Faculty Bibliography

Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging because of tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons' assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n = 10) and BCLP (n = 10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM, and 5 patients did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid e-mail addresses responded to the survey. For patients with UCLP, surgeons reported that, for NAM-prepared patients, 53.3% had minimum severity clefts, 58.9% were anticipated to be among their best surgical outcomes, and 82.9% were unlikely to need revision surgery. For patients with BCLP, these percentages were 29.8%, 38.6%, and 59.9%, respectively. Comparing NAM-prepared with non-NAM-prepared patients showed statistically significant differences (P < 0.001), favoring NAM-prepared patients. This study suggests that cleft surgeons assess NAM-prepared patients as more likely to have less severe clefts, to be among the best of their surgical outcomes, and to be less likely to need revision surgery when compared with patients not prepared with NAM.

CONTEXT.: Approximately 30% of women report pain in the affected breast prior to breast cancer surgery. OBJECTIVES: The purpose of this secondary analysis of our prospective study was to determine how women who experienced both preoperative and persistent postsurgical breast pain (n=107) differed from women who did not report preoperative breast pain and did (n=158) or did not (n=122) experience persistent postsurgical breast pain. METHODS: Differences in demographic and clinical characteristics were evaluated. Linear mixed effects (LME) modeling was used to evaluate for group differences in symptom severity, function, sensation, and quality of life (QOL) over time. RESULTS: Between-group differences in demographic and clinical characteristics as well as trajectories of shoulder function and QOL were identified. Women with both preoperative and persistent postsurgical breast pain were younger; were more likely to report swelling, strange sensations, hardness, and numbness in the affected breast prior to surgery; and were more likely to have reconstruction at the time of surgery. Women with both preoperative and persistent postsurgical breast pain had more biopsies in the prior year, more lymph nodes removed, and reported more severe acute postsurgical pain than women without preoperative breast pain. LME modeling revealed significant group effects for the majority of outcomes evaluated. Over the six months of the study, women with both preoperative and persistent postsurgical pain had persistently poorer shoulder flexion and physical well-being than women without preoperative breast pain. CONCLUSION: Investigations of the etiology and molecular mechanisms of preoperative breast pain, as well as interventions for this high risk group, are needed.

OBJECTIVE: Osseointegration has been a proven concept in implant dentistry and orthopedics for decades. Substantial efforts for engineering implants for reduced treatment time frames have focused on micrometer and most recently on nanometer length scale alterations with negligible attention devoted to the effect of both macrometer design alterations and surgical instrumentation on osseointegration. This manuscript revisits osseointegration addressing the individual and combined role of alterations on the macrometer, micrometer, and nanometer length scales on the basis of cell culture, preclinical in vivo studies, and clinical evidence. METHODS: A critical appraisal of the literature was performed regarding the impact of dental implant designing on osseointegration. Results from studies with different methodological approaches and the commonly observed inconsistencies are discussed. RESULTS: It is a consensus that implant surface topographical and chemical alterations can hasten osseointegration. However, the tailored combination between multiple length scale design parameters that provides maximal host response is yet to be determined. SIGNIFICANCE: In spite of the overabundant literature on osseointegration, a proportional inconsistency in findings hitherto encountered warrants a call for appropriate multivariable study designing to ensure that adequate data collection will enable osseointegration maximization and/or optimization, which will possibly lead to the engineering of endosteal implant designs that can be immediately placed/loaded regardless of patient dependent conditions.

The drilling technique and the surface characteristics are known to influence the healing times of oral implants. The influence of osteotomy dimension on osseointegration of microroughned implant surfaces treated with resorbable blasting media was tested in an in vivo model. Ninety-six implants (o4.5 mm, 8 mm in length) with resorbable blasting media-treated surfaces were placed in the ileum of six sheep. The final osteotomy diameters were 4.6 mm (reamer), 4.1 mm (loose), 3.7 mm (medium), and 3.2 mm (tight). After three and six weeks of healing, the implants were biomechanically tested and histologically evaluated. Statistical analysis was performed using Page L trend test for ordered and paired sample and linear regression, with significance level at p < 0.05. An overall increase in all dependent variables was observed with the reduction of osteotomy diameter. In addition, all osseointegration scores increased over time. At three weeks, the retention was significantly higher for smaller osteotomies. The histological sections depicted intimate contact of bone with all the implant surfaces and osteoblast lines were visible in all sections. The resorbable blasting media microroughed surfaces achieved successful osseointegration for all the instrumentation procedures tested, with higher osseointegration scores for the high insertion torque group.

Although preclinical and sparse human histology retrieval studies have shown that the interface between implant and bone is constantly remodeling, no human retrieval database has been developed to determine the effect of functional loading time and other clinical/implant design variables on osseointegration. The present study tested the hypothesis that bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) increase over functional loading time around dental implants. Due to prosthetic retreatment reasons, 93 human implant retrievals from the same manufacturer (Bicon LLC, Boston, MA, USA) were obtained over a period of approximately 15 years. The retrieved implants were under functional loading from 120 days to approximately 18 years and were histomorphologic/metrically evaluated. BIC/BAFO were assessed as a function of multiple independent variables: implant surface type, diameter, length, jaw (maxilla/mandible), region (anterior/posterior), and time of functional loading. The results showed that both BIC and BAFO increased over time independently of implant design/clinical variables, supporting the postulated hypothesis. (c) 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2014.

