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Background/purpose: Clear aligners are popular orthodontic tools because of their relatively aesthetic appearance and convenience of use. Nevertheless, bodily tooth movements still present challenges. This study evaluated various configurations of attachments placed on the mandibular canine in terms of the efficiency of canine bodily movement and correction of tipping. Materials and methods: A finite element model of the mandible was constructed to investigate the effects of various attachment configurations on the overall bodily movement and undesirable tipping of a mandibular canine. Canine movements were categorized into four types, namely tipping and bodily movements in the mesial and distal directions. The size and shape of the attachments were fixed, but their placement and orientation were varied. Five and seven attachment configurations were evaluated for their influence on tipping and bodily movements, respectively. Results: Attachment configuration significantly influenced mandibular canine tipping. The mesial occlusal–distal cervical and mesial occlusal–mesial cervical configurations had notable effects on mesial tipping, and the mesial occlusal–mesial cervical configuration excelled in distal tipping by increasing strain by 33.1%. The mesial occlusal–mesial cervical attachment configuration consistently had superior efficiency in facilitating both mesial and distal bodily movements of the canine. Conclusion: The mesial occlusal–mesial cervical attachment configuration excelled in all four types of canine movement. Irrespective of the attachment configuration, canines tend to move overall with slight tipping due to skeletal resistance and their center of rotation. The attachment configuration is crucial to the success of clear aligner treatment and must be carefully considered in clinical practice.

Background/purpose: The aim of this study was to determine the effects of age and sex on the difference between chronological age (CA) and dental age (DA) predicted using the Demirjian and Willems methods in Taiwanese children. Materials and methods: A total of 232 periapical X-ray images were obtained from children aged 5–12 years in Taiwan. Among them, 119 were boys, and 113 were girls. DA was calculated on the basis of the X-ray images of permanent teeth by using the aforementioned methods. The children were stratified by age (5–9 years [early mixed dentition period] vs. 10–12 years [late mixed dentition period]) and sex (boys vs. girls). Statistical analyses were performed to investigate potential age- and sex-based differences in the correlation between CA and DA. Results: No significant difference was observed between the mean CA and DA predicted using the Willems method in children with late mixed dentition and in girls. However, the correlation between CA and DA was stronger in children with early mixed dentition than in those with late mixed dentition and also stronger in boys than in girls. Conclusion: For children in mid-Taiwan, age and sex influence the development of permanent teeth. In addition, the correlation between DA and CA is relatively strong for boys in the early mixed dentition period.

Abstract Background Dental cone beam computed tomography (CBCT) is commonly used to evaluate cancellous bone density before dental implant surgery. However, to our knowledge, no measurement approach has been standardized yet. This study aimed to evaluate the relationship between three different regions of interest (ROI) methods on cancellous bone density at the dental implant site using dental CBCT images. Methods Patients’ dental CBCT images (n = 300) obtained before dental implant surgery were processed using Mimics (Materialise, Leuven, Belgium). At the potential implant sites, the rectangle, cylinder, and surrounding cylinder ROI methods were used to measure bone density. Repeated measures one-way analysis of variance was performed to compare the three ROI methods in terms of measurement results. Pearson correlation analysis was performed to identify the likely pair-wise correlations between the three ROI methods. Results The density value obtained using the surrounding cylinder approach (grayscale value [GV],523.56 ± 228.03) was significantly higher than the values obtained using the rectangle (GV, 497.04 ± 236.69) and cylinder (GV,493 ± 231.19) ROI methods in terms of results. Furthermore, significant correlations were noted between the ROI methods (r > 0.965; p

Abstract Background Metacarpal shaft fracture is a common type of hand fracture. Numerous studies have explored fixing transverse fractures in the midshaft of the metacarpal bone. However, this section of the metacarpal bone is often susceptible to high-energy injury, resulting in comminuted fracture or bone loss. In such cases, wedge-shaped bone defects can develop in the metacarpal shaft, increasing the difficulty of performing fracture fixation. Notably, the research on this type of fracture fixation is limited. This study compared the abilities of four fixation methods to fix metacarpal shaft fractures with wedge-shaped bone defects. Methods In total, 28 artificial metacarpal bones were used. To create wedge-shaped bone defects, an electric saw was used to create metacarpal shaft fractures at the midshaft of each bone. The artificial metacarpal bones were then divided into four groups for fixation. The bones in the first group were fixed with a dorsal locked plate (DP group), those in the second group were fixed with a volar locked plate (VP group), and those in the third group were fixed by combining dorsal and volar locked plates (DP + VP group), and those in the fourth group were fixed with two K-wires (2 K group). Cantilever bending tests were conducted using a material testing machine to measure yielding force and stiffness. The four groups’ fixation capabilities were then assessed through analysis of variance and Tukey’s test. Results The DP + VP group (164.1±44.0 N) achieved a significantly higher yielding force relative to the 2 K group (50.7 ± 8.9 N); the DP group (13.6 ± 3.0 N) and VP group (12.3 ± 1.0 N) did not differ significantly in terms of yielding force, with both achieving lower yielding forces relative to the DP + VP group and 2 K group. The DP + VP group (19.8±6.3 N/mm) achieved the highest level of stiffness, and the other three groups did not differ significantly in terms of stiffness (2 K group, 5.4 ± 1.1 N/mm; DP group, 4.0 ± 0.9 N/mm; VP group, 3.9 ± 1.9 N/mm). Conclusions The fixation method involving the combined use of dorsal and volar locked plates (DP + VP group) resulted in optimal outcomes with respect to fixing metacarpal shaft fractures with volar wedge bone defects.

Background/purpose: Few studies have investigated the effects of abutment screw diameter in the stress of dental implants and alveolar bones under occlusal forces. In this study, we investigated how variations in implant diameter, abutment screw diameter, and bone condition affect stresses in the abutment screw, implant, and surrounding bone. Materials and methods: Three-dimensional finite element (FE) models were fabricated for dental implants with external hex-type abutments measuring 4 and 5 mm in diameter. The models also included abutment screws measuring 2.0 and 2.5 mm in diameter. Each implant model was integrated with the mandibular bone comprising the cortical bone and four types of cancellous bone. In total, 12 finite element models were generated, subjected to three different occlusal forces, and analyzed using FE software to investigate the stress distribution of dental implant and alveolar bone. Results: Wider implants demonstrated lower stresses in implant and bone compared with standard-diameter implants. The quality of cancellous bone has a minimal impact on the stress values of the implant, abutment screw, and cortical bone. Regardless of occlusal arrangement or quality of cancellous bone, a consistent pattern emerged: larger abutment screw diameters led to increased stress levels on the screws, while the stress levels in both cortical and cancellous bone showed comparatively minor fluctuations. Conclusion: Wider implants tend to have better stress distribution than standard-diameter implants. The potential advantage of augmenting the abutment screw diameter is unfavorable. It may result in elevated stresses in the implant system.

