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This research project aimed to compare the number of maxillary incisors and canine movement between Invisalign and fixed orthodontic appliances using artificial intelligence and identify any limitations of Invisalign. Sixty patients (Invisalign, n = 30; braces, n = 30) were randomly selected from the Ohio State University Graduate Orthodontic Clinic archive. Peer Assessment Rating (PAR) analysis was used to indicate the severity of the patients in both groups. To analyze the incisors and canine movement, specific landmarks were identified on incisors and canines using an artificial intelligence framework, two-stage mesh deep learning. Total average tooth movement in the maxilla and individual (incisors and canine) tooth movement in 6 directions (buccolingual, mesiodistal, vertical, tipping, torque, rotation) were then analyzed at a significance level of α = 0.05. Based on the posttreatment Peer Assessment Rating scores, the quality of finished patients in both groups was similar. In maxillary incisors and canines, there was a significant difference in movement between Invisalign and conventional appliances for all 6 movement directions (P <0.05). The greatest differences were with rotation and tipping of the maxillary canine, along with incisor and canine torque. The smallest statistical differences observed for incisors and canines were crown translational tooth movement in the mesiodistal and buccolingual directions. When comparing fixed orthodontic appliances to Invisalign, patients treated with fixed appliances were found to have significantly more maxillary tooth movement in all directions, especially with rotation and tipping of the maxillary canine. • Invisalign has less amount of tooth movement than fixed appliances. • Incisor and canine torque, rotation, and mesiodistal tipping showed less tooth movements. • There seemed to be some limitations with Invisalign therapy. • Careful patient selection should be necessary for the ideal orthodontic treatment outcome. [ABSTRACT FROM AUTHOR]

Introduction: Digital scanning, treatment planning, 3-dimensional imaging, and printing are changing the practice of orthodontics. These tools are adopted with the hope that treatment becomes more predictable, efficient, and effective while reducing adverse outcomes. Digital tools are impacting care, but knowledge of nationwide adoption trends and motivators is incomplete.Methods: We aimed to identify adoption decision-makers, information sources, incentives, and barriers through the first nationwide survey of American Association of Orthodontics members on their technology adoption habits, needs, and outcomes. Data were assessed using descriptive and bivariate analyses. The survey was developed from a comprehensive qualitative interview phase as part of a mixed methodology study.Results: Responses (n = 343) revealed orthodontists make adoption decisions on the basis of advice from other dentists and company representatives while rarely consulting staff or research literature. Continuing education and meetings are most effective at disseminating information to practicing doctors, whereas journals generate less impact. Key adoption incentives include added capabilities, practice efficiency, ease of implementation, and performance, whereas cost is the main barrier to purchase. Early adopters with larger practices charge higher fees than other adopters to support the costs of technologies. Treatment outcome is not a primary adoption incentive for specific technologies.Conclusions: Orthodontists positively perceive the influence of intraoral scanning, cone-beam computed tomography imaging, 3-dimensional printing, computer-aided design-computer-aided manufacturing archwires, and clear aligner therapy on their practice and patient care. The orthodontic technological transformation is underway, and knowledge of adoption can guide our transition into modern practice, in which digital tools are effective adjuncts to the specialists' expertise. [ABSTRACT FROM AUTHOR]

Introduction: Orthodontic residents face challenges unparalleled to their predecessors, including competitive marketplaces, rising debt burdens, and changing demographics that have contributed to the shift in initial career choice from owner to employee. We aim to understand factors important to orthodontists at different career stages and the impact on job satisfaction through a sequential mixed methodology study.Methods: Semistructured interviews were conducted with 25 orthodontic residents and practitioners. A survey was developed from qualitative findings that explored career decision-making of orthodontic residents and practicing orthodontists, with descriptive and bivariate statistical analyses (n = 343 orthodontists and 185 residents).Results: Graduating orthodontic residents are choosing employment over ownership as their initial job, prioritizing high income to offset the educational debt. The majority of residents report thinking about their debt very often to all of the time and find it very to extremely stressful. Current residents have long-term goals of ownership, whereas practicing doctors of both genders became owners at equal frequencies. However, on average, women earn $119,000 less per year and report being the primary family caretaker more often than men.Conclusions: Excellent patient care, work-life balance, and sufficient income are the most important drivers for career choices and job satisfaction for orthodontists of all ages. Despite debt, most residents and working orthodontists report a high level of job satisfaction and would recommend the field of orthodontics to others. [ABSTRACT FROM AUTHOR]

