Eduardo Franzotti Sant'Anna

Bone mineral density

OBJECTIVE To verify whether bone mineral density (BMD) of cortical bone, trabecular bone, and total bone influence the primary stability of orthodontic miniscrews and to verify whether there is a correlation between the measurement of BMD by cone-beam computed tomography (CBCT) and central dual-energy x-ray absorptiometry (DEXA). MATERIALS AND METHODS Twenty bovine bone sections were extracted from the pubic and iliac bones from regions with cortical thicknesses of approximately 1 mm. The BMD of the total bone block was evaluated using two methods: CBCT and DEXA. The BMD of cortical, trabecular, and total bone in the region of interest (ROI) were also evaluated by CBCT. After scanning the bone blocks, 20 self-drilling miniscrews (INP®) 1.4 mm in diameter and 6 mm long were inserted into them. The peak implant insertion torque (IT) was registered. After this, the pull-out test (PS) was performed and the maximum force registered. The Pearson correlation test was applied to verify the correlations between variables. RESULTS The BMD of the total bone block verified by CBCT and DEXA showed a positive and strong correlation (r  =  0.866, P  =  .000). The BMD of the ROI for cortical bone influenced the IT (r  =  0.518, P  =  .40) and the PS of miniscrews (r  =  0.713, P  =  .001, Table 2). However, the total bone BMD (verified by CBCT and DEXA) and trabecular bone BMD presented weak and not statistically significant correlations with primary stability. CONCLUSIONS There was a positive correlation between total bone block BMD measured by DEXA and CBCT. The cortical BMD influenced the IT and PS.

Cone-beam computed tomography and radiographs in dentistry: aspects related to radiation dose.

Introduction. The aim of this study was to discuss the radiation doses associated with plain radiographs, cone-beam computed tomography (CBCT), and conventional computed tomography (CT) in dentistry, with a special focus on orthodontics. Methods. A systematic search for articles was realized by MEDLINE from 1997–March 2011. Results. Twenty-seven articles met the established criteria. The data of these papers were grouped in a table and discussed. Conclusions. Increases in kV, mA, exposure time, and field of view (FOV) increase the radiation dose. The dose for CT is greater than other modalities. When the full-mouth series (FMX) is performed with round collimation, the orthodontic radiographs transmit higher dose than most of the large FOV CBCT, but it can be reduced if used rectangular collimation, showing lower effective dose than large FOV CBCT. Despite the image quality, the CBCT does not replace the FMX. In addition to the radiation dose, image quality and diagnostic needs should be strongly taken into account.

Shear bond strength of brackets bonded with hydrophilic and hydrophobic bond systems under contamination

OBJECTIVE To compare, in vitro, the shear bond strength (SBS) of two bond systems: Transbond XT/XT primer (TXT/XT) and Transbond Plus Color Change/Transbond Self Etching Primer (TPCC/TSEP). MATERIALS AND METHODS Each system was examined under four enamel surface conditions (dry, water, saliva, and blood), and 160 bovine teeth were divided into eight groups of 20 according to enamel surface condition. Group 1 used TPCC/TSEP and Group 2 used TXT/XT under dry conditions; Group 3 used TPCC/TSEP and Group 4 used TXT/XT with water; Group 5 used TPCC/TSEP and Group 6 used TXT/XT under saliva; and Group 7 used TPCC/TSEP and Group 8 used TXT/XT with blood. Brackets were bonded, and the samples were thermocycled 500 times between 5 degrees C and 55 degrees C; they were then submitted to a shear bond test with a universal testing machine with a 50 kgf load cell at 5 mm/min. RESULTS Although water and saliva affected TXT/XT more than they affected TPCC/TSEP, there were no significant differences among the groups (Groups 3 and 4: P = .940; Groups 3 and 5 and Groups 4 and 6: P = 1.000; Groups 3 and 6: P = .988; Groups 4 and 5: P = .690; and Groups 5 and 6: P = .861). CONCLUSIONS The presence of blood resulted in the lowest SBS from both bond systems, but especially from TXT/XT. TPCC/TSEP resulted in a higher SBS than TXT/XT under all conditions except the dry enamel surface.

