Strategic Implants under Existing Partial Removable Dentures, Why, How Many, and Which Type?

Inserting strategic implants under existing removable partial dentures requires a comprehensive understanding of removable prosthodontic basics and possible designs, as well as a thorough understanding of implant therapy. Prior to the widespread adoption of implants as standard prosthetic therapy, remaining roots were preserved and used to minimize bone resorption under the removable denture. Root-supported overdentures become less common after the overwhelming clinical studies that emphasize dental implants’ reliability and high success and survival rate. Fixed prostheses cannot be used to treat a severely decreased dentition unless a significant number of implants can be inserted, sufficient bone quantity and quality are available, and the patients can afford the treatment. On the other hand, using strategic implants under existing RPD upgrades the design to a more favorable support type. It improves patient satisfaction with the RPD in speaking, chewing, retention, stability, and RPD support. This improvement could be reached earlier if the patient received immediate loading. Strategic implants can also improve chewing ability, stabilize the occlusion, increase bite force and improve patient oral health-related quality of life. Moreover, better distribution of occlusal forces that may reduce bone resorption may be gained. Furthermore, strategic implants can improve comfort, confidence, and esthetics by reducing the RPD size and removing the retainers from the esthetic zone.

Cross-sectional properties of reindeer long bones and metapodials allow identification of activity patterns

Habitual loading patterns of domesticated animals may differ due to human influence from their wild counterparts. In the early stages of human-reindeer interaction, cargo and draft use was likely important, as well as corralling tame reindeer. This may result to changes in loading as increased (working) or decreased (captive) loading, as well as foraging patterns (digging for lichen from under the snow versus fed working and/or captive reindeer). Our aim is to study whether differences in activity modify variation in bone cross-sectional properties and external dimensions. Our material consists of donated skeletons of modern reindeer: 20 working reindeer (19 racing and one draft), 24 zoo reindeer, and sample of 78 free-ranging/wild reindeer as a reference group. We used general linear modelling to first establish the total variation in cross-sectional properties among wild and free-ranging reindeer, and then to infer how differences in loading modify observed variation among zoo and working reindeer. According to our results, direction of greater bone quantity as well as external dimensions in of radioulna of female reindeer differs from female reference group, likely relating to foraging behavior. External dimensions of humerus differ in working and zoo male reindeer compared to male reference group. Increased robusticity of long bones, especially of tibia among working male reindeer, may indicate increased loading, and increased cortical area of long bones may indicate sedentary lifestyle among female reindeer. The results of this study can be used to understand early stages of reindeer domestication by observing reindeer activity patterns from archaeological material.

Hematopoietic Wnts Modulate Endochondral Ossification During Fracture Healing

Wnt signaling plays a critical role in bone formation, homeostasis, and injury repair. Multiple cell types in bone have been proposed to produce the Wnts required for these processes. The specific role of Wnts produced from cells of hematopoietic origin has not been previously characterized. Here, we examined if hematopoietic Wnts play a role in physiological musculoskeletal development and in fracture healing. Wnt secretion from hematopoietic cells was blocked by genetic knockout of the essential Wnt modifying enzyme PORCN, achieved by crossing Vav-Cre transgenic mice with Porcnflox mice. Knockout mice were compared with their wild-type littermates for musculoskeletal development including bone quantity and quality at maturation. Fracture healing including callus quality and quantity was assessed in a diaphyseal fracture model using quantitative micro computer-assisted tomographic scans, histological analysis, as well as biomechanical torsional and 4-point bending stress tests. The hematopoietic Porcn knockout mice had normal musculoskeletal development, with normal bone quantity and quality on micro-CT scans of the vertebrae. They also had normal gross skeletal dimensions and normal bone strength. Hematopoietic Wnt depletion in the healing fracture resulted in fewer osteoclasts in the fracture callus, with a resultant delay in callus remodeling. All calluses eventually progressed to full maturation. Hematopoietic Wnts, while not essential, modulate osteoclast numbers during fracture healing. These osteoclasts participate in callus maturation and remodeling. This demonstrates the importance of diverse Wnt sources in bone repair.

