Human odontoblast cell numbers after dental injury

OBJECTIVES: The purpose of this study was to measure the changes in odontoblast cell numbers in response to cavity restoration variables and patient factors, and the effect these factors have on dental repair by tertiary dentinogenesis. The number of vital odontoblasts is a critical factor for pulpal repair following restorative surgery, and yet little information is available on these cell numbers. METHODS: Class V non-exposed cavities were prepared in the buccal surface of intact first or second premolar teeth of 27 patients, between 9 and 17 years of age. Following tooth extraction (28-163 days) the area of reactionary dentine and the area of the odontoblasts were measured histomorphometrically. RESULTS: Patient factors, as well as cavity preparation and restoration variables, had little effect on the numbers of odontoblasts per pulpal unit area. However, the age of the patient did appear to have an effect on the reactionary dentine secretory capacity of odontoblasts per unit area, and on the relative number of odontoblasts beneath cut dentinal tubules. CONCLUSIONS: Odontoblast cell numbers were maintained following the preparation of cavities cut into dentine with a 0.5mm residual dentine thickness. The repair capacity of the pulp-dentine complex would appear to be age dependent, this may explain differences in the success of various restorative treatments between patients.     

What do patients expect from complete dentures?

OBJECTIVES: An investigation was undertaken with the aim of determining whether patients wearing complete dentures in dental hospital (DH) and dental practice (DP) had different expectations from their dentures, together with their requirements for information about denture construction and oral and denture care. METHODS: A total of 214 edentulous patients, with a mean age of 69 years, from DP (125) and DH (89) participated in the questionnaire-based study. A valid questionnaire (P-DEQ) was constructed which demonstrated good test-retest reliability (Cronbach's alpha 0.86). The P-DEQ sought to determine how patients responded to a series of questions related to what dentists are urged to achieve with complete dentures. The questions covered not only what might be termed "normative" expectations but also patients' perceived needs for further information about the stages of prosthodontic treatment and oral or denture care. RESULTS: Significant differences (p< or =0.001) emerged between the two groups; 82% of the DH group thought it essential that their dentures caused no pain compared with 59% of the DP group; for "absence of slackness" (DH 87%; DP 65%), and "good bite" (DH 82%; DP 55%). No significant differences emerged for the other parameters investigated, but both groups had high expectations for ease of chewing, speech, and good appearance. Differences (p<0.05) between the groups also emerged with respect to the demand for more information regarding the stages involved in denture construction (DH 57%, DP 76%) and how to care for dentures (DH 75%, DP 89%). Large proportions of patients from both groups would prefer to have more information about the selection of teeth (71% DH, 72% DP), and how to care for their mouths (84% DH, 86% DP), but there were no differences between the groups in these parameters. CONCLUSIONS: Most patient expectations appear to equate with the normative view expressed in standard prosthodontic texts. However, expectations may differ not only between individuals but also between patient groups managed in teaching hospital and DP settings. Edentulous patients also need information regarding the stages involved in denture construction and how to care for their mouths and dentures. This may have implications for the management of edentulous patients in DP and dental hospital.     

Hepatitis B: a perspective

A bstract — Hepatitis B is becoming increasingly common in the community. Carriers are generally difficult to identify in dental practice, and therefore preventing transmission of the disease depends primarily on sound general clinical hygiene.     

Frozen autogenous mandible as an immediate replacement graft.

A study in animals was designed to examine the feasibility of grafting autogenous frozen mandible. Two groups of animals were used. In the first group, periosteum was elevated from the bone before resection. In the second group, the periosteum was removed with the resected specimen. Osteogenesis was shown by clinical, radiographic, fluorescence, and histologic studies in both groups of animals. The same technique was performed in nine humans with carcinomas that involved the mandible. The results were encouraging. We believe that immediate or delayed reconstruction with autogenous frozen mandible in a patient undergoing ablative surgery of the head and neck with involvement of the bone may offer the patient, as well as the surgeon, another acceptable treatment modality.     

