cell osteogenesis is crucial for alveolar bone regeneration. We have investigated the effect of mechanical loading on osteogenesis in human dental pulp stromal cells (hDPSCs) in a novel in vitro model. Briefly, 1 × 10(7) hDPSCs were seeded into 1 ml 3% agarose gel in a 48-well-plate. A loading tube was then placed in the middle of the gel to mimic tooth-chewing movement (1 Hz, 3 × 30 min per day, n = 3). A non-loading group was used as a control. At various time points, the distribution of live/dead cells within the gel was confirmed by fluorescence markers and confocal microscopy. The correlation and interaction between the factors (e.g. force, time, depth and distance) were statistically analysed. The samples were processed for histology and immunohistochemistry. After 1-3 weeks of culture in the in-house-designed in vitro bioreactor, fluorescence imaging confirmed that additional mechanical loading increased the viable cell numbers over time as compared with the control. Cells of various phenotypes formed different patterns away from the reaction tube. The cells in the middle part of the gel showed enhanced alkaline phosphatase staining at week 1 but reduced staining at weeks 2 and 3. Additional loading enhanced Sirius Red and type I collagen staining compared with the control. We have thus successfully developed a novel in-house-designed in vitro bioreactor mimicking the biting force to enhance hDPSC osteogenesis in an agarose scaffold and to promote bone formation and/or prevent bone resorption.

Resorption of mandibular alveolar bone following loss of molar teeth and its relationship to age at death in a human skeletal population

Estimating adult age at death in skeletal remains is problematic, particularly in older adults. Molar wear is arguably the most reliable ageing technique for palaeopopulations, but many older adult skeletons have lost their molar teeth ante mortem, precluding its application. Resorption of the alveolar process occurs following tooth loss, and this appears to continue for a prolonged period. The current work investigates the relationship of this process to individual age in a nineteenth century AD European archaeological skeletal series of known age at death (N = 92 individuals), and discusses its potential as an age indicator. Mandibular corpus height was measured at the different molar positions. In females, reduction of corpus height with age was found at molar positions showing ante mortem loss. In both sexes, a relationship was found between age and a simple composite measure of corpus height in the molar region in those showing ante mortem loss of one or more mandibular molars. The correlation was stronger in females (r = -0.74) than in males (r = -0.49), appeared approximately linear, and continued into the ninth decade, the oldest age group in the study material. The results suggest that investigation of height of the posterior part of the mandibular corpus as a skeletal age indicator for individuals that have lost one or more molar teeth is merited in other palaeopopulations.

Loss of molar occlusion and mandibular morphology in adults in an ancient human population consuming a coarse diet

The purpose of the study is to investigate the link between number of molar teeth retained in occlusion and mandibular morphology in adults in an ancient, high dental wear human population. The study material comprises skeletons from Mediaeval Wharram Percy, England (N = 50 female, 69 male adults). It was hypothesized that adults retaining fewer occluding molars would show reduction in mandibular dimensions, particularly in the ascending ramus and gonial regions where the main muscles of mastication have their insertions. Molar occlusal status is assessed using the concept of functional units. Mandibular morphology is assessed using a suite of ten linear measurements plus the mandibular angle. Results show no evidence for any association between number of molars retained in occlusion and mandibular angle. There was an association between mandibular size and number of molars retained in occlusion, with smaller mandibular dimensions in those retaining fewer occluding molars. Some measurements were affected more than others so that there was also some shape alteration. Alteration of mandibular dimensions was more clearly demonstrable in females than in males. Only in females could significant reduction in the ascending ramus and gonial regions be demonstrated. Reasons for the apparent difference in response to loss of molar occlusion between male and female mandibles are unclear, but sex differences in bony metabolism mediated by hormonal factors may be implicated. Results suggest that care should be exercised when including mandibles from individuals showing loss of molar occlusion in morphological studies.

Dentition, bone loss, and the aging of the mandible

BACKGROUND

Facial aging is a dynamic process with impact on both the soft tissues and the bones. Despite a growing body of evidence, controversy still exists regarding absolute characteristics of the aging facial skeleton.

OBJECTIVE

The purpose of this study was to investigate various mandibular measurements in different age groups and to delineate the relation of the dentition to these parameters.

METHODS

Ninety Caucasian mandibles were assessed for the following distance landmarks: gonion-gonion, infradentale-gnathion, mental foramen-mandibular crest, mental foramen-inferior mandibular border, gnathion-gonion, condyle-gonion, and gonial angle. The measurements were compared according to age, sex, and dentition.

RESULTS

The number of teeth decreased significantly with increasing age in males (P = .002) and females (P < .001). There were no other statistically significant differences between age groups for the rest of the parameters. The infradentale-gnathion distance (P = .005) and the mental foramen-mandibular crest distance (P < .001) was found to increase with total number of teeth. Other parameters did not show a significant relation to dentition. All parameters were significantly larger in the male subgroups with the exception of gnathion-gonion distance and gonial angle. Bilateral mandibular measurements were symmetric except for the gonial angle, which was more obtuse on the right side in males (P = .007) and females (P = .018).