Background/purpose: Immediate implant placement in the mandibular anterior tooth region requires a thorough understanding of the alveolar bone anatomy for determining the ideal implant position and preventing labial bone perforation. The anatomical characteristics of the jaws are closely related to the sagittal root position (SRP) and labial concavity of the alveolar bone. This study evaluated SRP, labial concavity, and labial bone perforation in the mandibular anterior tooth region. Materials and methods: Cone-beam computed tomography images of 116 participants (696 teeth) were uploaded to medical imaging software. SRP classification, labial concavity of the alveolar bone, and labial bone perforation were analyzed. A t-test was performed to compare measurements between the central and lateral incisors, central incisors and canines, and lateral incisors and canines. Results: The results revealed that the frequency of SRP Class I (88.20%) was the highest, and that of SRP Class III was the lowest (0.53%). Central incisors had the highest mean labial concavity (144.5°), followed by the canines (143.9°) and lateral incisors (143.3°), and the differences were significant between any two of the tooth groups (all P

Background/purpose: Sealing ability in root canal obturation has always been a key concern for endodontic success. The purpose of this study was to analyze the percentage of voids in root canal space obturated by using single cone hydraulic condensation with different root canal sealers and to compare those with AH Plus sealer. Materials and methods: Experiments were conducted using twenty 3D-printed upper first premolars. After the buccal root canals were prepared using Ni–Ti rotary instruments, the teeth were divided into four groups: the AH Plus, BC sealer, BC sealer HiFlow, and Endoseal MTA groups. All buccal canals were obturated by single-cone hydraulic condensation. All specimens were scanned using micro-computed tomography and the percentage volume of the voids inside and outside the filled materials (Vin and Vout) at three different canal depth intervals were calculated by a Bruker micro-CT software. Differences according to root canal sealers were evaluated statistically using the Kruskal–Wallis test and the Wilcoxon Rank Sum test at a significance level of 0.05. Results: The results indicated that most of the voids were presented near the interface (Vout), the Vin is very small and not significant different between groups. The Vout decreased in the following order: AH Plus(1.837% ± 1.226%)≅BC sealer (1.225% ± 0.836%)>BC sealer Hiflow(0.349% ± 0.071%)>Endoseal MTA(0.203% ± 0.049%) Conclusion: For the percentage volume of voids between the root canal filling material and root canal surface, though the BC sealer Hiflow is slightly larger than Endoseal MTA, which is still much less than BC sealer and AH Plus.

Abstract Objective This study proposed a new classification method of bone quantity and quality at the dental implant site using cone-beam computed tomography (CBCT) image analysis, classifying cortical and cancellous bones separately and using CBCT for quantitative analysis. Methods Preoperative CBCT images were obtained from 128 implant patients (315 sites). First, measure the crestal cortical bone thickness (in mm) and the cancellous bone density [in grayscale values (GV) and bone mineral density (g/cm3)] at the implant sites. The new classification for bone quality at the implant site proposed in this study is a “nine-square division” bone classification system, where the cortical bone thickness is classified into A: > 1.1 mm, B:0.7–1.1 mm, and C: 600 GV (= 420 g/cm3), 2:300–600 GV (= 160 g/cm3–420 g/cm3), and 3:

Abstract Objective To investigate differences in the effectiveness of two lag screws, a regular bone plate, and locking bone plate fixation in treating horizontal oblique metacarpal shaft fractures. Materials and methods Horizontal oblique metacarpal shaft fractures were created in 21 artificial metacarpal bones and fixed using one of the three methods: (1) two lag screws, (2) a regular plate, and (3) a locking plate. All the specimens were subjected to the cantilever bending test performed using a material testing machine to enable recording of the force–displacement data of the specimens before failure. The Kruskal–Wallis test was used to compare failure force and stiffness values among the three fixation methods. Results The mean failure force of the two lag screw group (78.5 ± 6.6 N, mean + SD) was higher than those of the regular plate group (69.3 ± 17.6 N) and locking plate group (68.2 ± 14.2 N). However, the mean failure force did not significantly differ among the three groups. The mean stiffness value of the two lag screw group (17.8 ± 2.6 N/mm) was lower than those of the regular plate group (20.2 ± 10.5 N/mm) and locking plate group (21.8 ± 3.8 N/mm). However, the mean stiffness value did not significantly differ among the three groups. Conclusion The fixation strength of two lag screw fixation did not significantly differ from that of regular and locking bone plate fixation, as indicated by the measurement of the ability to sustain force and stiffness.

Background/purpose: Incisor liability is the discrepancy in the sum of the mesiodistal crown width between the primary and permanent incisors. Incisor liability affects the integrity and eruption of the permanent incisors during the transition from the primary to permanent dentition. This study investigated the incisor liability in the primary dentition of Taiwanese children. Methods: The digital periapical films of 203 upper arches of 105 boys and 98 girls and 195 lower arches of 119 boys and 76 girls aged between 3 and 6 years were selected in this retrospective study. The mesiodistal crown widths of the primary and permanent incisors were measured using the medical imaging software for both arches. Differences in incisor liability values were statistically analyzed. Results: The mean ± standard deviation of the incisor liability values were 8.32 ± 1.88 and 6.91 ± 1.13 mm for the upper and lower arches, respectively, in all children. The incisor liability was closely related with the total crown widths of the permanent incisors for upper and lower arches. The incisor liability values were higher among boys than girls for the upper but not lower arch. Conclusion: Incisor liability differs depending on ethnicity. In Taiwanese children, incisor liability was closely related with the crown widths of the permanent incisors. The incisor liability values of boys were higher than those of girls in the upper arch but not the lower arch.

Abstract The objective of this study was to evaluate the effect of bone–miniscrew contact percentage (BMC%) and bone quality and quantity on orthodontic miniscrew stability and the maximum insertion torque value (ITV). Orthodontic miniscrews of five different dimensions and several bovine iliac bone specimens were used in the evaluation. Miniscrews of each dimension group were inserted into 20 positions in bovine iliac bone specimens. The experiment was divided into three parts: (1) Bone quality and quantity were evaluated using cone-beam computed tomography (CBCT) and microcomputed tomography. (2) The 3D BMC% was calculated. (3) The ITVs during miniscrew insertion were recorded to evaluate the stability of the orthodontic miniscrews. The results indicated that longer and thicker miniscrews enabled higher ITVs. CBCT was used to accurately measure cortical bone thickness (r = 0.939, P

Abstract Background For oblique metacarpal shaft fracture, if anatomical reduction is achieved through conservative cast immobilization rather than stable fixation, bone malrotation can easily occur, resulting in severe loss in hand prehensile function. However, whether bone plate fixation or only lag screw fixation is more preferable remains unclear. Few studies have evaluated whether screw fixation can provide biomechanical fixation strength similar to bone plate fixation. Objective We assessed the difference in fixation strength between fixtation with two lag screws and bone plate for oblique metacarpal shaft fractures. Materials and methods We created oblique metacarpal shaft fractures on 21 artificial bones and fixated them using (1) double lag screw (2LS group), (2) regular plate (RP group), or (3) locked plate (LP group). To obtain the force–displacement data, a cantilever bending test was conducted for each specimen through a material testing machine. One-way analysis of variance and a Tukey test were conducted to compare the maximum fracture force and stiffness of the three fixation methods. Results The maximum fracture force of the 2LS group (mean + SD: 153.6 ± 26.5 N) was significantly lower than that of the RP (211.6 ± 18.5 N) and LP (227.5 ± 10.0 N) groups (p

Abstract Background Menopause-induced decline in estrogen levels in women is a main factor leading to osteoporosis. The objective of this study was to investigate the effect of intermittent parathyroid hormone (PTH) on bone structural parameters of the femoral neck in ovariectomized rats, in addition to correlations of maximum fracture force. Methods Fifteen female Wister rats were divided into three groups: (1) control group; (2) ovariectomized (OVX) group; and (3) OVX + PTH group. All rats were then killed and the femurs extracted for microcomputed tomography scanning to measure volumetric bone mineral density (vBMD) and bone structural parameters of the femoral neck. Furthermore, the fracture forces of femoral neck were measured using a material testing system. Results Compared with the control and OVX + PTH groups, the OVX group had significantly lower aBMD, bone parameter, and mechanical strength values. A comparison between OVX and OVX + PTH groups indicated that PTH treatment increased several bone parameters. However, the OVX + PTH groups did not significantly differ with the control group with respect to the bone structural parameters, except for trabecular bone thickness of cancellous bone, which was greater. In addition, among the bone structural parameters, the CSA and BSI of cortical bone were significantly correlated with the maximum fracture force of the femoral neck, with correlations of, respectively, 0.682 (p = 0.005) and 0.700 (p = 0.004). Conclusion Intermittent PTH helped treat ovariectomy-induced osteoporosis of cancellous bone and cortical bone in the femoral necks of rats. The ability of the femoral neck to resist fracture was highly correlated with the two parameters, namely cross-sectional area (CSA) and bone strength index (= vBMD × CSA), of cortical bone in the femoral neck and was less correlated with aBMD or other bone structural parameters.

