Biomedical subjects

C M Stanford

Publications and source records attributed to C M Stanford.

At least 19 recordsLinked to original sources

PubMed2005

Issues and considerations in dental implant occlusion: what do we know, and what do we need to find out?

Implant dentistry continues to struggle with what are the appropriate occlusal concept(s) for implant-supported restorations. The biological and mechanical consequences of the loading environment leads to establishing and maintaining an implant interface in a wide variety of bone quality and quantity, implant and prosthesis designs. To the restorative dentist, the role of occlusion is more focused on extending the service life of the restoration and the connecting abutment(s) than protecting the osseous integration of the implant(s). This study reviews the relevant issues regarding implant occlusion along with implant and prosthesis design in order to provide optimal patient care.

Animals↗

PubMed2001

Primary adult human bone cells do not respond to tissue (continuum) level strains.

Bone adapts to its mechanical environment, and, since the late 1800s, investigators have presumed that this adaptation relates to strain magnitude. Indeed, overwhelming evidence supports the view that either strain or some strain-related quantity stimulates bone adaptation or remodeling. Virtually all investigators, implicitly or explicitly, assume that the level of strain magnitude responsible for bone adaptation is that measured by strain gauges in vivo (i.e., 100-2500 microstrain) and that bone cells are directly deformed by strained matrix. We present evidence that bone cell deformation in this range does not cause bone adaptation. First, bone cells in vitro typically do not respond to average (continuum) levels of strain magnitude. Second, bone cells in vitro do respond to fluid flow-induced shear stresses in these ostensible physiological ranges. Third, in vivo strain magnitudes presumed to stimulate remodeling reflect only averages, and not local peaks, which are 2-15 times higher. Thus, we hypothesize that sensing cells do not respond to levels of strain presumed to be physiological.

Adaptation, Physiological↗

PubMed2001

Micromotion and dynamic fatigue properties of the dental implant-abutment interface.

STATEMENT OF PROBLEM: Clinical loading may result in micromotion and metal fatigue in apparently stable implant screw joints. This micromotion may contribute to tissue inflammation and prosthesis failure. PURPOSE: This study investigated dental implant screw joint micromotion and dynamic fatigue as a function of varied preload torque applied to abutment screws when tested under simulated clinical loading. MATERIAL AND METHODS: Fifteen noble alloy single-tooth implant restorations, each containing a hexed UCLA-style gold cylinder, were randomly assigned to 3 preload groups (16, 32, and 48 N.cm). Each group consisted of 5 implants (each 3.75 x 15 mm) and 5 square gold alloy abutment screws. A mechanical testing machine applied a compressive cyclic sine wave load between 20 and 130 N at 6 Hz to a contact point on each implant crown. A liquid metal strain gauge recorded the micromotion of the screw joint interface after 100, 500, 1,000, 5,000, 10,000, 50,000, and 100,000 cycles. Baseline data at 0 N.cm were collected before the application of the specified preload torque. RESULTS: The 16 N.cm group exhibited greater micromotion (P<.001) than both the 32 and 48 N.cm groups at all cycle intervals (2-way ANOVA, Tukey HSD). Micromotion of the implant-abutment interface remained constant (P=.99) for each of the preload groups through 105 cycles. CONCLUSION: Under the loading parameters of this study, no measurable fatigue of the implant-abutment interface occurred. However, dental implant screw joints tightened to lower preload values exhibited significantly greater micromotion at the implant-abutment interface.

Analysis of Variance↗

PubMed2001

Dynamic fatigue properties of the dental implant-abutment interface: joint opening in wide-diameter versus standard-diameter hex-type implants.

