Kiyoshi Koyano

Assessment of bruxism in the clinic

Bruxism is a much-discussed clinical issue in dentistry. Although bruxism is not a life-threatening disorder, it can influence the quality of human life, especially through dental problems, such as tooth wear, frequent fractures of dental restorations and pain in the oro-facial region. Therefore, various clinical methods have been devised to assess bruxism over the last 70 years. This paper reviews the assessment of bruxism, provides information on various assessment methods which are available in clinical situations and discusses their effectiveness and usefulness. Currently, there is no definitive method for assessing bruxism clinically that has reasonable diagnostic and technical validity, affects therapeutic decisions and is cost effective. One future direction is to refine questionnaire items and clinical examination because they are the easiest to apply in everyday practice. Another possible direction is to establish a method that can measure actual bruxism activity directly using a device that can be applied to patients routinely. More clinical studies should examine the clinical impact of bruxism on oral structures, treatment success and the factors influencing the decision-making process in dental treatment.

Current barrier membranes: Titanium mesh and other membranes for guided bone regeneration in dental applications

Research on guided bone regeneration (GBR) is still ongoing, with evidence mainly from preclinical studies. Various current barrier membranes should fulfill the main design criteria for GBR, such as biocompatibility, occlusivity, spaciousness, clinical manageability and the appropriate integration with the surrounding tissue. These GBR characteristics are required to provide the maximum membrane function and mechanical support to the tissue during bone formation. In this review, various commercially available, resorbable and non-resorbable membranes with different characteristics are discussed and summarized for their usefulness in preclinical studies. Membranes offer promising solutions in animal models; however, an ideal membrane has not been established yet for clinical applications. Every membrane type presents both advantages and disadvantages. Titanium mesh membranes offer superb mechanical properties for GBR treatment and its current efficacy in trials will be a focus in this review. A thorough understanding of the benefits and limitations inherent to various materials in specific clinical applications will be of great value and aid in the selection of an optimal membrane for GBR.

Diurnal Variation of Human Sweet Taste Recognition Thresholds Is Correlated With Plasma Leptin Levels

OBJECTIVE—It has recently been proposed that the peripheral taste organ is one of the targets for leptin. In lean mice, leptin selectively suppresses gustatory neural and behavioral responses to sweet compounds without affecting responses to other taste stimuli, whereas obese diabetic db/db mice with defects in leptin receptor lack this leptin suppression on sweet taste. Here, we further examined potential links between leptin and sweet taste in humans. RESEARCH DESIGN AND METHODS—A total of 91 nonobese subjects were used to determine recognition thresholds using a standard stair-case methodology for various taste stimuli. Plasma leptin levels were determined by an enzyme-linked immunosorbent assay at several timepoints during the day under normal and restricted-meal conditions. RESULTS—The recognition thresholds for sweet compounds exhibited a diurnal variation from 0800 to 2200 h that parallels variation for leptin levels, with the lowest thresholds in the morning and the highest thresholds at night. This diurnal variation is sweet-taste selective—it was not observed in thresholds for other taste stimuli (NaCl, citric acid, quinine, and mono-sodium glutamate). The diurnal variation for sweet thresholds in the normal feeding condition (three meals) was independent of meal timing and thereby blood glucose levels. Furthermore, when leptin levels were phase-shifted following imposition of one or two meals per day, the diurnal variation of thresholds for sweet taste shifted in parallel. CONCLUSIONS—This synchronization of diurnal variation in leptin levels and sweet taste recognition thresholds suggests a mechanistic connection between these two variables in humans.

Local application of statin promotes bone repair through the suppression of osteoclasts and the enhancement of osteoblasts at bone-healing sites in rats

OBJECTIVE We investigated whether the local administration of simvastatin affected both the cellular events and the bone formation at surgically created bone defects in rat. STUDY DESIGN Simvastatin (or a vehicle) was injected into a rat bony defect for 3 consecutive days from the day of surgery. Five or ten days after the injection, new bone tissue was collected, and the gene expressions of bone-related proteins were examined. For the histomorphometry, new bone area was measured. RESULTS At day 5, the statin group demonstrated significantly larger new bone area. The number of tartrate-resistant acid phosphatase-positive multinucleated cells in the statin group was less than in the control group. In the statin group, the expressions of both alkaline phosphatase and bone morphogenetic protein 2 mRNA significantly increased. In contrast, the expression of cathepsin K was significantly suppressed in the statin group. Although the levels of both RANK and osteoprotegerin were not affected by statin, the expression of RANKL was depressed. At day 10, there were no significant differences among the groups in either histomorphometric or reverse-transcription polymerase chain reaction analyses. CONCLUSION New bone area increased under the influence of simvastatin; however, the effect did not continue when the administration was terminated. Osteoclast suppression may be the consequence of RANKL depression.

