In vivo degradation of bleaching gel used in whitening teeth

BACKGROUND: The purpose of the study described here was to determine the in vivo degradation rate of 10 percent carbamide peroxide, or CP, gel in bleaching trays. The degradation rate indicates the remaining concentration of the active agent on the facial surfaces at various intervals. METHODS: The researchers fabricated bleaching trays with 0.5-millimeter reservoirs and loaded them with a 10 percent CP whitening gel. The tray was seated in place in 15 patients for six different intervals that ranged from 15 seconds to 10 hours. When the tray was removed, three samples were collected from each patient: the gel remaining in the tray; the adherent gel scraped from the teeth; and a "grab" sample from the reservoir of tooth no. 8. The researchers analyzed these samples for CP according to the method specified by the U.S. Pharmacopeial Convention. RESULTS: The percentage of CP recovered decreased as the intervals increased: 87 percent at 15 seconds, 10 percent at 10 hours. Log of tray, teeth and grab samples, respectively, at 15 seconds were 0.94, 0.98 and 0.96 and at 10 hours were -0.13, -0.38 and 0.11. The first-hour degradation rate for tray, teeth and grab samples, respectively, was 2.0 times, 3.6 times and one time the rate during the next nine hours. The within-subject repeatability of the samples was excellent. CONCLUSIONS: The degradation rate of CP during the bleaching process is biexponential. In the tray and teeth samples, the degradation rate was accelerated during the first hour. Further research is needed to determine the cause of this acceleration. CLINICAL IMPLICATIONS: The active agent in CP bleaching gel is available in bleaching trays for more than 10 hours. After two hours, more than 50 percent of the active agent is available, and 10 percent is available after 10 hours.     

Analysis of surgical referral patterns for endosseous dental implants

Endosseous implants have traditionally been surgically placed by oral and maxillofacial surgeons, periodontists, and general practitioners. The purpose of this study was to examine surgical referral patterns for patients receiving implants in the treatment of partial edentulism. The records of 542 patients who received 1,313 implants between 1993 and 1997 were analyzed. Data relative to anatomic area, patient demographics, type of implant system, and any complication encountered were collected. Surgical cohorts were compared using Wilcoxon's rank-sum or chi-square tests, and complication rates were estimated using survival analysis methods. Results indicate no significant difference (P > .05) between cohorts with regard to placement of implants in the anatomic locations of the anterior mandible, anterior maxilla, posterior mandible, and posterior maxilla. Patient demographic information was not statistically different, with the exception of mean patient age, where oral and maxillofacial surgeons have been younger patients (P < .0001). Relatively few complications were seen, with no significant difference in complications rates between cohorts (P > .05). The type of implant system used showed no significant difference with respect to anatomic location or complication occurrence (P > .05). This study indicates that implant surgical referral patterns were similar in this setting between periodontal and oral and maxillofacial surgeons, with the only difference being a tendency to refer younger patients to the oral surgeons.     

Photogrammetry--an alternative to conventional impressions in implant dentistry? A clinical pilot study

PURPOSE: The purpose of this clinical pilot study was to describe a photogrammetric technique to determine implant positions in the oral cavity, and to test and compare this technique to conventional impression/master cast procedures for fabrication of titanium frameworks with a computer numeric-controlled (CNC) milling technique. MATERIALS AND METHODS: Implant positions were recorded by means of conventional impressions/master casts as well as intraoral 3-dimensional photogrammetric measurements in 2 patients who were provided with 5 Br?nemark implants each in the edentulous mandible. For each patient 2 titanium frameworks were made by means of a CNC milling technique (All-in-One). Both frameworks had an identical design, but the orientations of the framework cylinder fit surfaces were machined either from measurements from the master casts or from the intraoral photogrammetric measurements. The frameworks were tried for fit in the oral cavity and on the master casts. RESULTS: Both cases showed different precision of fit when comparing the 2 frameworks on the master casts. One of the 2 photogrammetric frameworks was not considered acceptable when tried on the models. In the oral cavity, however, all 4 frameworks presented comparable fit, and all were accepted for clinical use. CONCLUSION: The clinical experiences with try-in of the 4 different frameworks indicated that the photogrammetric technique could be a valid option for conventional impressions when using CNC milling fabrication in implant dentistry. The different results from the model and oral examinations also imply the difficulties of assessing clinical fit when testing fit at the master cast level only.     

Fibroblastic growth and attachment on hydroxyapatite-coated titanium surfaces following the use of various detoxification modalities. Part I: Noncontaminated hydroxyapatite.

Hydroxyapatite-coated titanium alloy test strips were treated with chlorhexidine gluconate, stannous fluoride, citric acid, tetracycline HCl, polymyxin B, hydrogen peroxide, and a plastic Cavitron tip: untreated sterile strips served as controls. The strips were incubated with cultured human gingival and periodontal ligament fibroblasts. Image analysis of three photomicrographs of each test strip (original magnification x350) indicated that the tetracycline HCl treatment resulted in significantly greater cellular surface area coverage compared with the other treatments. Citric acid and the plastic Cavitron tip also stimulated cell attachment, although the results from the Cavitron tip were not significantly different from citric acid or the other treatment groups. The remainder of the modalities and the untreated cellular controls experienced similar cellular coverage.     

