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Effect of mechanical loading on periodontal cells.

Mechanical loading is an important regulatory factor in alveolar bone homeostasis, and plays an essential role in maintaining the structure and mass of the alveolar processes throughout lifetime. A better understanding of the cellular and molecular responses of periodontal cells is a prerequisite for further improvements of therapeutic approaches in orthodontics, periodontal and alveolar bone repair and regeneration, implantology, and post-surgical wound healing. The purpose of this review is to provide an insight into some cell culture and animal models used for studying the effects of mechanical loading on periodontal cells, and into the recent developments and utilization of new in vivo animal models. There has been an increased awareness about the need for improvement and development of in vivo models to supplement the widely used cell culture models, and for biological validation of in vitro results, especially in the light of evidence that developmental models may not always reflect bone homeostasis in an adult organism. Due to the limitations of in vivo models, previous studies on mechanical regulation of alveolar bone osteoblasts and cementoblasts mostly focused on proliferative responses, rather than on the stimulation of cell differentiation. To address this problem, we have recently characterized and implemented a mouse osteoinductive tooth movement model for studying mechanically induced regulation of osteoblast- and cementoblast-associated genes. In this model, a defined and reproducible mechanical osteogenic loading is applied during a time course of up to two weeks. Regulation of gene expression in either wild-type or transgenic animals is assessed by a relative quantitative measurement of the level of target mRNAs directly within the subpopulations of periodontal cells. To date, results demonstrate a defined temporal pattern of cell-specific gene regulation in periodontal osteoblasts mechanically stimulated to differentiate and deposit bone matrix. The responses of osteoblast-associated genes to mechanical loading were 10- to 20-fold greater than the increase in the numbers of these cells, indicating that the induction of differentiation and an increase of cell function are the primary responses to osteogenic loading. The progression of the osteoblast phenotype in the intact mouse periodontium was several-fold faster compared with that in cultured cells, suggesting that the mechanical signal may be targeting osteoblast precursors in the state of readiness to respond to an environmental challenge, without the initial proliferative response. An early response of alkaline phosphatase and bone sialoprotein genes was detected after 24 hrs of treatment, followed by a concomitant stimulation of osteocalcin and collagen I between 24 and 48 hrs, and deposition of osteoid after 72 hrs. Although cementoblasts constitutively express biochemical markers similar to those of osteoblasts, distinct responses of osteocalcin, collagen I, and bone sialoprotein genes to mechanical loading were observed in the two cell phenotypes. This finding indicates that differential genetic responses to mechanical loading provide functional markers for distinction of the cementoblast and osteoblast phenotypes.

Alkaline Phosphatase↗

[Mesenchymal tumors of the mouth].

The author describes rare cases of malignant tumors of mesenchymal origin in the oral cavity. These tumors have a poor prognosis and the majority is unresponsive to radiation. Primary therapy must always be surgery. Radiation therapy may only be applied for palliative purposes in inoperable cases, or as a postoperative treatment. An exception is the nongeneralized reticulum cell carcinoma originating from the alveolar process in which radiation may be regarded as the primary therapy of choice.

Adolescent↗

Cheek pressure and head posture.

Maxillary cheek pressures are measured in the molar area, at the teeth and high in the buccal sulcus, in both natural and extended head positions, with teeth at rest and in function. Highest pressures are found on the alveolar process, with some increases with the head extended and the jaw at dental rest position.

Adult↗

A preliminary study of the morphology of the upper gum pad at the age of 6 months.

Longitudinal records of 109 individuals born at full term and 30 pairs of twins have been used to study factors which determine the form of the upper gum pad at the age of six months and before the emergence of teeth. The contribution of heredity was found to be less than at birth, and that derived from the underlying teeth to have increased during the first six months of life. It is concluded that the shape of the alveolar process may be modified by physical forces such as sucking habits before teeth erupt into the mouth.

Alveolar Process↗

Long-term outcome of secondary alveolar bone grafting in patients with various types of cleft.

OBJECTIVE: To evaluate the results of secondary alveolar bone grafting in patients with various types of cleft. DESIGN: One hundred and seventy patients were classified as cleft lip and alveolar process alone (CLAP), complete unilateral cleft lip and palate (UCLP), and complete bilateral cleft lip and palate (BCLP). The Bergland criteria were used to assess the long-term outcome of alveolar bone grafting. RESULTS: In the UCLP and BCLP groups, the success rate was significantly better (P<0.05) when the cleft was grafted before the eruption of canines. When the operation was done after the eruption of canines, there was a significant difference in the success rate between CLAP and BCLP (P<0.05). CONCLUSION: The timing of the operation was the critical variable that affected the outcome in patients with complete cleft lip and palate. The severity of the deformity influenced the success rate when alveolar bone grafting was done after the eruption of canines.