Relationship between the bone density estimated by cone‐beam computed tomography and the primary stability of dental implants

OBJECTIVES The aims of this study were to objectively assess bone quality with density values obtained by cone-beam computed tomography (CBCT) and to determine the correlations between bone density and primary stability of dental implants. MATERIAL AND METHODS Eighteen Straumann implants were inserted into 18 fresh femoral heads of swine. The bone densities of implant recipient sites were preoperatively determined by the density value using CBCT. The maximum insertion torque value of each implant was recorded using a digital torque meter. Resonance frequency, which represented a quantitative unit called the implant stability quotient (ISQ), was measured using an Osstell Mentor immediately after the implant placement. Spearmans correlation coefficient was calculated to evaluate the correlations among density values, insertion torques, and ISQs at implant placement. RESULTS The density values ranged from 98 to 902. The mean density value, insertion torque, and ISQ were 591 ± 226, 13.4 ± 5.2 Ncm, and 67.1 ± 8.1, respectively. Statistically significant correlations were found between the density values and insertion torque (r(s) =0.796, P<0.001), density values and ISQ (r(s) =0.529, P=0.024), and insertion torque and ISQ (r(s) =0.758, P<0.001). CONCLUSIONS The bone quality evaluated by specific CBCT showed a high correlation with the primary stability of the implants. Hence, preoperative density value estimations by CBCT may allow clinicians to predict implant stability. Whether the density values obtained by the CBCT device used in the present study could be applied to other devices requires further elucidation.

Deformation analysis of the periodontium considering the viscoelasticity of the periodontal ligament

OBJECTIVES The aim of the present work was, by means of a combined experimental and numerical approach, to investigate the full-field distributions of displacement, stress and strain, and their evolution with loading in the entire fresh periodontium under an externally applied force. METHODS In situ intrusion tests were performed to identify the nonlinear, viscoelastic behavior of the periodontal ligament (PDL) of a pig mandible; a digital image correlation method was applied to examine the full-field deformation patterns in the entire periodontium. The finite element (FE) model was created based on the actual anatomic profiles of individual constituents of the tooth structure; the nonlinear and time-dependent viscoelastic properties of the PDL were input into the FE model to fit the numerical computations with the experimental measurements. RESULTS The nonlinear, viscoelastic behavior of the PDL was identified and characterized quantitatively. The simulation results were validated by the experiments. The results showed the tilting of tooth and the movement of cervical bone toward the mid-tooth in the studied periodontium under vertical compressive loading. Major strain was concentrated in the PDL, with the maxima near to the tooth apexes, at the tooth-root bifurcation and also at the sides of the tooth roots, and maintained a slight rise during holding of the applied displacement. High stress in the tooth was located mainly at the sides of tooth roots, in the bone it was concentrated near the apexes and the root bifurcation, and these stresses decreased gradually during the holding period. SIGNIFICANCE The combined approach of experiments that apply the digital image correlation method and FE analyses that take into account the nonlinear and time-dependent viscoelasticity of the PDL enables the acquisition of a full picture of detailed, realistic stress/strain fields and deformation patterns of the entire fresh periodontium, being of essence in orthodontics and dentistry.

Haemodynamic changes in human masseter and temporalis muscles induced by different levels of isometric contraction

This study evaluated the influence of low contraction forces on intramuscular haemodynamics in human masseter and temporalis using near-infrared tissue spectroscopy. This method allowed the intramuscular haemoglobin (Hb) to be assessed dynamically before, during and after a 5, 15, 25 and 100% maximum voluntary contraction (MVC). Twenty volunteers, 10 males and 10 females, without pain or dysfunction in the masticatory system were included in this study. Data were recorded for 30 s before, 30 s during and 5 min after the four sustained contraction tasks. The results showed that all four levels of voluntary contraction produced a clear haemodynamic response (during and after contraction) in both muscles. For analytical purposes, the maximum Hb achieved after 100% MVC was set equal to 1.00. In the masseter the mean peak Hb during the 5, 15, 25 and 100% MVC was 0.49, 0.92, 1.30 and 1.73 while after the contractions it was 0.50, 0.65, 0.78 and 1.00, respectively. In the temporalis the peak Hb during the contractions was 0.23, 0.36, 0.48 and 0.66 and after the contractions 0.32, 0.45, 0.56 and 1.00, respectively. Repeated-measures analysis of variance revealed a significant main effect for the different contraction levels both in the masseter (during contraction, p = 0.001; after contraction, p<0.001) and the temporalis (during contraction, p = 0.002; after contraction, p<0.001). These data suggest that low levels of contraction induce a clear haemodynamic response, even at 5% effort. When compared, the masseter and anterior temporalis showed clearly different patterns for the Hb signal during the contraction (p<0.001) as well as after it (p = 0.007). Specifically, the Hb during the contractions in the masseter appeared more stable than in the temporalis, which showed a strong return to baseline. Obviously the contracting masseter had a stronger and more sustained venous occlusion than the contracting temporalis. It is speculated that variation in architecture between the two muscles contributes to these differences in blood flow.

