Jack E. Lemons

Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee.

We performed an anatomical dissection of the medial soft-tissue retinacular fibers that restrain lateral patellar displacement and found that the medial patellofemoral ligament inserts not only on the patella but also on the undersurface of the distal aspect of the quadriceps mechanism. The deep capsular layer contained substantial retinacular fibers that were associated with the medial patellomeniscal ligament. Functional studies of the relative contributions of the medial soft-tissue restraints in the prevention of lateral patellar displacement were also performed. Twenty-five fresh-frozen specimens of the knee, obtained after amputations (nineteen specimens) or from cadavera (six specimens) were tested biomechanically on a universal testing instrument. We ranked the soft-tissue restraints, in order of their relative contributions to the restraining force, on the basis of the percentage of force provided by the retinacular and ligamentous tissue that resisted the lateral displacement of the patella. The medial patellofemoral ligament, although varying in size and importance, was found to be the major medial soft-tissue restraint that prevented lateral displacement of the distal knee-extensor mechanism, contributing an average of 53 per cent of the total force. The patellomeniscal ligament and associated retinacular fibers in the deep capsular layer of the knee, which were previously thought to be functionally unimportant in the stabilization of the patella, contributed an average of 22 per cent of the total force. The previously described retinacular fibers (the patellotibial band) were functionally unimportant in the prevention of lateral displacement.

Basic research methods and current trends of dental implant surfaces

Among dental implant design alterations, surface modifications have been by far the most investigated topic. Regarding implant surface research, the lack of hierarchical approaches relating in vitro, in vivo, clinical trials, and ex vivo analyses has hindered biomaterials scientists with clear informed rationale guidelines for implant surface design. This manuscript provides a critical hierarchical overview of the in vitro, laboratory in vivo, clinical, and ex vivo methodologies used to investigate the performance of novel biomaterials aiming to allow dental professionals to better evaluate the past, present, and future dental implant surface research. This manuscript also contains an overview of the commercially available surface texture and chemistry modifications including novel nanotechnology-based fabrication processes. Over the last decade, surface texturing has been the most utilized parameter for increasing the host-to-implant response. Recently, dental implant surfaces utilizing reduced length scale physico/chemical features (atomic and nanometric) have shown the potential to synergistically use both texture and the inclusion of bioactive ceramic components on the surface. Although surface modifications have been shown to enhance osseointegration at early implantation times, information concerning its long-term benefit to peri-implant tissues is lacking due to the reduced number of controlled clinical trials. Given the various implants/surfaces under study, the clinician should ask, founded on the basic hierarchical approach described for the in vitro, laboratory in vivo data, as well as the results of clinical studies to effectiveness before use of any dental implant.

Rationale for the application of immediate load in implant dentistry: part II.

Immediate loading in implant dentistry is increasing in popularity as a clinical procedure. A scientific rationale of immediate occlusal loading of the implant support system should emphasize methods to decrease surgical trauma during implant placement and to decrease bone loading trauma during the early loading period. The surgical trauma may be reduced by decreasing heat generation and pressure necrosis. The early loading trauma may be decreased by decreasing the bone strain adjacent to the implant interface. Greater microstrain conditions in bone increase the remodeling rate of bone. The higher the remodeling rate, the weaker the bone and the more risk of occlusal overload. Occlusal overload may lead to implant failure. Since strain is directly related to stress, methods to decrease stress are beneficial. In the present report, the stress-reducing influences include increasing the number of implants.

Quasi-linear viscoelastic behavior of the human periodontal ligament.

Previous studies have not produced a comprehensive mathematical description of the nonlinear viscoelastic stress-strain behavior of the periodontal ligament (PDL). In the present study, the quasi-linear viscoelastic (QLV) model was applied to mechanical tests of the human PDL. Transverse sections of cadaveric premolars were subjected to relaxation tests and loading to failure perpendicular to the plane of section. Distinct and repeatable toe and linear regions of stress-strain behavior were observed. The amount of strain associated with the toe region differed as a function of anatomical location along the tooth root. Stress relaxation behavior was comparable for different anatomical locations. Model predicted peak tissue stresses for cyclic loading were within 11% of experimental values, demonstrating that the QLV approach provided an improved, accurate quantification of PDL mechanical response. The success of the QLV approach supports its usefulness in future efforts of experimental characterization of PDL mechanical behavior.

Biomaterials, Biomechanics, Tissue Healing, and Immediate-Function Dental Implants

Selected factors and opinions are reviewed specific to immediate function of dental implants in terms of biomaterial and biomechanical properties and how they might influence postsurgical tissue healing. Comparisons are made among plate, rod, and screw vs plateau, finn, and porous geometry endosteal dental-implant designs with and without alterations in device body-surface microchemistry and microtopography. Available information introduces more questions than answers, and recommendations are made for ongoing studies of bone responses specific to the implant fit and fill parameters focused on the kinetics of postsurgical osteotomy healing and applied loading. The clinical literature supports opportunities for immediate function; however, proposals about pathways for bone healing need further investigation. The current trends within the discipline of implant dentistry offer opportunities to reevaluate current vs previous immediate-function systems.