Introduction: Orthodontic tooth movement (OTM) relies on efficient remodeling of alveolar bone. While a well-controlled inflammatory response is essential during OTM, the mechanism regulating inflammation is unknown. Autophagy, a conserved catabolic pathway, has been shown to protect cells from excess inflammation in disease states. We hypothesize that autophagy plays a role in regulating inflammation during OTM.Methods: A split-mouth design was used to force load molars in adult male mice, carrying a GFP-LC3 transgene for in vivo detection of autophagy. Confocal microscopy, Western blot, and quantitative polymerase chain reaction analyses were used to evaluate autophagy activation in tissues of loaded and control molars at time points after force application. Rapamycin, a Food and Drug Administration-approved immunosuppressant, was injected to evaluate induction of autophagy.Results: Autophagy activity increases shortly after loading, primarily on the compression side of the tooth, and is closely associated with inflammatory cytokine expression and osteoclast recruitment. Daily administration of rapamycin, an autophagy activator, led to reduced tooth movement and osteoclast recruitment, suggesting that autophagy downregulates the inflammatory response and bone turnover during OTM.Conclusions: This is the first demonstration that shows that autophagy is induced by orthodontic loading and plays a role during OTM, likely via negative regulation of inflammatory response and bone turnover. Exploring roles of autophagy in OTM holds great promise, as aberrant autophagy is associated with periodontal disease and its related systemic inflammatory disorders. [ABSTRACT FROM AUTHOR]

Limited information is available regarding the fabrication of tooth-supported interim single crowns (SCs) with either a digital or a conventional workflow. The purpose of this randomized clinical trial was to compare the time efficiency and fit of interim crowns fabricated by using either a digital or a conventional workflow. Forty participants in need of posterior tooth-supported SCs were enrolled and randomly allocated to either the digital or conventional group. In the digital group, the interim SCs were fabricated by using digital sextant scans and computer-aided design and computer-aided manufacturing (CAD-CAM) technology without definitive casts. The conventional group included conventional impressions and direct fabrication of the interim restorations intraorally. Five experienced and 5 less experienced clinicians were randomly assigned to fabricate the interim SCs. The total fabrication time (laboratory and clinical) was recorded for time efficiency. The fit assessment included marginal fit, proximal contact, occlusal contact, and crown morphology. The evaluated parameters were analyzed with the Mann-Whitney U Test (α=.05). The digital workflow required significantly less total fabrication time (laboratory and clinical) than the conventional workflow (P <.001). The less-experienced clinicians needed longer clinical time with the conventional workflow than the experienced ones (P =.023). In contrast, the laboratory time and total fabrication time were shorter for less-experienced clinicians using the digital workflow (P =.005 and P =.015). The interim SCs fabricated with the digital workflow had significantly better fit and occlusal contacts than those fabricated with the conventional workflow (P =.005 and P <.001). With the digital workflow, the interim SCs made by less-experienced clinicians were of the same quality as those made by experienced clinicians. When using the conventional workflow, the fit of the experienced clinicians was significantly better than that of the less-experienced clinicians. The interim SCs fabricated with a digital workflow required a shorter fabrication time and resulted in better fit than those fabricated with a conventional workflow, especially for less-experienced clinicians. [ABSTRACT FROM AUTHOR]

Introduction: Orthodontics is evolving with advances in 3D imaging, additive fabrication, digital scanning, and treatment planning. With digital tools, orthodontic treatment may become more predictable, efficient, and effective while reducing side-effects. These technologies are affecting patient care, but knowledge of their adoption patterns and influence is incomplete. We aimed to identify adoption decision makers, information sources, perspectives, incentives, and barriers.Methods: Twenty-four privately practicing orthodontists were interviewed in a semistructured format following a topic guide. Interview transcripts were analyzed to identify factors in technology adoption and its perceived influence on practice. Thematic patterns were established through iterative systematic analysis, and qualitative validity was ensured with researcher triangulation.Results: Qualitative interviews revealed that orthodontists make purchasing decisions independently from staff, after consulting other dentists and company representatives. Meetings, residency training, and continuing education courses are influential information sources, whereas research literature is not. Early and middle adopters are integrating digital imaging, planning, and fabrication technologies into practice and view enhanced ease of use, capabilities, performance, and procedural efficiency as primary incentives to adoption. Improving outcomes and patient comfort are not frequently cited as incentives, and all interviewees view cost as the largest barrier. Orthodontists positively perceive the influence of technology on their practices, but are concerned that further innovation and direct-to-consumer products will cause loss of market share.Conclusions: CAD/CAM appliances, 3D imaging, and digital treatment planning are viewed as future standards of care and are increasingly being incorporated into the orthodontic office. Understanding the technology adoption process can guide innovation to improve treatment and ease the transition into a digital workflow. [ABSTRACT FROM AUTHOR]

