Do-Gyoon Kim

Effect of bone thickness on alveolar bone-height measurements from cone-beam computed tomography images.

INTRODUCTION Cone-beam computed tomography (CBCT) has been used to assess alveolar bone changes after rapid palatal expansion. The purpose of this study was to investigate the accuracy of alveolar bone-height measurements from CBCT images with varied bone thicknesses and imaging resolutions. METHODS Eleven maxillary specimens from 6-month-old pigs were measured for alveolar bone height (distance between drilled reference holes and alveolar crests) at 6 locations with a digital caliper, followed by CBCT scanning at 0.4-mm and 0.25-mm voxel sizes. Buccal alveolar bone of these locations was then reduced approximately by 0.5 to 1.5 mm, followed by CBCT rescanning with the same voxel sizes. The CBCT images were measured by using 3-dimensional software to determine alveolar bone height and thickness in buccolingual slices by independent, blinded raters. The specimens were subsequently cut into buccolingual sections at reference-hole levels, and direct bone height and thickness were measured from these sections. Intrarater and interrater repeatability and the differences between CBCT and direct measurements were assessed. RESULTS Excellent intrarater (intraclass correlations, r = 0.89-0.98) and good interrater (r = 0.64-0.90) repeatability values were found for alveolar bone-height measurements from the CBCT images. Before alveolar bone reduction, the thickness was much greater than the CBCT voxel size (0.4 mm), and bone-height measurements from the CBCT images were 0.5 to 1 mm more than the direct measurements (paired t tests, P <0.017 at most locations). After bone reduction, the thickness at the subcrest 1-mm level was near or below the CBCT voxel size (0.4 mm), and bone-height measurements from the CBCT images were 0.9 to 1.2 mm less than the direct measurements (paired t tests, P <0.017 at most locations). These measurement inaccuracies were substantially improved by decreasing the CBCT voxel size to 0.25 mm. CONCLUSIONS Alveolar bone-height measurements from conventional clinical 0.4-mm voxel size CBCT images might overestimate alveolar bone-height loss associated with rapid palatal expansion.

Preparation and characterization of nano-sized hydroxyapatite/alginate/chitosan composite scaffolds for bone tissue engineering

The aim of this study was to develop chitosan composite scaffolds with high strength and controlled pore structures by homogenously dispersed nano-sized hydroxyapatite (nano-HAp) powders. In the fabrication of composite scaffolds, nano-HAp powders distributed in an alginate (AG) solution with a pH higher than 10 were mixed with a chitosan (CS) solution and then freeze dried. While the HAp content increased up to 70 wt.%, the compressive strength and the elastic modulus of the composite scaffolds significantly increased from 0.27 MPa and 4.42 MPa to 0.68 MPa and 13.35 MPa, respectively. Higher content of the HAp also helped develop more differentiation and mineralization of the MC3T3-E1 cells on the composite scaffolds. The uniform pore structure and the excellent mechanical properties of the HAp/CS composite scaffolds likely resulted from the use of the AG solution at pH 10 as a dispersant for the nano-HAp powders.

Biomechanical Comparison of Bicortical Versus Unicortical Screw Placement of Proximal Tibia Locking Plates: A Cadaveric Model

Objective: The purpose of this study was to compare the biomechanical properties of bicortical with unicortical screws in a proximal tibial fracture cadaveric model. Setting: Biomechanics laboratory at a Level 1 trauma center. Patients/Participants: Eight pairs (4 male and 4 female) of elderly (average age, 79 years; range, 63 to 104 years) cadaveric tibiae. Intervention: Osteotomies were performed in the proximal tibia to reproduce a 41-C2 bicondylar fracture pattern. The 4.5-mm proximal tibial periarticular locking plates (Smith-Nephew, Memphis, TN) were applied to the tibiae with 4 proximal bicortical or unicortical locking screws and 3 screws distal to the fracture site. The fixed tibiae were tested by using a materials testing machine (Instron, Canton, MA) with the axial load on the medial condyle. Outcome Measurements: The bicortical and unicortical constructs were compared for stiffness, yield load and displacement, and maximum load and displacement to failure. Results: Bicortical screw placement significantly outperformed unicortical screw placement in stiffness (53.1 ± 6.7 N/mm versus 35.6 ± 7.2 N/mm, P < 0.002) and maximum load (476.5 ± 83.8 N versus 258.9 ± 62.1 N, P < 0.001) but the yield properties and the ultimate displacement were not significantly different. Conclusion: Bicortical screw placement may provide a biomechanically superior construct than unicortical screw placement for the stabilization of unstable proximal tibia fractures.