Abstract Background Many types of titanium plates were used to treat subcondylar fracture clinically. However, the efficacy of fixation in different implant positions and lengths of the bone plate has not been thoroughly investigated. Therefore, the primary purpose of this study was to use finite element analysis (FEA) to analyze the biomechanical effects of subcondylar fracture fixation with miniplates at different positions and lengths so that clinicians were able to find a better strategy of fixation to improve the efficacy and outcome of treatment. Methods The CAD software was used to combine the mandible, miniplate, and screw to create seven different FEA computer models. These models with subcondylar fracture were fixed with miniplates at different positions and of different lengths. The right unilateral molar clench occlusal mode was applied. The observational indicators were the reaction force at the temporomandibular joint, von Mises stress of the mandibular bone, miniplate and screw, and the sliding distance on the oblique surface of the fracture site at the mandibular condyle. Results The results showed the efficacy of fixation was better when two miniplates were used comparing to only one miniplates. Moreover, using longer miniplates for fixation had better results than the short one. Furthermore, fixing miniplates at the posterior portion of subcondylar region would have a better fixation efficacy and less sliding distance (5.46–5.76 μm) than fixing at the anterolateral surface of subcondylar region (6.10–7.00 μm). Conclusion Miniplate fixation, which was placed closer to the posterior margin, could effectively reduce the amount of sliding distance in the fracture site, thereby achieving greater stability. Furthermore, fixation efficiency was improved when an additional miniplate was placed at the anterior margin. Our study suggested that the placement of miniplates at the posterior surface and the additional plate could effectively improve stability.

Abstract 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is widely used for tumor staging. This study sought to determine the relationship of preoperative primary tumor SUVmax (tSUVmax) with the clinicopathological features of patients with OSCC and to compare the prognostic ability of tSUVmax with that of other recurrence factors. Data of 340 patients with OSCC who were diagnosed, treated, and followed up at the Changhua Christian Hospital were retrospectively analyzed. Only patients with OSCC arising from gingiva, palate, floor of the mouth, and retromolar trigone and those who had received preoperative FDG-PET within 2 weeks before surgery were included. tSUVmax value > 9.2 was the strong predictor of bone invasion (area under the receiver operating characteristic curve, 0.844). tSUVmax value > 7.2 showed a strong association with advanced pathological T stage and recurrence factors and was associated with poor survival; tSUVmax > 7.2 showed stronger predictive power for poor disease-free survival (DFS) than pT stage and the other recurrence factors related to primary tumor. FDG-PET can be a useful supplement to contrast-enhanced computed tomography or contrast-enhanced magnetic resonance imaging for diagnosing bone invasion by OSCC. The tSUVmax value was an independent predictor of DFS in this study.

Abstract The incidence of oral cavity squamous cell carcinoma (OSCC) is particularly high in South Asia. According to the National Comprehensive Cancer Network, OSCC can arise in several subsites. We investigated survival rates and the clinical and pathological characteristics of OSCC in different anatomical subsites in the Taiwanese population. We retrospectively analyzed data for 3010 patients with OSCC treated at the Changhua Christian Hospital. Subsequently, we compared clinical and pathological features of OSCC in different subsites. Pathological T4 stage OSCCs occurred in the alveolar ridge and retromolar trigone in 56.4% and 43.7% of cases, respectively. More than 25% of patients with tongue OSCC and 23.4% of those with retromolar OSCC had lymph node metastasis. The prognosis was worst for hard palate OSCC (hazard ratio 1.848; p

Abstract Background Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side. Objective The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture. Materials and methods Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test. Results The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm). Conclusion According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

Abstract Background Metacarpal shaft fractures are a common type of hand fracture. Despite providing strong fixation strength, plate fixation has numerous shortcomings. Concerning internal fixation with Kirschner wires (K-wires), although this approach is frequently used to treat metacarpal shaft fractures, the lack of functional stability may result in fixation failure. Objective To evaluate the effect of figure-of-eight cerclage wire on fixation for transverse metacarpal shaft fractures using two K-wires. Materials and methods We used a saw blade to create transverse metacarpal shaft fractures in 14 fourth-generation artificial third metacarpal bones (Sawbones, Vashon, WA, USA), which were assigned to groups undergoing fixation with two K-wires (KP) or with two K-wires and figure-of-eight cerclage wire (KP&F8). All specimens were subjected to material testing, specifically cantilever bending tests. The maximum fracture force and stiffness of the two fixation types were determined on the basis of the force–displacement data. The Mann–Whitney U test was used to compare between-group differences in maximum fracture force and stiffness. Results The maximum fracture force of the KP group (median ± interquartile range = 97.30 ± 29.70 N) was significantly lower than that of the KP&F8 group (153.2 ± 69.50 N, p

The retromolar canal is an anatomical variation that occurs in the mandibular bone. The retromolar canal typically originates in the mandibular canal on the distal side of the third molar and extends forward and upward to the retromolar foramen (RMF), which contains the neurovascular bundle. Accidentally damaging the neurovascular bundle in the retromolar canal during the extraction of the third molar, dental implant surgery, or maxillofacial orthognathic surgery may lead to subsequent complications such as incomplete local anesthesia, paresthesia, and bleeding during operation. The objective of this study was to investigate the prevalence of the RMF in the Taiwanese population in a medical center by using dental cone-beam computed tomography (CBCT) and to identify the position of the RMF in the mandibular bone. The dental CBCT images for the mandibular bone of 68 hemi-mandible were uploaded to the medical imaging software Mimics 15.1 to determine the prevalence of the RMF in the Taiwanese population and the three positional parameters of the RMF in the mandibular bone: (1) The diameter of the RMF, (2) the horizontal distance from the midpoint of the RMF to the distal cementoenamel junction of the second molar, and (3) the vertical distance from the midpoint of the RMF to the upper border of the mandibular canal. Seven RMFs were observed in the 68 hemi-mandibles. Thus, the RMF prevalence was 10.3%. In addition, the diameter of the RMF was 1.41 ± 0.30 mm (mean ± standard deviation), the horizontal distance from the midpoint of the RMF to the distal cementoenamel junction of the the second molar was 12.93 ± 2.87 mm, and the vertical distance from the midpoint of the RMF to the upper border of the mandibular canal below second molar was 13.62 ± 1.3487 mm. This study determined the prevalence of the RMF in the Taiwanese population in a medical center and its relative position in the mandibular bone. This information can provide clinicians with a reference for posterior mandible anesthesia and surgery to ensure medical safety.

Abstract. Introduction:. Primary surgical treatment for oral squamous cell carcinoma (OSCC) is reserved for T1 to T4a tumors, but not for T4b tumors, according to the present National Comprehensive Cancer Network clinical practice guidelines. In this retrospective study, we aimed to determine the association between the clinicopathological characteristics and different treatment modalities for T4b OSCC based on whether patients received primary surgical treatment. Therefore, we conducted a survival analysis based on different treatment modalities. Methods:. This retrospective cohort study enrolled 125 patients with clinical stage T4b OSCC who received treatment and were followed up at Changhua Christian Hospital between January 1, 2008 and December 31, 2018. Results:. Overall, 81 patients received primary surgical treatment and 44 received primary nonsurgical treatment. Comparison of the clinicopathological characteristics between those who did and did not undergo surgery revealed no significant differences in age at tumor diagnosis, tumor location, clinical N stage, and involved tumor area based on computed tomography or magnetic resonance imaging, or stratified Charlson Comorbidity Index scores. In the survival analysis, Kaplan–Meier curves revealed that patients who received treatment modalities including surgery exhibited better survival than those who received treatment modalities that did not include surgery. Conclusions:. In the present study, patients with T4b OSCC treated with primary surgery had a better overall survival rate than those who received nonsurgical treatment. In the future, it will be necessary for clinicians worldwide to report the treatment outcomes of patients with T4b OSCC based on the common criteria.