Microglial Ca 2+ -Activated K + Channels Are Possible Molecular Targets for the Analgesic Effects of S -Ketamine on Neuropathic Pain

Ketamine is an important analgesia clinically used for both acute and chronic pain. The acute analgesic effects of ketamine are generally believed to be mediated by the inhibition of NMDA receptors in nociceptive neurons. However, the inhibition of neuronal NMDA receptors cannot fully account for its potent analgesic effects on chronic pain because there is a significant discrepancy between their potencies. The possible effect of ketamine on spinal microglia was first examined because hyperactivation of spinal microglia after nerve injury contributes to neuropathic pain. Optically pure S-ketamine preferentially suppressed the nerve injury-induced development of tactile allodynia and hyperactivation of spinal microglia. S-Ketamine also preferentially inhibited hyperactivation of cultured microglia after treatment with lipopolysaccharide, ATP, or lysophosphatidic acid. We next focused our attention on the Ca2+-activated K+ (KCa) currents in microglia, which are known to induce their hyperactivation and migration. S-Ketamine suppressed both nerve injury-induced large-conductance KCa (BK) currents and 1,3-dihydro-1-[2-hydroxy-5-(trifluoromethyl)phenyl]-5-(trifluoromethyl)-2H-benzimidazol-2-one (NS1619)-induced BK currents in spinal microglia. Furthermore, the intrathecal administration of charybdotoxin, a KCa channel blocker, significantly inhibited the nerve injury-induced tactile allodynia, the expression of P2X4 receptors, and the synthesis of brain-derived neurotrophic factor in spinal microglia. In contrast, NS1619-induced tactile allodynia was completely inhibited by S-ketamine. These observations strongly suggest that S-ketamine preferentially suppresses the nerve injury-induced hyperactivation and migration of spinal microglia through the blockade of BK channels. Therefore, the preferential inhibition of microglial BK channels in addition to neuronal NMDA receptors may account for the preferential and potent analgesic effects of S-ketamine on neuropathic pain.

Topical application of statin affects bone healing around implants

OBJECTIVES 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are widely used for hyperlipidemia. Recent studies demonstrate that statins stimulate bone morphogenetic protein-2 expression and lead to bone formation. The aim of this study was to evaluate whether the topical application of statin enhances the osteogenesis around a titanium implant. MATERIALS AND METHODS Ten-week-old female rats received pure titanium rods in both tibiae with or without fluvastatin. Propylene glycol alginate (PGA) was used as a carrier. The rats were divided into five groups: implant-only group, implant with PGA group, low-dose group [implant+PGA containing 3 microg of fluvastatin (FS)], medium-dose group (15 microg of FS), and high-dose group (75 microg of FS). The animals were sacrificed at 1 and 2 weeks after implantation. Peri-implant bone formation was assessed by histomorphometric procedures, i.e., measuring the bone-implant contact (BIC) and peri-implant bone volume (BV). A mechanical push-out test was also performed to evaluate the implant fixation strength. Statistical differences among the groups were determined by ANOVA and P < 0.05 was considered significant. RESULTS At week 1, there was no significant difference in BIC among the groups, however, BV and the push-out strength were significantly higher in the high-dose group than in the implant-only group. At week 2, BIC and BV had significantly increased in the high-dose group in comparison with the non-statin groups. The fluvastatin-treatment group showed a significant increase in push-out strength compared with the non-statin groups. CONCLUSION Our histomorphometrical and mechanical evaluations revealed the positive effect of topically applied fluvastatin on the bone around the implant.

Pattern of occlusal contacts in lateral positions: Canine protection and group function validity in classifying guidance patterns ☆ ☆☆ ★ ★★ ♢

STATEMENT OF PROBLEM The concept of canine protection and group function lack consistency in the definitions and examining methods, and a valid system for evaluating and classifying occlusal contact patterns has not been established. PURPOSE This study assessed the use of canine protection and group function in classifying occlusal guidance in the natural dentition. MATERIAL AND METHODS Occlusal contacts of 86 young adults were examined with shim stock in regulated lateral positions, 0.5,1,2 and 3 mm from the maximum intercuspation. The patterns of occlusal contacts varying with the lateral position were described. RESULTS Focusing on the working-side contact only, most contact patterns belonged to group function, and a few to canine protection. Focusing on both the working and nonworking side contacts, nearly half the contact patterns were those other than canine protection and group function and were classified into balanced occlusion. CONCLUSION The validity of the classification system using canine protection and group function is questionable. A new classification system of occlusal guidance is desirable.