Effect of Microcomputed Tomography Voxel Size on the Finite Element Model Accuracy for Human Cancellous Bone

The level of structural detail that can be acquired and incorporated in a finite element (FE) analysis might greatly influence the results of microcomputed tomography (microCT)-based FE simulations, especially when relatively large bones, such as whole vertebrae, are of concern. We evaluated the effect of scanning and reconstruction voxel size on the microCT-based FE analyses of human cancellous tissue samples for fixed- and free-end boundary conditions using different combinations of scan/reconstruction voxel size. We found that the bone volume fraction (BV/TV) did not differ considerably between images scanned at 21 and 50 microm and reconstructed at 21, 50, or 110 microm (-0.5% to 7.8% change from the 21/21 microm case). For the images scanned and reconstructed at 110 microm, however, there was a large increase in BV/TV compared to the 21/21 microm case (58.7%). Fixed-end boundary conditions resulted in 1.8% [coefficient of variation (COV)] to 14.6% (E) difference from the free-end case. Dependence of model output parameters on scanning and reconstruction voxel size was similar between free- and fixed-end simulations. Up to 26%, 30%, 17.8%, and 32.3% difference in modulus (E), and average (VMExp), standard deviation (VMSD) and coefficient of variation (COV) of von Mises stresses, respectively, was observed between the 21/21 microm case and other scan/reconstruction combinations within the same (free or fixed) simulation group. Observed differences were largely attributable to scanning resolution, although reconstruction resolution also contributed significantly at the largest voxel sizes. All 21/21 microm results (taken as the gold standard) could be predicted from the 21/50 (r2adj= 0.91-0.99;p<0.001), 21/110 (r2adj =0.58-0.99;p<0.02) and 50/50 results (r2adj=0.61-0.97;p<0.02). While BV/TV, VMSD, and VMExp/sigma(z) from the 21/21 could be predicted by those from the 50/110 (r2adj =0.63-0.93;p<0.02) and 110/110 (r2adj =0.41-0.77;p<0.05) simulations as well, prediction of E, VMExp, and COV became marginally significant (0.04<p<0.13) at 50/110 and nonsignificant at 110/110 (0.21<p<0.70). In conclusion, calculation of cancellous bone modulus, mean trabecular stress, and other parameters are subject to large errors at 110/110 microm voxel size. However, enough microstructural details for studying bone volume fraction, trabecular shear stress scatter, and trabecular shear stress amplification (VMExp/sigma(z)) can be resolved using a 21/110 microm, 50/110 microm, and 110/110 microm voxels for both free- and fixed-end constraints.

Estrogen deficiency increases variability of tissue mineral density of alveolar bone surrounding teeth

OBJECTIVE Estrogen deficiency increases bone remodeling leading to increased variability of tissue mineral density (TMD). Due to the functional demands of mastication, alveolar bone around teeth is inherently a highly remodeled region of bone tissue with a highly variable distribution of TMD. This study investigated the effect of estrogen deficiency on the TMD distribution of alveolar bone. DESIGN Using three-dimensional micro-computed tomography images of sham surgery (Sham) and ovariectomized (OVX) rat mandible sections, alveolar bone region (AB) and control bone region (CB) of interest were isolated. Based on histograms of gray levels equivalent to TMD values, mean (Mean), standard deviation (SD) and coefficient of variation (COV=SD/Mean) were computed. Fifth and 95th percentile gray level values were also obtained (Low(5) and High(5), respectively). Absolute value of percentage (%) differences of the gray level parameters between AB and CB regions were computed. RESULTS Both SD and COV were significantly higher in AB region than those in CB region for all specimens of both Sham and OVX groups (p<0.001). The mean values of % differences for SD were moderately higher (p<0.073) and those for COV and Low(5) were significantly higher for the OVX group than for the Sham group (p<0.04). CONCLUSIONS Higher variability of mineralization observed in AB of OVX group indicates that estrogen deficiency amplifies the active bone remodeling of AB already present due to the mastication. These findings provide an insight that the increased variability of TMD induced by estrogen deficiency may compromise the mechanical stability of the tooth-bearing alveolar bone.