CONCLUSIONS

Our findings support previous evidence that dentition is the main determinant of the morphology of the mandible. The skeletal characteristics are variable among individuals, and a longitudinal study is required to better understand age-related changes of the mandible.

Verification of the mechanostat theory in mandible remodeling after tooth extraction: animal study and numerical modeling

Bone tissue is capable of remodeling in response to environmental and physiological conditions. Mechanical loading is thought to be one of the most important environmental factors, affecting bone status. Mechanostat theory, which classifies bone behavior on the basis of the mechanical strain, has been vastly applied in cases of long bones. The present study surveyed the applicability of mechanostat theory in interpretation and anticipation of structural changes of the mandible due to tooth extraction, through experimental measurements and numerical modeling. The mandibular left first molar tooth of a 2-year-old male mongrel dog was extracted. Computed tomography (CT) images of the mandible were taken before, immediately after, and 1 year after extraction. Finite element models were constructed from the CT images and analyzed to evaluate the von Mises strain distribution within the mandible, specifically near the extraction site. Marked resorption around the extraction site and significant height reductions in the buccal and lingual ridges around the socket were observed one year after tooth removal. The deep socket made by extraction was filled and replaced by a smooth surface through bone remodeling in response to masticatory loading. Resultant strain analyses revealed a noticeable decline in strain level around the socket after tooth extraction, which activated bone remodeling according to mechanostat theory. At 1-year post-extraction, the strain magnitudes had increased significantly to near pre-extraction values. Alterations in the strain magnitudes along the mesio-distal axis were quantified for each stage and compared with the Mechanostat predefined regions. The FE results were surveyed in combination with the ridge height reductions, along the mesio-distal direction. Strain contours of the post-extraction stages were compatible with predictions by mechanostat theory. These findings validate the ability of mechanostat theory to describe mandible remodeling and predict post-extraction structural changes that occur near the extraction site. These results could be applied in dental treatment planning and implant design.

Prognostic factors for autotransplantation of teeth with complete root formation

OBJECTIVES

The aim of the present study was to evaluate the factors affecting the prognosis of the autotransplantation of teeth with complete root formation.

STUDY DESIGN

A total of 259 transplanted teeth were studied. The significance of each of the prognostic factors was examined in 2 ways, first in a univariate analysis and then in a multivariate analysis. The comprehensive risk combining these factors that remained after multivariate analysis was calculated.

RESULTS

Among 259 transplanted teeth, 27 (10.4%) were judged as unsuccessful cases. In the multivariate analysis, history of root canal treatment of donor tooth, multirooted, maxillary tooth as a donor, and duration of tooth absence at recipient site remained significantly associated with unsuccessful transplantation. Multifarious combination of the significant prognostic factors can decrease the comprehensive risk.

CONCLUSIONS

Minimizing the comprehensive risk by combining significant prognostic factors improved the prognosis of autotransplantation of teeth with complete root formation.

Implants Inserted in Different Sites: Analysis of 390 Fixtures

Oral rehabilitation by means dental implants is a surgical procedure with high standards of success. Since very few reports focus on clinical success related to implant site and no report is available on a new type of implants (FMD srl, Rome, Italy), a retrospective study was performed. A total of 390 two-piece implants were inserted, 213 in females and 177 in males. The median age was 59 ± 11 (min-max 24–80 years). Two hundred and five implants were inserted in upper jaw and 185 in mandible. Three implants were lost, survival rate = 99.23%. Among the studies variables immediate loaded implants on single tooth rehabilitations (p=0.047) have a worse clinical outcome. Then peri-implant bone resorption (i.e. delta IAJ) was used to investigate SCR. Among the remaining 387 implants, 47 fixtures have a crestal bone resorption greater than 1.5 mm (SCR = 87.85). Statistical analysis demonstrated that no studied variable has an impact on clinical outcome and thus there are no differences in term of SVR and SCR by sites. In conclusion FMD implants are reliable devices for oral rehabilitation with a very high SCR and SVR.

