Researchers at Case Western Reserve University School of Dental Medicine have unraveled one of the mysteries of how a small group of immune cells work: That some inflammation-fighting immune cells may actually convert into cells that trigger disease.

Their findings, recently reported in the journal Pathogens, could lead to advances in fighting diseases, said the project’s lead researcher Pushpa Pandiyan, an assistant professor at the dental school.

The cells at work

A type of white blood cell, called T-cells, is one of the body’s critical disease fighters. Regulatory immune cells, called “Tregs,” direct T-cells and control unwanted immune reactions that cause inflammation. They are known to produce only anti-inflammatory proteins to keep inflammation caused by disease in check.

But using mouse models, the researchers studied how the body fights off a common oral fungus that causes thrush. They found that these harmful invaders activate a mechanism in Tregs that could transform the inflammation-fighting cells into cells that allow the disease to flourish.

The study

When the immune system functions normally, disease-fighting T-cells produce inflammatory secretions — proteins that can cause symptoms, such as soreness or swelling at the infected site. This process is evident, for example, when a cut or glands swell from the infection’s inflammatory reaction.

Once the invader is gone, the disease-fighting cells — with help from Treg cells — normally shut down those proteins to control long-term inflammation.

But the researchers found that, during oral thrush, yeast sugars on the surface of the disease-causing fungus act as a binding agent and can activate a small population of Treg cells to make inflammatory proteins themselves. (The researchers are calling this novel subset of malfunctioning cells Treg-17 cells).

“An excess of these malfunctioning cells can lead to the inflammatory disease process instead of stopping it,” she said.

Other binding agents normally found in the body may create these cells and contribute to continued inflammation, the researchers concluded.

Other researchers have reported the presence of these cells in many human inflammation conditions, such as psoriasis, periodontitis and arthritis. Until now, however, the mechanisms of how these cells developed were not completely understood, Pandiyan said.


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The invisible retainer, as we use them, was developed by Robert Ponitz of Ann Arbor, Michigan.2 Typically
this retainer is formed from a sheet of thin Biocryl™ or other similar material that is heated and forced by suction1,2 or pressure3 on to a work model of the dentition. This type of retainer has many uses in routine orthodontic practice, not only as a finishing and retention appliance, but also as an active treatment adjunct. The
development of the Invisalign® System of aligners for comprehensive movement, a logical outgrowth of this


The steps in invisible retainer fabrication have been described previously by McNamara and co-workers3 in the Journal of Clinical Orthodontics. This article is updated below. In this summary, the possibilities of making minor changes in tooth position with invisible retainers will be stressed.

Preparation of the Work Models

Upper and lower alginate impressions are made with standard aluminum trays, and a wax bite registration is obtained in centric occlusion to articulate the models, if the correct occlusion is not obvious.The impressions are poured in plaster and trimmed as standard work models with minimal base (Fig. 27-2). Before articulating the maxillary and mandibular work models, excess plaster and any bubbles on the articulating surfaces of the teeth should be removed carefully with a laboratory kinfe or waxing instrument.


Self-ligating brackets (SLBs) are not new conceptually, having been pioneered in the 1930s. They have undergone a revival over the past 30 years with a variety of new appliances being developed. A host of advantages over conventional appliance systems have been claimed typically relating to reduced frictional resistance.1–4

The most compelling potential advantages attributed to SLBs are a reduction in overall treatment time5,6 and less associated subjective discomfort.7 Other purported improvements include more efficient chairside manipulation8 and promotion of periodontal health due to poorer biohostability. Preliminary retrospective research has pointed to a definite advantage, with a reduction in overall treatment time of 4 to 7 months and a similar decrease in required appointments.5,6 Consequently, the use of SLBs has increased exponentially; over 42% of American practitioners surveyed reported using at least one system in 2008.9 This figure was just 8.7% in 2002.10 Retrospective research may be confounded by a variety of factors including operator enthusiasm, different appointment intervals and archwire sequences, and multiple operators.

However, prospective research relating to SLBs has emerged in recent years. The purpose of this systematic review is to evaluate the clinically significant effects of SLBs on orthodontic treatment with respect to the quality of scientific evidence and the methodology of those reports. An understanding of clinical evidence on the impact of SLBs on orthodontic treatment would inform the orthodontist’s decisions in relation to their choice of fixed appliance system.


Indications Objectives of early Class III treatment may include  preventing progressive hard or soft tissue damage, such as enamel abrasion and bony or gingival dehiscence; improving skeletal discrepancies and possibly avoiding orthognathic surgery;  improving occlusal function;developing arch length; and  improving dental and facial esthetics.17 Common conditions warranting early treatment are anterior or posterior crossbites with or without functional shifts and blocked-out maxillary lateral incisors.

Favorable factors for successful early treatment include mild to moderate skeletal disharmony, no familial mandibular prognathism, a convergent facial type, symmetric condylar growth, and expected good cooperation. Patients and parents should be informed that unpredictable dysplastic skeletal growth in the future may necessitate orthognathic surgery despite early intervention.

The authors found low-level evidence, and no statistical methods were employed for the analysis. They stated that higher-level studies are necessary before definitive conclusions can be made.