STATEMENT OF PROBLEM: The clinical long-term success of single-tooth implant restorations depends, in part, on a stable connection between the prosthetic restoration and the implant body. PURPOSE: The purpose of this experiment was to investigate the fatigue life of UCLA-style abutment screws in wide-diameter versus conventionally sized dental implant restorations. MATERIAL AND METHODS: Five 3.75 x 15-mm and five 6.0 x 15-mm hexed dental implants were used. Ten frameworks were fabricated, 5 with a single UCLA-style, 3.75-mm hexed gold alloy cylinder, and 5 with a single UCLA-style, 6.0-mm hexed gold alloy cylinder. To simulate a common laboratory procedure, 2 abutment interfaces were relieved with a one-quarter round bur for both diameters. The 3.75-mm implant used a Gold-Tite central abutment screw torqued to 32 Ncm, and the 6.0-mm implant used a titanium central abutment screw torqued to 25 Ncm. Frameworks were dynamically loaded ( approximately 10 Hz) with a 120 +/- 10-N, 4-mm off-axis force. Liquid metal strain gauges were used to measure joint opening. Measurements were made at intervals of 10(3), 10(4), 10(5), and 5x10(5) cycles. Gauge output data were converted to displacement with a conversion factor determined by calibration. Linear regression analysis then was performed. RESULTS: Two observations were made in this study. Two of three 3.75-mm nonadjusted specimens and all three 6.0-mm nonadjusted specimens maintained joint closure (range of opening 0-20 microm) while measured under dynamic loading. The median joint opening at 5x10(5) cycles for 3.75-mm nonadjusted specimens was 14 +/- 7 microm; for 6.0-mm specimens, it was 11 +/- 10 microm. Both 3.75-mm adjusted specimens and 1 nonadjusted specimen failed to maintain joint closure (excess joint opening >50 microm). One of the 3.75-mm adjusted specimens had abutment screw fracture. One of two 6.0-mm adjusted specimens failed to maintain joint closure because of screw fracture. CONCLUSION: The dental implant-abutment interface of 3.75-mm and 6.0-mm externally hexed implants experienced similar joint opening after periods of dynamic loading. Laboratory adjustment of the interface significantly decreased the service life of the abutment screw joint.

Analysis of Variance↗

PubMed2000

Calcium and phosphate supplementation promotes bone cell mineralization: implications for hydroxyapatite (HA)-enhanced bone formation.

Organic phosphate, in particular beta-glycerophosphate (beta-GP), has been used to induce mineralization in cell culture systems. It serves as a source of inorganic phosphate when hydrolyzed by alkaline phosphatase. This study examined the effect of supplemental calcium and phosphate as well as the influence of various metabolic inhibitors on mineralization in a rat osteoblast-like cell-culture system. Mineralization was induced by supplementation of 1.8 mM of Ca(+2) and 5 mM of beta-GP or Pi. Mineral deposits associated with in vitro mineralization were revealed under SEM and TEM. Levamisole (10-100 microM) inhibited alkaline phosphatase activity and effectively reduced mineral formation. Actinomycin (500 ng/mL) and cycloheximide (50 microg/mL) also reduced mineral depositions by blocking RNA synthesis and protein synthesis, respectively. Levamisole and beta-GP did not appear to influence DNA synthesis. Spontaneous precipitation of calcium phosphate mineral was not detected in the culture medium with calcium and phosphate supplements in the absence of cell culture. The findings suggest that an elevated concentration of calcium and phosphate is crucial for in vitro mineralization. Furthermore, the mineralization process is associated with biologic events rather than with a spontaneous precipitation of calcium phosphate mineral. In view of the degradation potential of hydroxyapatite (HA)-coated implants, these results may be a viable indication that HA enhances bone formation through a similar mechanism.

Animals↗

PubMed2000

Primary human bone cultures from older patients do not respond at continuum levels of in vivo strain magnitudes.

Osteoporosis is characterized by excessive loss of bone mass, while exercise is believed to maintain or enhance bone mass. Since exercise marginally affects osteoporosis, we wondered whether bone cells from osteoporotic patients would fail to respond to strain. Primary human bone-like cultures were obtained from females over age 60 with hip arthroplasty procedures performed for either osteoporotic fracture (n = 8) or non-osteoporotic osteoarthrosis (n = 5). Cultures (96,000 cell/cm2) were strained in rectangular optically clear silastic wells. Three periods of uniaxial substratum strain (1000 micro-strain, 1 Hz, 10,000 cycles, sine wave) were provided every 24 h using a four-point bending, computer-controlled device. Results at a frequency of 1 Hz were compared to cultures exposed to 20 Hz with bone cells derived from one osteoarthritic subject. Alterations in protein level expression of bone-related proteins were determined using a semi-quantitative confocal approach along with enzyme (alkaline phosphatase) activity and enzyme mRNA copy number using cRNA RT-PCR. Strain did not alter levels of bone-related protein levels, enzyme activity, or steady state copy number per cell in response to strain in either group. Strained cultures from osteoporotic patients exhibited little variation from unstrained controls, while individual cultures from osteoarthritic patients exhibited increases in one protein or the other. The results suggest that bone cells from older individuals may not be responsive to continuum levels of strain anticipated with vigorous activity.

