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Biomedical subjects

H Denissen

Publications and source records attributed to H Denissen.

11 recordsLinked to original sources
PubMed2000

Marginal fit and short-term clinical performance of porcelain-veneered CICERO, CEREC, and Procera onlays.

STATEMENT OF PROBLEM: Onlay preparations are very complex surfaces for computer surface digitization, CAD, and CAM of all-ceramic onlay cores. PURPOSE: This study tested the hypothesis that onlays can be fabricated with CICERO, CEREC, and Procera core technologies. MATERIAL AND METHODS: Fifteen mandibular and 10 maxillary molars were prepared for onlays in 17 patients (11 women and 6 men). The onlay design was experimental. Molars were prepared with deep gingival chamfers in the proximal boxes and around the functional cusps. The nonfunctional cusps were prepared with broad bevels. Eight stone dies of preparations were measured with a laser beam (CICERO), 10 dies with a light beam (CEREC), and 7 dies with a contact probe (Procera). Two onlay cores were produced for the same stone die. One core was used to analyze fit on the stone die, and the other core was porcelain veneered for optimizing anatomy, esthetics, and fit of the onlay and cemented. The fit of the onlay core on the stone die and the cement width on a stone cast were measured by a microscopic digital imaging system. The onlays were evaluated for function every 6 months for 2 years. RESULTS: Measurements of the margins by the CICERO system were (1) precise (error <4%) and (2) accurate with an SD of less than 9 microm. The proposed onlay preparation design met the requirement that all points of the surface be visible from a single point of view for optical 3-dimensional mapping by the CEREC system. For the surface measurements by the Procera contact probe, the orientation of the sapphire tip toward the preparation surface was critical, and it was necessary to apply wax to smooth internal edges. The marginal gaps of the CICERO, CEREC, and Procera cores on the stone dies were 74 microm (SD 15), 85 microm (SD 40), and 68 microm (SD 53), respectively. The cement width was 81 microm (SD 64). No fractures occurred. CONCLUSION: Marginal gaps for the onlay cores were no more than 85 microm. The cement width of the semicomputer-produced onlays of 81 microm was a favorable measurement value for a clinically acceptable, strong all-ceramic onlay. However, this value as well as anatomy and esthetics of the onlay depended on the craftsmanship of the porcelain veneering by the dental technician.

Adult↗
PubMed2000

Normal osteoconduction and repair in and around submerged highly bisphosphonate-complexed hydroxyapatite implants in rat tibiae.

BACKGROUND: Ceramic hydroxyapatite implants have been used in dentistry for their unique compatibility with alveolar bone. Recently it was reported that bisphosphonates may be beneficial in preventing alveolar bone destruction associated with natural and experimental periodontal disease. Furthermore, bisphosphonate does prevent resorption of alveolar bone following mucoperiosteal flap surgery. We undertook a preliminary study evaluating the effects of highly bisphosphonate-complexed hydroxyapatite implants on osteoconduction and repair in rat tibiae. METHODS: Porous hydroxyapatite implants were pre-incubated in 10(-2)M bisphosphonate solutions at pH 3.49 and pH 7.32. The implants had a diameter of 2.1 mm and a height of 2 mm and adsorbed 115 microg bisphosphonate in vitro. Bisphosphonate/hydroxyapatite implants and plain hydroxyapatite implants were inserted in opposite tibial metaphyses of 35 rats. The measurement errors for the mineral density (MD) of the implants and the proximal trabecular mineral bone density (TD) were estimated by peripheral computed tomography and the bone mineral density (BMD) measurement error by dual x-ray absorptiometry. RESULTS: The measurement errors for the MD of the implants and the TD by peripheral computed tomography were 0.81% and 1.96%, respectively ex vivo. The BMD measurement error estimated by dual x-ray absorptiometry was 0.51% ex vivo. TD and BMD for bisphosphonate/hydroxyapatite implants were insignificantly higher compared to plain hydroxyapatite implants. Bisphosphonate/hydroxyapatite pre-incubated at pH 7.32 were found to be nondegradable implants, while bisphosphonate/hydroxyapatite (pH 3.49) implants were slowly degradable and lost a significant 5% of their density. Histologically, all bisphosphonate/hydroxyapatite implants appeared to be fully integrated and effective as bone replacement material in rat tibial bone. They exhibited vascularization and osteoconduction of tibial bone growth along and inside their porous structure. CONCLUSIONS: Our study suggests that normal osteoconduction and repair occurred in and around the highly bisphosphonate-complexed hydroxyapatite implants in rat tibiae.