Promoting osseointegration with electrical stimulation: a review

<p>Electrical stimulation has shown to be a promising approach for promoting osseointegration in bone-anchored implants, where osseointegration defines the biological bonding between an implant surface and bone tissue. Bone-anchored implants are used in the rehabilitation of hearing and limb loss, and extensively in edentulous patients. Inadequate osseointegration is one of the major factors of implant failure that could be prevented by accelerating or enhancing the osseointegration process by artificial means. In this article, we reviewed the efforts to enhance the biofunctionality at the implant-bone interface with electrical stimulation using various approaches such as different electrode configurations, power sources, and waveform-dependent stimulation parameters tested in different <i>in vitro</i> and <i>in vivo</i> models. We reviewed and compared studies from the last 45 years and found nonuniform protocols with disparities in cell type and animal model, implant location, experimental timeline, implant material, evaluation assays, and type of electrical stimulation. The reporting of stimulation parameters was also found to be inconsistent and incomplete throughout the literature. Studies using <i>in vitro</i> models showed that osteoblasts were sensitive to the magnitude of the electric field and duration of exposure, and such variables similarly affected bone quantity around implants in <i>in vivo </i>investigations. Most studies showed benefits of electrical stimulation in the underlying processes leading to osseointegration, and therefore we found the idea of promoting osseointegration by using electric fields to be supported by the available evidence. However, such an effect has not been demonstrated conclusively nor optimally in humans. We found that optimal stimulation parameters have not been thoroughly investigated and this remains an important step towards the clinical translation of this concept. In addition, there is a need for reporting standards to enable meta-analysis for evidence-based treatments.</p>

Promoting osseointegration with electrical stimulation: a review

<p>Electrical stimulation has shown to be a promising approach for promoting osseointegration in bone-anchored implants, where osseointegration defines the biological bonding between an implant surface and bone tissue. Bone-anchored implants are used in the rehabilitation of hearing and limb loss, and extensively in edentulous patients. Inadequate osseointegration is one of the major factors of implant failure that could be prevented by accelerating or enhancing the osseointegration process by artificial means. In this article, we reviewed the efforts to enhance the biofunctionality at the implant-bone interface with electrical stimulation using various approaches such as different electrode configurations, power sources, and waveform-dependent stimulation parameters tested in different <i>in vitro</i> and <i>in vivo</i> models. We reviewed and compared studies from the last 45 years and found nonuniform protocols with disparities in cell type and animal model, implant location, experimental timeline, implant material, evaluation assays, and type of electrical stimulation. The reporting of stimulation parameters was also found to be inconsistent and incomplete throughout the literature. Studies using <i>in vitro</i> models showed that osteoblasts were sensitive to the magnitude of the electric field and duration of exposure, and such variables similarly affected bone quantity around implants in <i>in vivo </i>investigations. Most studies showed benefits of electrical stimulation in the underlying processes leading to osseointegration, and therefore we found the idea of promoting osseointegration by using electric fields to be supported by the available evidence. However, such an effect has not been demonstrated conclusively nor optimally in humans. We found that optimal stimulation parameters have not been thoroughly investigated and this remains an important step towards the clinical translation of this concept. In addition, there is a need for reporting standards to enable meta-analysis for evidence-based treatments.</p>

Integrating Muscle Health in Predicting the Risk of Asymptomatic Vertebral Fracture in Older Adults

Background: The utility of muscle health for predicting asymptomatic vertebral fracture (VF) is uncertain. We aimed to determine the effects of muscle health on bone quantity and quality in the older adults and to integrate these factors into a predictive model for VF. Methods: We prospectively recruited participants with a body mass index <37 kg/m2. The total lean mass (TLM), appendicular skeletal muscle index, presence of sarcopenia, and bone mineral density were determined by dual-energy X-ray absorptiometry, and bone quality by the trabecular bone score (TBS). VF was diagnosed based on spine radiography. Results: A total of 414 females and 186 males were included; 257 participants had VF. Lower TLM was significantly associated with poorer bone quantity and quality in both males and females. A low TBS (OR: 11.302, p = 0.028) and sarcopenia (Odds ratio (OR): 2.820, p = 0.002) were significant predictors of VF in males, but not bone quantity. Moreover, integrating TBS and sarcopenia into the predictive model improved its performance. Conclusions: Although TLM was associated with bone quantity and quality in both sexes, sarcopenia and a low TBS were significant predictors of asymptomatic VF only in male participants.

The Role of Bone in Muscle Wasting

This review describes the role of bone resorption in muscle atrophy as well as in muscle protein anabolism. Both catabolic and anabolic pathways involve components of the proinflammatory cytokine families and release of factors stored in bone during resorption. The juxtaposition of the catabolic and anabolic resorption-dependent pathways raises new questions about control of release of factors from bone, quantity of release in a variety of conditions, and relation of factors released from bone. The catabolic responses involve release of calcium from bone into the circulation resulting in increased inflammatory response in intensity and/or duration. The release of transforming growth factor beta (TGF-β) from bone suppresses phosphorylation of the AKT/mTOR pathway and stimulates ubiquitin-mediated breakdown of muscle protein. In contrast, muscle IL-6 production is stimulated by undercarboxylated osteocalcin, which signals osteoblasts to produce more RANK ligand, stimulating resorptive release of undercarboxylated osteocalcin, which in turn stimulates muscle fiber nutrient uptake and an increase in muscle mass.