Faculty Bibliography

Peri-implant disease and gingival recession may be partially attributed to inadequate keratinized tissue. Soft tissue augmentation procedures utilizing non-autologous biomaterials, such as porcine-derived collagen membranes, have been gaining prominence and exogenous crosslinking is being actively investigated to improve the collagen membrane's stability and potential for keratinized tissue gain. The aim of this preclinical study was to evaluate the performance of a novel, crosslinked porcine collagen membrane (Zderm^TM, Osteogenics Biomedical, Lubbock, TX, USA) relative to an established, commercially available, non-crosslinked counterpart (Mucograft^®, Geistlich Pharma North America Inc., Princeton, NJ, USA) in a canine mandibular model. Bilateral split-thickness mucosal defects were created in adult beagles (n = 17), with each site receiving one membrane. Qualitative and quantitative histomorphometric analyses of groups were performed after 4, 8, and 12 weeks of healing and compared to unoperated, positive controls from the same subject. No significant differences in membrane presence were observed between Zderm^TM and Mucograft^® at 4, 8, and 12 weeks of permitted healing (p > 0.05). Similarly, the average keratinized tissue (KT) length between Zderm^TM and Mucograft^® groups was statistically equivalent across all healing times (p > 0.05). However, qualitative histological evaluation revealed greater rete ridge morphology amongst defects treated with Zderm^TM in comparison to Mucograft^®. Nevertheless, both membranes exhibited excellent biocompatibility and are well-suited for soft tissue augmentation procedures in the oral cavity.

Effective surface treatment of implants is essential for enhancing osseointegration outcomes. This study assessed the influence of alcohol decontamination both with and without secondary argon-based non-thermal plasma (NTP) treatment on osseointegration of endosteal implants in a large translational (sheep) model. Ti6Al4V dental implants were utilized either as received (CTRL), or subjected to ethanol cleaning (for 60 s) followed by NTP (for 60 s) (Clean+Plasma); or treated with NTP alone (Plasma) for 60 s. X-ray photoelectron spectroscopy was used for surface elemental analysis, followed by interferometry and sessile drop tests to measure changes in surface roughness and surface energy, respectively. Twelve sheep received implants (one implant per group per sheep) in the iliac crest, and bone healing was evaluated after 3 and 12 weeks using histomorphometric analysis (six sheep/time point). No significant differences in surface roughness (arithmetic mean (Sa) and root mean square (Sq) height: p > 0.161 and p > 0.173, respectively) or topographies were detected between implant surfaces. However, both NTP treated groups presented higher surface energies and lower water contact angle values relative to CTRL surface (p < 0.001). Compared to the CTRL, both NTP-treated groups exhibited reduced levels of Carbon and elevated levels of Oxygen. No significant differences in Bone-to-Implant Contact (BIC) or Bone Area Fractional Occupancy (BAFO) were observed among groups at 3 weeks. At the 12-week time point, Plasma implants demonstrated significantly higher BAFO (p = 0.014) compared to the CTRL group, as well as an increase in both BIC and BAFO over time (3 vs. 12 weeks in vivo) (p = 0.041 and p = 0.043, respectively). Building on the existing literature, the current study suggests that NTP treatment alone may be adequate to successfully enhance osseointegration while minimizing contamination risks, thereby eliminating the need for additional cleaning protocols.