Statement of problem Trueness and precision are used to evaluate the accuracy of intraoral optical impressions. Although the in vivo precision of intraoral optical impressions has been reported, in vivo trueness has not been evaluated because of limitations in the available protocols. Purpose The purpose of this clinical study was to compare the accuracy (trueness and precision) of optical and conventional impressions by using a novel study design. Material and methods Five study participants consented and were enrolled. For each participant, optical and conventional (vinylsiloxanether) impressions of a custom-made intraoral Co-Cr alloy reference appliance fitted to the mandibular arch were obtained by 1 operator. Three-dimensional (3D) digital models were created for stone casts obtained from the conventional impression group and for the reference appliances by using a validated high-accuracy reference scanner. For the optical impression group, 3D digital models were obtained directly from the intraoral scans. The total mean trueness of each impression system was calculated by averaging the mean absolute deviations of the impression replicates from their 3D reference model for each participant, followed by averaging the obtained values across all participants. The total mean precision for each impression system was calculated by averaging the mean absolute deviations between all the impression replicas for each participant (10 pairs), followed by averaging the obtained values across all participants. Data were analyzed using repeated measures ANOVA (α=.05), first to assess whether a systematic difference in trueness or precision of replicate impressions could be found among participants and second to assess whether the mean trueness and precision values differed between the 2 impression systems. Results Statistically significant differences were found between the 2 impression systems for both mean trueness ( P =.010) and mean precision ( P =.007). Conventional impressions had higher accuracy with a mean trueness of 17.0 ±6.6 μm and mean precision of 16.9 ±5.8 μm than optical impressions with a mean trueness of 46.2 ±11.4 μm and mean precision of 61.1 ±4.9 μm. Conclusions Complete arch (first molar-to-first molar) optical impressions were less accurate than conventional impressions but may be adequate for quadrant impressions. [ABSTRACT FROM AUTHOR]

Introduction: The aims of this study were to report contemporary orthodontic extraction frequencies at a university center and to investigate what patient-related factors might influence the likelihood of extraction.Methods: The records of 2184 consecutive patients treated at the University of North Carolina from 2000 to 2011 were analyzed. Year-by-year rates for overall orthodontic extractions and for extraction of 4 first premolars were calculated. Logistic regression, adjusting for all recorded patient risk factors for extraction, was used to examine both the changes in extraction frequencies over time and the influence of individual patient factors on the odds of extraction.Results: Small linear decreases in orthodontic extraction frequency overall (OR, 0.91; 95% CI, 0.88-0.95) and in extraction of 4 first premolars (OR, 0.95; 95% CI, 0.90-0.99) were seen. The overall extraction rate was 37.4% in 2000, and it fell just below 25% from 2006 onward. Four first premolar extraction rates ranged from 8.9% to 16.5%. Extractions were significantly more likely as crowding and overjet increased (OR, 1.2; 95% CI, 1.14-1.25; OR, 1.1; 95% CI. 1.07-1.19), as overbite decreased (OR, 0.8; 95% CI, 0.77-0.89), with Class II dental or skeletal relationships (OR, 1.5; 95% CI, 1.12- 2.05; OR, 1.4; 95% CI, 1.04-1.85), and for nonwhite patients (OR, 3.0; 95% CI, 2.2-4.06 for other races; OR, 4.1; 95% CI, 3.03-5.66 for African Americans).Conclusions: Extractions were just as likely to be associated with Class II dental and skeletal problems and with open-bite problems as with crowding alone. [ABSTRACT FROM AUTHOR]

