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Effect of Bone Loss Simulation and Periodontal Splinting On View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector a r c h i v e s o f o r a l b i o l o g y 5 6 ( 2 0 1 1 ) 1 3 7 3 – 1 3 8 1 availab le at www.sciencedirect.com journal homepage: http://www.elsevier.com/locate/aob Effect of bone loss simulation and periodontal splinting on bone strain Periodontal splints and bone strain a b Priscilla Barbosa Ferreira Soares , Alfredo Ju´ lio Fernandes Neto , a c d, Denildo Magalha˜ es , Antheunis Versluis , Carlos Jose´ Soares * a Department of Periodontology and Implantology, School of Dentistry, Federal University of Uberlaˆ ndia, Minas Gerais, Brazil b Department of Fixed Prosthodontics, Occlusion and Dental Materials, School of Dentistry, Federal University of Uberlandia, Minas Gerais, Brazil c Department of Restorative Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA d Department of Operative Dentistry and Dental Materials, School of Dentistry, Biomechanics Group, Federal University of Uberlandia, Minas Gerais, Brazil a r t i c l e i n f o a b s t r a c t Article history: Objectives: The influence of bone loss and periodontal splinting on strains in supporting Accepted 1 April 2011 bone is still not well understood. The aim of this study was to analyse the effect of bone loss and periodontal splints on strains in an anterior mandible structure. Keywords: Methods: Ten anterior mandible models were fabricated using polystyrene resin. Eighty human teeth were divided in 10 groups (right first premolar to left premolar) and embedded Alveolar bone in simulated periodontal ligament. Strain gauges were attached to the buccal and lingual Bone loss mandible surfaces. The models were sequentially tested for 7 conditions: no bone altera- Occlusal trauma tions and no splinting; 5 mm of bone loss between canine teeth; bone loss associated with Periodontal splinting resin splint between canine teeth; bone loss with wire splint; bone loss with wire/resin Periodontal disease splint; bone loss with extracoronal fibre–glass/resin splint; and bone loss with intracoronal Strain gauge Strain fibre–glass/resin splint. Oblique loads (50, 100, and 150 N) were applied on the teeth. Data were analysed using 3-way ANOVA and Scheffe’s test (a = .05). Results: Strains on buccal surface were higher than on lingual surface. Bone loss resulted in strain increase at 100 and 150 N loading. Dental splinting with resin resulted in strain values similar to the control levels. Conclusions: Bone loss increased strain mainly in the buccal region. Dental splints with adhesive system and composite resin produced lower bone strains irrespective of occlusal load. # 2011 Elsevier Ltd. Open access under the Elsevier OA license. 1. Introduction 1,2 bacterial factors present in dental plaque. As a result of the inflammatory process there is a disorganization of periodontal Periodontal disease is considered an infectious pathology fibres, induction of bone resorption, and destruction of 1,3,4 caused by the interaction between a susceptible host and epithelial cell attachment. Occlusal forces also play an * Corresponding author at: Biomechanic Research Group – Faculdade de Odontologia, Universidade Federal de Uberlaˆndia, A´ rea de Dentı´stica e Materiais Odontolo´ gicos, Av. Para´, n8 1720, CEP 38400-902, Bloco B, 2B24, Uberlaˆndia, Minas Gerais, Brazil. Tel.: +55 34 3218 2255; fax: +55 34 3218 2626. E-mail address: [email protected] (C.J. Soares). 0003–9969 # 2011 Elsevier Ltd. Open access under the Elsevier OA license. doi:10.1016/j.archoralbio.2011.04.002 1374 a r c h i v e s o f o r a l b i o l o g y 5 6 ( 2 0 1 1 ) 1 3 7 3 – 1 3 8 1 important role because they may exacerbate a preexisting periodontal lesion when they exceed the resistance threshold 2. Materials and methods 1–5 of a compromised attachment apparatus. In the presence of frequent loading, the time for bone remodelling may not be 2.1. Tooth selection 6 enough, and thus bone resorption takes place. Reduced periodontal attachment can therefore result in tooth mobility Eighty mandibular human teeth (approved by the Federal and migration, causing misaligned occlusal forces that hinder University of Uberlaˆndia Ethics Committee, protocol #112/06), 7 the balance between bone resorption and bone remodeling extracted for periodontal or orthodontic treatment, were 5 and the reorganization of periodontal fibres. The relationship selected in this study: 20 central incisors, 20 lateral incisors, 20 between occlusal trauma and tooth mobility therefore canines and 20 first premolars (being half of the right side and 1– depends on the intensity and frequency of occlusal forces. half of the left side). Teeth of similar size were selected, where 5,10,11 Periodontal disease and occlusal trauma are most the buccolingual and mesiodistal widths had a