Absorptiometry, Photon↗
PubMed2000

Alveolar bone response to submerged bisphosphonate-complexed hydroxyapatite implants.

BACKGROUND: In most studies using submerged hydroxyapatite implants, maintenance of alveolar bone after tooth extraction was attempted with plain hydroxyapatite materials. However, clinical results have shown that hydroxyapatite may require biological modification with a bone resorption-inhibiting agent which may be beneficial for maintenance of alveolar bone. We conducted experimental and clinical studies to evaluate the effect of highly bisphosphonate-complexed hydroxyapatite implants on osteoconduction and repair in alveolar bone. METHODS: Porous hydroxyapatite implants were pre-incubated in 10(-2)M bisphosphonate solutions at pH 3.49. The implants had a diameter of 2.1 mm and a height of 2 mm and adsorbed 115 microg bisphosphonate. Five goats were implanted with 4 plain hydroxyapatite implants on each side of the mandible in root extraction sockets for the precision analysis of dual x-ray absorptiometry (DEXA) measurements. Ten goats were implanted with 4 bisphosphonate/hydroxyapatite implants on one side of the mandible and 4 plain hydroxyapatite implants on the opposite mandible. In a clinical study, 23 bisphosphonate/hydroxyapatite implants were placed in periodontally destroyed tooth root sockets and followed up during one year. RESULTS: The range for the bone mineral density (BMD) measurement errors for goat histologic sections was 0.48% to 1.03%. There were large differences in peri-implant BMDs in the left and right mandible of the same goat, irrespective as to whether hydroxyapatite or bisphosphonate/hydroxyapatite implants were present. This was due to local anatomical differences typical of alveolar bone. These differences were not significant. Histologically, all bisphosphonate/hydroxyapatite as well as hydroxyapatite controls appeared to be fully integrated and effective as bone replacement material in goat alveolar bone. They exhibited vascularization and osteoconduction of alveolar bone growth along and inside their porous structure. In patients peri-implant healing was clinically and radiographically comparable to plain hydroxyapatite implants. All implants were retained and no dehiscences developed. Radiographically, peri-implant radiolucencies disappeared and alveolar bone was deposited in close proximity to the implants. CONCLUSIONS: This study contributes to the understanding of the biological properties of hydroxyapatite implants as carriers for the bone-modulating agent bisphosphonate. Our study suggests that normal osteoconduction and repair occurred in alveolar bone around the highly bisphosphonate-complexed hydroxyapatite implants.

Absorptiometry, Photon↗
PubMed1999

Assessing mineral density in small trephined jawbone biopsy specimens.

This study reports the test of the hypothesis that mineral density can be precisely assessed in small trephined jawbone biopsy specimens. Mineral density was measured by dual-energy X-ray absorptiometry (DEXA) and peripheral quantitative computed tomography (pQCT). Ten fresh and ten histologically processed specimens, which were not the same, were measured. The coefficient of variations (CVs) for the alcohol stored and the histologic specimens by DEXA were respectively 1.60 and 1.71%. The CVs by pQCT for the total bone density in the alcohol stored and the histologic specimens were respectively 0.07 and 0.16%, for the trabecular bone density 0.69 and 1.04% and for the cortical bone density 0.07 and 0.12%. It was concluded that DEXA and pQCT are precise for mineral density assessment of small trephined jawbone biopsy specimens both alcohol stored and histologically processed.

Absorptiometry, Photon↗
PubMed1999

Computer copings for partial coverage.

Partial coverage posterior tooth preparations are very complex surfaces for computer surface digitization, computer design, and manufacture of ceramic copings. The aim of this study was therefore to determine whether the Computer Integrated Crown Reconstruction (Cicero) system was compatible with a proposed partial coverage preparation design and capable of producing ceramic copings. Posterior teeth were prepared for partial coverage copings with deep gingival chamfers in the proximal boxes and around the functional cusps (buccal of mandibular and lingual of maxillary posterior teeth). The nonfunctional cusps (lingual of mandibular and buccal of maxillary posterior teeth) were prepared with broad bevels following the inclined occlusal plane pattern. Optical impressions were taken of stone dies by means of a fast laser-line scanning method that measured the three-dimensional geometry of the partial coverage preparation. Computers digitized the images, and designed and produced the ceramic copings. The Cicero system digitized the partial coverage preparation surfaces precisely with a minor coefficient of variance of 0.2%. The accuracy of the surface digitization, the design, and the computer aided milling showed that the system was capable of producing partial coverage copings with a mean marginal gap of 74 microns. This value was obtained before optimizing the marginal fit by means of porcelain veneering. In summary, Cicero computer technology, i.e., surface digitization, coping design, and manufacture, was compatible with the described partial coverage preparations for posterior teeth.