Aged↗

PubMed2000

Development and application of a new abrasion testing device.

STATEMENT OF PROBLEM: Wear of gypsum materials is a significant problem in the fabrication of accurately fitting cast prosthetic devices. Unfortunately, there is little agreement on how to measure it. PURPOSE: This study was designed to evaluate the efficacy of a newly designed abrasion device and to develop a test methodology that provides a clinically relevant measure of material loss from gypsum material. MATERIAL AND METHODS: In this study, a unique benchtop microabrasion/microimpact device was created. The device consists of a vertical arm with a variably loaded stylus and a reciprocating table that moves the specimen under the stylus. Type IV gypsum samples (Silky Rock, Whip Mix Corp, Louisville, Ky.) were made with 1 mm vertical, 45-degree angled ridges used to represent crown margins. Samples (n = 30) were separated 1 hour after pouring and allowed to bench set for 24 hours or 7 days. Three loads (15, 50, and 75 g) were used, and the resulting defect was evaluated after 5, 10, 15, or 20 cycles of loading. Changes in mass and volume were recorded. RESULTS: At both 24 hours and 7 days, there was an increase in both mass and material volume loss with increasing load on the stylus (P<0.0001). There was no significant change in mass after 5 cycles of loading (P<0.05), but an increase in the volume loss occurred because of compaction of the walls of the defect (P<0.0001). CONCLUSION: Under these conditions, the increasing load had a greater effect than the number of load cycles on gypsum brittle fracture.

Analysis of Variance↗

PubMed2000

Cell mechanics.

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Biomechanical Phenomena↗

PubMed2000

Removal of supragingival plaque in an intraoral model by use of the Sonicare toothbrush.

This study was performed to evaluate plaque removal efficacy of a mechanical toothbrush in a controlled in vivo trial. The study used enamel sections, obtained from extracted human teeth, to evaluate the efficacy of supragingival plaque removal by a mechanical powered toothbrush in various modes of use. Enamel sections were positioned in milled depressions on metal extensions of a maxillary partial denture that bilaterally extended along the buccal corridors. Four sections were used per side, positioned zero, 2 or 3mm from the surface of the metal extension. The prosthesis was worn for 16 hours, whereupon four enamel sections (two per side) were removed. Intra-oral brushing was then performed for 5 or 15 seconds on the remaining four sections. The total of adherent bacteria was then assayed from all enamel sections. Ten to twenty trials were performed (n=4 pairs/trial) for each set of variables. When the electric toothbrush was used as a manual brush ('off'), it was equivalent in plaque removal to a conventional toothbrush (Oral-B 35; P = 0.49). However, when the powered brush was in its active mode ('on'), it removed more bacteria (P < 0.0001); this efficacy was observed even when the bristle tips were at a distance from the plaque surface.

Analysis of Variance↗

PubMed1999

Significant role of adhesion properties of primary osteoblast-like cells in early adhesion events for chondroitin sulfate and dermatan sulfate surface molecules.

The purpose of this study was to characterize the role of cell surface adhesive macromolecules through enzyme modulation and metabolic recovery prior to and during a kinetic cell adhesion assay. Primary rat calvarial osteoblast-like cells were derived from Sprague-Dawley calvarial plates. Cell adhesion kinetics was evaluated with the definition of first-order adhesion kinetics. Osteoblasts were incubated in an adhesion buffer for 1 h prior to a cell attachment assay using various enzymes to remove cell surface glycosaminoglycans (GAGs). A subtractive adhesion analysis was performed by plating cells at 5 x 10(4)/well for variable periods through 2 h. The medium was collected, the well surface washed and pooled, and the number of cells enumerated with a Coulter Counter. Cell adhesion demonstrated first-order logarithmic adhesion kinetics in the first 60 min. Scatchard analysis demonstrated a linear relationship. Preexposure of cells to various enzyme combinations demonstrated that 50% of the equilibrium adhesion was dependent on chondroitin sulfate or dermatan sulfate surface macromolecules. These results were confirmed with pretreatment with a metabolic inhibitor of GAG synthesis (beta-D-xyloside). These results suggest an important role for cell associated chondroitin sulfate and dermatan sulfate in cell adhesion in addition to Arg-Gly-Asp or integrin mediated adhesion events.