maximum prevalent in the mandibular anterior region. Although occlu- deviation of 10% from the mean. Soft tissue and calculus sal forces may be lower in this region compared to other deposits were removed with a periodontal curette (Hu-Friedy, 8,9 regions, stress levels might be higher due to less bone Chicago, IL, USA). The teeth were cleaned using a rubber cup thickness. and fine pumice water slurry and stored in 0.2% thymol Treatment of tooth mobility in periodontal disease is solution (Pharmacia Biopharma Ltda, Uberlaˆndia, Brazil). The determined by the degree of damage to the bone support. For teeth were randomly divided into 10 groups. The teeth were mobility caused by a widened periodontal space as a result of stored in distilled water at 4 8C. 1,5,10 adaptation to functional demands, the treatment is occlusal adjustments in combination with periodontal thera- 2.2. Mandible replica 1,10 py. In teeth affected by gingival inflammation and with 1,5 higher mobility due to loss of bone tissue, the treatment is a To reproduce the anatomy of the anterior mandible, an intact combination of periodontal therapy, occlusal adjustments, dentate human mandible was obtained from the Laboratory of 2,3,5,10,12 and tooth restraints for stability. Stability is accom- Human Anatomy at Federal University of Uberlaˆndia. A wax plished by periodontal splinting, which redistributes func- barrier (Wilson, Polidental Indu´ stria e Come´rcio Ltda, Cotia, 6 tional and parafunctional forces. This helps the process of Brazil) was made around the anterior mandibular region up to reorganization of the gingival tissues, periodontal fibres and the first molars (Fig. 1). A vinyl polysiloxane impression 3 2–4 alveolar bone, and maintains patient comfort. When material (Aerojet, Sa˜o Paulo, Brazil) was prepared according to periodontal splinting is used before surgical periodontal the manufacturer’s instructions and inserted into the wax 2,6 2 therapy, it will promote tooth stabilization and tissue barrier. After 24 h the mandible was removed, leaving its 2,6 healing by reducing inflammation. Various techniques have impression in the vinyl polysiloxane mould. Melted wax was been used to create periodontal splints, such as, composite inserted into this mould to create a wax model. From the wax 6,10,13 resin in combination with adhesive systems, orthodontic model, all teeth were removed at the level of the alveolar bone 13,14 wire, orthodontic wire in combination with composite crest. An impression was made from the wax model using resin, or preimpregnated fibre-reinforced composite in com- vinyl polysiloxane material. After 24 h the wax model was 6,10,15 bination with composite resin. An important aspect for removed, creating a mould of the external anatomy of the the selection of a splint type is the mechanical interaction anterior mandible. Ten wax (Epoxiglass, Diadema, SP, Brazil) 12,16,17 between splinting materials and tooth substrates. replicas were made. Eight alveoli were created in the wax However, the impact of bone loss and splint type on the models. Before the teeth were inserted in the created alveoli, biomechanical response has not been measured yet. There- their roots were dipped into melted wax up to 2.0 mm below fore, determining when to splint and selecting the most the cementoenamel junction (CEJ), resulting in a 0.2–0.3 mm appropriate technique remains a difficult decision for clin- thick wax layer to accommodate the space for a periodontal 19,22–24 icians. ligament. Petroleum jelly (Rioquı´mica, Sa˜o Jose´ do Rio The aim of this study was to assess the biomechanical Preto, Brazil) was painted over the wax covered roots before response in the anterior region of a mandible to bone loss and the teeth were inserted into the alveoli that had first been filled to different types of periodontal splints by measuring strains. with melted wax. Wax excess was carefully removed, avoiding Strains represent deformation, and thus indicate the bio- damage to the external anatomy of the mandible model. mechanical response of the mandible. Strains have previous- Subsequently, the teeth were removed from artificial alveoli ly been measured using strain gauges to analyse the and the wax was removed from the root surface. A final vinyl biomechanical response of mandibular bone and tooth polysiloxane impression was made of the wax model with the 19 18 structures during masticatory loading in vivo and in artificial alveoli, and the mandible anatomy was reproduced in 20 cadavers with natural teeth after implant insertion. Bone polystyrene resin (Aerojet, Sa˜o Paulo, Brazil). Polystyrene resin 3 25,26 deformation has also been estimated indirectly by measuring has an elastic modulus (13.5 Â 10 MPa) similar to cortical 21 3 27 strains on mandible replicas made of epoxy resin or bone (14.4 Â 10 MPa).
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