Bicuspid↗
PubMed1997

Net-shaped hydroxyapatite implants for release of agents modulating periodontal-like tissues.

Periodontal-like tissues and, in particular, alveolar bone- and root cementum-like material can theoretically be modulated by release of biochemical agents such as bisphosphonate (PCP), growth hormone (GH) and alkaline phosphatase (ALP) from the implant surface. The present research focused on porous ceramic hydroxyapatite (PCHA) implants. In the past the PCHA implants were machined on a lathe out of simple blocks of PCHA ceramic. This was a tedious and cumbersome method, often resulting in implants with undesirable characteristics: different porosities, cracks and fractures. Therefore a moulding technique was developed to sinter near-net-shaped PCHA implants at 2 different sintering temperatures: 1170 degrees C and 1280 degrees C, resulting in PCHA implants with porosities of 62.06% (PCHA type 1) and 40.74% (PCHA type 2), respectively. After 1 h incubation in a 10(-2) M solution of PCP, the total amounts adsorbed onto PCHA type 1 and type 2 were 114.9 +/- 2.1 micrograms and 46.1 +/- 1.5 micrograms, respectively. This was approximately 5 times higher than after incubation for 1 wk in a 10(-4) M solution of PCP. The total amounts of PCP released after the observation period of 75 d from PCHA type 1 and type 2 after incubation in the 10(-2) M solution were 103.1 +/- 1.8 micrograms and 42.8 +/- 1.5 micrograms, respectively. The total amounts released from type 1 and 2 after incubation in the 10(-4) M solution were 7.4 +/- 0.4 micrograms and 4.1 +/- 0.1 micrograms, respectively. After 2 wk of incubation in a liver/bone/kidney ALP solution the total amount of ALP adsorbed onto PCHA type 1 implants was 5039 +/- 412 mU/ml. The total amounts of ALP released were 4674 +/- 438 mU/ml and 53 +/- 20 mU/ml after 1 and 2 wk, respectively. The release of ALP was high at the beginning but slowed down thereafter. It was evident that despite the well-known high bonding affinity of PCP to HA the release of PCP occurred steadily, over a long period of time in vitro.

Adsorption↗
PubMed1997

Degradable bisphosphonate-alkaline phosphatase-complexed hydroxyapatite implants in vitro.

Degradable hydroxyapatite (HA) implants complexed with the resorption inhibiting agent bisphosphonate (PCP) and the mineralizing agent alkaline phosphatase (ALP) can theoretically maintain alveolar bone mass directly after extraction of teeth. The present in vitro study investigated the surface properties of PCP-ALP-complexed HA implants in relation to the requirements of implant behavior and action. Adsorbed PCP (pH 3.49) resulted in a flattening and broadening of the phosphate peaks and the formation of carbonate peaks in the HA pattern of the implant indicating a chemical alteration of the HA surface. Adsorption of ALP onto PCP-altered HA surfaces was 26% lower than onto HA implant blank surfaces. PCP-ALP-complexed HA implants released the PCP and ALP steadily and continuously over observation periods of, respectively, 75 and 14 days. During these observation periods, the ceramic grains of the HA implant became smaller and intergrain boundaries became broader. These morphologic characteristics suggested preconditioning of the HA implant surface for future bonding and degradation in vivo. Individual grains were no longer bonded to other grains and detached from the implant which had become rounded in shape. From in vitro mice experiments we found that PCP concentrations between 10(-4) and 10(-3) M resulted in 45Ca-release from the bone HA. Our calculations showed, however, that only a total concentration of 1.4 x 10(-4) M PCP was gradually released over the whole observation period. In another experiment, it appeared that a PCP concentration in solution < 10(-3) M did not reduce ALP activity. It is concluded that release of PCP by the PCP-ALP-complexed implants is maintained at levels in the range to impair osteoclast bone resorption but not high enough to block osteoblast activity. The amount of ALP released can lead to induction of bone formation onto implant surfaces. pH-induced alterations in the microstructure and chemistry of the HA surface allow for controlled degradation of the HA implants in vitro. A PCP-ALP-complexed HA implant acting as temporary scaffolding for alveolar bone growth enhancement, mineralization, and maintenance seems to be a reasonable concept for preservation of the edentulous alveolus.