Animals↗

PubMed1999

Toward an understanding of implant occlusion and strain adaptive bone modeling and remodeling.

STATEMENT OF PROBLEM: Dental implant failure rates for osseointegration are greater in the highly atro-phic maxilla. Presuming higher failure rates relate to strain-driven adaptation, an enhanced understanding of formative bone response to loading (modeling) and maintenance of an integrated state (remodeling) should improve treatment. PURPOSE: To understand the role of occlusal loading on long-term osseointegration in areas of compromised cancellous bone, a review of the salient features of adaptive bone modeling and remodeling is presented with an emphasis on cancellous bone responses. CONCLUSIONS: The ability for dental implants to maintain a long-term stable interface in the maxilla lies in the ability of trabecular bone to maintain adequate local material (strength) and architectural (connectivity) properties. In this discussion, an emphasis has been placed on understanding how trabecular bone can respond to the mastication-induced loading environment on an implant.

Adaptation, Physiological↗

PubMed1999

Biomechanical and functional behavior of implants.

The ability to achieve a long-term stable implant interface is not a significant clinical issue when sufficient uni- or bi-cortical stabilization is available. Clinical outcomes studies suggest that the higher-risk implants are those placed in compromised cortical bone (thin, porous, etc.) in anatomic sites with minimal existing trabecular bone (characterized as type IV bone). In establishing and maintaining an implant interface in such an environment, one needs to consider the impact of masticatory forces. These forces, in turn, have the potential to create localized changes in interfacial stiffness through the viscoelastic properties of bone. Changes in these properties will alter the communication between osteocytes and osteoblasts, leading to an increase in new bone growth, a maintenance of established bone, or a loss (potentially catastrophic) of either cortical or trabecular bone. Therefore, a key to understanding the biomechanical and functional behavior at an implant interface is to control the extent of anticipated modeling and remodeling behavior through an optimal implant design combined with a thorough understanding of how tissues respond to the mechanically active environment.

Alveolar Process↗

PubMed1998

Evaluation of resilient abutment components on measured strain using dynamic loading conditions.

STATEMENT OF PROBLEM: Factors that affect transmission of strain from prostheses to bone may affect the long-term success of loaded implants. Current in vitro models are theoretically predictive (finite element modeling) or facsimile (photoelastic) in nature. A more clinically relevant in vitro model for strain evaluation should be investigated. PURPOSE: This study attempted: (1) to validate a human cadaver bone model for vitro measurement of cortical bone strain, and (2) to evaluate the effect on cortical strain measurements of a resilient plastic component incorporated within a titanium implant in response to variable dynamic loading. MATERIAL AND METHODS: Two IMZ (Interpore International) abutment alternatives were used: the titanium Abutment Complete and the polyoxymethylene Intra-mobile Element. The model system consisted of two implants placed in unfixed human cadaver ulna bone to simulate an implant bound edentulous region. Four biaxial rosette strain gauges simultaneously recorded cortical bone strain immediately mesial and distal to each implant. During experimentation a simulated prosthetic framework supported by either titanium or polyoxymethylene abutments was dynamically loaded 6 min from the terminal abutment along a cantilever extension. Cyclic nominal peak loads were applied with a materials testing machine at 20-N intervals from 20 to 200 N at a crosshead speed of 5 mm/minute. The protocol allowed frequency of load application to vary. A Newtonian linear correlation (r2 > or = 0.98) between load application and strain output was determined for each gauge position except for the terminal gauge located opposite the cantilever. RESULTS: Cortical strains recorded were within reported physiologic ranges involved in bone modeling and remodeling. Further, the polyoxymethylene abutment components did not result in reduction of peak microstrain at any gauge position. The Intra-mobile Element abutments, however, did increase the time required to complete 10 loading cycles when compared with the titanium Abutment Complete abutments for the crosshead speed and ultimate loads evaluated. CONCLUSIONS: Results indicate the cadaver bone behaved in an elastic manner within the load range evaluated, and as such represents a viable in vitro experimental model. Under these conditions, polyoxymethylene abutment components do not affect measurable bone strain in response to variable loading when compared with titanium.