Abstract Background Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage. Objective We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture. Materials and methods We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups. Results The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively. Conclusion Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

Background/Purpose: Impact of the implant shape on the biomechanical performance of all-on-four treatment of dental implant is still unclear. This study evaluated the all-on-four treatment with four osseointegrated implants in terms of the biomechanical effects of implant design and loading position on the implant and surrounding bone by using both in vitro strain gauge tests and three-dimensional (3D) finite element (FE) analyses. Methods: Both in vitro and 3D FE models were constructed with placing NobelSpeedy and NobelActive implants as well as a titanium framework in an edentulous jawbone based on the concept of all-on-four treatment. Three types of loads were applied: at the central incisor area (loading position 1) and at the molar regions with (loading position 2) and without (loading position 3) the denture cantilever. For the in vitro tests, the principal bone strains were recorded by rosette strain gauges and statistically evaluated using Wilcoxon's rank-sum test. The 3D FE simulations analyzed the peak von-Mises stresses in the implant and surrounding cortical bone. Results: The peak stress and strain in the surrounding bone were typically 36–62% (3D FE analysis) and 47–57% (in vitro test) (p

Dental implant surgery involves the insertion of a dental implant into the alveolar bone; the success of the surgery depends on the initial stability of the implant. The objective of this study was to examine the effects of dental implant insertion approaches in clinical surgery and in accordance with the standards of American Society for Testing and Materials on initial implant stability. Three insertion approaches were used for dental implant placement (Branemark Systems NobelSpeedy Groovy, Nobel Biocare AB, Gothenburg, Sweden) in two types of artificial bone—good bone (GB) and poor bone (PB). The three insertion approaches were as follows: (1) continuous rotation insertion (CRI): using a torque testing machine to continuously screw in an implant to completion and (2 and 3) intermittent rotation insertion (IRI)_90 and IRI_80: using CRI to bury an implant to 90% and 80% of its full length followed by IRI to complete the implantation, respectively. The maximum insertion torque value (ITV), periotest value (PTV), and implant stability quotient (ISQ) were measured and compared. The results indicated that bone quality and insertion approach both affected implant stability. Insertion approaches affected all three implant stability indicators differently in the GB and PB groups (p=0.008). In GB groups, the insertion approach primarily affected ITV, whereas in PB groups, it primarily affected PTV. The effect of the insertion approach was less apparent for ISQ. Overall, in both the GB and PB groups, the implant stability for IRI_80 was greater than that for IRI_90, and the implant stability for IRI_90 was greater than that for CRI. Future in vitro studies should adopt an insertion approach that complies with the clinical practice for dental implant surgery. Dentists should adjust the timing for IRI in dental implant surgery to achieve greater initial dental implant stability.

Convolutional neural networks (CNNs) have been widely applied in super-resolution (SR) and other image restoration tasks. Recently, Hinton et al. proposed capsule neural networks to resolve the problem of viewpoint variations in image classification tasks. Each capsule is represented as either a vector or a matrix to encode more object information, such as position, size, direction, etc. Instead of detecting specific features, these capsule neural networks search for the most relevant features using an iterative process. Therefore, capsule neural networks require fewer parameters compared to traditional neural networks. Inspired by these advances, we make use of a capsule neural network to exploit more potential features for image SR. In this paper, we develope two frameworks: the Capsule Image Restoration Neural Network (CIRNN) and the Capsule Attention and Reconstruction Neural Network (CARNN), to incorporate capsules into image SR convolutional neural networks. The CIRNN takes advantage of the rich information encoded in the capsules to reconstruct accurate high-resolution images. The CARNN generates SR attention features by utilizing the robust segmentation capability of the capsules. Our experiments show that both frameworks can enhance SR for most testing datasets. The CIRNN performs better than the CARNN and can achieve better performance than other traditional CNN methods with a similar amount of parameters.

Background/purpose: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease affecting oral health. Evidence shows possible association between T1DM and periodontal diseases (PDs). We conducted a nationwide population-based study in Taiwan, with a 14-year follow-up to investigate the risk of PDs in T1DM patients. Methods: We used data from the National Health Insurance Research Database in Taiwan. The T1DM cohort was identified with newly diagnosed T1DM from 1998 to 2011. The non-T1DM cohort was frequency matched with the T1DM cohort. Participants comprised 4248 patients in the T1DM cohort and 16992 persons in the non-T1DM cohort. Results: The T1DM patients showed an increased risk of PDs compared to non-T1DM individuals [adjusted hazard ratio (aHR) = 1.45]. T1DM patients who visited the emergency room more than twice per year had a higher aHR of 13.0 for developing PDs. The aHR for PDs was 13.2 in the T1DM patients who had been hospitalized more than twice per year. Conclusion: T1DM patients are at higher risk of developing PDs than non-T1DM individuals. Our results further showed that the number of T1DM interventions; that is, annual emergency visits and hospitalizations were associated with increased the risk of developing PDs. Keywords: Diabetes, Type 1 diabetes mellitus (T1DM), Periodontal disease, Cohort study

Background/purpose: Acupuncture is well known to be effective for pain relief and muscle relaxation, and hence it is feasible that acupuncture treatment could change the occlusal forces and mandibular movements in subjects with deep-bite malocclusion. The purpose of this research was to determine the distribution of occlusal force and the border movement of the mandible in patients with deep-bite malocclusion before and after acupuncture treatment. Materials and methods: This study involved 17 volunteers with deep-bite malocclusion and aged 20–30 years. Before and after acupuncture treatment, the distribution of the occlusal-force percentage at each tooth was measured and the percentage biting force in the first molar area during maximal clenching was recorded. Additionally, the mandibular movements including the maximum mouth opening and maximum lateral border movement were also evaluated. All of the data were analyzed statistically using the Wilcoxon signed-rank test. Results: The percentage biting force at the first molar differed significantly between before and after the acupuncture treatments (P = 0.017). However, no treatment effects were seen for the maximum mouth opening and the maximum lateral border movement. Conclusion: Although the mandibular border movements did not change significantly, this study has confirmed that acupuncture treatment may become an alternative choice on improving the occlusal force of deep-bite patients. Keywords: Deep-bite malocclusion, Acupuncture treatment, Occlusal-force percentage, Mandibular border movement

Abstract Background In this study, we explored how various preprocessing approaches can be employed to enhance the capability of dental CBCT to accurately estimate trabecular bone microarchitectural parameters. Methods In total, 30 bovine vertebrae cancellous bone specimens were used for in study. Voxel resolution 18-μm micro-computed tomography (micro-CT) and 100-μm dental CBCT were used to scan each specimen. Micro-CT images were used to calculate trabecular bone microarchitectural parameters; the results were set as the gold standard. Subsequently, before the dental CBCT images were converted into binary images to calculate trabecular bone microarchitectural parameters, three preprocessing approaches were used to process the dental CBCT images. For Group 1, no preprocessing approach was applied. For Group 2, images were sharpened and despeckable noises were removed. For Group 3, the function of local thresholding was added to Group 2 to form Group 3. For Group 4, the air pixels was removed from Group 3 to form Group 4. Subsequently, all images were imported into a software package to estimate trabecular bone microarchitectural parameters (bone volume fraction (BV/TV), trabecular thickness (TbTh), trabecular number (TbN), and trabecular separation (TbSp)). Finally, a paired t-test and a Pearson correlation test were performed to compare the capability of micro-CT with the capability of dental CBCT for estimating trabecular bone microarchitectural parameters. Results Regardless of whether dental CBCT images underwent image preprocessing (Groups 1 to 4), the four trabecular bone microarchitectural parameters measured using dental CBCT images were significantly different from those measured using micro-CT images. However, after three image preprocessing approaches were applied to the dental CBCT images (Group 4), the BV/TV obtained using dental CBCT was highly positively correlated with that obtained using micro-CT (r = 0.87, p < 0.001); the correlation coefficient was greater than that of Group 1 (r = −0.15, p = 0.412), Group 2 (r = 0.16, p = 0.386), and Group 3 (r = 0.47, p = 0.006). After dental CBCT images underwent image preprocessing, the efficacy of using dental CBCT for estimating TbN and TbSp was enhanced. Conclusions Image preprocessing approaches can be used to enhance the efficacy of using dental CBCT for predicting trabecular bone microarchitectural parameters.