Improvements in bracket base design

Acid etch bonding of orthodontic attachments to the labial and lingual surfaces of teeth is generally adequate for clinical service. Failures do occur, and these are related to technique problems in acid etching or resin manipulation or to bracket base design. The widely used foil mesh base can present problems in retention because of design defects or corrosion. Improvement in mechanical retention of resin to the attachment base would result in significant improvements in bonding and fewer clinical failures. One of our approaches to improved retention is to fuse metallic or ceramic particles onto the bracket base so as to achieve a particulate or porous layer into which resin can penetrate. The results of bond-strength tests showed that a 100 percent increase in bond strength could be obtained with sintered porous metal-coated brackets. Further development is proceeding.     

Effects of transforming growth factor beta1 (TGFbeta-1) and dentin non-collagenous proteins (DNCP) on human embryonic ectomesenchymal cells in a three-dimensional culture system

Cranial neural crest-derived ectomesenchymal cells represent a population of pluripotent stem cells giving rise to many of the various oro-facial and dental tissues. The factors determining the terminal fate of these cells are still unclear. The potentiality of human embryonic ectomesenchymal cells from the first branchial arch have been investigated when isolated and grown in a three-dimensional (3D)-collagen gel culture system in the presence of dentin matrix-derived non-collagenous proteins (DNCP) and TGFbeta-1. Functional differentiation of cells showing some characteristics of odontoblast-like cells could be observed when the cells were cultured with DNCP+TGFbeta-1 or DNCP, however, only cytological differentiation was observed during culture with TGFbeta-1 alone. The characteristics of these cells was assessed by morphological appearance, expression of the odontoblast phenotype marker dentin sialophosphoprotein (DSPP), increased alkaline phosphatase levels and formation of mineralised nodules in vitro. The results indicate that these embryonic cells from the first branchial arch are capable of responding to the inductive stimulus of DNCP or DNCP+TGFbeta-1 when isolated and grown in the 3D collagen gel culture system. The capacity of the isolated cells to differentiate into mineralizing cells showing some characteristics of odontoblast-like cells under these growth conditions highlights the potential of such approaches for tissue engineering strategies for hard-tissue regeneration after injury.     

Measurement of stain on extracted teeth using spectrophotometry and digital image analysis

Abstract: Aim: The aim of this study was to assess the reliability and validate a customized image analysis system, designed for use within clinical trials of general dental hygiene and whitening products, for the measurement of stain levels on extracted teeth and to compare it with reflectance spectrophotometry. Method: Twenty non‐carious extracted teeth were soaked in an artificial saliva, brushed for 1 min using an electric toothbrush and a standard toothpaste, bleached using a 5.3% hydrogen peroxide solution and cycled for 6 h daily through a tea solution. CIE L* values were obtained after each treatment step using the customized image analysis system and a reflectance spectrophotometer. A statistical analysis was carried out in SPSS. Results: Fleiss’ coefficient of reliability for intra‐operator repeatability of the image analysis system and spectrophotometry was 0.996 and 0.946 respectively. CIE L* values were consistently higher using the image analysis compared with spectrophotometry, and t‐tests for each treatment step showed significant differences (P < 0.05) for the two methods. Limits of agreement between the methods were ?27.95 to +2.07, with a 95% confidence of the difference calculated as ?14.26 to ?11.84. The combined results for all treatment steps showed a significant difference between the methods for the CIE L* values (P < 0.05). Conclusion: The image analysis system has proven to be a reliable method for assessment of changes in stain level on extracted teeth. The method has been validated against reflectance spectrophotometry. This method may be used for pilot in vitro studies/trials of oral hygiene and whitening products, before expensive in vivo tests are carried out.     