Introduction: The first straight-wire appliance was introduced over 40 years ago to increase the consistency and efficiency of orthodontic treatment. More recently, computer-aided design and computer-aided manufacturing (CAD/CAM) technology has been used to create individualized orthodontic appliances. The purpose of this study was to investigate the clinical effectiveness and efficiency of CAD/CAM customized orthodontic appliances compared with direct and indirect bonded stock orthodontic brackets.Methods: This retrospective study included 3 treatment groups: group 1 patients were direct bonded with self-ligating appliances, group 2 patients were indirect bonded with self-ligating appliances, and group 3 patients were indirect bonded with CAD/CAM self-ligating appliances. Complete pretreatment and posttreatment records were obtained for all patients. The American Board of Orthodontics (ABO) Discrepancy Index was used to evaluate the pretreatment records, and the posttreatment outcomes were analyzed using the ABO Cast-Radiograph Evaluation. All data collection and analysis were completed by 1 evaluator.Results: There were no statistically significant differences in the ABO Discrepancy Index or the ABO Cast-Radiograph Evaluation among the groups. Treatment times for the 3 groups were significantly different; the CAD/CAM group was the shortest at 13.8 ± 3.4 months, compared with 21.9 ± 5.0 and 16.9 ± 4.1 months for the direct bonded and indirect bonded groups, respectively. The number of treatment appointments for the CAD/CAM group was significantly fewer than for the direct bonded group.Conclusions: The CAD/CAM orthodontic bracket system evaluated in this study was as effective in treatment outcome measures as were standard brackets bonded both directly and indirectly. The CAD/CAM appliance was more efficient in regard to treatment duration, although the decrease in total archwire appointments was minimal. Further investigation is needed to better quantify the clinical benefits of CAD/CAM orthodontic appliances. [ABSTRACT FROM AUTHOR]

Introduction: Orthodontic tooth movement (OTM) relies on bone remodeling and controlled aseptic inflammation. Autophagy, a conserved homeostatic pathway, has been shown to play a role in bone turnover. We hypothesize that autophagy participates in regulating bone remodeling during OTM in a force-dependent and cell type-specific manner.Methods: A split-mouth design was used to load molars with 1 of 3 force levels (15, 30, or 45 g of force) in mice carrying a green fluorescent protein-LC3 transgene to detect cellular autophagy. Fluorescent microscopy and quantitative polymerase chain reaction analyses were used to evaluate autophagy activation and its correlation with force level. Cell type-specific antibodies were used to identify cells with green fluorescent protein-positive puncta (autophagosomes) in periodontal tissues.Results: Autophagic activity increased shortly after loading with moderate force and was associated with the expression of bone turnover, inflammatory, and autophagy markers. Different load levels resulted in altered degrees of autophagic activation, gene expression, and osteoclast recruitment. Autophagy was specifically induced by loading in macrophages and osteoclasts found in the periodontal ligament and alveolar bone. Data suggest autophagy participates in regulating bone turnover during OTM.Conclusions: Autophagy is induced in macrophage lineage cells by orthodontic loading in a force-dependent manner and plays a role during OTM, possibly through modulation of osteoclast bone resorption. Exploring the roles of autophagy in OTM is medically relevant, given that autophagy is associated with oral and systemic inflammatory conditions. [ABSTRACT FROM AUTHOR]

Introduction: Nickel-titanium closed-coil springs are purported to deliver constant forces over extended ranges of activation and working times. In-vivo studies supporting this claim are limited. The objective of this study was to evaluate changes in force-decay properties of nickel-titanium closed-coil springs after clinical use. Methods: Pseudoelastic force-deflection curves for 30 nickel-titanium coil springs (used intraorally) and 15 matched laboratory control springs (simulated intraoral conditions: artificial saliva, 37°C) were tested before and after retrieval via dynamic mechanical analysis and a testing machine, respectively, to evaluate the amounts of force-loss and hysteresis change after 4, 8, or 12 weeks of working time (n = 10 per group). The effects of the oral environment and clinical use on force properties were evaluated by comparing in-vivo and in-vitro data. Results: The springs studied showed a statistically significant decrease in force (approximately 12%) after 4 weeks of clinical use (P <0.01), with a further significant decrease (approximately 7%) from 4 to 8 weeks (P = 0.03), and force levels appearing to remain steady thereafter. Clinical space closure at an average rate of 0.91 mm per month was still observed despite this decrease in force. In-vivo and in-vitro force-loss data were not statistically different. Conclusions: Nickel-titanium closed-coil springs do not deliver constant forces when used intraorally, but they still allow for space-closure rates of approximately 1 mm per month. [ABSTRACT FROM AUTHOR]