Adolescent↗

The pediatric mandible: I. A primer on growth and development.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe embryonic and fetal mandibular development. 2. Summarize the aggregate changes in mandibular form from birth to puberty. 3. Describe the eruption and maturation of the deciduous and permanent mandibular dentition. BACKGROUND: In this, the first of two articles addressing the surgical management of pediatric mandibular fractures, the authors provide a detailed discussion of mandibular development and anatomy during the fetal period, infancy, and childhood. METHODS: A review of the pertinent literature was performed. The changing structure of the developing mandible is discussed, with particular attention to surgically relevant anatomical structures. RESULTS: Throughout development, key anatomical structures with relevance to surgical therapy change markedly in position. The mandible undergoes significant change in its bony structure and the composition of its surrounding soft tissues. The mandible's bony structure becomes more robust, with an increasingly acute gonial angle and enlargement of the ramus and body. Furthermore, the mandible provides the bony structure from which tooth buds erupt as the deciduous and permanent dentition--a process that generates significant growth of the alveolar process. As a consequence, the distance between the developing dentition and the inferior mandibular border increases. While the canal of the inferior alveolar nerve undergoes significant superior displacement, the mental foramen becomes positioned more posteriorly over time. In addition, the ligamentous and muscular attachments that surround the temporomandibular joint become increasingly robust. Throughout childhood and adolescence, the blood supply of the mandibular body changes little, with the buccal periosteal plexus and inferior dental artery making significant contributions. CONCLUSIONS: Mandibular growth provides the basis for normal occlusal relations and the generation of increasingly large masticatory force. Although the exact mechanisms of bone remodeling during mandibular development remain unclear, the process likely receives contributions from primary growth centers and the response to local alterations in biomechanical force produced by surrounding soft-tissue structures. A working knowledge of the changing mandibular anatomy is a prerequisite for effective clinical management of traumatic injury.

Bone Remodeling↗

Incidence and suggested surgical management of septa in sinus-lift procedures.

A variable number of septa, also referred to as Underwood's septa, divide the floor of the maxillary sinus into several recesses and may thus cause various complications during sinus-lift procedures. The incidence of Underwood's septa was evaluated by examining 41 edentulous maxillas. In 13 of these maxillas (31.7% of the cases), sinus floors with at least one septum were observed. Most of the septa were located in the region between the second premolar and the first molar. A possible cause of septal formation could be the variable phases of maxillary sinus pneumatization of the empty alveolar process following tooth extraction.

Adult↗

Immediate labial contour restoration for improved esthetics: a radiographic study on bone splitting in anterior single-tooth replacement.

A bone-splitting technique used for anterior single-tooth replacement was evaluated in 54 patients and 68 sites. The cumulative rate of implant survival was 93.7% (SE 4.6%) after more than 4 years. The decrease in marginal bone height ranged from 0.8 to 1.3 mm. Some reaction of the bone levels around the adjacent teeth should be anticipated (0.3 to 0.5 mm). It was concluded that the bone-splitting procedure is a safe and predictable technique when performed carefully on selected patients and with the proper instrumentation. The procedure seeks to reconstruct the labial contour of the alveolar process, which is a prerequisite for optimal and lasting implant esthetics.

Adult↗

A radiographic method for assessing changes in alveolar bone height following periodontal therapy.

A method is described for obtaining reproducible radiographs of several groups of teeth in the same jaw. The method was applied to assess changes in the alveolar bone height following periodontal treatment. An oral device was designed to permit direction of the central rays of the beam perpendicularly to the alveolar process in different parts of the jaws. The exposures were made at 60 kVp and 10mA, and standardized procedures were used for developing, fixing and rinsing the films. Alterations in the marginal alveolar bone level were determined in a stereocomparator system. The reproducibility of the method was determined. A pilot experiment was performed on 5 patients with periodontal disease. Following conservative treatment, including scaling and root planning, all patients were subjected to periodontal surgery, including alveolar bone denudation. Radiographs of the alveolar bone were obtained before and 2 months after the operation. By measuring in the stereocomparator parallaxes of both control points and points of the alveolar bone crest on paired radiographs, a mean decrease in interproximal alveolar bone height of 0.69 mm was found. Taking into account the small errors which are inherent in the method, this change in bone height could be regarded as a reliable measure of actual loss of bone.