Factors affecting the accuracy of buccal alveolar bone height measurements from cone-beam computed tomography images

INTRODUCTION The reasons for inaccuracies in alveolar bone measurement from cone-beam computed tomography (CBCT) images might be multifactorial. In this study, we investigated the impact of software, the presence or absence of soft tissues, the voxel size of the scan, and the regions in the jaws on buccal alveolar bone height measurements in pigs at an age equivalent to human adolescents. METHODS Marker holes, apical to the maxillary and mandibular molar roots, and mesiodistal molar occlusal reference grooves were created in 6 fresh pig heads (12 for each jaw), followed by CBCT scans at 0.4-mm and 0.2-mm voxel sizes under soft-tissue presence and soft-tissue absence conditions. Subsequently, buccolingual sections bisecting the marker holes were cut, from which the physical alveolar bone height and thickness were measured. One blinded rater, using Dolphin (version 11.5 Premium; Dolphin Imaging, Chatsworth, Calif) and OsiriX (version 3.9; www.osirix-viewer.com) software, independently collected alveolar bone height measurements from the CBCT images. Differences between the CBCT and the physical measurements were calculated. The mean differences and the limit of agreement (LOA, ±1.96 SD) for every jaw, voxel-size, soft-tissue, and software condition were depicted. Each measurement was then assessed for clinical inaccuracy by using 2 levels of criteria (absolute differences between CBCT and physical measurements ≥1 mm, or absolute differences between CBCT and physical measurements ≥0.5 mm), and the interactions between soft-tissue and voxel-size factors for every jaw and software condition were assessed by chi-square tests. RESULTS Overall, the mean differences between the CBCT and the physical measurements for every jaw, voxel-size, soft-tissue, and software condition were near 0. With all other conditions kept equal, the accuracy of the maxillary CBCT measurements was inferior (larger limit of agreement ranges and higher frequencies of clinical inaccuracy) to the mandibular measurements. The physical thickness of the maxillary alveolar crestal bone was less than 1 mm and significantly thinner than the mandibular counterparts. For every jaw and software condition, the accuracy of measurements from the 0.2-mm soft-tissue presence CBCT images was consistently superior (smaller limit of agreement ranges and lower frequencies of clinical inaccuracy) to those from the 0.4-mm soft-tissue presence, the 0.4-mm soft-tissue absence, and the 0.2-mm soft-tissue absence images; all showed similar accuracies. Qualitatively, the soft-tissue absence images demonstrated much brighter enamel and alveolar bone surface contours than did the soft-tissue presence images. CONCLUSIONS At an adolescent age, the buccal alveolar bone height measured from the maxillary molar region based on 0.4-mm voxel-size CBCT images can have relatively large and frequently inaccurate measurements, possibly due to its thinness. By using 0.2-mm voxel-size scans, measurement accuracy might be improved, but only when the overlying facial and gingival tissues are kept intact.

Bone Ingrowth and Initial Stability of Titanium and Porous Tantalum Dental Implants: A Pilot Canine Study

Purpose:To investigate if a dental implant system with a midsection covered by 3-dimensionally porous tantalum material would exhibit stability comparable with a traditional threaded titanium alloy implant system and whether bone would grow into the porous section. Methods:Three experimental and 3 control implants were placed in the individual mandibles of 8 dogs. Resonance frequency analysis assessed implant stability at 0, 2, 4, 8, and 12 weeks of healing. Histomorphometric and backscattered scanning electron microscopic analyses examined the presence of bone ingrowth into the experimental implant’s porous section and bone-to-implant contact along the titanium surfaces of both implants. Results:Implant stability did not significantly differ during 0 to 12 weeks of healing. Progressive tissue mineralization developed inside porous sections from weeks 2 to 12. Porous implants exhibited a combination of progressive osseointegration along their titanium surfaces and bone ingrowth inside their porous tantalum sections. Conclusions:Cortical and apical implant threads, combined with the porous section, were able to stabilize the experimental implant to the same degree as the fully threaded control implant.

Scaffold-Based Delivery of Autologous Mesenchymal Stem Cells for Mandibular Distraction Osteogenesis: Preliminary Studies in a Porcine Model

Purpose Bone regeneration through distraction osteogenesis (DO) is promising but remarkably slow. To accelerate it, autologous mesenchymal stem cells have been directly injected to the distraction site in a few recent studies. Compared to direct injection, a scaffold-based method can provide earlier cell delivery with potentially better controlled cell distribution and retention. This pilot project investigated a scaffold-based cell-delivery approach in a porcine mandibular DO model. Materials and Methods Eleven adolescent domestic pigs were used for two major sets of studies. The in-vitro set established methodologies to: aspirate bone marrow from the tibia; isolate, characterize and expand bone marrow-derived mesenchymal stem cells (BM-MSCs); enhance BM-MSC osteogenic differentiation using FGF-2; and confirm cell integration with a gelatin-based Gelfoam scaffold. The in-vivo set transplanted autologous stem cells into the mandibular distraction sites using Gelfoam scaffolds; completed a standard DO-course and assessed bone regeneration by macroscopic, radiographic and histological methods. Repeated-measure ANOVAs and t-tests were used for statistical analyses. Results From aspirated bone marrow, multi-potent, heterogeneous BM-MSCs purified from hematopoietic stem cell contamination were obtained. FGF-2 significantly enhanced pig BM-MSC osteogenic differentiation and proliferation, with 5 ng/ml determined as the optimal dosage. Pig BM-MSCs integrated readily with Gelfoam and maintained viability and proliferative ability. After integration with Gelfoam scaffolds, 2.4–5.8×107 autologous BM-MSCs (undifferentiated or differentiated) were transplanted to each experimental DO site. Among 8 evaluable DO sites included in the final analyses, the experimental DO sites demonstrated less interfragmentary mobility, more advanced gap obliteration, higher mineral content and faster mineral apposition than the control sites, and all transplanted scaffolds were completely degraded. Conclusion It is technically feasible and biologically sound to deliver autologous BM-MSCs to the distraction site immediately after osteotomy using a Gelfoam scaffold to enhance mandibular DO.