Bone and Bones↗

PubMed1997

Effects of radiofrequency glow discharge on impression material surface wettability.

STATEMENT OF PROBLEM: Argon radiofrequency glow discharge (RGD) may simultaneously sterilize and improve surface wettability of impression materials. PURPOSE: The purpose of this study was to define RGD technical parameters that influence the surface wettability of impression material (optimization phase). Definition of RGD was followed by an assessment of these optimized RGD parameters on the wettability of four impression materials either uncontaminated or contaminated with saliva, compared with conventional liquid disinfection (application phase). MATERIAL AND METHODS: For the optimization phase, addition silicone samples were cast against glass with 10 samples per group/parameter (n = 210). Parameters evaluated were duration of exposure, sample shape and angle, position within the RGD chamber, and argon gas delivery pressure. Changes in surface wettability were determined with contact angle measurements. For the application phase, standardized RGD parameters (90 degrees to the plasma flow, flat, 60 seconds, 5 psi) were used on four groups of impression materials with (n = 120 samples, 30 per material) or without (n = 120 samples, 30 per material) prior saliva contamination. RESULTS: RGD treatment of a polyvinyl siloxane impression material significantly (p < 0.0001) reduced contact angle measurements from 63 +/- 1 to 13 +/- 4 degrees, regardless of the parameter evaluated. For the application phase, results indicated different responses to RGD relative to nontreated controls. With all materials treated with RGD or disinfectant exposure, the finest 20 microns standard line was reproduced at x10 magnification with the American National Standards Institute/American Dental Association Specification 19 test die (Sabri Enterprise, Downers Grove, Ill.; n = 80, 10 samples per group). CONCLUSION: These results suggest RGD selectively alters impression material surface wettability.

Analysis of Variance↗

PubMed1997

Finite element stress analysis of IMZ abutment designs: development of a model.

PURPOSE: This article describes the development of a model system for use in finite element stress analysis of three different IMZ abutment designs: original threaded Intra-Mobile Element (IME), Abutment Complete (ABC), and Intra-Mobile Connector (IMC). MATERIALS AND METHODS: A three-dimensional model simulating a cast gold crown restoration attached to an osseointegrated IMZ implant fixture was generated for each abutment design. Each model was discretized into axisymmetric finite elements representing the crown, the various implant system components, and supporting structures. A convergence test was performed to optimize the mesh. Convergence test mesh refinement for the IME, the IMC, and the ABC abutment models resulted in 818 elements, 2,566 nodes; 738 elements, 2,362 nodes; and 663 elements, 2,051 nodes, respectively. Progressive tightening of the retaining screw (preload) was simulated; the degree of screw tightening necessary to prevent opening of the crown-abutment interface in extreme loading (500-N occlusal load at 45 degrees) was determined individually for each system. CONCLUSIONS: Models of three IMZ abutment designs have been refined and the appropriate relative screw preloads determined. This model system is to be used subsequently in stress analysis comparison for the three systems.

Biomechanical Phenomena↗

PubMed1997

Deflection and stress distribution in three different IMZ abutment designs.

PURPOSE: The purpose of this study was to compare the stress distribution in the resin element and the retaining screw for three different IMZ prosthetic systems: 1) original threaded Intra-Mobile Element (IME); 2) Abutment Complete (ABC); and 3) Intra-Mobile Connector (IMC). This stress distribution comparison was then related to variations in deflection of the prosthetic superstructure. MATERIALS AND METHODS: Employing the finite element method, a three-dimensional model simulating a cast gold restoration attached to an osseointegrated IMZ implant fixture was generated for each system. The representation of the implant fixture, the supporting structures, and the external contours of the crown were identical in the three models, while the configuration of the abutment varied to characterize the individual systems. Each model was discretized into axisymmetric finite elements representing the crown, the various implant system components, and supporting structures. A series of harmonic functions was written to define non-axisymmetric loads of 100 N and 500 N evenly distributed over the entire occlusal surface of the crown. Each load was applied individually to the models, first in a vertical direction, and then at a 45 degree angle to the median plane. Predicted deflection and stress distributions were computed and plotted for each loading condition of each model. RESULTS: Deflections measured at the buccal cusp tip ranged from 0.002 mm (100-N load applied vertically to the ABC model) to 0.802 mm (500-N load applied at 45 degrees to the IME model). Maximum effective stresses in the retaining screw ranged from 129 MPa (100-N load applied vertically to the ABC model) to 1,315 MPa (500-N load applied at 45 degrees C to the IMC model). A correlation was observed between the peak stresses in the screw and the deflection of the superstructure. CONCLUSIONS: Deflections and stress concentrations with the IMC were predicted to be in the same range as with the IME, but much greater than with the ABC.