Is trabecular bone related to primary stability of miniscrews

OBJECTIVE To compare the primary stability of miniscrews inserted into bone blocks of different bone mineral densities (BMDs) with and without cortical bone, and investigate whether some trabecular properties could influence primary stability. MATERIALS AND METHODS Fifty-two bone blocks were extracted from fresh bovine pelvic bone. Four groups were created based on bone type (iliac or pubic region) and presence or absence of cortical bone. Specimens were micro-computed tomography imaged to evaluate trabecular thickness, trabecular number, trabecular separation, bone volume density (BV/TV), BMD, and cortical thickness. Miniscrews 1.4 mm in diameter and 6 mm long were inserted into the bone blocks, and primary stability was evaluated by insertion torque (IT), mini-implant mobility (PTV), and pull-out strength (PS). RESULTS Intergroup comparison showed lower levels of primary stability when the BMD of trabecular bone was lower and in the absence of cortical bone (P≤.05). The Pearson correlation test showed correlation between trabecular number, trabecular thickness, BV/TV, trabecular BMD, total BMD, and IT, PTV, and PS. There was correlation between cortical thickness and IT and PS (P≤.05). CONCLUSION Cancellous bone plays an important role in primary stability of mini-implants in the presence or absence of cortical bone.

Microstructural and strength evaluation of regenerate tissue during the consolidation period after vertical mandibular ramus distraction

Mandibular ramus height restoration by distraction osteogenesis (DO) is a key procedure in mandibular hypoplasia reconstruction. The objective of this study was to evaluate short-term skeletal changes in the regenerated bone after vertical mandibular ramus DO using a buried distraction device. Eight subadult beagle dogs underwent bilateral vertical mandibular ramus DO. After a 7-day latency period, distraction was performed at a rate of 0.5 mm twice a day for 12 days. Four dogs were killed at 1 month and four dogs at 2 months after the end of distraction. One intact beagle was included as an unoperated control. After sacrifice, micro computed tomography (μCT) and mechanical testing of distracted sites were used to measure bone volume (BV), total volume (TV), and mechanical peak load strength, respectively. The μCT images showed wide variation in the response, with some animals demonstrating considerable bone formation and reconstitution of the canal for the inferior alveolar nerve. Quantitatively, BV was no more than 67% and BV/TV was less than 25% of the intact control, and strength was approximately 33% of the intact control value. The 1 and 2 month values were similar. These results suggest that internal distractors can successfully reconstitute bone but that the regenerated tissue did not regain structural and mechanical characteristics of native bone within the 2 month study period.

Micro-computed tomography evaluation of the glenoid fossa and mandibular condyle bone after bilateral vertical ramus mandibular distraction in a canine model.

The aim of this study was to quantify bone microarchitecture within the glenoid fossa and mandibular condyle following mandibular distraction osteogenesis. Eight 6- to 9-month-old male beagle dogs underwent bilateral vertical mandibular distraction with semiburied distractors (12 days of distraction at 1 mm per day). One unoperated animal served as control. After distraction the animals were divided into two groups (N = 4) and killed after 1 or 2 months of consolidation. Three-dimensional trabecular architecture was analyzed by micro-computed tomography (μCT). At both sites the overall trends were similar. In the glenoid fossa, there was decreased bone volume, trabecular number, and connectivity density and increased trabecular separation at 1 month and decreased trabecular thickness and increased structure model index compared with the control (P < 0.05). In the mandibular condyle, there was decreased bone volume, trabecular number, and connectivity density at both 1 and 2 months, with decreased trabecular thickness and increased structure model index at 2 months only compared with the control (P < 0.05). The bone became less dense and more rodlike. These bone changes are similar to those seen by the effects of aging or impaired normal function. Thus, in the short term, changes occur in the bone microstructure of the glenoid fossa and mandibular condyle after vertical mandibular ramus distraction in the canine model.

Mutagenicity and cytotoxicity in patients submitted to ionizing radiation.

OBJECTIVES To evaluate and compare mutagenicity (micronucleus) and cytotoxicity (karyorrhexis, pyknosis, and karyolysis) in exfoliated buccal mucosa cells of children following cone beam computed tomography (CBCT) or conventional radiograph exposure necessary for orthodontic planning. MATERIALS AND METHODS A total of 49 healthy children were submitted to CBCT or a conventional orthodontic radiographic protocol; they were divided into two groups based on exam: CBCT (n  =  24) and Radiographic Set (n  =  25) groups. The micronucleus test in the exfoliated buccal mucosa cells was applied. RESULTS There was not a statistically significant difference (P > .05) found between the number of micronucleated buccal mucosa cells (MNC) before and after exposure to radiation in either group, showing that neither group experienced a mutagenic effect. However, radiation did cause other nuclear alterations closely related to cytotoxicity, including karyorrhexis, pyknosis, and karyolysis, in both groups (P < .05). The CBCT group presented a greater increase in cell death than was noted in the Radiographic Set group (P < .044). CONCLUSION According to the micronucleus test, mutagenicity was not induced by the CBCT or the conventional radiographs, but cytotoxicity was verified after these exams, especially after CBCT. That might have happened once the CBCT group received a greater radiation dose than the Radiographic Set group as a result of the protocols used in orthodontic planning for this study.

