Sunil Kapila

Mechanical properties and clinical applications of orthodontic wires

This review article describes the mechanical properties and clinical applications of stainless steel, cobalt-chromium, nickel-titanium, beta-titanium, and multistranded wires. The consolidation of this literature will provide the clinician with the basic working knowledge on orthodontic wire characteristics and usage. Mechanical properties of these wires are generally assessed by tensile, bending, and torsional tests. Although wire characteristics determined by these tests do not necessarily reflect the behavior of the wires under clinical conditions, they provide a basis for comparison of these wires. The characteristics desirable in an orthodontic wire are a large springback, low stiffness, good formability, high stored energy, biocompatibility and environmental stability, low surface friction, and the capability to be welded or soldered to auxiliaries. Stainless steel wires have remained popular since their introduction to orthodontics because of their formability, biocompatibility and environmental stability, stiffness, resilience, and low cost. Cobalt-chromium (Co-Cr) wires can be manipulated in a softened state and then subjected to heat treatment. Heat treatment of Co-Cr wires results in a wire with properties similar to those of stainless steel. Nitinol wires have a good springback and low stiffness. This alloy, however, has poor formability and joinability. Beta-titanium wires provide a combination of adequate springback, average stiffness, good formability, and can be welded to auxiliaries. Multistranded wires have a high springback and low stiffness when compared with solid stainless steel wires. Optimal use of these orthodontic wires can be made by carefully selecting the appropriate wire type and size to meet the demands of a particular clinical situation.

Evaluation of friction between edgewise stainless steel brackets and orthodontic wires of four alloys

This investigation was designed to determine the effects of wire size and alloy on frictional force generated between bracket and wire during in vitro translatory displacement of bracket relative to wire. Stainless steel (SS), cobalt-chromium (Co-Cr), nickel-titanium (NiTi), and beta-titanium (beta-Ti) wires of several sizes were tested in narrow single (0.050-inch), medium twin (0.130-inch) and wide twin (0.180-inch) stainless steel brackets in both 0.018- and 0.022-inch slots. The wires were ligated into the brackets with elastomeric ligatures. Bracket movement along the wire was implemented by means of a mechanical testing instrument, and frictional forces were measured by a compression cell and recorded on an X-Y recorder. beta-Ti and NiTi wires generated greater amounts of frictional forces than SS or Co-Cr wires did for most wire sizes. Increase in wire size generally resulted in increased bracket-wire friction. The wire size-alloy interaction on the magnitude of bracket-wire friction was statistically significant (p less than 0.005). With most wire sizes and alloys, narrow single brackets were associated with lower amounts of friction than wider brackets were. The levels of frictional forces in 0.018-inch brackets ranged from 49 gm with 0.016-inch SS wires in narrow single brackets to 336 gm with 0.017 x 0.025-inch beta-Ti wires in wide twin brackets. Similarly for 0.022-inch brackets, frictional forces ranged from 40 gm with 0.018-inch SS wires in narrow single brackets to 222 gm with 0.019 x 0.025-inch NiTi wires in wide twin brackets.

Growth changes in the soft tissue facial profile

Longitudinal growth changes in the soft tissue profile of 40 caucasians between the ages of 7 and 18 were studied. The sample consisted of 17 males and 23 females who had Class I dentitions and balanced faces at age 7 and 18 years. None of the subjects received any orthodontic treatment. Cephalometric radiographs were available, as a rule, on a yearly basis. Soft tissue thickness, measured at the nose, upper lip, lower lip and chin, as well as the length of the upper and lower lip, all increased by varying amounts over the period of the study. Females acquired more growth as a percentage of their adult size (at age 18) than males in all variables except the angle of inclination of the skeletal chin which increased more in males. The largest increase in relative size was noted in the nose measurements. In males, the nose had not attained adult size even at age 18. Upper lip length growth, on the other hand, in both males and females was complete by the 15th year. The difference between male and female lip length growth was clinically significant; the average aggregate increase in upper and lower lips combined in males was 6.9 millimeters compared to 2.65 millimeters in females. The total gain in thickness at laberale superius was over four times as much in males as in females and continued to increase in males even at age 18. The change in thickness of the soft tissue at pogonion was not large, an average of 2.4 millimeters in males and 1.5 millimeters in females. The major contribution to the anterior growth of the chin was translatory, contributed largely by growth in the skeletal length from pogonion to pterygomaxillary plane.