Adult↗

Primary reconstruction of the mandibular alveolar ridge following resection.

Standard techniques of mandibular reconstruction aim at the restoration of function. However, the height and shape of the alveolar ridge are often neglected and reconstruction often results in difficulty in subsequent denture wear. Immediate reconstruction of the alveolar process with particulate autologous iliac bone is described, a technique used in 10 patients since 1978.

Adolescent↗

[Dentoalveolar characteristics in skeletal class I patients with excessive overjet].

OBJECTIVE: To investigate the dentoalveolar characteristics in skeletal class I patients with excessive overjet. METHODS: Ten cephalometric measurements of 60 skeletal class I patients with excessive overjet were analyzed. RESULTS: Compared with patients with normal overjet, 1-SN, 1-NA and MxAAH were significantly increased in excessive overjet group I (overjet: 3 - 5 mm) and 1-SN, 1-NA and MxAAH were significantly increased in excessive overjet group II (overjet: 5 - 7 mm). CONCLUSIONS: The protrusion and tipping of maxillary incisor, and absence of compensatory proclination of mandibular incisor may be the factors, caused skeletal class I excessive overjet. Increased height of anterior maxillary anterior alveolar process was the compensatory change in skeletal class I patients with excessive overjet.

Adolescent↗

Biological reactions of alveolar bone to orthodontic loading of oral implants.

Enosseous oral implants have been suggested as anchorage for orthodontic appliances in cases where the existing dentition cannot provide sufficient stability. Long-term studies of oral implants have suggested that excessive loading may contribute as an etiologic factor in the pathogenesis of failing implants. The purpose of the present study was to perform a histomorphometric analysis of tissue reactions around implants subjected to a well-defined force system. The analysis was performed on undecalcified sections cut perpendicularly to the long axis of the implant. The degree of osseointegration, bone density at varying distances from the implant as well as the relative extent of resorption and formation of alveolar bone adjacent to the implant-bone interface were evaluated. The results were correlated with the local strain of the tissue estimated by the means of a finite element analysis. It was found that loading significantly influenced both the turnover and the density of the alveolar bone in the proximity of the implants. However, even unloaded implants tended to maintain the bone characteristics of the alveolar process. On the other hand, the degree of osseointegration appeared to be independent of the loading of the implant.

Alveolar Process↗

[Comparative evaluation of biomaterials use in surgical treatment of periodontitis].

Clinical and radiological evaluation of three biomaterials--HA-Biocer, Bio-Gran and Bio-Oss was carried out two years after their grafting in parodontium. The tests were carried out for 91 patients with parodontis. Comparative clinical results (remission of the inflammatory state of parodontium tissues, essential reduction of gingival pockets and rebuilding of alveolar process bone on aimed X-ray pictures) were noted. The carried out observations show that biomaterials application for filling vertical alveoral process bone defects for patients with parodontis gives satisfactory clinical results.

Adult↗

Mandibular alveolar bone mass, structure and thickness in relation to skeletal bone density in dentate women.

The aim of this series of studies was to investigate the relationship between skeletal bone mineral density (BMD) and mandibular alveolar bone mass (MABM), structure, and thickness, as well as to evaluate the possible effect of local functional factors on MABM and alveolar thickness. A further aim was to elucidate whether longitudinal changes in mandibular radiographic characteristics and the bucco-lingual dimension of the alveolar process were related to alterations of BMD. BMD was measured in 160 dentate women using dual X-ray absorptiometry of the forearm. On periapical radiographs MABM was estimated using densitometry and the grey-level value. The alveolar bone structure was evaluated with a visual index and by examining the bone texture on periapical radiographs. The thickness of the masseter was assessed with ultrasound imaging to estimate the masticatory functional factor, and the bucco-lingual alveolar thickness was measured on casts. MABM and alveolar structure were significantly correlated to BMD. The best correlation was found between BMD and trabecular pattern evaluated with the visual index (r = 0.62, p < 0.001). The alveolar thickness was correlated to BMD, and to masseter thickness. MABM was influenced of age, the alveolar thickness, the number of occluding teeth, and the masseter muscle thickness but these factors had no effect on the trabecular structure. After five years, all measurements except the ultrasound imaging of the masseter muscle were repeated in 136 women. The mean BMD, MABM, and alveolar thickness decreased significantly during this period, whereas no significant change was found in the bone structure. In posterior region, the alterations in alveolar bone thickness, radiographic grey-level value, and bone texture were significantly correlated to the changes in BMD. In the anterior region, the alterations in alveolar thickness were not correlated with the changes in BMD. Furthermore, no correlation was found between alterations in MABM, estimated by densitometry, and changes in BMD. In conclusion, a significant relationship exists between BMD and mandibular alveolar bone mass, structure, and thickness. The local functional factors mainly influence MABM and the alveolar thickness in the molar region, whereas BMD influences the trabecular structure. Dense trabeculation is a strong indicator of high BMD, whereas sparse trabeculation predicts low bone mass. In peri- and postmenopausal women the alveolar shape in the premolar region can be used to predict BMD level. In the lower premolar region, the longitudinal alterations in BMD are related to longitudinal changes in grey-level value, bone texture and alveolar thickness. The decrease in bucco-lingual alveolar thickness may be due to periosteal resorption related to skeletal bone loss.

