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Support Immersion Endoscopy in Post-Extraction Alveolar Bone Chambers: A New Window for Microscopic Bone Imaging In Vivo

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      Abstract

      Using an endoscopic approach, small intraoral bone chambers, which are routinely obtained during tooth extraction and implantation, provide visual in vivo access to internal bone structures. The aim of the present paper is to present a new method to quantify bone microstructure and vascularisation in vivo. Ten extraction sockets and 6 implant sites in 14 patients (6 men / 8 women) were examined by support immersion endoscopy (SIE). After tooth extraction or implant site preparation, microscopic bone analysis (MBA) was performed using short distance SIE video sequences of representative bone areas for off-line analysis with ImageJ. Quantitative assessment of the microstructure and vascularisation of the bone in dental extraction and implant sites in vivo was performed using ImageJ. MBA revealed bone morphology details such as unmineralised and mineralised areas, vascular canals and the presence of bleeding through vascular canals. Morphometric examination revealed that there was more unmineralised bone and less vascular canal area in the implant sites than in the extraction sockets.

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      Most cited references 27

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      BoneJ: Free and extensible bone image analysis in ImageJ.

      Bone geometry is commonly measured on computed tomographic (CT) and X-ray microtomographic (μCT) images. We obtained hundreds of CT, μCT and synchrotron μCT images of bones from diverse species that needed to be analysed remote from scanning hardware, but found that available software solutions were expensive, inflexible or methodologically opaque. We implemented standard bone measurements in a novel ImageJ plugin, BoneJ, with which we analysed trabecular bone, whole bones and osteocyte lacunae. BoneJ is open source and free for anyone to download, use, modify and distribute. Copyright © 2010 Elsevier Inc. All rights reserved.
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        Bone classification: an objective scale of bone density using the computerized tomography scan.

        Dental implants are subject to masticatory loads of varying magnitude. Implant performance is closely related to load transmission at the bone-to-implant interface where bone quality will be highly variable. The type and architecture of bone is known to influence its load bearing capacity and it has been demonstrated that poorer quality bone is associated with higher failure rates. To date, bone classifications have only provided rough subjective methods for pre-operative assessment, which can prove unreliable. The results of an extensive analysis of computerized tomography scans using Simplant software (Columbia Scientific Inc., Columbia, MD, USA) demonstrate that an objective scale of bone density based on the Houndsfield scale, can be established and that there is a strong correlation between bone density value and subjective quality score (P = 0.002) as well as between the bone density score and the region of the mouth (P < 0.001).
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          Trabecular bone architecture in the pathogenesis and prevention of fracture.

          Rapid loss of trabecular bone (as after menopause) occurs by complete removal of some structural elements, leaving those that remain more widely separated and less well connected. The most likely cellular mechanism is an increase in the number of resorption cavities deep enough to lead to focal perforation of trabecular plates, either as a non-specific consequence of increased remodeling activation, or as a specific consequence (direct or indirect) of estrogen deficiency. Disruption of the connections between structural elements produces a disproportionate loss of strength, for which the increased thickness of the remaining trabeculae can only partly compensate. Consequently, the most biomechanically significant component of trabecular bone loss occurs rapidly and irreversibly. This emphasizes the importance of prevention, but no treatment except estrogen replacement is of proven efficacy in preventing estrogen-dependent bone loss. For adequate repair of structural damage after it has been allowed to occur, adding bone to existing surfaces may be insufficient, and it may be necessary to devise some means of forming new bone directly in the bone marrow cavity in order to re-establish normal connectivity.
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            Author and article information

            Affiliations
            [1 ]Department Oral and Maxillofacial Surgery, Georg-August-University Hospital, Göttingen, Germany
            [2 ]Department of Molecular Biology of Neuronal Signals, Max Planck Institute of Experimental Medicine, Göttingen, Germany
            [3 ]Research Centre in Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
            University of Zaragoza, SPAIN
            Author notes

            Competing Interests: The authors have declared that no competing interests exist.

            Conceived and designed the experiments: EW LM BV. Performed the experiments: EW LM BV. Analyzed the data: EW LM BV. Contributed reagents/materials/analysis tools: EW LM BV SW. Wrote the paper: EW LM BV.

            Contributors
            Role: Editor
            Journal
            PLoS One
            PLoS ONE
            plos
            plosone
            PLoS ONE
            Public Library of Science (San Francisco, CA USA )
            1932-6203
            29 December 2015
            2015
            : 10
            : 12
            26713617
            4695096
            10.1371/journal.pone.0145767
            PONE-D-15-40510
            (Editor)
            © 2015 Engelke et al

            This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

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            Figures: 2, Tables: 1, Pages: 9
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            All relevant data are within the paper and its Supporting Information files.

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