Evaluation of guided bone regeneration and/or bone grafts in the treatment of ligature-induced peri-implantitis defects: a morphometric study in dogs

The goal of this study was to evaluate, morphometrically, hard-tissue healing following the treatment of ligature-induced peri-implantitis defects in dogs and guided bone regeneration and/or bone grafts. Five dogs were used, and the mandibular premolars were removed. Three months later, two titanium implants were installed on each side of the mandible, and after another 3 months, abutment connection was performed. Following abutment connection, experimental periimplantitis was induced by placing cotton ligatures in a submarginal position. Ligatures and abutments were removed after 1 month and the bony defects were randomly assigned to one of the following treatments: debridement (DE), debridement plus guided bone regeneration (GBR), debridement plus mineralized bone graft (BG), and debridement plus guided bone regeneration associated with mineralized bone graft (GBR/BG). The dogs were euthanatized after 5 months. Morphometric analysis did not reveal significant differences among the treatments neither with respect to the percentage of bone to implant contact (p = 0.996) nor to the bone area (p = 0.946) within the limits of the threads of the implant. Within the limits of this investigation, there is insufficient evidence to indicate that any of the treatments presented an improved response in dealing with bony defects resulting from peri-implantitis.     

Clinical and histologic evaluation of the demineralized freeze-dried bone membrane used for ridge augmentation

The biologic principle of guided bone regeneration has been successfully used to regenerate alveolar ridges. The objective of this pilot study was to clinically and histologically evaluate the demineralized freeze-dried bone membrane. Four premolar teeth were extracted from two dogs, and the remaining alveolar bone was surgically reduced in width and height to produce Class III ridge defects. After a 2-month healing period, mucoperiosteal flaps were elevated, and demineralized freeze-dried cortical columns were used as space maintainers. Bone membranes were used as barriers. The animals were sacrificed at 3 months and the surgical areas were recovered and processed for histologic evaluation. Results showed ridge augmentation in all sites. Clinically, the augmented areas appeared to have the same hardness as the surrounding bone on the periphery of the experimental site. After elevation of a mucoperiosteal flap, the bone membrane could be seen. Histologically, the bone membrane acted as an efficient barrier, excluding the nonosteogenic tissues. New bone formation underneath the membrane was found in all specimens. This study suggests that a bone membrane in combination with a space maintainer can guide new bone formation to regenerate localized chronic alveolar ridge defects.     

Advances in subperiosteal implant reconstruction

Recent advances in subperiosteal implant surgery of the mandible and maxilla are described in terms of changes in implant design, use of particulate autogenous marrow cancellous bone in conjunction with subperiosteal implant to structurally rebuild marked deficient mandibles at the time the implant is placed, and the of computerized tomography to develop a three-dimensional model for the construction of implant framework, eliminating the direct bone impression surgery. The latter procedure has revolutionized the use of subperiosteal implants. These techniques are outlined, and areas of future research in use of implants in structurally deficient areas are described.     

Demineralized bone matrix polydioxanone composite as a substitute for bone graft: a comparative study in rats.

Demineralized bone matrix (DBM) has been successfully used as a substitute for bone grafting. Autogenous bone grafts (ABG) may cause donor site morbidity and undergo significant resorption. DBM may overcome these problems but is mechanically unstable when originally placed. We explored using a slowly resorbable template, polydioxanone (PDS), in combination with DBM and compared it to ABG in a rat 9 x 9 mm cranial defect model. After both 1 and 3 months, histologically and biochemically well-formed bone was present in ABG/PDS and DBM/PDS-treated defects, but not in control defects (PDS alone). Mechanical push-out tests using a servohydraulic testing frame were conducted. Maximum load before failure of DBM/PDS increased from 65% at 1 month to 100% of that of intact skull at 3 months. In contrast, ABG/PDS was 50% as strong as DBM/PDS and not significantly stronger than PDS alone. ABG/DBM did not significantly increase in strength from 1 to 3 months. We conclude that DBM/PDS is better than ABG/PDS in treating cranial defects in the rat model, and that an absorbable osteoinductive bone substitute with superior mechanical advantage is possible without the disadvantages of ABG.     

Effect of procedure on diametral tensile strength of composite resin.

The sensitivity of the test for diametral tensile strength to variations in testing procedure was investigated. Composite resin specimens of four different surface roughnesses at both ends of the specimens were loaded at one of three crosshead speeds. The diametral tensile strength values varied between 43.9 and 65.7 MPa. Diametral tensile strength was found to decrease with increasing loading rate, with decreasing roughness of the specimens, and with increasing length of the cylindrical specimens. The significant influence of the surface roughness is suggested to be a result of the correlation between roughness and length of specimens, and not the expression of a true influence on diametral tensile strength of surface roughness of the specimens' ends.