Prostaglandin effect on tooth movement Prostaglandins (PGs) are inflammatory mediator and a paracrine hormone that acts on nearby cells; it stimulates bone resorption by increasing directly the number of osteoclasts. In vivo and in vitro experiments were conducted to show clearly the relation between PGs, applied forces, and the acceleration of tooth movement. Yamasaki [10,11] was among the first to investigate the effect of local administration of prostaglandin on rats and monkeys. In addition, experiments done in [7] have shown that injections of exogenous PGE2 over an extended period of time caused acceleration of tooth movements in rats. Furthermore, the acceleration rate was not affected by single or multiple injections or between different concentrations of the injected PGE2. However, root resorption was very clearly related to the different concentrations and number of injections given. It has also been shown that the administration of PGE2 in the presence of calcium stabilizes root resorption while accelerating tooth movement [13]. Furthermore, chemically produced PGE2 has been studied in human trials with split-mouth experiments in the first premolar extraction cases. In these experiments the rate of distal retraction of canines was 1.6-fold faster than the control side [12].

Effect of Vitamin D3 on tooth movement Vitamin D3 has also attracted the attention of some scientist to its role in the acceleration of tooth movement; 1,25 dihydroxycholecalciferol is a hormonal form of vitamin D and plays an important role in calcium homeostasis with calcitonin and parathyroid hormone (PTH). Another set of investigators [16] has made an experiment where they have injected vitamin D metabolite on the PDL of cats for several weeks; it was found that vitamin D had accelerated tooth movement at 60% more than the control group due to the increasement of osteoclasts on the pressure site as detected histologically. A comparison between local injection of vitamin D and PGEs on two different groups of rats was also investigated. It was found that there is no significant difference in acceleration between the two groups.



■ Bone preservation. Because the implant replaces the tooth root, it transmits chewing forces to the jaw, helping maintain the bone.

■ Natural look and feel. Besides looking natural, implants feel natural, so you can eat without worries.

■ Unaffected adjacent teeth. Unlike bridges, implants do not require the grinding down of neighboring teeth, so your remaining dental structure stays natural.

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Ask your dentist about choosing dental implants for you.


Implants verses root canal therapy is a current controversy in dentistry. The purpose of this investigation was to compare the success of each treatment, with minimal subjective grading. Outcome was determined by clinical chart notes and radiographs. Failure was defined as removal of the implant or tooth. Uncertain findings for implants were defined as mobility class I or greater, radiographic signs of bone loss, or an additional surgical procedure.

Mobility, periapical index score of 3 or greater, or the need for apical surgery was classified as uncertain for endodontically treated teeth. Success was recorded if the implant or tooth was in place and functional. Implants were placed by periodontists in a group practice, whereas the endodontic treatments were performed by endodontists in group practice. Charts of 129 implants meeting inclusion criteria showed follow-up of an average of 36 months (range, 15–57 months), with a success rate of 98.4%. One hundred forty-three endodontically treated teeth were followed for an average of 22 months (range, 18–59 months), with a success rate of 99.3%. No statistically significant differences were found (P = .56).

When uncertain findings were added to the failures, implant success dropped to 87.6%, and endodontic success declined to 90.2%. This difference was not statistically significant (P = .61). We found that 12.4% of implants required interventions, whereas 1.3% of endodontically treated teeth required interventions, which was statistically significant (P = .0003). The success of implant and endodontically treated teeth was essentially identical, but implants required more postoperative treatments to maintain them.


When mini implants are splinted in fixed partial or complete dentures, the adjacent implants are anchored to each other, dissipating force and minimizing the potential for implant micromovement. However, cement ported prostheses to prevent this complication. The most retentive metal-to-metal cements are the resins and resin-modified glass ionomers. Care should be taken to ensure that the surface tension of the mixed cement does not prevent the cement from reaching the deepest part of the casting during the cementation procedure. Mini implants are one piece and do not have separate abutments. Thus, there is no micro-gap issue. The coronal portion of the implant is the abutment and can be prepared for parallelism. A conventional crown and bridge impression technique is appropriate. Polyvinyl siloxane materials provide a satisfactory impression with little tissue toxicity.

The coronal portion of the implant may require preparation to ensure parallelism and a passive fit. The implant surgeon should take care to place the mini implants closely parallel so that only minimum or no preparation is required. Excessive preparation may predispose the corona to metal fatigue fracture. Natural teeth have periodontal ligaments and intrude under an occlusal load to as much as 200 mm. Implants do not intrude under an occlusal load. During clenching and grinding, the implant-supported prosthesis may be the only contact and may thus bear the full force of occlusion (26). Each patient is different in this regard, and this tooth intrusion is difficult to measure, so a builtin prosthetic occlusal relief or a gap in unforced maximal intercuspation of approximately 100 mm may be appropriate. This ensures that the implant-supported prosthesis will not bear the full force of the jaws during clenching.


Varieties of Implant and their Prognoses

A significant number of manufacturing companies produce significant variety of implants. According to a
systematic review that evaluated clinical results of various types of implants, some research shows that
the marginal bone loss associated with the cylindrical IMZ Implant is greater than that of the Brånemark
System or the Straumann ITI. Concerning implants with smooth surfaces (machined surface), the risk of
peri-implantitis is 22% lower than implants with rough surfaces. There have not yet been any specific
implants with which its excellence proven over a long duration of time, or confirm that the failure to
concentrates in a given type of implant.

This review was based on the results of a few randomized clinical trials, the number of people who took
part in these studies was limited, and the assessment period were short, therefore, the results carry the
risk of being biased. In order to draw accurate conclusions, a set of randomized clinical trials performed
for a longer period are thus necessary, conducted in a sufficient number of patients to gain significance43).
Surveying these articles that describe implant prognosis, it becomes clear that most of the authors of
these papers are from university hospitals or from well-equipped institutions, where the pre-operative
examination and diagnosis can be presumed to be conducted under the supervision of experienced
surgeons. Therefore, it is not rational to directly apply the results of these studies to those of general
11 practitioners, and equal success in treatment should not be expected.


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