Introduction: The biomechanics of a continuous archwire inserted into multiple orthodontic brackets is poorly understood. The purpose of this research was to apply the birth-death technique to simulate the insertion of an orthodontic wire and the consequent transfer of forces to the dentition in an anatomically accurate model. Methods: A digital model containing the maxillary dentition, periodontal ligament, and surrounding bone was constructed from computerized tomography data. Virtual brackets were placed on 4 teeth (central and lateral incisors, canine, and first premolar), and a steel archwire (0.019 × 0.025 in) with a 0.5-mm step bend to intrude the lateral incisor was virtually inserted into the bracket slots. Forces applied to the dentition and surrounding structures were simulated by using the birth-death technique. Results: The goal of simulating a complete bracket-wire system on accurate anatomy including multiple teeth was achieved. Orthodontic forces delivered by the wire-bracket interaction were 19.1 N on the central incisor, 21.9 N on the lateral incisor, and 19.9 N on the canine. Loading the model with equivalent point forces showed a different stress distribution in the periodontal ligament. Conclusions: The birth-death technique proved to be a useful biomechanical simulation method for placement of a continuous archwire in orthodontic brackets. The ability to view the stress distribution with proper anatomy and appliances advances our understanding of orthodontic biomechanics. [ABSTRACT FROM AUTHOR]

Statement of problem: There is confusion in the literature about how physical properties of bone vary between maxillary and mandibular regions and which physical properties affect initial implant stability. Purpose: The purpose of this study was to determine correlations between physical properties of bone and initial implant stability, and to determine how physical properties and initial stability vary among regions of jawbone. Material and Methods: Four pairs of edentulous maxillae and mandibles were retrieved from fresh human cadavers. Six implants per pair were placed in different anatomical regions (maxillary anterior, right and left maxillary posterior, mandibular anterior, right and left mandibular posterior). Immediately after surgery, initial implant stability was measured with a resonance frequency device and a tapping device. Implant surgeries and initial stability measurements were performed within 72 hours of death. Elastic modulus (EM) and hardness were measured using nano-indentation. Composite apparent density (cAD) was measured using Archimedes'' principle. Bone-implant contact percentage and cortical bone thickness were recorded histomorphometrically. Mixed linear models and univariate-correlation analyses were used (α=.05). Results: Generally, mandibular bone had higher initial implant stability and physical properties than maxillary bone. Initial implant stability was higher in the anterior region than in the posterior. EM was higher in the posterior region than in the anterior; the reverse was true for cAD. Conclusions: Of the properties evaluated, cAD had the highest correlation with initial implant stability (r=0.82). Both physical properties of bone and initial implant stability differed between regions of jawbone. (J Prosthet Dent 2009;101:306–318) [Copyright &y& Elsevier]

Purpose: The purpose of this study was to perform a retrieval analysis of temporomandibular joint (TMJ) alloplastic interpositional implants and test possible correlation between implant failure features and patient clinical outcomes. In addition, we investigated the implants'' surface and examined the foreign body reaction associated with different types of alloplastic materials. Materials and Methods: Twelve implants (Proplast/Teflon [Vitek, Houston, TX] and Silastic [Dow Corning, Midland, MI]) were surgically removed from the patients'' TMJs. Implant surface failure features (fracture length, perforation of the implants) were observed using stereomicroscopy and recorded for description of the failure mechanisms and to statistically compare with clinical outcomes. Patients'' clinical data (pain symptoms and mandibular function) were collected and examined. Clinical outcomes were obtained relative to symptom severity (Symptom Severity Index [SSI]) and jaw function (modified Mandibular Function Impairment Questionnaire [mMFIQ]). Peri-implant soft tissues and implants were analyzed with light microscopy and stereo zoom microscopy. Electron microprobe analysis of implant fragments and peri-implant tissues was performed. Results: The statistical results showed that only the presence of implant perforation was statistically associated with the SSI, specifically with the pain tolerability dimension. No statistical association was seen between any of the other implant failure predictors and the SSI and between the predictors and the mMFIQ. Stereo zoom microscopy suggested that Proplast/Teflon implants (n = 7) were susceptible to perforation, layer tearing, fracture and fiber extrusion. The Silastic implants (n = 3) revealed a possible center perforation with fracture lines towards the periphery and fiber extrusion. Teflon implant wear debris particles appear to trigger a multinucleated giant cell foreign body reaction. Conclusion: Facial pain was a significant correlate to perforation and breakdown of the alloplastic TMJ interpositional implants, and most likely was the reason for implant removal. [Copyright &y& Elsevier]