Post-Extractive Implants: Outcome of 40 Cases

In the last two decades, several investigators have reported immediate placement of dental implants into extraction sockets achieving excellent results with a two-stage surgical procedure. Recently immediate loading has become an emerging technique as it has been documented to be a successful and time saving procedure. As regard the possibility of immediate/early loading of implants placed in fresh extraction sockets few reports are available. In addition they are based on limited series with short follow-up. Thus we decided to perform a retrospective study on a series of post-extractive implants. A total of 40 two-piece implants (FMD srl, Rome, Italy) were inserted in post extractive sockets, 22 in females and 18 in males. The median age was 52 ± 11 (min-max 24–69 years). Twenty-one implants were inserted in upper jaw and 19 in mandible. Fixtures replaced 7 incisors, 3 cuspids, 12 premolars and 18 molars. Implant' length was x ≤ 10 mm, 10,30 ≤ x ≤ 12.30, equal to 13 mm and x ≥14 mm in 6,14,9, and 11 cases, respectively. Implant' diameter was narrower than 3.5 mm, equal to 3.8 mm and wider than 4.0 mm in 1,7, and 32 cases, respectively. There were 28, 2 and 10 Elisir, I-fix, and Shiner implant types, respectively. No implant on single tooth rehabilitations, was lost, survival rate = 100%. Then peri-implant bone resorption (i.e. delta IAJ) was used to investigate SCR. Seven fixtures have a crestal bone resorption greater than 1.5 mm (SCR = 82.5%). Statistical analysis demonstrated that there was a difference between surgeons (p= 0.005). In conclusion FMD implants are reliable devices for oral rehabilitation with a very high SCR and SVR.

Compromised osseous healing of dental extraction sites in zoledronic acid-treated dogs

The goal of this study was to document how treatment with high doses of zoledronic acid affects dental extraction healing. Our results, showing significantly compromised osseous healing within the socket as well as presence of exposed bone and development of a sequestrum in one animal, provide a building block toward understanding osteonecrosis of the jaw.

PURPOSE

The goal of this study was to document how treatment with a bisphosphonate affects the bone tissue following dental extraction.

METHODS

Skeletally mature female beagle dogs were either untreated controls (CON) or treated with intravenous zoledronic acid (ZOL). Following the extraction of the fourth premolars, healing was allowed for 4 or 8 weeks. Properties of the extraction site were assessed using microcomputed tomography (micro-CT) and dynamic histomorphometry.

RESULTS

The initial infilling of the extraction socket with bone was not affected by ZOL, but subsequent removal of this bone was significantly suppressed compared to CON. After 8 weeks of healing, the alveolar cortical bone adjacent to the extraction socket had a remodeling rate of ∼50% per year in CON animals while ZOL-treated animals had a rate of <1% per year. One ZOL-treated animal developed exposed bone post-extraction which eventually led to the formation of a sequestrum. Assessment of the sequestrum with micro-CT and histology showed that it had features consistent with those reported in humans with osteonecrosis of the jaw.

CONCLUSIONS

These results, showing significantly compromised post-extraction osseous healing as well as presence of exposed bone and development of a sequestrum in one ZOL animal, provide a building block toward understanding the pathophysiology of osteonecrosis of the jaw.

A genetic association study of single nucleotide polymorphisms in FGFR1OP2/wit3.0 and long-term atrophy of edentulous mandible

BACKGROUND

After dental extraction, the external surface of alveolar bone undergoes resorption at various rates, and a group of patients develop excessive jawbone atrophy. Oral mucosa overlying the atrophied jawbone is unusually thin; therefore, we have hypothesized that excessive jawbone atrophy may be associated with abnormal oral mucosa contraction. FGFR1OP2/wit3.0, a cytoskeleton molecule initially identified in oral wound fibroblasts, has been shown to induce oral mucosa contraction after dental extraction. This study examined the genetic association between single nucleotide polymorphisms (SNPs) of FGFR1OP2/wit3.0 and excessive atrophy of edentulous mandible.

METHODS AND FINDINGS

First, the expression of FGFR1OP2/wit3.0 was determined in gingival tissues of 8 subjects before and after dental extraction. In situ hybridization revealed that all subject increased FGFR1OP2/wit3.0 expression in the post-operative oral mucosa tissues; however, significantly high levels of FGFR1OP2/wit3.0 were observed in 3 out of 8 subjects. In a separate study, 20 long-term edentulous subjects (66.4 ± 9.4 years) were recruited. Tag-SNPs in the FGFR1OP2/wit3.0 allele were determined by Taqman-based polymerase chain reaction. The mandibular bone height was determined following the American College of Prosthodontists (ACP) protocol. Subjects with minor allele of rs840869 or rs859024 were found in the highly atrophied group by the ACP classification (Chi square test, p = 0.0384 and p = 0.0565, respectively; Fisher's Exact, p= 0.0515 and p = 0.2604, respectively). The linear regression analysis indicated a suggestive association between rs859024 and the decreased bone heights (Mann-Whitney, p = 0.06). The average bone height of the subjects with rs840869 or rs859024 minor alleles (10.6 ± 3.2 mm and 9.6 ± 3.2 mm, respectively) was significantly smaller than that of those subjects with the major alleles (14.2 ± 4.5 mm, p<0.05).

CONCLUSIONS

The patients with the minor allele of rs840869 or rs859024 were associated with excessive atrophy of edentulous mandible. This study may provide the basis for a genetic marker identifying susceptible individuals to develop jawbone atrophy after dental extraction.