Elaine Romberg

Histologic Evaluation of New Attachment Apparatus Formation in Humans

There is conflicting evidence regarding the value of graft materials in enhancing the formation of new bone, cementum, and periodontal ligament (new attachment apparatus). Part II of this study compared the healing of intrabony defects with and without the placement of decalcified freeze-dried bone allograft (DFDBA) in a submerged environment. The most apical level of calculus on the root served as a histologic reference point to measure regeneration on root surfaces exposed to the oral environment. Biopsies were obtained at 6-months and evaluated histometrically by two investigators unaware of the treatment performed. Data from 9 patients with 30 grafted defects and 13 nongrafted defects were submitted for statistical analysis. Results indicate that in a submerged environment significantly more new attachment apparatus (P less than .05) and new bone (P less than .05) formed in grafted than nongrafted sites. Significantly greater loss of alveolar crest height occurred in nongrafted than grafted defects (P less than .05); regeneration of new attachment apparatus, new bone, and new cementum occurred more frequently in grafted than nongrafted defects. There was a greater chance for the regeneration of a connective tissue attachment in nongrafted intrabony defects than in grafted defects; new cellular cementum formed equally well on old cementum, dentin, or both old cementum and dentin in the same defect. The periodontal ligament was oriented parallel, perpendicular, or both parallel and perpendicular in the same defect; and, no extensive root resorption, ankylosis, or pulp death was observed in grafted or nongrafted defects.

Stem/progenitor cells from inflamed human dental pulp retain tissue regeneration potential

BACKGROUND Potent stem/progenitor cells have been isolated from normal human dental pulps termed dental pulp stem cells (DPSCs). However, it is unknown whether these cells exist in inflamed pulps (IPs). AIMS To determine whether DPSCs can be identified and isolated from IPs; and if they can be successfully cultured, whether they retain tissue regeneration potential in vivo. MATERIALS & METHODS DPSCs from freshly collected normal pulps (NPs) and IPs were characterized in vitro and their tissue regeneration potential tested using an in vivo study model. RESULTS The immunohistochemical analysis showed that IPs expressed higher levels of mesenchymal stem cell markers STRO-1, CD90, CD105 and CD146 compared with NPs (p < 0.05). Flow cytometry analysis showed that DPSCs from both NPs and IPs expressed moderate to high levels of CD146, stage-specific embryonic antigen-4, CD73 and CD166. Total population doubling of DPSCs-IPs (44.6 + or - 2.9) was lower than that of DPSCs-NPs (58.9 + or - 2.5) (p < 0.05), and DPSCs-IPs appeared to have a decreased osteo/dentinogenic potential compared with DPSCs-NPs based on the mineral deposition in cultures. Nonetheless, DPSCs-IPs formed pulp/dentin complexes similar to DPSCs-NPs when transplanted into immunocompromised mice. CONCLUSION DPSCs-IPs can be isolated and their mesenchymal stem cell marker profiles are similar to those from NPs. Although some stem cell properties of DPSCs-IPs were altered, cells from some samples remained potent in tissue regeneration in vivo.

The Effect of Age on Bacterial Penetration of Radicular Dentin

The aim of this study was to determine the effects of patients age on the prevalence and depth of bacterial penetration inside dentinal tubules. Fifty-six single-rooted teeth were divided in two groups based on the patients age: young (ages 18-25) and old (age >or=60). Teeth were instrumented and inoculated with a standardized bacterial load and incubated for 20 days. Histological analysis was performed to determine the degree of infection of the dentinal tubules by counting the number of invaded tubules and the depth of penetration of bacteria inside the tubules. A significantly higher number of tubules were invaded by bacteria in the young group compared with the old group (p = 0.014). Also, the depth of invasion by bacteria was significantly higher in the young than in the old group (p = 0.033). These results suggest that bacterial infection of dentinal tubules occur to a lesser extent in older patients.

The change in retentive values of locator attachments and hader clips over time.