Evaluation of Maxillary Permanent Molars in Patients With Syndromic Craniosynostosis After Monobloc Osteotomy and Midface Advancement With Rigid External Distraction (RED)

OBJECTIVE This retrospective study was conducted to analyze changes in the maxillary permanent molars after monobloc advancement with rigid external distraction (RED). SETTING University hospital-based craniofacial center. MATERIALS AND METHODS Fourteen patients, three in primary, eight in mixed, and three in permanent dentition underwent monobloc advancement with RED. After a latency period of 6 days, distraction was carried out for 18 days. Lateral cephalometric radiographs were taken before surgery (T1) and an average of 3.72 months after the removal of the distractor (T2). Panoramic radiographs were taken at T1, T2, and T3 (an average of 14.87 months after RED removal), to search for surgical tooth trauma, arrested crown/root development, impaction, tooth germ displacement, dilacerations, and other possible dental abnormalities. Vertical and horizontal displacement and angulations of the permanent maxillary molars were evaluated before and after surgery. STATISTICS A paired t test was used to analyze significant changes in molar position after distraction. RESULTS AND CONCLUSIONS Distraction created posterior arch length with significant horizontal forward movement of the first and second molars (p<.05) and minimal vertical displacement (p>.05). The procedure disrupted the development of one of the first molars, three of the second molars, and two of the third molars. Incidence of molar damage was increased in patients operated on during primary dentition. Careful surgical technique during pterygomaxillary disjunction, especially in young children, and long-term radiographic follow-up of maxillary molars is strongly recommended.

Histological Evaluation of the Temporomandibular Joint After Bilateral Vertical Ramus Mandibular Distraction in a Canine Model

The aim of this pilot study was to histologically evaluate the effect of bilateral vertical mandibular distraction osteogenesis (DO) on the temporomandibular joint (TMJ) in a canine model. Eight male beagle dogs underwent DO, with the placement of single-vector internal distractors. One unoperated animal served as control. After a latency period of 7 days, distraction was performed at a rate of 1 mm a day for an average of 12 days. The animals were divided into two groups (n = 4) and sacrificed after one or two months of consolidation. Eighteen TMJs were prepared for histological evaluation. Control TMJs surfaces were smooth, with no irregularities and trabecular bone was thick and multiply connected. In the one-month group, thinning of the trabecular bone was evident. The trabeculae were long, not multiply connected, parallel to each other and perpendicular to the articular surface. Although overall fibrous-cartilaginous tissues covering the TMJs were maintained with no signs of degenerative changes, one condyle from the one-month group had depressions and erosions of the fibro-cartilage layer and subcortical bone. In the two-month group, overall bone and cartilage architecture was more similar to the control specimens. This study indicates that, in the short term, gross changes can occur in the TMJ after bilateral mandibular vertical ramus distraction. These changes seem to be a process of biological adaptation to the pressure and functional changes secondary to surgery and distraction. However, long-term studies are needed to confirm whether the changes are completely reversible.

Ceramic Surface Polishing Techniques After Removal of Orthodontic Adhesive

OBJECTIVE Verify the in vitro effectiveness of different porcelain surface polishing systems used after orthodontic debonding. MATERIALS AND METHODS Restorations were simulated by 52 metallic samples covered with glazed feldspathic porcelain. Four of these intact samples composed the control group (C). The remaining samples were divided into four groups (n = 12), according to the surface preparation they were to receive: no surface treatment (G1); roughened with a diamond bur (G2); etched with 10% hydrofluoric acid (G3); and sandblasted with aluminum oxide (G4). All experimental samples were treated with silane and bonded with a primer and standardized amount of adhesive. After composite removal, each group was divided into subgroups randomly (n = 4), according to the porcelain polishing system used: Edenta (P1); Identoflex (P2); and Komet (P3). All 52 sample-surfaces were evaluated quantitatively with a profilometer, and a mean roughness profile (Ra) value was determined for each sample. Both control and experimental specimens were evaluated qualitatively using a scanning electron microscope (SEM) to assess surface morphology. RESULTS Statistical analysis with analysis of variance (ANOVA) and post-hoc Tukey multiple comparisons test showed statistical differences between surface preparation groups (G1 not equal G2 = G3 = G4), at alpha = .05 level of significance; as for polishing protocols, no statistical difference was found. CONCLUSIONS The surface preparation was the determinant for final surface texture. No combination between surface preparation and polishing system was able to reestablish the original glazed porcelain smoothness.