Statement of problem: Initial implant stability has been used as an indicator for future osseointegration and whether an immediate/early loading protocol should be applied. However, differences in initial stability in relation to anatomical regions of jawbone have not been studied extensively because of the risks involved with stability measurements. Purpose: The purpose of this study was to determine whether initial implant stability varies with anatomical regions of the jawbone. Material and methods: Four pairs of edentulous maxillae and mandibles were retrieved from fresh human cadavers. Six implants (Biomet 3i) per pair were placed in different anatomical regions (maxillary anterior, right and left maxillary posterior, mandibular anterior, right and left mandibular posterior). Immediately after implant placement, initial implant stability was measured with a custom-made resonance frequency analyzer, a commercial resonance frequency analysis device (Osstell), and a mechanical tapping device (Periotest). All implant surgeries and initial stability measurements were performed within 72 hours of death to simulate a clinical setting. Repeated measures ANOVA (α=.05) and univariate correlation analyses were used to analyze the data. Results: Mandibular implants had significantly higher initial stability than maxillary implants. Posterior maxillary implants were least stable. Stability was less buccolingually than mesiodistally. The measurements from 3 stability measuring devices were strongly associated with each other. Conclusions: Initial implant stability varied among anatomical regions of jawbone. Rank of Periotest value and implant stability quotient (Osstell) had the highest correlation (r=-0.852). (J Prosthet Dent 2008;99:425-434) [Copyright &y& Elsevier]

Purpose: This study compared modified distraction osteogenesis (DO) protocol with conventional DO protocol on healing bone formation. Computer simulation was performed to understand the mechanical environment of modified DO protocol, which applies compression during the consolidation period. Materials and Methods: Fifty rats were used in this study. Twenty-five rats in the conventional DO (control) group were sacrificed at postoperative days 11, 21, 28, 35, and 49 after osteotomy. In the modified DO (experimental) group, compression was applied on day 7 after distraction (day 18 postoperatively) for 4 days during the early consolidation period and 25 rats were sacrificed on postoperative day 19, 28, 39, 46, and 53. The histologic and radiographic findings were used to compare the 2 groups. Further, computer simulation was used to predict the mechanical environment of healing bone under conventional and modified DO protocol. Results: Radiographic findings showed that the experimental group resulted in denser and wider healing bone. Histologically, the experimental group yielded more mature lamellar bone than the control group. Computer simulation showed that absolute values of tissue strains were nearly double in the control group because of the softer healing tissues. Both the experimental and control groups showed high strains at the ridge crest. Concentrated tensile strain along the distraction direction at the ridge crest might hinder bone formation at the interface, while compressive strain could facilitate the process. Conclusion: This study proposed a modified DO protocol of adding compression during the early consolidation period of conventional DO protocol. This new technique appears to provide faster and denser bone regeneration. [Copyright &y& Elsevier]

The hydroxyapatite (HAp)/gelatin (GEL) nanocomposite was prepared through the coprecipitation and then cross-linked by using glutaraldehyde (GA). From FT-IR measurement the spectral features for amide bands and phosphate bands were severely modified by the cross-linkage and the organic content increased with the degree of cross-linkage. From Transmission Electron Microscopy (TEM) and electron diffraction analyses we could confirm the preferentially directional growth of needle-like HAp particles, which were embedded in GEL by the mineralization. Also we could observe worm-like stria patterns of contrast, which were revealed by the mineralization on the individual GEL fibrils. Moire´ images were observed in a highly cross-linked HAp/GEL nanocomposite sample and we think the cross-linkage induced the assembly of unordered individual fibrils along the preferential direction. [Copyright &y& Elsevier]

A nanocomposite of gelatin[GEL]-hydroxyapatite[HAp] was prepared using the biomimetic process. The hydroxyapatite nanocrystals were precipitated in aqueous solution of gelatin at pH 8 and 38°C. The chemical bonding between calcium ions of HAp and carboxyl ions of GEL molecules induced a red-shift of the 1339 cm−1 band of GEL in FT-IR analysis. TEM images and electron diffraction patterns for the nanocomposite strongly indicate the self-organization of HAp nanocrystals along the GEL fibrils. Electron diffraction for the nanocomposites showed a strong preferred orientation of the (0 0 2) plane in HAp nanocrystals. The development of HAp nanocrystals in an aqueous GEL solution was highly influenced by the concentration ratio of GEL to HAp. A higher concentration of GEL induced the formation of tiny crystallites (4 nm×9 nm size), while a lower concentration of GEL contributed to the development of bigger crystallites (30 nm×70 nm size). From DT/TGA data, the HAp-GEL nanocomposite showed typically three exothermic temperatures. The increase in decomposition temperatures indicates the formation of a primary chemical bond between HAp and GEL. The higher concentration of GEL supplies abundant reaction sites containing groups such as carboxyl, which can bind with calcium ions. The abundant supply of reaction sites leads to a very large number of HAp nuclei. However, the formation of a large number of nuclei depletes the concentration of calcium ions that available for growth to the extent that the nuclei cannot grow very large. This in turn will lead to the creation of a large number of tiny nanocrystals at this higher GEL concentration. [Copyright &y& Elsevier]