PURPOSE The aim of this study was to examine early changes in retentive values of implant overdenture attachments during multiple pulls. MATERIALS AND METHODS Two implant attachment systems (Hader bar and clip, Locator system) were used in this study. The experimental groups were divided into yellow Hader clips, white Locator attachments, and green Locator attachments. Each group consisted of 21 matrix attachments. The attachments were placed into a custom-made acrylic resin block seated passively on another acrylic block containing a Hader bar or two Locator abutments with different angulations. Each attachment was subjected to 20 consecutive pulls using a universal testing machine. The peak load-to-dislodgement of the attachments after each pull was documented, and the percent reduction of the peak load-to-dislodgement was calculated. One-way ANOVA and Tukeys honestly significant difference test were used for data analyses. A p < or = 0.05 was considered significant. RESULTS There was a significant difference in the percent reduction in peak load-to-dislodgement between the attachments after the first pull (p= 0.005) and after the final pull (p= 0.0001). The yellow Hader clips exhibited the least percent reduction in peak load-to-dislodgement (6.50 +/- 3.59%) after the first pull, followed by the white Locator attachments (8.60 +/- 4.42%); the green Locator attachments exhibited the greatest reduction (11.05 +/- 4.94%). CONCLUSION The results of this in vitro study demonstrate that retentive values of the Locator attachments are reduced significantly after multiple pulls. Although this reduction might not be noticeable to the patient, it is recommended that the clinician place and remove the overdenture multiple times before delivery.

Vertical fracture of root filled teeth restored with posts: the effects of patient age and dentine thickness

AIM To determine whether patient age contributed to the fracture resistance of teeth subjected to root canal treatment and post placement. METHODOLOGY Forty-five single-rooted, single-canal human teeth were mounted, instrumented, obturated and prepared for a post. The teeth were divided into young (18 < or = age < or = 35) and old (60 < or = age) groups and subjected to cyclic loading until fracture; those reaching 200,000 cycles without undergoing failure were then subjected to static loading to fracture. Statistical differences between groups were examined using one-way anovas, and correlations were identified using Pearsons r; significance was established at P < or = 0.05. RESULTS There was no significant difference between the two age groups in terms of the number of cycles to fracture (P > 0.05) or the load to fracture (P > 0.05). However, there was a significant correlation (P < or = 0.05) between the root fracture resistance and individual age, indicating that the susceptibility to root fracture increases significantly with increasing patient age. Also, the dentine thickness of roots that fractured was significantly less than those that did not (P = 0.04). CONCLUSION Vertical root fracture of teeth receiving root canal treatment with posts is more likely to occur in the teeth of older patients (60+) and particularly in those with low dentine thickness.

ABRASIVE MACHINING OF GLASS-INFILTRATED ALUMINA WITH DIAMOND BURS

The abrasive machining characteristics of a glass-infiltrated alumina used for fabrication of all-ceramic dental crowns were investigated using a high-speed dental handpiece and diamond burs with different grit sizes. The material removal rate, surface roughness, and extent of edge chipping were measured as a function of grit size. The removal rate decreased substantially with decreasing bur grit size from supercoarse (180 μm) to fine (40 μm) and ultrafine (10 μm). The removal rate with the supercoarse burs was approximately twice that achieved with the fine burs and four times the removal rate with the ultrafine burs. Both surface roughness and edge chipping damage were sensitive to diamond grit size. Chipping damage was severe and the surface roughness substantial with the supercoarse burs, while negligible edge chipping and smooth surfaces were obtained with the ultrafine burs. The removal rate also decreased with continued machining for all grit sizes. The observed reduction in removal rate was found to be primarily due to wear of the diamond grit and accumulation of debris on the bur (i.e., bur loading). After prolonged use, a significant loss of diamond grit was observed that led to a substantial loss of cutting efficiency. It is concluded that, with respect to material removal rate and surface integrity, diamond machining is a feasible machining process for glass-infiltrated alumina in the final infiltrated state. However, caution should be exercised in the use of diamond grit larger than 40 μm. Such burs may result in excessively rough surfaces, chipped edges, and strength limiting surface and subsurface microcracks.

The Reduction in Fatigue Crack Growth Resistance of Dentin with Depth

The fatigue crack growth resistance of dentin was characterized as a function of depth from the dentino-enamel junction. Compact tension (CT) specimens were prepared from the crowns of third molars in the deep, middle, and peripheral dentin. The microstructure was quantified in terms of the average tubule dimensions and density. Fatigue cracks were grown in-plane with the tubules and characterized in terms of the initiation and growth responses. Deep dentin exhibited the lowest resistance to the initiation of fatigue crack growth, as indicated by the stress intensity threshold (ΔKth ≈ 0.8 MPa•m0.5) and the highest incremental fatigue crack growth rate (over 1000 times that in peripheral dentin). Cracks in deep dentin underwent incremental extension under cyclic stresses that were 40% lower than those required in peripheral dentin. The average fatigue crack growth rates increased significantly with tubule density, indicating the importance of microstructure on the potential for tooth fracture. Molars with deep restorations are more likely to suffer from the cracked-tooth syndrome, because of the lower fatigue crack growth resistance of deep dentin.