Physico/chemical characterization and in vivo evaluation of nanothickness bioceramic depositions on alumina-blasted/acid-etched Ti-6Al-4V implant surfaces

The objective of this study was to physico/chemically characterize and evaluate the in vivo performance of two nanothickness ion beam assisted depositions (IBAD) of bioceramic coatings on implants in a beagle model. Alumina-blasted/acid-etched (AB/AE) Ti-6Al-4V implants were subjected to two different IBAD depositions (IBAD I and IBAD II), which were physico/chemically characterized by SEM, EDS, XPS, XPS + ion-beam milling (depth profiling), XRD, AFM, and ToF-SIMS. A beagle dog tibia model was utilized for histomorphometric and biomechanical (torque) comparison between AB/AE, IBAD I, IBAD II, and plasma-sprayed hydroxyapatite (PSHA) coated implants that remained in vivo for 3 and 5 weeks. The coatings were characterized as amorphous Ca-P with high Ca/P stoichiometries with thicknesses of an order of magnitude difference (IBAD I = 30-50 nm and IBAD II = 300-500 nm). The histomorphometric and biomechanical testing results showed that the 300-500 nm thickness deposition (IBAD II) and PSHA positively modulated bone healing at early implantation times.

Early healing of nanothickness bioceramic coatings on dental implants. An experimental study in dogs.

Thick bioceramic coatings like plasma sprayed hydroxyapatite have been shown to increase the overall tissue response and biomechanical fixation of dental implants. However, the presence and potential fracture of a bone-coating-metallic substrate interface at long times after implantation led these implants to fall from favor in clinical practice. The purpose of this study was to evaluate the biomechanical fixation and biological response of Ca- and P-based, 20-50 nm thickness bioceramic deposition on a previously alumina-blasted/acid-etched Ti-6Al-4V implant surface in a dog model. Cylindrical alumina-blasted/acid-etched (AB/AE) (Control, n = 16), and Nanothickness bioceramic coated AB/AE(Nano, n = 16) implant surfaces were surgically placed in dogs proximal tibia and remained for 2 and 4 weeks in vivo. Following euthanization, the implants-in-bone were mounted in epoxy and pullout at a 0.5 mm/min rate. Following mechanical testing, the specimens were decalcified and processed (Hematoxylin and Eosin) for standard transmitted light microscopy evaluation. Percent bone-to-implant contact (BIC) to the pulled out implant surface was determined through computer software. Statistical analyses were performed by one-way ANOVA at 95% level of significance and Tukeys post-hoc multiple comparisons. No significant differences in pullout force were observed (p > 0.88): 2W Control (212.08 +/- 42.96 N), 2W Nano (224.35 +/- 42.97 N), 4W Control (207.07 +/- 42.97 N), and 4W Nano (190.15 +/- 45.94 N). No significant differences in %BIC were observed (p > 0.94): 2W Control (72.66 +/- 8.51), 2W Nano (69.44 +/- 8.51), 4W Control (70.44 +/- 8.51), and 4W Nano (69.11 +/- 9.09). It is shown that 20-50 nm thickness bioceramic depositions onto previously alumina-blasted/acid-etched substrates did not improve the biomechanical fixation and the BIC at early implantation times, and studies concerning shorter and longer implantation times are recommended for confirmation or before a conclusion can be made.

Histologic study of hydroxylapatite as an implant material for mandibular augmentation.

Dogs were used to compare supraperiosteal implantation of hydroxylapatite with subperiosteal implantation with and without partial decortication of the underlying bone. Whereas supraperiosteal implants were unstable, nine months of observation indicated that the subperiosteal implants developed a strong attachment and mechanical stabilization as a result of formation of investing fibrous and osseous tissues. These results provide a basis for a technique of alveolar augmentation and denture construction.

Effect of surface treatment on unalloyed titanium implants : Spectroscopic analyses

Surgical implant finishing and sterilization procedures were investigated to determine surface characteristics of unalloyed titanium (Ti). All specimens initially were cleaned with phosphoric acid and divided into five groups for comparisons of different surface treatments (C = cleaned as above, no further treatment; CP = C and passivated in nitric acid; CPS = CP and dry-heat sterilized; CPSS = CPS and resterilized; CS = C and dry-heat sterilized). Auger (AES), X-ray photoelectron (XPS), and Raman spectroscopic methods were used to examine surface compositions. The surface oxides formed by all treatments primarily were TiO2, with some Ti2O3 and possibly TiO. Significant concentrations of carbonaceous substances also were observed. The cleaning procedure alone resulted in residual phosphorus, primarily as phosphate groups along with some hydrogen phosphates. A higher percentage of physisorbed water appeared to be associated with the phosphorus. Passivation (with HNO3) alone removed phosphorus from the surface; specimens sterilized without prior passivation showed the thickest oxide and phosphorus profiles, suggesting that passivation alters the oxide characteristics either directly by altering the oxide structure or indirectly by removing moieties that alter the oxide. Raman spectroscopy showed no crystalline order in the oxide. Carbon, oxygen, phosphorus, and nitrogen presence were found to correlate with previously determined surface energy.

Biodegradation of Restorative Metallic Systems

Metallic materials utilized for the construction of intra-oral and implant dental restorations include a wide range of relatively pure metals and multicomponent alloys. Basic corrosion and biodegradation properties of these alloys have been studied by both in vitro and in vivo techniques. These property characteristics have been shown to be dependent on composition and metallurgical state, combinations within a construct, surface conditions, mechanical aspects of function, and the local and systemic host environment. The susceptibility of these metallic materials to various forms of biodegradation will be presented, with emphasis on corrosion.