Journal of Dental Research

It is generally accepted that glass ionomers inhibit secondary caries in vivo, and data from in vitro studies support this effect. The aim of this review was a systematic assessment, from the literature, of clinical evidence for the ability of glass-ionomer restoratives to inhibit secondary caries the restoration margin. Inclusion and exclusion criteria for selection of the review papers were established prior to commencement of the literature search. Papers which conformed to these criteria, and reported on secondary caries as an outcome, were selected (N = 52). Primary and secondary of systematic for use in the assessment of the papers were drawn up. The primary list of 14 criteria was applied to each paper. No paper fulfilled all these criteria, necessitating the use of the secondary measures: (i) a prospective study and (ii) use of an appropriate control. This yielded 28 papers. Tabulation of these papers by occurrence of secondary caries in the glass-ionomer or control groups demonstrated an even distribution between positive and negative outcomes. Valid evidence is to be best obtained from randomized, controlled of sufficient sample size. No conclusive evidence for or against a treatment effect of inhibition of secondary caries by the glass-ionomer restoratives was obtained from the systematic review. There is a need for appraisal of the methods currently adopted for the clinical of glass-ionomer restorative materials, for further development of the methodology to support future systematic reviews.

The Oral Health Impact Profile (OHIP) is a measure of oral-health-related quality of life developed in Australia but being used increasingly in other populations. In view of the culturally specific nature of peoples' perceptions of health, if we are to make between-population comparisons of oral-health-related quality of life, cross-cultural equivalency of the relevant instruments needs to be verified. A study was therefore undertaken to compare item weights generated by an Australian sample with those generated by a sample of English-speaking Canadians and another of French-speaking Canadians. In addition, within-group comparisons by age were performed. The items and subscales used for the 2 Canadian samples were identical to those developed in Australia, although a formal French translation was used for the French-speaking sample. The method used for the generation of weights was Thurstone's paired-comparison technique, based on the judgments of convenience samples of subjects drawn from each of the three cultural settings. Comparisons were made by means of intra-subscale weight rankings and magnitude. Spearman's rank correlations of r ≥ 0.6 were found for 16/21 between-group comparisons and for 12/21, 19/21, and 8/21 within-group comparisons made by age in Australia, Ontario, and Quebec, respectively. Comparisons of the magnitudes of weights found that, even when items were ranked similarly, magnitudes could be quite different. These results suggest a reasonable degree of cross-cultural consistency, and hence validity, for the OHIP.

Single items from a typical clinical examination have proved disappointing in their predictive value for temporomandibular joint (TMJ) disc displacement. Only one criterion (the 12 o'clock) is used to diagnose normal disc position. According to this criterion, the posterior band of the disc should be located at the top of the condyle, at the 12 o'clock position. The purpose of this study was to determine which signs and symptoms provide a valid prediction of the condition of the joint based on 4 magnetic resonance imaging (MRI) criteria used to define normal disc position. Sagittal MRI and clinical findings of 137 temporomandibular disorder patients and 23 normal asymptomatic volunteers were used. Three calibrated and blinded observers interpreted the images. Disc position with the mouth closed was evaluated based on 4 MRI criteria: 12, 11, 10 o'clock, and the intermediate zone. Disc position with the mouth open was determined based on one criterion. It was considered normal if the intermediate zone of the disc was located between the condyle and the articular eminence. Joints were classified as normal or as having disc displacement with or without reduction. The sensitivity and specificity of multiple clinical parameters for predicting the condition of the joint established by each of these 4 gold-standard MRI criteria were then determined. Regarding disc displacement with reduction, significant differences were observed in the sensitivity and specificity of all of the clinical parameters used to predict the imaging diagnosis established by each of the criteria. Concerning disc displacement without reduction, no significant differences were observed. The intermediate zone criterion was the criterion that most accurately reflected the condition of the joint. The clinical predictability of the disorder diagnosed according to this criterion suggests that clinical findings alone are too often nonspecific as predictors of the imaging stage of disc displacement. However, we found that combining the most sensitive clinical items to predict the disorder and using an overall criterion for positivity to interpret the results led to an impressive increase in the specificity of the combination, enabling false-positive diagnoses to be excluded.