Predation Pattern and Phylogenetic Analysis of Bdellovibrionaceae from the Great Salt Lake, Utah

The Bdellovibrionaceae are predatory, intraperiplasmic bacteria that prey upon a variety of Gram-negative bacteria. The prey susceptibility pattern is frequently used to characterize new isolates. The objective in this study was to isolate and characterize predators from the Great Salt Lake (GSL) by prey susceptibility testing. To recover the predators, water samples were inoculated into an enrichment medium with Vibrio parahaemolyticus as prey. After several days of incubation, the predators were isolated, pure DNA was extracted, and partial 16S rDNA gene was sequenced. Water samples were also plated for isolation of heterotrophic bacteria. The susceptibility of bacterial isolates from the lake and other sources to each predator isolate was determined. The results revealed that there are predators in the GSL, and they preferentially prey on bacteria from the lake. This is the first report of the isolation of Bdellovibrionaceae from GSL and the predators showing preferences for bacteria from the same habitat.

Contributions of aging to the fatigue crack growth resistance of human dentin.

An evaluation of the fatigue crack resistance of human dentin was conducted to identify the degree of degradation that arises with aging and the dependency on tubule orientation. Fatigue crack growth was achieved in specimens of coronal dentin through application of Mode I cyclic loading and over clinically relevant lengths (0 ≤ a ≤ 2 mm). The study considered two directions of cyclic crack growth in which the crack was either in-plane (0°) or perpendicular (90°) to the dentin tubules. Results showed that regardless of tubule orientation, aging of dentin is accompanied by a significant reduction in the resistance to the initiation of fatigue crack growth, as well as a significant increase in the rate of incremental extension. Perpendicular to the tubules, the fatigue crack exponent increased significantly (from m=14.2 ± 1.5 to 24.1 ± 5.0), suggesting an increase in brittleness of the tissue with age. For cracks extending in-plane with the tubules, the fatigue crack growth exponent does not change significantly with patient age (from m=25.4 ± 3.03 to 22.9 ± 5.3), but there is a significant increase in the incremental crack growth rate. Regardless of age, coronal dentin exhibits the lowest resistance to fatigue crack growth perpendicular to the tubules. While there are changes in the cyclic crack growth rate and mechanisms of cyclic extension with aging, this tissue maintains its anisotropy.

The effect of denture cleansing solutions on the retention of pink Locator attachments: an in vitro study.

PURPOSE To evaluate the changes in retention of pink Locator attachments after exposure to various denture cleansers. MATERIALS AND METHODS Six groups (20 pairs each) of pink Locator attachments (3.0 lb. Light Retention replacement patrix attachments) were soaked for the equivalent of 6 months of clinical use in the following solutions: Water (control), Polident Regular, Efferdent, 6.15% sodium hypochlorite (NaOCL, 1:10 dilution), Polident Overnight, and Cool Mint Listerine mouthwash. A universal testing machine set at a crosshead speed of 2 in/min was used to perform one pull. The peak load-to-dislodgement was recorded to reflect changes in the retention of the Locator attachments after soaking. Data were analyzed by one-way ANOVA followed by Tukeys Honestly Significant Difference test. A p< or = 0.05 was considered significant. RESULTS Denture cleansing solutions significantly affected the retentive values of pink Locator attachments (F = 344.3, p< or = 0.0001). Cool Mint Listerine mouthwash increased the retentive values of the attachments (51.10 +/- 5.31 N) when compared to the control group (45.25 +/- 3.49 N). There was no significant difference in the retentive values of attachments soaked in Polident Regular or Polident Overnight when compared to the control group. Efferdent caused a small reduction in the retentive values (40.81 +/- 2.56 N) and most importantly, diluted NaOCl caused a large reduction in the retentive values (7.83 +/- 2.50 N) of pink Locator attachments. In addition, Cool Mint Listerine mouthwash caused blue discoloration of the Locator attachments, and NaOCl caused whitening and softening of the pink Locator attachments. CONCLUSION Cool Mint Listerine and Efferdents small effect on the retentive values of the Locators might be clinically unimportant; however, NaOCl caused a large reduction in the retentive values of the attachments. Because of their effect on retentive values and on the color of the Locator attachments, NaOCl and Cool Mint Listerine are not recommended. These results should be interpreted clinically with caution, realizing that different results may be obtained when fatigue stress during function and multiple pulls (in vivo) are combined with the chemical action of denture cleansers.