Shinya Horiuchi

Three-dimensional finite element analysis of cartilaginous tissues in human temporomandibular joint during prolonged clenching.

OBJECTIVE Bruxism, the parafunctional habit of nocturnal grinding of the teeth and clenching, is associated with the onset of joint degeneration. Especially prolonged clenching is suggested to cause functional overloading in the temporomandibular joint (TMJ). In this study, the distributions of stresses in the cartilaginous TMJ disc and articular cartilage, were analysed during prolonged clenching. The purpose of this study was to examine if joint degradation due to prolonged clenching can be attributed to changes in stress concentration in the cartilaginous tissues. DESIGN Finite element model was developed on the basis of magnetic resonance images from a healthy volunteer. Condylar movements recorded during prolonged clenching were used as the loading condition for stress analysis. RESULTS At the onset of clenching (time=0s), the highest von Mises stresses were located in the middle and posterior areas (6.18MPa) of the inferior disc surface facing the condylar cartilage. The largest magnitude of the minimum principal stress (-6.72MPa) was found in the condylar cartilage. The stress concentrations were relieved towards the superior disc surface facing the temporal cartilage. On the surfaces of the temporal cartilage, relatively lower stresses were found. After 5-min clenching, both stress values induced in the TMJ components were reduced to 50-80% of the stress values at the onset of clenching, although the concomitant strains increased slightly during this period. CONCLUSIONS It is suggested that both the condylar and temporal cartilage layers along with the TMJ disc, play an important role in stress distribution and transmission during prolonged clenching due to tissue expansion. Furthermore, our study suggests that a development of stress concentrations in the TMJ during prolonged clenching and risk factors for the initiation of TMJ degeneration could not be confirmed.

Low-Intensity Pulsed Ultrasound in Dentofacial Tissue Engineering

Oral and maxillofacial diseases affect millions of people worldwide and hence tissue engineering can be considered an interesting and clinically relevant approach to regenerate orofacial tissues after being affected by different diseases. Among several innovations for tissue regeneration, low-intensity pulsed ultrasound (LIPUS) has been used extensively in medicine as a therapeutic, operative, and diagnostic tool. LIPUS is accepted to promote bone fracture repair and regeneration. Furthermore, the effect of LIPUS on soft tissues regeneration has been paid much attention, and many studies have performed to evaluate the potential use of LIPUS to tissue engineering soft tissues. The present article provides an overview about the status of LIPUS stimulation as a tool to be used to enhance regeneration/tissue engineering. This review consists of five parts. Part 1 is a brief introduction of the acoustic description of LIPUS and mechanical action. In Part 2, biological problems in dentofacial tissue engineering are proposed. Part 3 explores biologic mechanisms of LIPUS to cells and tissues in living body. In Part 4, the effectiveness of LIPUS on cell metabolism and tissue regeneration in dentistry are summarized. Finally, Part 5 relates the possibility of clinical application of LIPUS in orthodontics. The present review brings out better understanding of the bioeffect of LIPUS therapy on orofacial tissues which is essential to the successful integration of management remedies for tissue regeneration/engineering. To develop an evidence-based approach to clinical management and treatment of orofacial degenerative diseases using LIPUS, we would like to be in full pursuit of LIPUS biotherapy. Still, there are many challenges for this relatively new strategy, but the up to date achievements using it promises to go far beyond the present possibilities.

Fabrications of zinc-releasing biocement combining zinc calcium phosphate to calcium phosphate cement

Recently, zinc-releasing bioceramics have been the focus of much attention owing to their bone-forming ability. Thus, some types of zinc-containing calcium phosphate (e.g., zinc-doped tricalcium phosphate and zinc-substituted hydroxyapatite) are examined and their osteoblastic cell responses determined. In this investigation, we studied the effects of zinc calcium phosphate (ZCP) derived from zinc phosphate incorporated into calcium phosphate cement (CPC) in terms of its setting reaction and MC3T3-E1 osteoblast-like cell responses. Compositional analysis by powder X-ray diffraction analysis revealed that HAP crystals were precipitated in the CPC containing 10 or 30wt% ZCP after successfully hardening. However, the crystal growth observed by scanning electron microscopy was delayed in the presence of additional ZCP. These findings indicate that the additional zinc inhibits crystal growth and the conversion of CPC to the HAP crystals. The proliferation of the cells and alkaline phosphatase (ALP) activity were enhanced when 10wt% ZCP was added to CPC. Taken together, ZCP added CPC at an appropriate fraction has a potent promotional effect on bone substitute biomaterials.