The occurrence of missing teeth is a vexing and growing problem in epidemiological studies of dental disease. The number of units of measurement (i.e., teeth/tooth sites) varies between persons and may affect summary statistics in descriptive studies as well as in analytical studies. The purpose of the present study was to develop a general model to adjust summary statistics for missing teeth. The proposed method was applied to alveolar bone loss in current smokers, former smokers, and non-smokers, from 45 to 64 years of age (n = 812). Alveolar bone loss was measured on bitewing radiographs. The adjustment method was based on the assumption that the probability of losing a tooth was an increasing function of alveolar bone loss. The main finding of the present study was that mean alveolar bone loss increased after adjustment for the number of missing teeth. This increase was larger for current smokers than for non-smokers, indicating that the effects of smoking were slightly underestimated when missing sites were ignored. Further research is required for the model to be applied to other data, estimating different types of dental disease with various degrees of disease prevalence and various numbers of missing teeth, and for validating the adjustment method by means of longitudinal data.

The formation of the human alveolar process around the incisors and canines is a hitherto unreported aspect of fetal oral development. The question is how, where, and when the alveolar process is formed. The purpose of this study was to elucidate the questions where and when and hence to analyze the pattern of formation of the alveolar bone around developing human deciduous canine and incisor teeth. The study was conducted with material selected from a sample of 61 normal human fetuses, legally or spontaneously aborted. Fertilization ages ranged from 9 to 22 weeks, crown-rump Length from 25 to 205 mm, and foot length from 4 to 34 mm. From this material, 7 maxillae and 10 mandibles were selected for the study according to developmental stages of the canines and incisors and according to the orientation of the histological sections. The skeletal investigation consisted of macroscopic and microscopic analysis of the mandibles and maxillae. The investigations revealed the absence of bone between the central and lateral incisors in the mandibles and maxillae of fetuses below the ages of 21 and 22 weeks, respectively. In three specimens, alveolar bone between the central and lateral incisors was recorded (21, 21, and 22 weeks of fertilization). Absence of bone labial to the canine was recorded in all fetuses investigated. In all other regions, alveolar bone occurred as a regular finding. The present study has shown that alveolar bone formation is strictly coordinated with tooth formation. Alveolar bone occurs later in the area labial to the canine and in the region between the central and lateral incisors than it does in other areas associated with the incisor/canine regions. Knowledge of this pattern in the formation of the alveolar process seems to be of importance for a future elucidation of how the alveolar process is initially formed.

c-jun and jun-B are nuclear proto-oncogenes induced by growth factors such as bone morphogenetic proteins (BMPs). These gene products enhance the expression of many genes, including osteocalcin and collagen types, indicating that c-jun and jun-B play important roles in the cell differentiation process. It is also known that BMPs affect the differentiation of pulp cells to odontoblast-like cells during reparative dentinogenesis, but little is known about the transcriptional regulation of genes in cells associated with reparative dentinogenesis. In this study, we examined the expression of c-jun and jun-B in pulp cells during reparative dentinogenesis after cavity preparation of rat molars by in situ hybridization. In rat tooth germs, c-jun and jun-B were co-expressed in the odontoblastic lineage. In rat adult molars, c-jun was expressed in the odontoblast layer, but the jun-B expression was absent in all pulp cells. After cavity preparation, we found that c-jun and jun-B were co-expressed in pulp cells underneath cavities. During the early phase of reparative dentinogenesis, levels of c-jun and jun-B greatly increased in pulp cells within and around the reparative dentin matrix formed adjacent to the cavity floor. Fourteen days after cavity preparation, c-jun and jun-B were expressed only in pulp cells lining the irregular surface of the thick reparative dentin. These results suggest that c-jun and jun-B may play important roles both in physiological and in reparative dentinogenesis; in particular, the limited distribution of the jun-B expression suggests a specific role of jun-B only in cells involved with the active formation of the dentin matrix during primary and reparative dentinogenesis.