Achieving the appropriate primary stability for immediate or early loading in areas with low-density bone, such as the posterior maxilla, is challenging. A three-dimensional (3D) stabilization implant design featuring a tapered body with continuous cutting flutes along the length of the external thread form, with a combination of curved and linear geometric surfaces on the thread's crest, has the capacity to enhance early biomechanical and osseointegration outcomes compared to implants with traditional buttressed thread profiles. Commercially available implants with a buttress thread design (TP), and an experimental implant that incorporated the 3D stabilization trimmed-thread design (TP 3DS) were used in this study. Six osteotomies were surgically created in the ilium of adult sheep (N = 14). Osteotomy sites were randomized to receive either the TP or TP 3DS implant to reduce site bias. Subjects were allowed to heal for either 3 or 12 weeks (N = 7 sheep/time point), after which samples were collected en bloc (including the implants and surrounding bone) and implants were either subjected to bench-top biomechanical testing (e.g., lateral loading), histological/histomorphometric analysis, or nanoindentation testing. Both implant designs yielded high insertion torque (ITV ≥ 30 N⋅cm) and implant stability quotient (ISQ ≥ 70) values, indicative of high primary stability. Qualitative histomorphological analysis revealed that the TP 3DS group exhibited a continuous bone-implant interface along the threaded region, in contrast to the TP group at the early, 3-week, healing time point. Furthermore, TP 3DS's cutting flutes along the entire length of the implant permitted the distribution of autologous bone chips within the healing chambers. Histological evaluation at 12 weeks revealed an increase in woven bone containing a greater presence of lacunae within the healing chambers in both groups, consistent with an intramembranous-like healing pattern and absence of bone dieback. The TP 3DS macrogeometry yielded a ~66% increase in average lateral load during pushout testing at baseline (T = 0 weeks, p = 0.036) and significantly higher bone-to-implant contact (BIC) values at 3 weeks post-implantation (p = 0.006), relative to the traditional TP implant. In a low-density (Type IV) bone model, the TP 3DS implant demonstrated improved performance compared to the conventional TP, as evidenced by an increase in baseline lateral loading capacity and increased BIC during the early stages of osseointegration. These findings indicate that the modified implant configuration of the TP 3DS facilitates more favorable biomechanical integration and may promote more rapid and stable bone anchorage under compromised bone quality conditions. Therefore, such improvements could have important clinical implications for the success and longevity of dental implants placed in regions with low bone density.

The aim of the study was to assess the effect of bulk material on the reliability and failure modes of narrow-diameter implants. Narrow implants (Ø3.5 × 10 mm - 11° internal conical connection) were manufactured from three different bulk materials: commercially pure titanium grade-IV (CP4), cold-worked titanium (CW), and 4Titude (4Ti), and were evaluated under fatigue testing. Eighteen samples per group were tested under step-stress accelerated life testing through 30° off-axis load application in mild, moderate, and aggressive loading profiles. The number of cycles and load at failure were used to calculate use-level probability curves and reliability for missions of 100,000 cycles up to 200 N, followed by fractographic analyses. Beta values suggested that damage accumulation dictated failures. Reliability analyses at 80, 120, and 150 N evidenced high reliability for narrow implants independent of bulk material. At 200 N, a decrease in reliability was observed for all groups (∼46%). Failure mode analysis depicted similar failures for all groups and comprised implant fracture, abutment fracture, and implant + abutment fractures. Narrow implants presented high reliability for physiologic masticatory forces in the anterior region. Characteristic strength, reliability, and failure modes were similar regardless of bulk material, suggesting that fatigue damage accumulation at thin wall implants dictated failure over bulk material strength.

Giant cell tumors (GCTs) are benign but locally aggressive bone neoplasms that primarily affect skeletally mature individuals. They are characterized by a tendency for recurrence and being associated with significant morbidity. Traditional treatment has focused on surgical resection; however, the role of medical therapies, such as Denosumab, a bone anti-resorptive drug, which has been Food and Drug Administration (FDA)-approved for unresectable GCTs since 2013, recently has gained prominence. Denosumab is a human monoclonal antibody that inhibits receptor activator of nuclear factor kappa B ligand (RANKL). This article aims to consolidate the current literature on Denosumab's efficacy in treating GCTs, highlighting its mechanism of action, clinical evidence, and potential complications. Clinical studies have demonstrated that Denosumab effectively reduces tumor size improving patient outcomes. Yet, some clinicians maintain concerns and reservations regarding local recurrence and malignant transformation. This review discusses the biochemical background of GCTs, current treatment guidelines, challenges, and future directions for research. Ultimately, Denosumab represents a potentially viable advancement in the management of GCTs, particularly in cases where surgical options are limited.

To evaluate the effect of silanized filler particles and blue light-sensitive photoinitiator system on the internal and marginal fit of 3D printed resin crowns as well as the volume of provisional cement space. This study evaluated three commercially available 3D-printing resins (Smart Print Temp/SP, Resilab 3D Temp/RL, and Cosmos Temp/CT). The experimental groups consisted of the addition of 30% by weight (30 wt%) of silanized filler particles and a blue light-sensitive Ternary Photoinitiator System (TPS). Samples were printed for each group (n = 10) and evaluated for internal and marginal fit and volume of cement space using a micro-computed tomography (μCT). The obtained data were analyzed by Generalized Linear Models (α = 0.05). The incorporation of TPS and filler particles to the 3D printing resins altered the internal fit and the marginal fit, increasing the cement space at the occlusal face and decreasing the cement space of the axial walls for all tested materials. The volume was significantly affected too, especially for RL and CT. Internal misfit was significantly higher with the addition of TPS, and marginal misfit with the addition of filler particles. In general, the incorporation of TPS and 30 wt% of filler particles promoted an increase in the volume of cement space, as well as an increase in occlusal space and marginal space and a decrease in the axial walls' spaces.