Stress analysis in the mandibular condyle during prolonged clenching: a theoretical approach with the finite element method

Abstract Parafunctional habits, such as bruxism and prolonged clenching, have been associated with functional overloading in the temporomandibular joint (TMJ), which may result in internal derangement and osteoarthrosis of the TMJ. In this study, the distributions of stress on the mandibular condylar surface during prolonged clenching were examined with TMJ mathematical models. Finite element models were developed on the basis of magnetic resonance images from two subjects with or without anterior disc displacement of the TMJ. Masticatory muscle forces were used as a loading condition for stress analysis during a 10 min clenching. In the asymptomatic model, the stress values in the anterior area (0.100 MPa) and lateral area (0.074 MPa) were relatively high among the five areas at 10 min. In the middle and posterior areas, stress relaxation occurred during the first 2 min. In contrast, the stress value in the lateral area was markedly lower (0.020 MPa) than in other areas in the symptomatic model at 10 min. The largest stress (0.050 MPa) was located in the posterior area. All except the anterior area revealed an increase in stress during the first 2 min. The present result indicates that the displacement of the disc could affect the stress distribution on the condylar articular surface during prolonged clenching, especially in the posterior area, probably leading to the cartilage breakdown on the condylar articular surface.

Novel PAX9 Mutations Cause Non-syndromic Tooth Agenesis

PAX9 is a transcription factor expressed in the tooth mesenchyme during tooth morphogenesis. In Pax9-null mice, tooth development is arrested at the bud stage. In humans, heterozygous mutations in PAX9 have been associated with non-syndromic tooth agenesis, predominantly in the molars. Here, we report 2 novel mutations in the paired domain of PAX9, a three-nucleotide deletion (73-75 delATC) and a missense mutation (C146T), in two unrelated Japanese patients with non-syndromic tooth agenesis. The individual with the 73-75del ATC mutation was missing all maxillary molars and mandibular second and third molars. The individual with the C146T mutation was missing the mandibular central incisors, maxillary second premolars, and first molars, along with all second and third molars. Both mutations affected amino acids that are highly conserved among different species and are critical for DNA binding. When both mutants were transfected to COS7 cells, nuclear localization of PAX9 proteins was not affected. However, reduced expression of the mutant proteins and almost no transcriptional activity of the target BMP4 gene were observed, suggesting haploinsufficiency of PAX9 as the cause of non-syndromic tooth agenesis.

Oral rehabilitation of an orthodontic patient with cleft lip and palate and hypodontia using secondary bone grafting, osseo-integrated implants, and prosthetic treatment.

Objective Complete skeletal and dental reconstruction of the anterior maxilla is of great importance to patients with cleft lip and palate. Accordingly, osseo-integrated implants have been utilized for dental reconstruction after secondary bone grafting. In this report, the orthodontic management of a patient with unilateral cleft lip and plate with associated hypodontia is described. The patient was treated with comprehensive orthodontic treatment in addition to secondary bone grafting, and dental reconstruction was achieved with a combination of osseo-integrated implants and fixed prosthodontic treatment.

Development of a novel cement by conversion of hopeite in set zinc phosphate cement into biocompatible apatite