This study reports a method for controlling loads on an in vivo dental implant and its application for the investigation of early loading versus delayed loading of dental implants. The method was developed for the purpose of studying an ongoing hypothesis that amounts to bone loss around dental implants are related to mechanical-mediated adaptation of the alveolar bone. Using a customized intra-oral hydraulic system, the daily loading over a dental implant has been completed and recorded for six Sinclair swine. Each pig had a 5-month duration implant loading. During the experiments (loading), no analgesic treatment was supplied. The mean of the in vivo daily loadings was confirmed through an in vitro bench test after each animal was euthanized. Variations of the averaged loading input among the six animals were smaller than 10%. Preliminary data produced by the model suggests that cervical bone loss is less for early loading than for delayed loading. The current system is expected to provide a useful load control model for the study of alveolar bone adaptation around dental implants in relation to various loadings. [Copyright &y& Elsevier]

Paget's disease of bone (PDB) is a degenerative disorder affecting the skull and bones. Hyperactive osteoclasts (OCs) initiate bone degradation in the early stage, followed by increased bone formation by osteoblasts (OBs) in trabecular bones during the advanced stage. This OB-OC uncoupling results in bone deformations and irregular trabecular bone patterns. Current mouse models poorly replicate the advanced-stage characteristics of PDB. Optineurin (Gene: OPTN in humans, Optn in mice, protein: OPTN) has been implicated in PDB by genetic analyses. We identified PDB-like cortical lesions associated with OC hyperactivation in an Optn knockout (Optn −/−) mouse model. However, the effects of OPTN dysfunction on OBs and trabecular bone in advanced PDB remain unclear. In this study, we used the Optn −/− mouse model to investigate trabecular bone abnormalities and OB activity in PDB. Micro-computed tomography analysis revealed severe pagetic alterations in craniofacial bones and femurs of aged Optn −/− mice, resembling clinical manifestations of PDB. Altered OB activity was observed in aged Optn −/− mice, implicating compensatory OB response in trabecular bone anomalies. To elucidate the role of OC-OB interactions in PDB, we conducted in vitro experiments using OC conditioned media (CM) to examine the effects on OB osteogenic potential. We found OC CM restored compromised osteogenic induction of Optn −/− bone marrow stromal cells (BMSCs) from young mice, suggesting OCs maintain OB activity through secreted factors. Strikingly, OC CM from aged Optn −/− mice significantly enhanced osteogenic capability of Optn −/− BMSCs, providing evidence for increased OB activity in advanced stages of PDB. We further identified TGF-β/BMP signaling pathway in mediating the effects of OC CM on OBs. Our findings provide insights into Optn's role in trabecular bone abnormalities and OB activity in PDB. This enhances understanding of PDB pathogenesis and may contribute to potential therapeutic strategies for PDB and related skeletal disorders. • Pagetic alterations exhibit in the trabecular bones of aged Optn −/− mice. • Altered osteoblast (OB) activity may contribute to such pagetic phenotypes. • Osteoclast (OC) secretions increase OB activity in aged Optn −/− mice in vitro. • Optn −/− OC secretions activate TGF-β/BMP signaling in aged Optn −/− OB cells. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Cells derived from the neural crest (NC) contribute to the development of several adult tissues, including tooth and periodontal tissue. Here, two transgenic lines, Wnt1-Cre/ZEG and P0-Cre/ZEG, were analysed to determine the fate and distribution of neural crest cells (NCCs) in adult mouse periodontal ligament (PDL). Design: Paraffin-embedded and decalcified histology samples were prepared from Wnt1-Cre/ZEG and P0-Cre/ZEG mice that were 4-, 8-, or 12-weeks old. Expression of GFP (NC-derived cells), NC-markers (Slug, AP-2 alpha, HNK-1, p75NTR and Nestin), and mesenchymal stem cell markers (CD29 and STRO-1) were examined using immunohistochemistry. Results: In four-week-old Wnt1-Cre/ZEG mice, GFP(+) NC-derived cells were specifically detected in the mid-zone of PDL. The GFP(+) cells constituted 1.4% of all cells in PDL, and this percentage decreased as the mice aged. The distribution and prevalence of GFP(+) cells were comparable between Wnt1-Cre/ZEG and P0-Cre/ZEG mice. NC-marker(+) cells were expressed only in GFP(+) cells while MSC markers were detected only in GFP(−) cells. Conclusion: The prevalence and specific distribution of NC-derived cells in adult PDL of Wnt1-Cre/ZEG and P0-Cre/ZEG mouse were examined. Interestingly, various NC markers, including markers for undifferentiated NCCs, were still expressed at high levels in GFP(+) cells. These observations may indicate that labelled cells in the Wnt1-Cre/ZEG and P0-Cre/ZEG mice did not constituted all NC-derived cells, but rather an interesting subset of NC-derived cells. These findings may be useful in understanding the homeostatic character of the PDL and contribute to establishing successful periodontal tissue maintenance. [Copyright &y& Elsevier]