Trabecular shear stress amplification and variability in human vertebral cancellous bone: Relationship with age, gender, spine level and trabecular architecture

Trabecular shear stress magnitude and variability have been implicated in damage formation and reduced bone strength associated with bone loss for human vertebral bone. This study addresses the issue of whether these parameters change with age, gender or anatomical location, and if so whether this is independent of bone mass. Additionally, 3D-stereology-based architectural parameters were examined in order to establish the relationship between stress distribution parameters and trabecular architecture. Eighty cancellous bone specimens were cored from the anterior region of thoracic 12 and donor-matched lumbar 1 vertebrae from a randomly selected population of 40 cadavers. The specimens were scanned at 21-microm voxel size using microcomputed tomography (microCT) and reconstructed at 50microm. Bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), bone surface-to-volume ratio (BS/BV), degree of anisotropy (MIL1/MIL3), and connectivity density (-#Euler/Vol) were calculated directly from micro-CT images. Large-scale finite element models were constructed and superoinferior compressive loading was simulated. Apparent cancellous modulus (EFEM) was calculated. The average trabecular von Mises stress generated per uniaxial apparent stress (sigma (-)VM / sigmaapp) and coefficient of variation of trabecular von Mises stresses (COV) were calculated as measures of the magnitude and variability of shear stresses in the trabeculae. Mixed-models and regression were used for analysis. sigma(-)VM / sigmaapp and COV were not different between genders and vertebrae. Both sigma(-)VM / sigmaapp and COV increased with age accompanied by a decrease in BV/TV. Strong relationship of sigma(-)VM / sigmaapp with BV/TV was found whereas COV was strongly related to EFEM/(BV/TV). The results from T12 and L1 were not different and highly correlated with each other. The relationship of sigma(-)VM / sigmaapp with COV was observed to be different between males and females. This difference could not be explained by architectural parameters considered in this study. Our results support the relevance of trabecular shear stress amplification and variability in age-related vertebral bone fragility. The relationships found are expected to help understand the micro-mechanisms by which cancellous bone mass and mechanical properties are modulated through a collection of local stress parameters.

Increased variability of bone tissue mineral density resulting from estrogen deficiency influences creep behavior in a rat vertebral body

Progressive vertebral deformation increases the fracture risk of a vertebral body in the postmenopausal patient. Many studies have observed that bone can demonstrate creep behavior, defined as continued time-dependent deformation even when mechanical loading is held constant. Creep is a characteristic of viscoelastic behavior, which is common in biological materials. We hypothesized that estrogen deficiency-dependent alteration of the mineral distribution of bone at the tissue level could influence the progressive postmenopausal vertebral deformity that is observed as the creep response at the organ level. The objective of this study was thus to examine whether the creep behavior of vertebral bone is changed by estrogen deficiency, and to determine which bone property parameters are responsible for the creep response of vertebral bone at physiological loading levels using an ovariectomized (OVX) rat model. Correlations of creep parameters with bone mineral density (BMD), tissue mineral density (TMD) and architectural parameters of both OVX and sham surgery vertebral bone were tested. As the vertebral creep was not fully recovered during the post-creep unloading period, there was substantial residual displacement for both the sham and OVX groups. A strong positive correlation between loading creep and residual displacement was found (r=0.868, p<0.001). Of the various parameters studied, TMD variability was the parameter that best predicted the creep behavior of the OVX group (p<0.038). The current results indicated that creep caused progressive, permanent reduction in vertebral height for both the sham and OVX groups. In addition, estrogen deficiency-induced active bone remodeling increased variability of trabecular TMD in the OVX group. Taken together, these results suggest that increased variability of trabecular TMD resulting from high bone turnover influences creep behavior of the OVX vertebrae.