Absorption↗
PubMed1996

Dual-energy X-ray absorptiometry for histologic bone sections.

In fundamental osteoporosis research precise and accurate assessment of the mineral quantity in histological bone sections is of particular importance when studying the local effects of implants releasing bone modulating agents. A potentially useful technique to estimate the bone mineral density (BMD) is dual-energy X-ray absorptiometry (DXA). A highly collimated (0.13 mm) Hologic 2000 with a line spacing and point resolution of 0.13 mm was used. The mineral content was measured in regions of 3.1 mm(2). A ceramic hydroxyapatite (CHA) phantom was developed as a reference standard. The phantom was made of a single-phase hydroxyapatite starting powder by compressing and sintering at 1000 degrees Celsius. The true density was 3.14 + or - 0.001 g/cm(3). The calcium/phosphorus ratio was close to the theoretical one of 1.67. The mean precision error expressed as the coefficient of variation (CV) of the mineral density (MD) measurements of the phantoms with thicknesses of 1, 2, and 3 mm was 0.2%. Embedded undecalcified alveolar bone sections of dogs (0.0015-1 mm in thickness) were scanned simultaneously with a phantom 1 mm in thickness. The precision error (CV) of the BMD measurements calculated by DXA for sections > or = 0.1 mm and with a BMD > or = 0.14 g/cm(2) was 0.81%. There was a linear relationship between the BMD calculated by DXA and the estimated BMD in the histological bone sections by means of the true density of the phantom. It is concluded that DXA using a standard CHA phantom is a precise and accurate method to measure MD changes as small as 1% in histological bone areas of 3.1 mm(2) provided that the loss or gain in BMD is > or = 0.14 g/cm(2).

Absorptiometry, Photon↗
PubMed1996

Dual X-ray absorptiometry for alveolar bone: precision of peri-implant mineral measurements ex vivo.

The precision of measurements of minor mineral changes in alveolar bone mineral content (ABMC) and alveolar bone mineral density (ABMD) on implant surfaces was determined in small regions (0.03 +/- 0.005 cm2) using dual X-ray absorptiometry (DXA). Dog hemimandibles with alveolar processes containing 17 implants were studied ex vivo. The precision was expressed as the coefficient of variation in percent (c.v. %). The ultra-high resolution protocol was applied to the mesial, distal and apical subregions of each implant. The line spacing was 0.0254 cm and the point resolution was 0.0127 cm. The mean c.v. (%) +/- s.d. for the ABMC in the mesial, distal and apical regions were 0.42 +/- 17, 0.47 +/- 0.21 and 0.48 +/- 0.18, respectively. For the ABMD these values were 0.42 +/- 0.16, 0.47 +/- 0.19 and 0.48 +/- 0.16. For each region approximately 68% of the 17 c.v. values were distributed within 1 s.d. from the mean c.v. These results indicate that measurements are highly reproducible (better than 0.48%) and that there are no differences in precision between several peri-implant regions. Changes as small as 0.85% in ABMC and ABMD in small areas adjacent to implant surfaces are measurable with a confidence level of 95%. Therefore the DXA technique will be expedient for our research evaluating the efficacy of the ceramic hydroxyapatite implant releasing agents affecting or inducing alveolar bone- and root cementum-like materials on its surface.

Absorptiometry, Photon↗
PubMed1994

Ceramic hydroxyapatite implants for the release of bisphosphonate.

Maintaining bone mass after extraction of teeth is a major problem in the prevention of oral disease. Maintenance theoretically could be enhanced by immediate implantation of submerged ceramic hydroxyapatite (HA) implants releasing the bone resorption-inhibiting agent bisphosphonate (P-C-P). Four different types of ceramic HA implants were designed as release systems for an in vitro study and assayed in saline at a temperature of 37 degrees C during 3 months. The implants were either rod- or tube-shaped, with densities of 3.104 g/cm3 and 1.408 g/cm3 (microporous) or 2.369 g/cm3 (macro/microporous). Loading of the implants with the P-C-P was done by adsorption into the ceramic (rod-shaped implants) or by filling the reservoir of the implant (tube-shaped implants). Despite the fact that P-C-P has a high bonding affinity to HA it appeared that the release of adsorbed P-C-P from the ceramic HA occurred steady, controlled and over a long period of time. The rod-shaped implants had much better release properties than the tube-shaped implants. Microporous ceramic HA rods sintered at 800 degrees C and macro/microporous rods sintered at 1300 degrees C are considered to be promising release systems for P-C-Ps.

Adsorption↗