Application of cine computed tomography to the assessment of velopharyngeal form and function

The mechanism of velopharyngeal closure is clearly three-dimensional in nature. Numerous attempts have been made to obtain a comprehensive picture of velopharyngeal movement, with varying degrees of success. A computed tomography scan system has recently been developed that may be used for real-time motion study of various body systems. This preliminary study was designed to assess the applicability of multi-level cine computed tomography scanning as a tool in the three-dimensional analysis of the velopharynx. One normal speaker and one speaker with an unrepaired palatal cleft were asked to phonate while serial sections were taken at 650-millisecond intervals through a number of transverse sections in the velopharyngeal region. This paper includes an explanation of cine CT technology, examples of scans on two speakers with clearly different velopharyngeal mechanisms, and discussion of the potential use of cine computed tomography as a tool in the analysis of both normal and disordered velopharyngeal function.     

Pain and anxiety reduction using a manual stimulation distraction device when administering local analgesia oro-dental injections: a multi-center clinical investigation

OBJECTIVE: This study was designed to assess the effects of a manual stimulating distraction device (Isoflex referred to as Manual Stimulation Distraction Device or MSDD) for reducing pain and anxiety experienced with standard dental local anesthetic injections. Additionally, the memory recall effects on injection pain and anxiety were also explored. METHODOLOGY: Patients from different dental clinics were identified by their practitioners as requiring dental procedures under local anesthesia, in the same area on both sides of the mouth. A local anesthetic solution was injected on either the left or right side at different times by random selection; one side using MSDD, while the opposite side used a solution without MSDD. Each patient acted as his or her own symmetrical split-mouth control. The same dentist administered both injections, using identical technique and equipment for each side. Forty-six patients used the MSDD first with the injection, while 54 used MSDD second when they received the injection. Using 10-point visual analogue nominal and ordinal scales, pain and stress were recorded by the patient each time after receiving the injection. The results were pooled and subjected to statistical analysis. Student's paired t-test was employed to test for significant differences in pain and anxiety (stress) when injections were administered with and without MSDD. RESULTS: Results showed significant reductions in perceived pain and stress from local analgesia injections (p < 0.001) when MSDD was used. There was no correlation of pain reduction with age, gender, upper or lower jaw, with or without MSDD. There was a trend for pain and stress to be scored higher for those subjects who had a lower period since the first injection (POFI) scores. This was attributed to recent memory of pain, as POFI scores over one week were significantly lower (p < 0.05). Stress reduction for POFI scores greater than one week proved to be non-significant (p = 0.099). CONCLUSION: In this study, MSDD was effective at reducing pain and stress experienced with local regional analgesic injections.     

Root substance removal by scaling and root planing.

The amount of root substance removed by scaling and root planing is largely unknown. The present study evaluated in vitro the root substance loss caused by a defined number of working strokes at known forces. Forty extracted teeth with loss of connective tissue attachment into the middle third of the roots were washed and embedded in plaster, leaving one entire corono-apical tooth aspect exposed. The teeth were reproducibly repositioned in a bench-vise, where a profilometer repeatedly measured root surface levels at the same location. In a standard area of the roots a total of 40 working strokes were applied. Low forces were used in 30 teeth and high forces in 10 teeth. The forces were recorded using a piezo-electric receiver built into the upper shank of the curet. Root substance loss was measured after 5, 10, 20, and 40 working strokes. The results showed that the mean low force used per working stroke across all 40 strokes was 3.04 Newtons for the low forces, and 8.48 Newtons for the high forces. Mean cumulative loss of root substance across 40 strokes was 148.7 microns at low forces, and 343.3 microns at high forces. The mean force per stroke increased slightly across the 40 strokes, while substance removal per stroke decreased. Substance removal per stroke during strokes 1 to 5 was 6.8 microns using low forces and 20.6 microns using high forces. During strokes 21 to 40 mean removal per stroke was 2.3 microns at low forces, and 5.6 microns at high forces. These results suggest that high forces remove more root substance, and loss per stroke becomes less with increasing numbers of strokes.