Residual alveolar ridge resorption often occurs after tooth extraction, which causes issues requiring further prothesis rehabilitation. A treatment concept referred to as all-on-four, involving fixed dentures supported with four implants, was recently developed. The current study aimed to determine the effect of changing bone atrophy and implant length in all-on-four treatments on stress and strain in the surrounding bone of the implant. A three-dimensional finite element method was used in this research. The stress analysis was conducted with von Mises stress values. Two types of synthetic jawbone models with mild and moderate atrophy were used. Furthermore, two different implant lengths with a similar implant design and diameter were selected, and they were classified into eight models. Then, the bone model was assessed via a computed tomography (CT) scan and was transformed into a virtual model in Geomagic and SolidWorks with implant rebuilding. After modifying bone atrophy, the von Mises stresses in the surrounding bone of the implant were as follows: mild type 2 < mild type 3 < moderate type 3 < moderate type 4. The bone quantity change rate increased more than when bone conditions were limited. Compared with changes in implant lengths, the stresses in the peri-implant surrounding bone were generally higher in the 9 mm implant length group than in the 11.5 mm group. However, the results did not significantly differ. In conclusion, the von Mises stress and strain increased in the models with moderate atrophy and low-density trabecular bone. Hence, bone atrophy and its presurgical diagnosis in long-term implant prognosis are crucial.

Objective. This study evaluated the biomechanical effects of a metallic orthodontic mini-implant (OMI) covered with various types of angled revolving cap on the peri-OMI bone and the canine periodontal ligament (PDL) by finite element (FE) analyses. Materials and Methods. Three-dimensional FE models included comprised cortical bone and cancellous bone of the maxilla, and the OMIs were created. The forces (0.98 N) pulled in both the canine hook and the revolving cap, pulling towards each other in both directions as loading conditions. The upper surface of the maxilla was fixed as a boundary condition. Results. The bone stresses were increasing in the models by using OMI covered with a revolving cap as compared with that in the conventional model (in which only the OMI was placed). However, no obvious differences in bone stresses were observed among the models with various types of angled revolving cap. The minimum principal strain in the canine PDL was highest for condition 180T, followed by condition 180L. However, the maximum differences in the values between each experimental model and the conventional model were around 5%. Conclusion. This study showed no obvious effects in decreasing or increasing stress/strain in bone and PDL by using various types of angled revolving cap covered metallic mini-implant in orthodontic treatment of canine retraction.

Background and Objectives: Hepatitis C virus (HCV) is a major cause of liver disease worldwide. People who inject drugs (PWIDs) constitute the majority of patients with HCV infection in the United States and Central Asia. There are several obstacles to treating HCV infection in PWIDs because PWIDs are often accompanied by concurrent infection, low compliance, substance abuse, and risky behavior. The aim of the study is to compare the efficacies of direct-acting antiviral (DAA) therapy for HCV infection in PWIDs and those without opioid injection. Materials and Methods: In this retrospective cohort study, we included 53 PWIDs with HCV infections treated on site in a methadone program and 106 age- and sex-matched patients with HCV infections who had no history of opioid injection (ratio of 1:2). All eligible subjects received anti-HCV treatment by DAA agents in our hospital from March 2018 to December 2020. The charts of these patients were carefully reviewed for demographic data, types of DAA agents, and treatment outcomes. The primary outcome measure was sustained virological response (SVR). Results: PWIDs and non-drug users had different HCV genotype profiles (p = 0.013). The former had higher proportions of genotype 3 (18.9% vs. 7.5%) and genotype 6 (24.5% vs. 14.2%) than the latter. The two patient groups had comparable rates of complete drug refilling (100.0% vs. 91.1%) and frequency of loss to follow-up (3.8% vs. 0.9%). However, PWIDs had a lower SVR rate of DAA treatment than non-drug users (92.2% vs. 99.0%; p = 0.04). Further analysis showed that both human immunodeficiency virus (HIV) coinfection and history of PWID were risk factors associated with treatment failure. The subjects with coinfection with HIV had lower SVR rates than those without HIV infection (50.0% vs. 96.5%; p = 0.021). Conclusions: PWIDs with HCV infections have higher proportions of HCV genotype 3 and genotype 6 than non-drug users with infections. DAA therapy can achieve a high cure rate (>90%) for HCV infection in PWID, but its efficacy in PWID is lower than that in non-drug users.

Clinically, a reconstruction plate can be used for the facial repair of patients with mandibular segmental defects, but it cannot restore their chewing function. The main purpose of this research is to design a new three-dimensionally (3D) printed porous titanium mandibular implant with both facial restoration and oral chewing function reconstruction. Its biomechanical properties were examined using both finite element analysis (FEA) and in vitro experiments. Cone beam computed tomography images of the mandible of a patient with oral cancer were selected as a reference to create 3D computational models of the bone and of the 3D-printed porous implant. The pores of the porous implant were circles or hexagons of 1 or 2 mm in size. A nonporous implant was fabricated as a control model. For the FEA, two chewing modes, namely right unilateral molar clench and right group function, were set as loading conditions. Regarding the boundary condition, the displacement of both condyles was fixed in all directions. For the in vitro experiments, an occlusal force (100 N) was applied to the abutment of the 3D-printed mandibular implants with and without porous designs as the loading condition. The porous mandibular implants withstood higher stress and strain than the nonporous mandibular implant, but all stress values were lower than the yield strength of Ti-6Al-4V (800 MPa). The strain value of the bone surrounding the mandibular implant was affected not only by the shape and size of the pores but also by the chewing mode. According to Frost’s mechanostat theory of bone, higher bone strain under the porous implants might help maintain or improve bone quality and bone strength. The findings of this study serve as a biomechanical reference for the design of 3D-printed titanium mandibular implants and require confirmation through clinical investigations.

The TNM staging system for oral squamous cell carcinoma (OSCC) provides clinicians a dependable foundation for patient prognosis and management decisions, but in clinical practice, treatment outcomes of patients with OSCC are sometimes unsatisfactory. This retrospective study investigated the association between survival and clinicopathological characteristics and histological grades of 2535 patients with OSCC. Additionally, the present study aimed to compare the predictive abilities of histological grades with other common prognostic factors. The enrolled patients were divided into three groups by two experienced pathologists into well-differentiated, moderately differentiated, and poorly differentiated groups, according to the WHO classification. Finally, we designed an observational, retrospective study based on the histological grading of tumors to compare their clinicopathological characteristics and conducted survival analysis among the three groups. Advanced tumor stage was diagnosed in 23.9%, 44.0%, and 55.1% of patients with grades 1-3 OSCC, respectively. By T status, T3 or T4 tumors were found in approximately 22%, 34%, and 40% of patients with grades 1-3 OSCC, respectively. By N status, lymph node metastases were found in 6.1%, 29.3%, and 45.9% of patients with grades 1-3 OSCC, respectively. Thus, significant survival differences were observed based on different OSCC histological grades. Meanwhile, in the multivariate (adjusted) analysis, N1 and N2 stages, extranodal spread, and poor differentiation were associated with a higher recurrence risk than the other common prognostic factors. In conclusion, 5% of patients in our study presented with poorly differentiated OSCC at diagnosis. Furthermore, grade 3 OSCC has worse prognosis and is more aggressive than grades 1 and 2 OSCC. In the future, we should focus on modifying individual therapy for poorly differentiated OSCC to achieve improved outcomes.