Clinically, the most apparent difference between the primary and permanent dentitions is the physiologic loss of the primary tooth by root resorption. Root resorption is associated with loss of integrity of the periodontal ligament (PDL), followed by recruitment of resorptive cells that remove root structure. We therefore cultured primary dentition PDL fibroblasts (PPDL cells) to investigate in vitro their production of matrix metalloproteinases (MMPs) and tissue inhibitors of MMP (TIMPs), and the effects of soluble factors produced by these cells on osteoclast-like cell differentiation. These studies demonstrate that PPDL cells in vitro have a heterogeneous morphology, and they constitutively synthesize 92-kDa gelatinase, 72-kDa gelatinase, and 53/57-kDa procollagenase as well as TIMP-1, -2, and a third inhibitor of matrix metalloproteinase, as determined by substrate gel zymography and immunoblot analysis. Compared with PDL cells from the permanent dentition, PPDL cells generally produced a greater amount of collagenase but similar amounts of the gelatinases and inhibitors. PPDL cells were treated with pro-inflammatory cytokines to determine their effect on the expression of matrix-degrading enzymes and inhibitors. Interleukin-la and tumor necrosis factor-a enhanced the constitutive expression of proteinases but not that of inhibitors in PPDL cells. Conditioned media from PPDL cell lines inhibited the differentiation of osteoclastlike cells in mouse bone marrow cultures. These findings indicate that PPDL cells may modulate the cascade of root resorption both by their regulated production of proteinases and inhibitors and by synthesis of unknown soluble factor(s) that may regulate osteoclast development.

Human salivary histatin-5 (Hsn-5), a 24-amino acid polypeptide, is a potent candidacidal molecule. In this study, we have explored the following two hypotheses: More potent Hsn molecules may be achieved by duplication of the functional domain of Hsn-5 (C16, residues 9-24 of Hsn-5), and Hsn may act like other cationic peptides which aggregate and form channels across the target membrane. A PCR-based gene splicing by overlap extension (SOE) method was used to construct the DNA fragments encoding the following fusion molecules: Hsn-5-Hsn-5, Hsn-5—C16, and C16—C16. These constructs were expressed in E. coli, the proteins produced were purified, and their anticandidal activities as well as secondary structures were determined. Contrary to our hypotheses, results showed that none of the multimers possessed increased candidacidal activity. Specifically, C16—C16 and Hsn-5—C16 displayed candidacidal activity comparable with that of Hsn-5, while Hsn-5-Hsn-5 possessed significantly decreased candidacidal activity, yet all molecules retained an a-helical structure in a hydrophobic environment. Additionally, the circular dichroism data showed that Hsn-5 in an a-helical conformation does not aggregate in a hydrophobic environment, not even at 14- to 18-fold its physiological concentration. Our results suggest that the development of enhanced Hsn-5 molecules may not be achieved by duplication of its functional domain, and that Hsns may not act like other antimicrobial cationic peptides which aggregate and form channels across the target membrane.