Absorptiometry, Photon↗

The relationship between the metacarpal index and the rate of mandibular ridge resorption.

This study tried to determine whether a relationship exists between the degree of alveolar resorption of the edentulous mandible and the degree of osteoporosis, as expressed by the metacarpal index. Eighty patients were examined. Each had a radiograph of the left hand to show the second metacarpal, and a standard pan-oral radiograph. A morphological measurement of the metacarpal bone, which is a good indication of the mineral content of the skeleton, was made on each hand radiograph. Alveolar resorption was estimated on the pan-oral radiograph by taking the original height of the alveolar process as being three times the distance from the inferior border of the madible to the inferior edge of the mental foramen. The regression analysis revealed no relationship between osteoporosis, as measured by the metacarpal index, and the amount of alveolar bone resorption.

Adult↗

Effect of RGD peptide coating of titanium implants on periimplant bone formation in the alveolar crest. An experimental pilot study in dogs.

The aim of the present study was to analyse the effect of organic coating of titanium implants on periimplant bone formation and bone/implant contact. Three types of implants were used: (i) Ti6Al4V implants with polished surface (control 1) (ii) Ti6Al4V implants with collagen coating (control 2) (iii) Ti6Al4V implants with collagen coating and covalently bound RGD peptides. All implants had square cross-sections with an oblique diameter of 4.6 mm and were inserted press fit into trephine burr holes of 4.6 mm in the mandibles of 10 beagle dogs. The implants of five animals each were evaluated after a healing period of 1 month and 3 months, during which sequential fluorochrome labelling of bone formation was performed. Bone formation was evaluated by morphometric measurement of the newly formed bone around the implant and the percentage of implant bone contact. After 1 month there was only little bone/implant contact, varying between 2.6 and 6.7% in the cortical bone and 4.4 and 5.7% in the cancellous bone, with no significant differences between the three types of implants. After 3 months, implants with polished surfaces exhibited 26.5 and 31.2% contact in the cortical and cancellous bone, respectively, while collagen-coated implants had 19.5 and 28.4% bone contact in these areas. Implants with RGD coating showed the highest values with 42.1% and 49.7%, respectively. Differences between the surface types as such were not significant, but the increase in bone/implant contact from 1 to 3 months postoperatively was significant only in the group of RGD-coated implants (P = 0.008 and P = 0.000). The results of this pilot study thus provide only weak evidence that coating of titanium implants with RGD peptides in the present form and dosage may increase periimplant bone formation in the alveolar process. The results therefore require further verification in a modified experimental setting.

Alloys↗

Location of flap margin after suturing.

Facial and lingual flaps were reflected on 23 patients who required an apically positioned flap procedure. Immediately after suturing, the distance from the flap margin to the crest of the alveolar process was recorded by routine pocket probing techniques. Root coverage was about 2 mm, significantly greater than the coverage previously recommended.

Alveolar Process↗

Clinical evaluation of orthodontic treatment after surgical repositioning or transplantation of teeth.

Fourteen impacted teeth in thirteen patients aged 9 to 17 years were either repositioned or transplanted, followed by postoperative orthodontic treatment. Successful results were achieved in twelve of the teeth. In one tooth, ankylosis of the root prevented a successful outcome, and deficient bone healing of the alveolar process led to an unsuccessful result in a second tooth.

Adolescent↗