Background/Purpose: Spaced primary dentition plays a critical role in the eruption of permanent teeth and the establishment of ideal occlusion. A lack of these spaces in deciduous dentition may result in disproportionate jaw and tooth sizes. Additionally, spaced primary dentition is significantly affected by ethnic factors. However, few of these studies have been conducted in Asia. The purpose of this study was to investigate the prevalence of spaced primary dentition in Taiwan. Methods: One hundred and forty-seven 3- to 6-year-old Taiwanese children (58 girls and 89 boys) were recruited for a cross-sectional study. Primate and interdental spaces were recorded by intraoral photos. The prevalence of spaced dentition was evaluated. The interpersonal agreement of spaced dentition between the upper and lower arches was also assessed. Results: Most of the subjects had spaced primary dentition. The prevalence of primate space was 83.7% in the upper arch and 61.2% in the lower arch, whereas the prevalence of interdental space was 44.2% in the upper arch and 53.1% in the lower arch. The prevalence rates of interdental space and upper primate space were significantly higher in boys than in girls. Interdental spaces of the lower arch increased with age. Conclusion: Ethnic factors can affect the ratio of spaced dentition. Most of the 3- to 6-year-old Taiwanese children have spaced dentition. The boys have higher incidence of spaced dentition than the girls. Furthermore, primate space is more frequently found in the upper arch than in the lower arch, whereas interdental space is reversed. Keywords: Spaced dentition, Primary dentition, Interdental space, Primate space, Dental arch

Abstract Background Fifth metacarpal neck fracture, also known as boxer’s fracture, is the most common metacarpal fracture. Percutaneous Kirschner-wire (K-wire) pinning has been shown to produce favorable clinical results. However, the fixation power of K-wires is a major concern. Plate fixation is also a surgical option, but it has the disadvantages of tendon adhesion, requirement of secondary surgery for removal of the implant, and postoperative joint stiffness. A fixation method that causes little soft tissue damage and provides high biomechanical stability is required for patients with fifth metacarpal neck fracture for whom surgical intervention is indicated. The present study proposed fixation using K-wires and a cerclage wire to treat fifth metacarpal neck fracture. The fixation power of this new method was compared with that of K-wires alone and plates. Methods We used a saw blade to create transverse metacarpal neck fractures in 16 artificial metacarpal bone specimens, which were then treated with four types of fixation as follows: (1) locking plate with five locking bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two K-wires (K group), and (4) two K-wires and a figure-of-eight cerclage wire (KW group). The specimens were tested by using cantilever bending testing on a material testing system. The stiffness of the four fixation types was determined by observing force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the Mann–Whitney exact test was performed to conduct paired comparison between the fixation types. Results The fixation strength levels of the four fixation approaches for treating fifth metacarpal neck fracture were ranked in a descending order of LP group (24.6 ± 5.1 N/mm, median ± interquartile range) > RP group (22.2 ± 5.8 N/mm) ≅ KW group (20.1 ± 3.2 N/mm) > K group (16.9 ± 3.0 N/mm). Conclusion The fixation strength of two K-wires was significantly higher when reinforcement was provided using a figure-of-eight cerclage wire. The strength of the proposed approach is similar to that of a regular plate with five bicortical screws but weaker than that of a locking plate with the same amount of bicortical screws. Cerclage wire-integrated K-wires can be an alternative method that avoids the excessive soft tissue dissection required for plating in open reduction internal fixation for fifth metacarpal neck fracture.

Purpose: Leeway space is clinically crucial in pediatric dentistry because it is utilized to resolve tooth crowding and allow the first molars to drift mesially to establish a Class I molar relationship in the later stages of mixed dentition. This study investigated leeway space in the mixed dentition of Taiwanese children of different sexes and ages. Materials and Methods: The digital panoramic dental films of 182 lower arches of 119 boys and 63 girls aged 5–10 years were analyzed in this retrospective study. The mesiodistal crown widths of the primary canines and first and second molars and the permanent canines and first and second premolars were measured using medical imaging software. Differences in leeway space were statistically analyzed. Results: The average leeway space was 1.29 ± 1.48 mm on each side of the lower arch. The leeway space of children aged 5–6 years was significantly greater than that of children aged 7–8 years. No gender difference in crown width was discovered, except with regard to the primary first molar. Although no gender difference in leeway space was observed, permanent teeth affected leeway space more for girls than for boys. Conclusion: In Taiwanese children, although leeway space does not differ by sex, age affects leeway space. However, permanent tooth size has an influence on the leeway space of girls.

Abstract Background The influences of potential bone-to-implant contact (BIC) area (pBICA), BIC area (BICA), and three dimensional (3D) BIC percentage (3D BIC%; defined as BICA divided by pBICA) in relation to the implant length on initial implant stability were studied. Correlations between these parameters were also evaluated. Methods Implants with lengths of 8.5, 10, 11.5, and 13 mm were placed in artificial bone specimens to measure three indexes of the initial implant stability: insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ). The implants and bone specimens were also scanned by microcomputed tomography, and the obtained images were imported into Mimics software to reconstruct the 3D models and calculate the parameters of 3D bone-to-implant contact including pBICA, BICA, and 3D BIC%. The Kruskal-Wallis test, Wilcoxon rank-sum test with Bonferroni adjustment, and Spearman correlations were applied for statistical and correlation analyses. Results The implant length affected ITV more than PTV and ISQ, and significantly affected pBICA, BICA, and 3D BIC%. A longer implant increased pBICA and BICA but decreased 3D BIC%. The Spearman coefficients were high (>0.78) for the correlations between the three 3D BIC parameters and the three indexes of the initial implant stability. Conclusions pBICA, BICA, and 3D BIC% are useful when deciding on treatment plans related to various implant lengths, since these 3D BIC parameters are predictive of the initial implant stability.

This study investigated the effects of three three-dimensional (3D) bone-to-implant contact (BIC) parameters—potential BIC area (pBICA), BIC area (BICA), and 3D BIC percentage (3D BIC%; defined as BICA divided by pBICA)—in relation to the implant diameter on primary implant stability, as well as their correlations were also evaluated. Methods: Dental implants with diameters of 3.75, 4, 5, and 6 mm and artificial bone specimens were scanned by microcomputed tomography to construct 3D models for calculating pBICA, BICA, and 3D BIC%. Indexes of the primary implant stability including the insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ) were measured after implants with various diameters were placed into bone specimens. The Kruskal–Wallis test, Wilcoxon rank-sum test with Bonferroni adjustment, and Spearman correlations were all performed as statistical and correlation analyses. Results: The implant diameter significantly influenced pBICA and BICA, but not 3D BIC%. ITV and PTV were more sensitive to implant diameter than was ISQ. The coefficients of determination were high (>0.92) for the correlations between pBICA (or BICA) and indexes of the primary implant stability. Conclusion: This study revealed how the implant diameter and the three-dimensional (3D) BIC influence the primary stabilities of dental implant. ITV and PTV were more sensitively influenced by the implant diameter than ISQ. The pBICA and BICA seem to be more important than 3D BIC % for using wider implant in treatment plan, since those two parameters are highly predictive of variations in the primary stability of dental implant.

Abstract Background Intermittent parathyroid hormone (PTH) can be used to treat osteoporosis of the spine and hip. However, whether it can be used to treat osteoporosis of the mandible is unclear. The purpose of this study was to explore the influence of applying intermittent PTH to ovariectomized rats on the trabecular bone microarchitecture of the mandible and femoral head. Methods Eighteen female rats were divided into three groups: the healthy group, ovariectomized (OVX) group, and OVX + PTH group. The OVX group and OVX + PTH group had an OVX at 8 weeks of age. The OVX + PTH group received intermittent PTH therapy for 12 weeks. The mandibles and femurs of all rats were removed at 20 weeks and were then scanned using microcomputed tomography (micro-CT). Results From the micro-CT analysis, the trabecular bone microarchitecture of the mandible and femoral head are offered as follows: (1) The bone volume fraction and trabecular thickness in the OVX group were lower than those in the healthy group. (2) The bone volume fraction and trabecular thickness in the OVX + PTH group approximated those in the healthy group. Conclusion The conclusions of this study regarding the trabecular bone microarchitecture of the mandible and femoral head are offered as follows: (1) The BV/TV and TbTh in the OVX group were lower than those in the healthy group. (2) The BV/TV and TbTh in the OVX + PTH group approximated those in the healthy group, therefore, intermittent PTH displayed high efficacy for treating femoral or mandibular deterioration of bone microstructure resulting from loss of ovarian function. Osteoporosis of the femur or mandible in the rats was ameliorated by intermittent PTH therapy.