Synthetic bone cement that has zinc oxide core particles covered with hydroxyapatite (HAP) was developed; that is, the conversion of hopeite, the traditional zinc phosphate cement, into HAP was attempted. Here, hopeite is the final product of the reaction between powders and trituration liquid of the traditional zinc phosphate cement. This cement may have many advantages not only in terms of biological functions but also the setting process of the traditional cement and the mechanical properties of the developed compact if the hopeite can be converted into calcium phosphate (CP). In this study, calcium nitrate solutions of various concentrations were used for the conversion of hopeite crystals into CP. The products after the solution treatment were analyzed by X-ray diffractometry (XRD), Fourier transform infrared spectrometry (FTIR), and scanning electron microscope (SEM) observation. These results indicated that the converted scholzite crystals could be partially detected. Several types of set zinc phosphate cement with different P/L ratios were arranged. The surface products of the set cement after the solution treatment were analyzed by XRD. However, the crystal phase such as hopeite was not detected except for zinc oxide. The set cement, which was treated with the calcium nitrate solution, was immersed in simulated body fluid (SBF). HAP-like crystals on the set cement could be detected for the specimens immersed for 4 weeks. These findings suggested that the binding phase in the set cement could be converted into HAP by immersion in SBF.

Torque Ratio as a Predictable Factor on Primary Stability of Orthodontic Miniscrew Implants

Objective: To evaluate the torque ratio (TR) as a predictable factor on primary stability of orthodontic miniscrews. Design: Fifty-eight orthodontic patients (17 men, 41 women; mean age, 21.9 years) with a total of 112 titanium miniscrews of 3 different diameters were subjected. Maximum insertion torque (MIT) and maximum removal torque (MRT) were measured by a digital torque checker at the screw placement. Four weeks after the placement, the stable screw was recorded as a success. Multiple logistic regression analysis was performed to estimate the influence of each clinical variable on success. Results: Success rates were 82.1% to 89.5%, and there were no significant differences in the 3 types of miniscrews. MIT and MRT showed a positive correlation but did not affect the success rates of miniscrews directly. On the contrary, TR was significantly higher in the success group than in the failure group. In multiple regression analysis, age, TR, and screw proximity had a significant influence on the miniscrew success. Conclusions: TR might be related with the miniscrew success rates, and it can be used as a predictable factor on primary stability of orthodontic miniscrew implants. Miniscrew implants should be replaced if MRT is significantly lower than MIT at placement surgery.

Reinforcement of bond strength of self-etching orthodontic adhesive.

OBJECTIVE To determine the reinforcement of bond strength of a self-etching system by applying a pretreatment agent. MATERIALS AND METHODS Sixty extracted human premolars were used in this study. The enamel surfaces were treated with four pretreatment agents-phosphoric acid, polyacrylic acid, citric acid, and ammonium hexafluorosilicate (SiF)-and were examined under a scanning electron microscope. Afterward, orthodontic brackets were bonded with a self-etching adhesive system (n  =  10 for each agent), and shear bond strength was measured through a debonding process. The adhesive remnant index (ARI) was also assessed. RESULTS Enamel surfaces treated with polyacrylic acid seemed almost the same as intact enamel. Treatment with SiF induced slight shallow depressions compared with the intact enamel. On the other hand, enamel surfaces treated with citric acid and phosphoric acid showed severe etching patterns. All pretreatments increased the bond strength, but SiF-treated specimens revealed the greatest strength (12.201 ± 1.048 MPa), followed by polyacrylic acid (12.030 ± 2.103 MPa). The control group with no pretreatment showed the least strength (9.078 ± 1.678 MPa). All pretreatments increased ARI score compared with the control group. CONCLUSIONS Surface conditioning before bracket adhesion could reinforce the bond strength of the self-etching adhesive system, resulting in a more reliable bonding system.

Skeletal anchorage for intrusion of bimaxillary molars in a patient with skeletal open bite and temporomandibular disorders

The treatment of severe skeletal anterior open bite is extremely difficult in adults, and orthognathic surgery is generally selected for its treatment. We report the case of an 18-year-old adult patient with skeletal anterior open bite and temporomandibular disorders who was successfully treated using temporary anchorage devices. She had an open bite of −2.0 mm and an increased facial height. Miniplates were implanted in both the maxilla and mandible, and molar intrusion resulted in counterclockwise rotation of the mandible over a period of 12 months. After active treatment, her upper and lower first molars were intruded by approximately 2 mm and her overbite became +2.5 mm. Her retrognathic profile improved with counterclockwise rotation of the mandible. Orthodontic treatment aided with skeletal anchorage is beneficial for intrusion of bimaxillary molars in patients with anterior open bite.