Abstract: Objectives: This study investigated the surrounding bone stress and the implant–bone interfacial sliding of implant designs and implant sizes of immediately loaded implant with maxillary sinus augmentation by using three-dimensional (3D) non-linear finite element (FE) analysis. Methods: Twenty-four FE models including four implant designs (cylindrical, threaded, stepped and step-thread implants) and three implant dimensions (standard, long and wide threaded implants) with a bonded and three levels of frictional contact of implant–bone interfaces were analyzed. The maxillary model was constructed from computer tomography (CT) images of a human skull and all 3D implant models were created via the computer-aided design (CAD) software. Results: The use of threaded implants decreased the bone stress and sliding distance obviously about 30% as compared with non-threaded (cylindrical and stepped) implants. Increasing the implant''s length or diameter reduced the bone stress by 13–26%. Employing a immediately loaded implant with smooth machine surface (μ =0.3, μ represents frictional coefficient) increased the bone stress by 28–63% as compared with the osseointegrated (bonded interfaces) implants. Roughening the implant surface (μ >0.3) did not reduced the bone stress, however it did decrease the interfacial sliding between implant and bone. Conclusions: For an immediately loaded implant placed with sinus augmentation, using threaded implant could decrease both the bone stress and implant–bone sliding distance which may improve the implant initial stability and long-term survival. Rough surface of implants shows no benefit to reduce the bone stress but they could lower the interfacial sliding. On the contrary, employing long or wide implants decrease the bone stress but they cannot diminish the interfacial sliding. [Copyright &y& Elsevier]

How the nervous system regulates bone remodeling is an exciting area of emerging research in bone biology. Accumulating evidence suggest that neurotransmitter-mediated inputs from neurons may act directly on osteoclasts. Dopamine is a neurotransmitter that can be released by hypothalamic neurons to regulate bone metabolism through the hypothalamic-pituitary-gonadal axis. Dopamine is also present in sympathetic nerves that penetrate skeletal structures throughout the body. It has been shown that dopamine suppresses osteoclast differentiation via a D2-like receptors (D2R)-dependent manner, but the intracellular secondary signaling pathway has not been elucidated. In this study, we found that cAMP-response element binding protein (CREB) activity responds to dopamine treatment during osteoclastogenesis. Considering the critical role of CREB in osteoclastogenesis, we hypothesize that CREB may be a critical target in dopamine's regulation of osteoclast differentiation. We confirmed that D2R is also present in RAW cells and activated by dopamine. Binding of dopamine to D2R inhibits the cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) signaling pathway which ultimately decreases CREB phosphorylation during osteoclastogenesis. This was also associated with diminished expression of osteoclast markers that are downstream of CREB. Pharmacological activation of adenylate cyclase (to increase cAMP production) and PKA reverses the effect of dopamine on CREB activity and osteoclastogenesis. Therefore, we have identified D2R/cAMP/PKA/CREB as a candidate pathway that mediates dopamine's inhibition of osteoclast differentiation. These findings will contribute to our understanding of how the nervous and skeletal systems interact to regulate bone remodeling. This will enable future work toward elucidating the role of the nervous system in bone development, repair, aging, and degenerative disease. Unlabelled Image • We identified a candidate pathway (D2R/cAMP/PKA/CREB) that mediates dopamine's regulation of osteoclast differentiation. • Pharmacological activation of cAMP/PKA/CREB pathway reverses dopamine's inhibition of osteoclastogenesis. • Dopamine and CREB may be promising mediators of neuronal regulation of bone remodeling. [ABSTRACT FROM AUTHOR]