Multiple Differentiation Capacity of STRO-1+/CD146+ PDL Mesenchymal Progenitor Cells

Although mesenchymal progenitor cells can be isolated from periodontal ligament (PDL) tissues using stem cell markers STRO-1 and CD146, the proportion of these cells that have the capacity to differentiate into multiple cell lineages remains to be determined. This study was designed to quantify the proportions of primary human PDL cells that can undergo multilineage differentiation and to compare the magnitude of these capabilities relative to bone marrow-derived mesenchymal stem cells (MSCs) and parental PDL (PPDL) cells. PDL mesenchymal progenitor (PMP) cells were isolated from PPDL cells using the markers STRO-1 and CD146. The colony-forming efficiency and multilineage differentiation potential of PMP, PPDL, and MSCs under chondrogenic, osteogenic, and adipogenic conditions were determined. Flow cytometry revealed that on average 2.6% of PPDL cells were STRO-1(+)/CD146(+), whereas more than 63% were STRO-1(-)/CD146(-). Colony-forming efficiency of STRO-1(+)/CD146(+) PMP cells (19.3%) and MSCs (16.7%) was significantly higher than that of PPDL cells (6.8%). Cartilage-specific genes, early markers of osteoblastic differentiation, and adipogenic markers were significantly upregulated under appropriate conditions in PMP cells and MSCs compared to either their noninduced counterparts or induced PPDL cells. Consistent with these findings, immunohistochemistry revealed substantial accumulation of cartilaginous macromolecules, mineralized calcium nodules, and lipid vacuoles under chondrogenic, osteogenic, or adipogenic conditions in PMP and MSC cultures, respectively, compared to noninduced controls or induced PPDL cells. Thus STRO-1(+)/CD146(+) PMP cells demonstrate multilineage differentiation capacity comparable in magnitude to MSCs and could potentially be utilized for regeneration of the periodontium and other tissues.

Evaluation of friction between ceramic brackets and orthodontic wires of four alloys

The purpose of this investigation was to determine the frictional resistance offered by ceramic brackets used in combination with wires of different alloys and sizes during in vitro translatory displacement of brackets. Findings with ceramic brackets were also compared with outcomes of treatment with stainless steel brackets. Stainless steel, cobalt-chromium, beta-titanium, and nickel-titanium wires of different cross-sectional sizes were tested in medium-twin monocrystalline ceramic brackets with both 0.018-inch and 0.022-inch slot sizes. The wires were ligated into the brackets with elastomeric modules. Brackets were moved along the wire by means of an Instron universal testing machine, and frictional force was measured by a compression cell and recorded graphically on an xy recorder. Wire friction in the ceramic brackets increased as wire size increased, and rectangular wires produced greater friction than round wires. Beta-titanium and nickel-titanium wires were associated with higher frictional forces than stainless steel or cobalt-chromium wires. These findings follow the same general trends as those found with stainless steel brackets; however, wires in ceramic brackets generated significantly stronger frictional force than did wires in stainless steel brackets.

Chondrogenic differentiation of human mesenchymal stem cells in three-dimensional alginate gels.

We characterized the temporal changes in chondrogenic genes and developed a staging scheme for in vitro chondrogenic differentiation of human mesenchymal stem cells (hMSCs) in three-dimensional (3D) alginate gels. A time-dependent accumulation of glycosaminoglycans, aggrecan, and type II collagen was observed in chondrogenic but not in basal constructs over 24 days. qRT-PCR demonstrated a largely characteristic temporal pattern of chondrogenic markers and provided a basis for staging the cellular phenotype into four stages. Stage I (days 0-6) was defined by collagen types I and VI, Sox 4, and BMP-2 showing peak expression levels. In stage II (days 6-12), gene expression for cartilage oligomeric matrix protein, HAPLN1, collagen type XI, and Sox 9 reached peak levels, while gene expression of matrilin 3, Ihh, Homeobox 7, chondroadherin, and WNT 11 peaked at stage III (days 12-18). Finally, cells in stage IV (days 18-24) attained peak levels of aggrecan; collagen IX, II, and X; osteocalcin; fibromodulin; PTHrP; and alkaline phosphatase. Gene profiles at stages III and IV were analogous to those in juvenile articular and adult nucleus pulposus chondrocytes. Gene ontology analyses also demonstrated a specific expression pattern of several putative novel marker genes. These data provide comprehensive insights on chondrogenesis of hMSCs in 3D gels. The derivation of this staging scheme may aid in defining maximally responsive time points for mechanobiological modulation of constructs to produce optimally engineered tissues.