The bilateral sagittal split osteotomy (BSSO) technique is commonly used to correct mandibular deficiency. If the patient is exposed to excessive external forces after the procedure, occlusal changes or nonunion may occur. However, previous studies only focused on single external forces on the mandible and did not conduct relevant research on the forces exerted by different occlusion conditions. The main purpose of this study was to use finite element analysis methods to determine the biomechanics of four common occlusion conditions after BSSO surgical treatment. This study constructed a finite element analysis computer model of a miniplate implanted in the lower jaw. The structure of the model consisted of the mandible, miniplate, and screws. In addition, external forces were applied to the superficial masseter, deep masseter, medial pterygoid, anterior temporalis, middle temporalis, and posterior temporalis muscles to simulate the incisal clench, intercuspal position (ICP), right unilateral molar clench (RMOL), and right group function occlusion conditions. Subsequently, this study observed the effects of these conditions on the miniplate, screws, and mandible, including the von Mises stress values. The results showed that all of the different occlusion conditions that this study evaluated placed high stress on the miniplate. In the ICP and RMOL occlusion conditions, the overall mandibular structure experienced very high stress. The screw on the proximal segment near the bone gap experienced high stress, as did the screw on the buccal side. According to the present analysis, although the data were not directly obtained from clinical practice, the finite element analysis could evaluate the trend of results under different external forces. The result of this study recommended that patients without intermaxillary fixation avoid the ICP and RMOL occlusion conditions. It can be used as a pilot study in the future for providing clinicians more information on the biomechanics of implantation.

X-ray radiography is currently used in dentistry and can be divided into two categories: two-dimensional (2D) radiographic images (e.g., using periapical film, cephalometric film, and panoramic X-ray) and three-dimensional (3D) radiographic images (e.g., using dental cone-beam computed tomography (CBCT)). Among them, 2D periapical film images are most commonly used. However, 2D periapical film compresses 3D image information into a 2D image, which means that depth cannot be identified from the image. Such compressed images lose a considerable amount of information, reducing their clinical applicability. A 2.5D periapical radiography system prototype was developed by our research team. Our previous study indicated that this prototype could be used to capture images at different depths of an object. However, the prototype was limited by its commercially available intraoral periapical sensor, which had a low temporal resolution and could not capture multiple images in a short period of time. Therefore, the total time required for image capture was too long for practical clinical application. The present study developed a high-frame-rate intraoral periapical sensor with a sensor imaging speed of up to 15 Hz. The primary components of the developed intraoral periapical sensor include a scintillator, complementary metal oxide semiconductor chip, component circuit board, and video processing board. The external dimensions of the sensor are 41×26×6.6 mm3. The performance of the developed high-frame-rate intraoral periapical sensor was verified through qualified and quantified analyses using line pairs. The results showed that the resolution of the developed intraoral periapical sensor could reach 18 lp/mm. The sensor was further installed in our 2.5D periapical radiography system to conduct image capturing. The results indicated that the developed sensor could be used for high-frame-rate imaging to incorporate tomosynthesis to obtain reconstructed slice images of different depths. The developed sensor has the potential for clinical dentistry applications in the future.

To improve the accuracy of bracket placement in vivo, a protocol and device were introduced, which consisted of operative procedures for accurate control, a computer-aided design, and an augmented reality–assisted bracket navigation system. The present study evaluated the accuracy of this protocol. Methods: Thirty-one incisor teeth were tested from four participators. The teeth were bonded by novice and expert orthodontists. Compared with the control group by Boone gauge and the experiment group by augmented reality-assisted bracket navigation system, our study used for brackets measurement. To evaluate the accuracy, deviations of positions for bracket placement were measured. Results: The augmented reality-assisted bracket navigation system and control group were used in the same 31 cases. The priority of bonding brackets between control group or experiment group was decided by tossing coins, and then the teeth were debonded and the other technique was used. The medium vertical (incisogingival) position deviation in the control and AR groups by the novice orthodontist was 0.90 ± 0.06 mm and 0.51 ± 0.24 mm, respectively (p < 0.05), and by the expert orthodontist was 0.40 ± 0.29 mm and 0.29 ± 0.08 mm, respectively (p < 0.05). No significant changes in the horizontal position deviation were noted regardless of the orthodontist experience or use of the augmented reality–assisted bracket navigation system. Conclusion: The augmented reality–assisted bracket navigation system increased the accuracy rate by the expert orthodontist in the incisogingival direction and helped the novice orthodontist guide the bracket position within an acceptable clinical error of approximately 0.5 mm.

Small-diameter dental implants are associated with a higher risk of implant failure. This study used both three-dimensional finite-element (FE) simulations and in-vitro experimental tests to analyze the stresses and strains in both the implant and the surrounding bone when using one-piece (NobelDirect) and two-piece (NobelReplace) small-diameter implants, with the aim of understanding the underlying biomechanical mechanisms. Methods: Six experimental artificial jawbone models and two FE models were prepared for one-piece and two-piece 3.5-mm diameter implants. Rosette strain gauges were used for in-vitro tests, with peak values of the principal bone strain recorded with a data acquisition system. Implant stability as quantified by Periotest values (PTV) were also recorded for both types of implants. Experimental data were analyzed statistically using Wilcoxon's rank-sum test. In FE simulations, the peak value and distribution of von-Mises stresses in the implant and bone were selected for evaluation. Results: In in-vitro tests, the peak bone strain was 42% lower for two-piece implants than for one-piece implants. The PTV was slightly lower for one-piece implants (PTV = −6) than for two-piece implants (PTV = −5). In FE simulations, the stresses in the bone and implant were about 23% higher and 12% lower, respectively, for one-piece implants than those for two-piece implants. Conclusion: Due to the higher peri-implant bone stresses and strains, one-piece implants (NobelDirect) might be not suitable for use as small-diameter implants.

Dental implant surgery is a common treatment for missing teeth. Its survival rate is considerably affected by host bone quality and quantity, which is often assessed prior to surgery through dental cone-beam computed tomography (CBCT). Dental CBCT was used in this study to evaluate dental implant sites for (1) differences in and (2) correlations between cancellous bone density and cortical bone thickness among four regions of the jawbone. In total, 315 dental implant sites (39 in the anterior mandible, 42 in the anterior maxilla, 107 in the posterior mandible, and 127 in the posterior maxilla) were identified in dental CBCT images from 128 patients. All CBCT images were loaded into Mimics 15.0 to measure cancellous bone density (unit: grayscale value (GV) and cortical bone thickness (unit: mm)). Differences among the four regions of the jawbone were evaluated using one-way analysis of variance and Scheffe’s posttest. Pearson coefficients for correlations between cancellous bone density and cortical bone thickness were also calculated for the four jawbone regions. The results revealed that the mean cancellous bone density was highest in the anterior mandible (722 ± 227 GV), followed by the anterior maxilla (542 ± 208 GV), posterior mandible (535 ± 206 GV), and posterior maxilla (388 ± 206 GV). Cortical bone thickness was highest in the posterior mandible (1.15 ± 0.42 mm), followed by the anterior mandible (1.01 ± 0.32 mm), anterior maxilla (0.89 ± 0.26 mm), and posterior maxilla (0.72 ± 0.19 mm). In the whole jawbone, a weak correlation (r = 0.133, p = 0.041) was detected between cancellous bone density and cortical bone thickness. Furthermore, except for the anterior maxilla (r = 0.306, p = 0.048), no correlation between the two bone parameters was observed (all p > 0.05). Cancellous bone density and cortical bone thickness varies by implant site in the four regions of the jawbone. The cortical and cancellous bone of a jawbone dental implant site should be evaluated individually before surgery.

