Faculty Bibliography

The oral rehabilitation of adolescent patients with amelogenesis imperfecta (AI) is complex due to the presence of mixed dentition with altered eruption sequence. In this manuscript, the interdisciplinary treatment approach for adolescent patients with AI is discussed. The types and timing of treatments at various stages of growth are described through a literature review on this topic. AI is an inherited condition that disturbs the development of the enamel structure. Because of the presence of mixed dentition, definitive treatment options often have to be delayed until eruption of permanent dentition is complete, requiring careful treatment coordination and proper sequencing between different dental disciplines starting at a young age. Adolescent patients require prosthodontic treatment design that can be adapted to the changes in arch shapes, sizes, interarch relationship, and esthetic needs. AI patients are often challenged with both excessive and limited restorative spaces within the same arch due to the abnormal growth patterns, enamel structure, tooth size, and tooth shape. Therefore, careful determination of the required restorative space is critical to ensure optimal prognosis. This clinical report discusses treatment recommendations, timing of various treatment modalities, and involvement of appropriate interdisciplinary teams for managing adolescent patients. This article is protected by copyright. All rights reserved.

In this study, we evaluated the effect of local injection of osteoblastic cells differentiated from bone marrow or adipose tissue-mesenchymal stromal cells (BM-OB and AT-OB, respectively) on bone repair. For that, the cells were harvested from male Wistar rats (200 g), under the rules of the Committee of Ethics in Animal Research of the University of Sao Paulo. The BM-OB were obtained by osteoblastic differentiation of bone marrow-mesenchymal stromal cells for 10 days. The AT-OB were obtained by osteoblastic differentiation of adipose tissue-mesenchymal stromal cells for 10 days. Under general anesthesia, unilateral 5-mm defect was created in the calvaria of rats and in order to simulate preexisting defects only after 2 weeks the defects were treated. Each defect was locally injected with BM-OB or AT-OB (5 9 10⁶ cells/defect in 50 ll PBS). PBS without cells was injected as Control. Four weeks after cell injection, the animals were euthanized, and the bone formation was analyzed by microtomography (micro-CT) and nanoindentation assay. The data were evaluated using the ANOVA test followed by the Tukey's test when appropriated (p B 0.05). The morphometric parameters generated from micro-CT images showed that bone volume, percentage of bone volume, bone surface and trabecular number were higher in defects injected with BM-OB or AT-OB compared with Control (p = 0.001 for all). Trabecular separation was lower in defects injected with BM-OB or AT-OB compared with Control (p = 0.001). The qualitative parameters generated from nanoindentation indicated that elastic modulus and hardness of bone formed in defects injected with BM-OB or AT-OB were higher compared with Control (p = 0.05 for both). In conclusion, the use of local injection of osteoblastic cells differentiated from bone marrow or adipose tissue-mesenchymal stromal cells induced the same amount of bone formation opening new therapeutic possibilities for the treatment of bone defects

OBJECTIVE:To evaluate the reliability and failure mode of zirconia-reinforced lithium silicate (ZLS) molar crowns of different thicknesses. METHODS:Monolithic ZLS molar crowns (0.5mm, 1.0mm, and 1.5 mm thickness) were modeled and milled using a CAD/CAM system (n = 21/group). Crowns were cemented on dentin-like epoxy resin replicas with a resin cement. The specimens were subjected to single load-to-failure test for step-stress profiles designing. Mouth-motion step-stress accelerated-life test was performed under water by sliding an indenter 0.7 mm lingually down on the distobuccal cusp until specimen fracture or suspension. Use level probability Weibull curves and reliability were calculated and plotted. Polarized-light optical microscope and scanning electron microscope (SEM) were used to characterize fracture patterns. RESULTS:Irrespective of crown thickness, beta (β) values were higher than 1 and fatigue accelerated failures. While 0.5 mm ZLS crowns exhibited a significant reduction in the probability of survival at 200N, 300N and 400 N mission loads (69%, 41% and 19%, respectively), no significant difference was observed between 1.0 mm and 1.5 mm crowns. Both thicknesses have maintained the survivability at approximately 90%. Failure primarily comprised bulk fracture where radial cracks originated from the cementation surface beneath the indenter loading trail and propagated towards the cervical margin. SIGNIFICANCE/CONCLUSIONS:1.5 mm- and 1.0 mm-thickness monolithic ZLS crowns presented higher probability of survival compared to 0.5 mm crowns. Bulk fracture was the chief failure mode, regardless of thickness.

Since 2005, facial transplantation has emerged as a viable reconstructive option for the most severe defects not amenable to conventional reconstructive techniques, with promising aesthetic and functional outcomes to date. Key facial subunits and midface structures such as the eyelids, lips, and nose are now able to be successfully replaced rather than reconstructed, enabling adequate functional outcomes in even the most extensive defects. However, even in cases of severe facial disfigurement, the decision to proceed with transplantation versus autologous reconstruction remains a source of debate, with no current consensus regarding precise indications and inclusion/exclusion criteria. This report details the case of a candidate referred for face transplantation who ultimately underwent autologous facial reconstruction. Through this representative case, our objective is to clarify the criteria that make a patient a suitable face transplant candidate, as well as to demonstrate the outcomes achievable with a conventional autologous reconstruction, using a methodically planned, multistaged approach.

Purpose Facial transplantation involves partial or total replacement of neuromuscular and skeletal structures of the face, head, and neck using donor tissues and is among the most extensive facial reconstructive procedures. This case report compares changes in speech production and articulator movement in a 44-year-old man from pretransplant to a 13-month posttransplant period. Method Speech production and articulator movement data were examined at 5 time points, once pretransplant and 4 times posttransplant (4, 7, 10, and 13 months), and compared to 4 healthy controls. A motion capture system was used to track jaw and vertical/horizontal lip movement during nonspeech and speech tasks. Speech intelligibility, jaw displacement, lip aperture, and movement variability were measured. Results Speech intelligibility varied across the study period and was restored to control status by 7 months posttransplant. Jaw displacement and lip aperture in the vertical plane significantly increased over time for nonspeech and speech tasks. Changes in horizontal lip movements over time were minimal. Jaw and lip movement variability fluctuated over time and was greater than the controls by 13 months posttransplant. Discussion Findings quantify changes in articulator movement and contributions to improved speech production following facial transplant. Changes reflect the adaptability of the speech motor system and are discussed in relation to pretransplant speech motor control patterns.