Composite Resins↗

PubMed1997

Efficacy of the Sonicare toothbrush fluid dynamic action on removal of human supragingival plaque.

The fluid pressure and shear forces generated by the high frequency bristle motion of the Sonicare sonic toothbrush remove adherent colonies of cultured bacteria from model dental surfaces in vitro. These dynamic fluid effects can remove bacteria in vitro even at distances up to 4 mm beyond the tips of the bristles. To evaluate the efficacy of the Sonicare in removing actual human plaque deposits formed in vivo, an intraoral model was developed. Enamel sections were obtained from extracted human teeth and mounted on acrylic resin palatal prostheses, worn by two volunteers. Six enamel sections were arranged as three pairs at different locations on the prosthesis, and plaque was allowed to form overnight (approximately 16 h). The sections were removed, placed in phosphate-buffered saline, and exposed in vitro to the sonic toothbrush for 5, 10 or 15 seconds. The bristle tips were maintained at distances of 2 or 3 mm from the enamel surface. As a comparison, sections were also exposed to another electric toothbrush (Interplak) for 10 seconds using a distance of 3 mm between the bristles and the enamel. Following exposure to the toothbrushes, residual bacteria were removed from the sections by ultrasonication for 15 seconds, and total viable cell counts determined by serial dilution on blood agar plates. One section from each pair was used to measure total (baseline) microbial accumulation. At a distance of 3 mm between bristles and enamel, the sections exposed to Sonicare demonstrated significant (p < 0.001) plaque removal of 56-78% relative to non-treated controls. In contrast, the control electric brush did not demonstrate removal of plaque bacteria after 10 seconds exposure. These quantitative results were visually confirmed by scanning electron microscopy. The findings demonstrate that the fluid dynamic activity generated by the sonic vibrations of the Sonicare toothbrush removed microbial plaque formed in vivo, even at a distance of 3 mm beyond its bristle tips.

Biofilms↗

PubMed1996

In vitro mineralization and implant calcium phosphate-hydroxyapatite crystallinity.

Biological dissolution of implant calcium phosphate coatings release local concentrations of divalent ions, which may influence mineralization. The objective of this study was to determine the effects of calcium phosphate release from coated commercially pure titanium discs using a bone-like cell culture bioassay. Sandblasted discs were prepared with or without hydroxyapatite crystallinities (50, 75, and 90 percent). Samples of each coating were randomly assigned and either preincubated for 24 hours with media or not before the addition of cells (2200/ mm2). Cultures were grown for 72 hours in culture medium containing 0.5 microCi/mL45 Ca. After rinsing, the remaining calcium phosphate surface was dissolved and counted. Three independent trials were performed. Results indicated proliferation was not altered as a function of crystallinity (P > 0.05) among any of the groups. However, a significant (P < 0.01) inverse relationship was found for biologically mediated mineralization as a function of calcium phosphate crystallinity. Low crystalline surfaces (nominally 50 percent) had the highest level of mineralization, with 75 percent crystalline surfaces being intermediate and 90 percent crystalline samples having the lowest amount of relative mineral formation. Mineralization only occurred on sandblasted commercially pure titanium upon supplementation of the growth medium with an organophosphate (beta-glycerophosphate), although this was less than on culture plastic. The results suggest calcium phosphate dissolution, as a function of implant coating crystallinity, can alter biological mineralization and may be one means in which enhanced mineral formation occurs around calcium phosphate-coated dental implants.

Analysis of Variance↗