OBJECTIVES: To define the effect of APP treatments on the mechanical properties of enamel and on its ability to promote sealant bonding to unetched enamel. METHODS: Human molar teeth were sectioned exposing flat enamel regions at the buccal and lingual surfaces. The specimens were divided into two substrate groups (etched and unetched) and distributed over three surface treatments (i) 5 slm Argon APP treatment, NaOH surface treatment, and (iii) compressed air application (control). The Enamel surfaces were characterized by SEM, IFM, and Goniometer instruments. For the mechanical tests nanoindentation and microshear bond strength were employed. Initial data evaluation comprised normality verification (SPS S software) and variance checking and the appropriated statistical analysis model employed. For all statistical inferences, significance was set at 0.05. RESULTS: SE was significantly higher for the etched and unetched group treated with Plasma relative to the NaOH and control groups. Nanoindentation testing determined that Rank hardness was significantly higher in the control and Plasma group relative to NaOH for the etched group. Rank Elastic Modulus was significantly higher on Control groups relative to NaOH and Plasma groups for the etched substrate. No difference was detected between treatments for the unetched group. For the microSBS test, we observed that APP treatment on etched and unetched enamel increased bonds significantly (p < 0.001). CONCLUSIONS: This study demonstrated that APP increased SE, surface wettability and bond strength between enamel and sealants potentially serving as a substitute for conventional acid etching procedures or as an adjuvant for self-etch sealants. (c) 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2014.

BACKGROUND: Patients with unilateral cleft lip and palate (CLP) deformities commonly develop nasal airway obstruction, necessitating septoplasty at the time of definitive rhinoplasty. We assessed the contribution of the bony septum to airway obstruction using computed tomography (CT) and cone beam CT (CBCT). METHODS: A 2-year retrospective review of all subjects with unilateral CLP who underwent CBCT imaging (n = 22) and age-matched controls (n = 9) who underwent CT imaging was conducted. Control CT scans were used to determine the segment of nasal septum comprised almost entirely of bone. The CBCT of the nasal airway was assessed using Dolphin software to determine the contribution of the bony septum to septal deviation and airway obstruction. RESULTS: The nasal septum posterior to the midpoint between anterior and posterior nasal spine is comprised of 96% bone. The nasal airway associated with this posterior bony segment was 43.1% (P < 0.001) larger by volume on the non-cleft side in patients with unilateral CLP. The average septal deviation within the posterior bony segment was 5.4 mm, accounting for 74.4% of the maximal deviation within the nasal airway. The average airway stenosis within the posterior bony nasal airway was 0.45 mm (0-2.2 mm). CONCLUSIONS: In patients with unilateral CLP, the bony nasal septum can demonstrate significant deviation and airway stenosis. Surgeons should consider a bony septoplasty in their treatment algorithm in unilateral CLP patients who have reached skeletal maturity.

Objectives: The aim of this study was to quantify the polymerization volumetric shrinkage of one regular and two low shrinkage bulk fill composites in class I cavities with or without an adhesive layer, using three-dimensional (3D) micro-computed tomography (muCT). Methods: Class I cavity preparations (2.5 mm depth x 4 mm length x 4 mm wide) were standardized in 36 extracted human third molars, which were randomly divided in six groups (n = 6 each) as follows: Group VIT (regular composite without bonding agent); Group SDR (low shrinkage flowable composite without bonding agent); Group TET (low shrinkage composite without bonding agent); Group VIT/P (regular composite with bonding agent); Group SDR/X (low shrinkage flowable composite with bonding agent); TET/T (low shrinkage composite with bonding agent). Each tooth was scanned via microCT at cavity preparation, immediately after cavity filling, and after light-curing. Acquired muCT data were imported into Amira software for analysis and volume values evaluated between steps from cavity preparation until light-curing. Results: Both low shrinkage composites showed a significantly less volumetric shrinkage than VIT. The use of dental adhesive significantly decreased the average volumetric contraction similarly for the three composites, by about 20%. Conclusion: Both low shrinkage composites showed less volumetric polymerization contraction than the regular composite. The use of dental adhesive decreased the total volumetric shrinkage for all evaluated composites. (c) 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2014.

OBJECTIVES: The objective of this histologic study was to determine the effect of three drilling protocols (oversized, intermediate, and undersized) on biologic responses to a single implant type at early healing periods (2 weeks in vivo) in a beagle dog model. MATERIALS AND METHODS: Ten beagle dogs were acquired and subjected to surgeries in the tibia 2 weeks before euthanasia. During surgery, each dog received three Unitite implants, 4 mm in diameter by 10 mm in length, in bone sites drilled to 3.5, 3.75, and 4.0 mm in final diameter. The insertion torque was recorded during surgery, and bone-to-implant contact (BIC), and bone area fraction occupied (BAFO) measured from the histology. Each outcome measure was compared between treatment conditions with the Wilcoxon signed-rank test. Bonferroni-corrected statistical significance was set to 95%. RESULTS: Insertion torque increased as an inverse function of drilling diameter, as indicated by significant differences in torque levels between each pair of conditions (P = 0.005). BIC and BAFO levels were highest and statistically similar in the recommended and undersized conditions and significantly reduced in the oversized condition (P < 0.01). CONCLUSIONS: Reduced drilling dimensions resulted in increased insertion torque (primary stability). While BIC and BAFO were maximized when drilling the recommended diameter hole, only the oversized hole resulted in evidence of statistically reduced integration.