Craniofacial imaging in orthodontics: Historical perspective, current status, and future developments

Rapid and substantial advances in imaging methods and technology have not always been expediently or adequately communicated to the practicing orthodontist. In this review we highlight contemporary imaging techniques and innovations in imaging that, in the future, are likely to greatly improve the depiction of craniofacial structures for use in diagnosis and treatment planning. In order to provide an appropriate background for this topic, we first discuss the evolution of craniofacial imaging in orthodontics and review the limitations of current methods, including the two-dimensional representation of three-dimensional anatomy, depiction as a patchwork of site-specific images, associated geometric errors, and images that have a limited point of view and are static in space and time. Three-dimensional computed tomography can be considered a partial solution to these limitations, but imaging costs, radiation exposure, and lack of soft tissue representation may make it unacceptable for routine orthodontics. A more complete solution might be achieved through digital processing of contemporary imaging technologies that would extend their capabilities, overcome many of their limitations, and result in an increase in the amount of relevant information obtained. Digital processes are currently being developed that create accurate multidimensional models that integrate form and function. These models will be interactive, linked to knowledge databases, and will provide the clinician with answers to pertinent questions. These advances in imaging are likely to enhance the accuracy and reliability of orthodontic diagnosis and treatment planning, and will be of importance in both clinical practice and research.

Pressure and Distortion Regulate Human Mesenchymal Stem Cell Gene Expression

While the concept that physical forces such as tension and compression are involved in mature tissue modeling is widely accepted, the role of these specific types of mechanical loading in the differentiation and maturation of uncommitted cell types like human mesenchymal stem cells (hMSCs) is currently unknown. We observed that hMSCs have the fundamental ability to distinguish between dynamic tensile and compressive loading by regulating distinct gene expression patterns and that these differences in gene expression can be related to conformational changes in cell shape and volume. Dynamic tension was found to regulate both fibroblastic and osteogenic associated genes while dynamic compression up-regulated genes associated with chondrogenesis. Identifying genes involved in the mechanotransduction of different modes of physical loading in hMSC may greatly enhance the ability to rationally design tissue regeneration systems to restore proper tissue function.

Fibronectin and fibronectin fragments modulate the expression of proteinases and proteinase inhibitors in human periodontal ligament cells

Fragments of the matrix molecule fibronectin (FN) have been shown to modulate tissue remodeling activity by inducing matrix metalloproteinases (MMPs) in synovial fibroblasts. These molecules could contribute to the tissue degradation that occurs during periodontal disease if they also modulate the expression of proteinases in cells of the periodontal ligament (PDL). We tested the hypothesis that FN and specific FN fragments induce the expression of specific proteinases in PDL cells. Using substrate zymograms, reverse zymograms and Western immunoblots, we found that PDL cells constitutively express 72 kDa gelatinase, urokinase-type plasminogen activator (uPA) and at least three inhibitors whose molecular masses correspond to those of the tissue inhibitors of metalloproteinases (TIMPs). A fourth, previously uncharacterized, proteinase inhibitor of approximately 22 kDa was also observed in some cell isolates. PDL cells, when exposed to a 120 kDa proteolytic FN fragment containing the cell-binding domain, were induced to express collagenase and stromelysin and also demonstrated an increased secretion of the serine proteinase uPA. Expression of collagenase increased with increasing concentrations (0.001 microM-1 microM) of the 120 kDa FN fragment. This fragment also induced the expression of a 20 kDa inhibitor, but not of the higher-molecular-mass inhibitors, in PDL cells. The observed alterations in proteinases were associated specifically with the 120 kDa FN fragment, since similar responses were not seen when PDL cells were exposed to either a 60 kDa heparin-binding FN fragment or a 45 kDa collagen/gelatin-binding FN fragment. PDL cells exposed to intact FN did not express the proteinases induced by the 120 kDa fragment but did express 92 kDa gelatinase and the 20 kDa proteinase inhibitor. These data suggest that FN and specific FN fragments can differentially induce the expression of proteinases in PDL cells. Thus, functional regions of FN may modulate many of the functions of PDL cells that contribute to periodontal disease, wound healing and maintenance of extracellular matrix in periodontal tissues.

Analysis of soft tissue facial profile in white males

Three of the integumental variables, namely, the total facial convexity, upper lip to esthetic plane, and lower lip length, showed significant measurement errors in the preadolescent boys. Large standard deviations were also found for several variables in both age groups. This suggests that a range of values, rather than means, should be used in clinical cephalometric evaluations. A table of means, standard deviations, and ranges for the variables evaluated is provided. The nasolabial and the mentolabial angles did not differ significantly between the younger and the older age groups. The total soft tissue facial convexity was noted to have a marginally significant difference between the adults and children. Other variables were significantly different between the two age groups, and indicated that the adults had a relatively straighter facial profile than the children. In addition, the upper and lower lips were more retrusive relative to the esthetic plane in adults. Sagittal proportions relating nasal depth/nose to most protrusive lip/chin to most protrusive lip were found to have a ratio of 2.1:1.0:1.2 in children and 1.8:1.0:0.3 in adults.