During the development of the microtensile bond-testing method, large variations in bond strengths were noted among serial sections. The reason for these variations is unknown. The purpose of this work was to determine the consistency of resin-dentin bond strengths across the occlusal surface of coronal dentin by dividing composite resin buildups into an array of 1 x 1 mm beams, the top half consisting of composite resin, and the bottom half consisting of dentin. Extracted human third molars had the occlusal enamel removed as a single section by means of a diamond saw. Resin composite buildups were made after the dentin was bonded with either One-Step or MacBond. After being stored in 37°C water for 1 day, the teeth were vertically sectioned at 1-mm increments into slabs of bonded teeth. Each slab was further subdivided by vertical sections into 1 x 1 x 8 mm beams. Each beam was assigned an x-y coordinate and tested for tensile bond strength. Two different clinicians (A and B) performed the same procedures using One-Step in a parallel study. Using One-Step, clinician A obtained a large number of zero bonds in superficial dentin but fewer in deep dentin. This resulted in a very large standard deviation in bond strengths (mean ± SD of 22 ± 20 MPa in superficial dentin and 27 ± 14 MPa in deep dentin). Clinician B obtained much higher (p < 0.001) and more uniform bond strengths with One-Step (56 ± 13 MPa in superficial dentin and 57 ± 12 MPa in deep dentin). With MacBond, there were no zero bonds and hence less variation, with a mean of 41 ± 13 MPa in superficial dentin and 27 ± 12 MPa (x ± SD) in deep dentin. When pairs of Z100 resin composite cylinders were bonded together with One-Step and then sectioned into an array, there was little variation in regional bond strength (37 ± 1 MPa). Dividing bonded resin composite buildups into an array of 20 to 30 1 x 1 x 8 mm beams allows for the evaluation of uniformity of resin-dentin bonds. The method used in this study detected local regional differences in resin-dentin bond strengths. The largest differences were shown to be related to technique rather than to material. The results indicate that resin-dentin bonds may not be as homogenous as was previously thought.

Resin composites currently available are not suitable for use as large stress-bearing posterior restorations involving cusps due to their tendencies toward excessive fracture and wear. The glass fillers in composites provide only limited reinforcement because of the brittleness and low strength of glass. The aim of the present study was to reinforce dental resins with ceramic single-crystalline whiskers of elongated shapes that possess extremely high strength. A novel method was developed that consisted of fusing silicate glass particles onto the surfaces of individual whiskers for a two-fold benefit: (1) to facilitate silanization regardless of whisker composition; and (2) to enhance whisker retention in the matrix by providing rougher whisker surfaces. Silicon nitride whiskers, with an average diameter of 0.4 μm and length of 5 μm, were coated by the fusion of silica particles 0.04 μm in size to the whisker surface at temperatures ranging from 650°C to 1000°C. The coated whiskers were silanized and manually blended with resins by spatulation. Flexural, fracture toughness, and indentation tests were carried out for evaluation of the properties of the whisker-reinforced composites in comparison with conventional composites. A two-fold increase in strength and toughness was achieved in the whisker-reinforced composite, together with a substantially enhanced resistance to contact damage and microcracking. The highest flexural strength (195 ± 8 MPa) and fracture toughness (2.1 ± 0.3 MPa · m^1/2 ) occurred in a composite reinforced with a whisker-silica mixture at whisker:silica mass ratio of 2:1 fused at 800°C. To conclude, the strength, toughness, and contact damage resistance of dental resin composites can be substantially improved by reinforcement with fillers of ceramic whiskers fused with silica glass particles.

For differences among materials to be easily detected, low variation in in vitro wear tests is desirable. The working hypothesis of this paper was that antagonists standardized for shape and size and according to materials would show mean values similar to those found in natural, non-standardized cusps, and that standardization would lead to a reduction in mean variation. First, the shapes and sizes of palatal cusps of non-erupted human upper third molars were measured. The cusp cupola was best described by the formula y = 0.001 x2 and was symmetrical around the axis of rotation. Up to 200 μm of the y-axis, this parabola corresponded best to a ball radius of 0.6 mm. Based on this information, standardized antagonists were fabricated from both human enamel and steatite. Wear in the occlusal contact area and the wear of opposing conventional ceramic and fine hybrid composite, respectively, were quantified in a computerized chewing simulator. As a control, natural human enamel cusps were used. Standardization of enamel cusps did not reduce the variation of the resulting wear compared with that of non-standardized enamel antagonists. Furthermore, standardization led to significantly different results both in the antagonists and in the opposing restorative materials. Thus, natural enamel antagonists are preferable for the simulation of wear in the occlusal contact area.