Assessing bone quality and quantity at the location of dental implants before dental implantation is crucial. In recent years, dental cone-beam computed tomography (dental CBCT) has often been used to assess bone quality and quantity prior to dental implant. However, the effect of scanning resolution on the prediction of trabecular bone microarchitectural parameters (TBMPs) remains unclear. The objective of this study was to examine how dental CBCT with various scanning resolution differs with regard to predicting TBMPs. This study used micro-computed tomography (micro-CT) with 18 μm resolution and dental CBCT with 100 μm and 150 μm resolutions on 28 fresh bovine vertebrae cancellous bone specimens. Subsequently, all images were input into the ImageJ software to measure four TBMPs: bone volume total volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and trabecular separation (Tb.Sp). One-way analysis of variance and Tukey’s test were subsequently used to assess the differences between three scanning modes for the four TBMPs. In addition, correlations between measurement results obtained from micro-CT and dental CBCT with two resolutions were measured. The experimental results indicated that significant differences in four TBMPs were observed between micro-CT and dental CBCT (p < 0.05). The correlation coefficients between BV/TV, Tb.N, and Tb.Sp obtained from micro-CT and from dental CBCT with 100 μm resolution (0.840, 0.739, and 0.820, respectively) were greater than the correlation coefficients between BV/TV, Tb.N, and Tb.Sp obtained from micro-CT and from dental CBCT with 150 μm resolution (0.758, 0.367, and 0.724, respectively). The experimental results revealed that the TBMPs measured with dental CBCT with two resolutions differed from ideal values, but a higher resolution could provide more accurate prediction results, particularly for BV/TV, Tb.N, and Tb.Sp.

Pure titanium (Ti) and titanium alloys are widely used as artificial implant materials for biomedical applications. The excellent biocompatibility of Ti has been attributed to the presence of a natural or artificial surface layer of titanium dioxide. Zinc oxide and tantalum oxide thin films are recognized due to their outstanding antibacterial properties. In this study, high power impulse magnetron sputtering (HiPIMS) was used for the deposition of tantalum oxide and zinc-doped Ta(Zn)O thin films on Ti with rough and porous surface, which was pretreated by plasma electrolytic oxidation (PEO). Surface morphology, antibacterial property as well as cell biocompatibility were analyzed. The antibacterial effect was studied individually for the Gram-positive and Gram-negative bacteria Staphylococcus aureus (S. aureus) and Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans). The deposited Ta (Zn)O coating was composed of amorphous tantalum oxide and crystalline ZnO. The antibacterial results on the tantalum oxide and Ta(Zn)O coated Ti indicated a significant inhibition of both S. aureus and A. actinomycetemcomitans bacteria when compared with the uncoated Ti samples. The deposited Ta(Zn)O showed the best antibacterial performance. The Ta(Zn)O coated Ti showed lower level of the cell viability in MG-63 cells compared to other groups, indicating that Zn-doped Ta(Zn)O coatings may restrict the cell viability of hard tissue-derived MG-63 cells. However, the biocompatibility tests demonstrated that the tantalum oxide and Ta(Zn)O coatings improved cell attachment and cell growth in human skin fibroblasts. The cytotoxicity was found similar between the Ta2O5 and Ta(Zn)O coated Ti. By adopting a first PEO surface modification and a subsequent HiPIMS coating deposition, we synthetized amorphous tantalum oxide and Ta(Zn)O coatings that improved titanium surface properties and morphologies, making them a good surface treatment for titanium-based implants.

We used the finite-element method (FEM) to investigate the effects of jawbone model integrity and the material properties of the periodontal ligament (PDL) on orthodontic tooth movement. Medical imaging software and computer-aided design software were used to create finite-element models of a partial and complete mandibles based on dental cone beam computed tomography images of the human skull. Additionally, we exerted an orthodontic force on the canine crown in the direction of an orthodontic miniscrew under a lower molar root to compare the von Mises strain on the canine PDL in three models: a partial mandible model under orthodontic force (Model 1), a complete mandible model under orthodontic force (Model 2), and a complete mandible model under orthodontic force with clench occlusion in the intercuspal position (ICP; Model 3). Additionally, in the complete mandible model under orthodontic force with ICP occlusion, we analyzed the effects of a PDL with a low (Model 4), moderate (Model 5), and high (Model 6) linear elastic modulus and a PDL a bilinear elastic modulus (Model 7). The simulation results for mandible integrity indicated that the maximum von Mises strains on the canine PDL for Models 1, 2, and 3 were 0.461, 0.394, and 1.811, respectively. Moreover, for the models with different PDL material properties, the maximum von Mises strains on the canine PDLs for Models 4, 5, 6, and 7 were 6.047, 2.594, 0.887, and 1.811, respectively. When the FEM was used to evaluate tooth movement caused by orthodontic force, the transformation of a complete mandible model into a partial mandible model or alteration of the elastic modulus of the PDL influenced the biomechanical responses of the PDL. Additionally, the incorporation of daily ICP occlusion resulted in a larger effect.

The objective of this study was to evaluate the effect of the measurement directions of the Periotest value (PTV) and implant stability quotient (ISQ) of dental implant fixtures inserted at various angles and depths. Five groups were organized: vertically inserted implants in an evencrestal position; implants inserted at a 17° tilt in a distal subcrestal position; implants inserted at a 17° tilt in a mesial supracrestal position; implants inserted at a 30° tilt in a distal subcrestal position; and implants inserted at a 30° tilt in a mesial supracrestal position. The PTV and ISQ were measured along four directions (buccal, lingual, mesial, and distal directions) in all specimens. The PTV and ISQ exhibited a highly negative correlation when the fixture was vertically inserted. Compared to the implants inserted vertically and at the distal subcrestal position, the fixture with a greater tilt and inserted at the mesial supracrestal position had a lower stability. The PTV and ISQ of the tilted implants were affected by the measurement direction, inserted angulation and depth.

The objective of this study was to evaluate and compare the biomechanical behavior of internal fixation techniques in bilateral sagittal split ramus osteotomies (BSSROs) for mandibular setback. Artificial polyurethane mandibles were used in this study. The distal segment of the mandible was repositioned in an 8-mm setback position. All mandibles were divided into three groups: Group 1 had a straight plate with a four-hole monocortical fixation, Group 2 had a curved plate with a four-hole monocortical fixation, and Group 3 had a three–inverted L-type bicortical screw fixation. Vertical loads were applied on the incisal edge by a material testing system. The resistance force at 1, 3, 5, and 10 mm of displacement was analyzed. From the experimental results, Group 1 showed significantly lower results than Groups 2 and 3. No significant difference was observed between Groups 2 and 3 at 1, 3, and 5 mm of displacement. However, at 10 mm of displacement, the resistance force of Group 3 was greater than that of Group 2. For BSSROs, this study concluded that curved plate fixation exhibited the same rigidity as the inverted-L bicortical screw fixation did at ≤5 mm displacement.

In finite element (FE) simulations, the peak bone stresses were higher when loading with a cantilever extension (CE) than when loading without a CE by 33−49% in the cortical bone. In the in vitro experiments, the highest values of principal strain were all within the range of the minimum principal strain, and those peak bone strains were 40−58% greater when loading with a CE than when loading without a CE (p < 0.001). This study investigated how varying the implanted position and angulation of anterior implants in the All-on-Four treatment influenced the biomechanical environment in the alveolar bone around the dental implants. Ten numerical simulations of FE models and three in vitro samples of All-on-Four treatment of dental implants were created to investigate the effects of altering the implanted position and angulation type of anterior implants. A single load of 100 N was applied in the molar region in the presence or absence of a CE of the denture. The 3D FE simulations analyzed the von-Mises stresses in the surrounding cortical bone and trabecular bone. For the in vitro tests, the principal bone strains were recorded by rosette strain gauges and statistically evaluated using the Mann−Whitney U test and the Kruskal−Wallis test. Loading in the presence of a CE of the denture induced the highest bone stress and strain, which were 53−97% greater in the FE simulation and 68−140% in the in vitro experiments (p < 0.008) than when loading without a CE. The bone stresses in the FE models of various implanted positions and angulation types of anterior implants were similar to those in the model of a typical All-on-Four treatment. In vitro tests revealed that the bone strains were significantly higher in the samples with various angulation types of anterior implants (p < 0.008). In the All-on-Four treatment of dental implants, the bone stress and strain were higher when the load was applied to the CE of dentures. Altering the position or angulation of the anterior dental implant in the All-on-Four treatment has no benefit in relieving the stress and strain of the bone around the dental implant.