Sodium-glucose transporter-2 inhibitor (SGLT2i) drugs are widely used for lowering blood glucose levels independent of insulin. Beyond this, these drugs induce various metabolic changes, including weight loss and impaired bone integrity. There is a significant gap in understanding SGLT2i-induced skeletal changes, as SGLT2 is not expressed in osteoblasts or osteocytes, which use glucose to remodel the bone matrix. We studied the impact of 1, 3, or 6 months of canagliflozin (CANA), an SGLT2i treatment, on the skeleton of 6-month-old genetically heterogeneous UM-HET3 mice. Significant metabolic adaptations to CANA were evident as early as 1.5 months post-treatment, specifically in male mice. CANA-treated male mice exhibited notable reductions in body weight and decreased proinflammatory and bone remodeling markers associated with reduced cortical bone remodeling indices. Bone tissue metabolome indicated enrichment in metabolites related to amino acid transport and tryptophan catabolism in CANA-treated male mice. In contrast, CANA-treated female mice showed increases in nucleic acid metabolism. An integrOmics approach of source-matched bone tissue metabolome and bone marrow RNAseq indicated a positive correlation between the two omics data sets in male mice. Three clusters of transcripts and metabolites involved in energy metabolism, oxidative stress response, and cellular proliferation and differentiation were reduced in CANA-treated male mice. In conclusion, CANA affects bone metabolism mainly via the 'glucose restriction state' it induces and impacts bone cell proliferation and differentiation. These findings underline the effects of SGLT2i on bone health and highlight the need to consider sex-specific responses when developing clinical treatments that alter substrate availability.

This manuscript reviews the transformative impact of 3-dimensional (3D) printing technologies in the treatment and management of cleft lip and palate (CLP), highlighting its application across presurgical planning, surgical training, implantable scaffolds, and postoperative care. By integrating patient-specific data through computer-aided design and manufacturing, 3D printing offers tailored solutions that improve surgical outcomes, reduce operation times, and enhance patient care. The review synthesizes current research findings, technical advancements, and clinical applications, illustrating the potential of 3D printing to revolutionize CLP treatment. Further, it discusses the future directions of combining 3D printing with other innovative technologies like artificial intelligence, 4D printing, and in situ bioprinting for more comprehensive care strategies. This paper underscores the necessity for multidisciplinary collaboration and further research to overcome existing challenges and fully utilize the capabilities of 3D printing in CLP repair.

Guided bone regeneration (GBR) procedures have been indicated to enhance bone response, reliably regenerate lost tissue, and create an anatomically pleasing ridge contour for biomechanically favorable and prosthetically driven implant placement. The aim of the current study was to evaluate and compare the bone regenerative performance of deproteinized bovine bone (DBB) and deproteinized porcine bone (DPB) grafts in a beagle mandibular model for the purposes of GBR. Four bilateral defects of 10 mm × 10 mm were induced through the mandibular thickness in each of the 10 adult beagle dogs being studied. Two of the defects were filled with DPB, while the other two were filled with DBB, after which they were covered with collagen-based membranes to allow compartmentalized healing. Animals were euthanized after 6, 12, 24, or 48 weeks postoperatively. Bone regenerative capacity was evaluated by qualitative histological and quantitative microtomographic analyses. Microcomputed tomography data of the bone (%), graft (%), and space (%) were compared using a mixed model analysis. Qualitatively, no histomorphological differences in healing were observed between the DBB and DPB grafts at any time point. By 48 weeks, the xenografts (DBB and DPB) were observed to have osseointegrated with regenerating spongy bone and a close resemblance to native bone morphology. Quantitatively, a higher amount of bone (%) and a corresponding reduction in empty space (space (%)) were observed in defects treated by DBB and DPB grafts over time. However, no statistically significant differences in bone (%)were observed between DBB (71.04 ± 8.41 at 48 weeks) and DPB grafts (68.38 ± 10.30 at 48 weeks) (p > 0.05). GBR with DBB and DPB showed no signs of adverse immune response and led to similar trends in bone regeneration over 48 weeks of permitted healing.